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Skip to 0 minutes and 12 seconds DAVID HEYMANN: I’m going to be talking about the International Health Regulations and the Public Health Emergency of International Concern.

Skip to 0 minutes and 24 seconds A PHEIC is a Public Health Emergency of International Concern– P-H-E-I-C. And a PHEIC is a decision made by the director general on evidence that he collects from many different sources about a current infectious disease outbreak, whether or not it’s unexpected and whether or not it’s spreading internationally and might require a global effort to stop.

Skip to 0 minutes and 55 seconds Well, the PHEIC came about after the SARS outbreak in 2003, but it’s a part of a long history of attempts to control the international spread of infectious diseases which began with the International Health Regulations in 1969. Those regulations were a treaty which required countries to report one of four diseases if it occurred in their country– yellow fever, cholera, plague, and smallpox. At the same time, the regulations required that border posts in countries make sure that they didn’t have any standing water or any possibility that vectors, such as insects or rodents, could breed at the entry points of people coming into the country.

Skip to 1 minute and 44 seconds When countries reported to WHO about one of these four diseases, then WHO published this in its weekly epidemiological record. And countries that were receiving passengers on public conveyances from those countries could require certain things of those passengers, such as a yellow fever vaccination certificate, if yellow fever had been reported by the country from which they were travelling. It was recognised in the 1990s that really the regulations were invalid in many ways because you can’t stop infectious disease at borders. It crosses in the incubation period and in many other ways. And, at the same time, those four diseases were not what was important in the world today.

Skip to 2 minutes and 28 seconds Although they were important, there are other important infections that were also– had a potential to spread internationally, such as influenza or other infections. So the regulations were asked by the World Health Assembly of WHO to be revised and they were revised based on a way of working that WHO developed at that time which used modern communication technologies.

Skip to 2 minutes and 57 seconds Information that’s needed to determine whether a Public Health Emergency of International Concern is occurring is epidemiological information from countries where the events are occurring. It’s also information about whether or not this could impact on travel and trade and whether it could spread internationally. Those are the criteria that are used because the regulations are really attempting to make sure that there’s maximum public health security for populations with minimum interference in travel and trade.

Skip to 3 minutes and 35 seconds When the PHEIC for COVID-19 was determined, there was epidemiological information that came in from China and other countries where outbreaks were occurring. And there was information coming in from experts around the world– public health experts– as what they might expect from this outbreak based on what was known about the SARS outbreak and the MERS coronavirus outbreak. So all that information was taken together by the emergency committee and they then make recommendations as to a way forward. The first emergency committee meeting did not feel there was enough evidence to declare a Public Health Emergency of International Concern. At the second meeting they had enough evidence to recommend to the director general that he call a public health emergency.

Skip to 4 minutes and 22 seconds The director general, at the same time, was meeting with a group of public health experts from around the world that he had selected to meet with him on a regular basis during this outbreak and they met with him the day before the emergency committee met. And there is also an advisory group at WHO called the Scientific and Technical Advisory Group for Infectious Hazards, which also provided their assessment to the director general. So the assessment from these three sources– the director general made a decision that this was a Public Health Emergency of International Concern.

Skip to 4 minutes and 58 seconds An emergency committee is an advisory group to the director general of the World Health Organisation made of experts from around the world who represent the six WHO regions. These experts come from a list of experts that each country has submitted to WHO and the director general and his team select the people they want on the emergency committee. Each outbreak that’s evaluated as a potential Public Health Emergency of International Concern by an emergency committee has a different emergency committee group. So the group that’s been developed for the current outbreak, COVID-19, is different from the group that was developed for the most recent Ebola outbreak in DRC.

Skip to 5 minutes and 47 seconds The implications for countries are that they must begin to share all data they have about the outbreaks occurring in their own countries and any information they may know about the outbreaks occurring elsewhere. And, at the same time, it calls for solidarity in helping WHO develop a way of working that interferes minimally with travel and trade but gets maximum impact on containing outbreaks that are occurring.

What is a PHEIC and what is needed to call one?

Professor David Heymann discusses the process that informs declaration of a Public Health Emergency of International Concern (PHEIC), the International Health Regulations requirement of States in the context of a PHEIC and what informed the PHEIC decision (recorded 25th February 2020).

Declaring a PHEIC is part of a process of alerting the world to an international risk. As you watch the video, consider whether you think it could have been declared earlier – or later? Going forward there is also the suggestion that there could be a grading process, to reduce the “all or nothing” decision. Do you think that’s a good idea? What are the pros and cons?

There have been other PHEICs declared in recent years, if you are interested in the discussions around these, have a look at the Editorial from the Lancet on The Politics of PHEIC in the See Also section.

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