PHEIC & Decision Instrument

Dr Reuben SamuelWHO Country Office - India

What is a PHEIC? PHIEC – Public Health Emergency

of International Concern

An extraordinary event which is determined, as provided in these Regulations:

i. to constitute a public health risk to other Member States through international spread of disease and

ii. to potentially require a coordinated international response.

Alert and Response Operations

DetectionDetection

VerificationVerification

Risk assessment Risk assessment

ResponseResponse

Events that may constitute aPublic Health Emergency of International Concern need:

Verification of events

Value of unofficial sources of information for early alert

WHO requests for verification of potential public health events of international importance

Member States provide initial reply within 24 hours and provision of information

On-site assessment, when necessary

Event notification

Any event that may constitute a Public Health Emergency of International Concern (PHEIC)

Within 24 hours of assessment

By the most efficient means of communication

Continue to provide WHO with detailed information

Does NOT mean a real “PHEIC”

Disease List

Four diseases (a single case is notifiable):

Smallpox, Poliomyelitis, human influenza (caused by a new subtype), SARS

Utilization of the decision instrument: Cholera, plague, viral haemorrhagic fevers, yellow

fever, …

Diseases of regional concern: dengue fever, meningococcal diseases…

Decision Instrument

1. Is the public health impact of the event serious?

2. Is the event unusual or unexpected?

3. Is there a significant risk of international spread?

4. Is there a significant risk of international travel or trade restrictions?

Answering "yes" to any twotwo of the criteria requires a member state to notify WHO

Criteria for assessment

Is the event serious?

Is the event unexpected?

Could it (or has it) spread internationally?

Risk for international sanctions?

Not notified at this stage.

No

Notify the event under the International Health Regulations

Yes No

No

No

Is the event unexpected?

Yes

Yes

Yes

Yes

No

Could it (or has it) spread internationally?Yes

No

Is the event serious?

Morbidity and mortality Does the event have potential for high impact?

Population at risk Cases in health staff; highly infectious Factors affecting response e.g. war, natural

catastrophe High population density

Immediate or potential need for external assistance

Is the event unexpected?

Is the cause of the event unknown? Are the circumstances unusual?

Cases worse than usual Treatment failures Event unusual for place/season Caused by eliminated/eradicated agent

Suspected or known intentional or accidental release of chemical, biological or radiological agent

Is the event likely to spread internationally?

Similar cases in other countries where it was unexpected?

Factors alerting to cross-border implications? Caused by epidemic-prone organism Source suspected/ known to be related to food

import/export Index case with international travel history In area with international tourism/ traffic, person or

goods In border areas with limited capacity for control

Is event likely to result in international travel and trade restrictions?

Similar events previously led to restriction on travel/ trade?

Source known or suspected food product/ goods known to be imported or exported?

In area with international tourism? Attracted media attention?

Combinations of answers requiring notification

Serious and unexpected Serious and risk for international spread Serious and risk for international

restrictions Unexpected and risk for international

spread Unexpected and risk for international

restrictions

Thanks