Epidemic sans frontieres

My Op ed article published in the Indian Express on 24 June 2009:

As of June 17, 88 countries have officially reported 39,620 cases of influenza A (H1N1) infection, also known as swine flu. These include 167 deaths. According to the World Health Organisation (WHO), 44 confirmed cases were reported in India. The global nature of the swine flu situation is clearly alarming for public health officials and policy makers. It is therefore important to know what legal options are available for countries, especially developing countries, to cooperate in combating this virus.
The problem and implications of the spread of diseases globally across international frontiers has not gone unnoticed by the world community. The World Health Assembly, the highest policy-making body of the WHO, is empowered to adopt binding regulations concerning sanitary and quarantine requirements to prevent the international spread of disease. In 1951, WHO adopted International Sanitary Regulations followed by the International Health Regulations (1969). IHR 1969 addressed specific infectious diseases such as cholera, plague and yellow fever. But the rapid emergence of infectious diseases such as the Ebola virus, severe acute respiratory syndrome (SARS), avian influenza and incidents such as the Chernobyl nuclear disaster in 1986 posed a palpable threat to public health and highlighted the inadequacies of the 1969 IHR regulations. A ten-year effort between 1994 and 2005 culminated in the revision of IHR 1969. The new regulations — the international Health Regulations 2005 (IHR 2005) — that have been applied in the aftermath of the swine flu, are binding on WHO member states.
Under the WHO Constitution, regulations are legally binding once they are adopted by the World Health Assembly, which is an annual forum of all member states. In comparison to IHR 1969, the 2005 regulations are broader in scope, defining rights and obligations of states to report public health events to the WHO, and establish procedures to maintain global public health security. For instance, IHR 2005 mandates that any case involving human influenza caused by a new stereotype must be notified by states parties to the WHO, which assesses the threat levels of such cases. The objective is to help the international community in responding to and preventing acute public health risks, both infectious diseases as well as challenges posed by chemical, biological and radiological threats, whether naturally occurring, deliberate or accidental affecting individuals across the world. Thus IHR 2005 serves as a global framework for international cooperation.
On April 25 2009, in response to the swine flu, WHO swung into action. The WHO Director-General, Dr. Margaret Chan, convened an Emergency Committee on swine flu, and based on its advice declared that the outbreak constituted a “public health emergency of international concern” under IHR 2005. It was for the first time that the Director-General invoked the regulations to convene the Emergency Committee. Upon the request of the Director-General, the Emergency Committee provides its views on whether an event constitutes a public health emergency of international concern (PHEIC). A PHEIC is determined to constitute “a public health risk to other states through the international spread of disease and which potentially require a coordinated international response.”
The WHO’s recommendations are not meant to limit countries from tackling swine flu with their own innovative measures. The IHR 2005 does not preclude states parties from implementing measures that achieve a greater level of health protection than the “temporary recommendations” of WHO, provided that such measures are otherwise consistent with the regulations and are neither restrictive of international trade or travel nor intrusive to persons.
The worry that countries might restrict travel while combating swine flu is a very real one. Human rights concerns may arise with the need for interventions like compulsory isolation, quarantine, and treatment, which might infringe on civil and political rights. The IHR 2005 and the International Covenant on Civil and Political Rights recognise the legality of such interventions, provided they are in consonance with certain principles such as a respect for the dignity, human rights and fundamental freedoms of individuals.
IHR 2005 entered into force in India on 8 August 2007. Strengthening national surveillance systems and amendments to the Public Health Act 1925 is important for the implementation of IHR 2005 in India. The National Institute of Communicable Diseases is designated as the national focal point, which should coordinate with local authorities, including civil society organisations . In a federal structure like India where health is a state subject, there is a need for more jurisdictional clarity between various levels of government in responding to public health emergencies.