Although WHO is the last organization that we discuss in this book, it is perhaps the most important because of the inexorable trend towards globalization of trade and travel.
WHO is the United Nations' specialized agency for health. Its objective, as stated in its constitution (WHO, 1946), is the attainment by all peoples of the highest possible level of health, defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 2005b).
The governance of WHO comprises the World Health Assembly, the Executive Board, and an executive branch called the Secretariat. The World Health Assembly is an annual meeting of representatives of all 192 member-states (countries) to approve the WHO program and the budget and to decide major policy questions. The Executive Board comprises 32 elected members who are technically qualified in the field of health. The Executive Board appoints the Director General of WHO. The Director General is the director of the Secretariat, which employs approximately 3500 professional and support staff.
WHO influences the communicable disease practices of its 192 member-states through International Health Regulations, collection and dissemination of biosurveillance information, and through direct assistance in the control of disease. The biosurveillance functions are concentrated in the Department of Communicable Disease Surveillance and Response (www.who.int/csr/).
The International Health Regulations (IHR) refers to two international legal instruments, the current International Health Regulations, IHR(1969), and the revised International Health Regulations, the IHR(2005). The IHR(1969) will be replaced by the IHR(2005) when they come into effect in June 2007.
The purpose of the IHR(1969) are to ensure maximum security against the international spread of diseases with a minimum interference with world traffic. This philosophy of striking a balance between physical and economic health is similar to that of the OIE regulations described in Chapter 17. The IHR(1969) only apply to three infectious diseases: cholera, plague and yellow fever. The experience with IHR(1969) was that many countries fail to report outbreaks out of concern for potential economic consequences due to effects on trade and tourism. Additionally, the rules were difficult to enforce.
The purpose and scope of the IHR(2005) are to prevent, protect against, control, and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade. The IHR(2005) also establish a single code of procedures and practices for routine public health measures at international airports and ports and some ground crossings (WHO, 2005c).
According to IHR(2005), the key roles of WHO (as opposed to member-states) include:
• To conduct daily global surveillance of international intelligence to detect possible risks of a public health emergency of international concern for verification with member-states.
• To determine whether a particular event notified by a state under the regulations constitutes a public health emergency of international concern.
• To provide technical assistance to states in their response to public health emergencies of international concern.
• To provide guidance to states to strengthen their existing surveillance and response capacity to contain and control public health risks and emergencies.
• To develop and recommend measures for use by states during public health emergencies of international concern, based on a consistent process of risk verification and assessment.
• To update the regulations and supporting guides as necessary to maintain scientific and regulatory validity.
• To respond to the needs of states regarding the interpretation and implementation of the regulations (WHO, 2005c).
6.2. Department of Communicable Disease Surveillance and Response
Figure 12.2 presents the organization chart of WHO's Department of Communicable Disease Surveillance and Response. Biosurveillance functions for influenza are separate from other diseases (which are under Office of Alert and Response Operations).
The Global Outbreak Alert and Response Network (GOARN) is a technical collaboration of hundreds of existing institutions and networks (administered by WHO) that pools human and technical resources for the rapid identification, confirmation, and response to outbreaks of international importance.
GOARN systematically gathers official reports and rumors of suspected outbreaks from a wide range of formal and informal sources. More than 60% of the initial outbreak reports come from unofficial informal sources, including sources other than the electronic media, which require verification.
Formal sources include ministries of health, national institutes of public health, WHO regional and country offices, WHO collaborating center, civilian and military laboratories, academic institutes, and nongovernmental organizations (NGOs), all of which submit reports to WHO.
The informal sources include global media sources, such as news wires and websites. The Global Public Health Intelligence Network (GPHIN) is one of the most important sources of informal information related to outbreaks. GPHIN was developed by Health Canada in collaboration with WHO. It is a secure Internet-based multilingual early-warning tool that continuously searches global media sources to identify information about disease outbreaks and other events of potential international public health concern (see Chapter 26).
The goal of WHO's biosurveillance is to identify outbreaks that are international threats. Figure 12.3 summarizes the process in use in 2000 to distill the large amount of biosurveillance data to identify and disseminate events of interest to international public health.
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