The International Health Regulations 10 years on: the governing framework for global health security.
The International Health Regulations 10 years on: the governing framework for global health security.
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DOI：
10.1016/s0140-6736(15)00948-4
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发表时间：
2015-11-28
期刊：
影响因子：
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通讯作者：
Friedman EA
中科院分区：
文献类型：
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作者：
Gostin LO;DeBartolo MC;Friedman EA
2005年对《国际卫生条例》进行了根本性修订，旨在预示全球卫生安全和合作的新时代的到来。然而，10年后，《国际卫生条例》面临批评，特别是在西非埃博拉疫情之后。若干高级别小组正在审查《国际卫生条例》的职能并敦促进行改革。2全球卫生安全议程是一个多边伙伴关系，侧重于预防、发现和应对自然、意外或故意的疾病暴发，具有类似的能力建设目标，但主要在《国际卫生条例》之外运作。《国际卫生条例》是一项具有法律约束力的文书，于2007年6月生效，目前已有196个缔约国——所有世卫组织成员国加上列支敦士登和罗马教廷。6《国际卫生条例》的范围是“预防、防范、控制疾病的国际传播并提供公共卫生应对措施”（第2条）。该范围包括一项所有危害战略，涵盖健康威胁，不论其来源或来源（第1条），这与以前版本的《国际卫生条例》中使用的针对特定疾病的模式不同。其目的是将生物、化学和放射性核事件结合起来。《国际卫生条例》要求缔约国发展快速发现和反应的核心能力，包括监测、实验室和风险通报能力，并得到立法、资金和国家协调中心的支持。核心能力包括加强地方基础设施和系统的公共卫生战略，以便在疫情向国际传播之前从源头发现、预防和控制疫情。缔约国同意“相互合作”以发展和维持核心能力。此外，缔约国必须迅速向世卫组织通报可能构成国际关注的突发公共卫生事件的事件，并继续有义务向世卫组织通报任何最新情况。为指导通报，《国际卫生条例》附件2载有一份“决定文书”，以协助评估是否向世卫组织通报可能引起国际关注的卫生事件。某些威胁，如天花，总是需要通知。对于其他威胁，缔约国必须利用该文书确定它们是否需要通知世卫组织。与以前的版本不同，《国际卫生条例》授权世卫组织考虑诸如科学家和媒体等非官方来源。当它收到一个非官方的
Fundamental revisions to the International Health Regulations in 2005 were meant to herald a new era of global health security and cooperation. Yet, 10 years later, the International Health Regulations face criticism, particularly after the west African Ebola epidemic. Several high-level panels1 are reviewing the International Health Regulations’ functions and urging reforms. 2 The Global Health Security Agenda, a multilateral partnership focused on preventing, detecting, and responding to natural, accidental, or intentional disease outbreaks, has similar capacity building aims, but operates largely outside the International Health Regulations. 3, 4 Here, we review the International Health Regulations’ performance and future.The International Health Regulations5 is a legally binding instrument, which came into force in June, 2007, and now has 196 States Parties—every WHO member state plus Lichtenstein and the Holy See. 6 The scope of the International Health Regulations is “to prevent, protect against, control and provide a public health response to the international spread of disease”(article 2). The scope embraces an all-hazards strategy, covering health threats irrespective of their origin or source (article 1), which is distinct from the disease-specific model used in previous versions of the International Health Regulations. The intention was to incorporate biological, chemical, and radionuclear events. The International Health Regulations requires States Parties to develop core capacities for rapid detection and response, including for surveillance, laboratories, and risk communication—buttressed by legislation, financing, and national focal points. Core capacities embrace a public health strategy of strengthening local infrastructure and systems to detect, prevent, and contain outbreaks at their source before spreading internationally. States Parties agreed to “collaborate with each other” to develop and maintain core capacities. Furthermore, States Parties must promptly notify WHO of events that might constitute a public health emergency of international concern, with a continuing obligation to inform WHO of any updates. To guide notifications, annex 2 of the International Health Regulations contains a “decision instrument” to aid in assessing whether to notify WHO of a health event of potential international concern. Certain threats, such as smallpox, always require notification. For other threats, States Parties must use the instrument to establish whether they need to notify WHO. Departing from previous versions, the International Health Regulations authorises WHO to consider unofficial sources, such as scientists and the media. When it receives an unofficial