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With the signing of the revised International Health Regulations (IHR) in 2005, the international community agreed to improve the detection and reporting of potential public health emergencies worldwide. IHR (2005) better addresses today’s global health security concerns and are a critical part of protecting global health. The regulations require that all countries have the ability to detect, assess, report and respond to public health events.

In response to the exponential increase in international travel and trade, and emergence and reemergence of international disease threats and other health risks, 196 countries across the globe agreed to implement the International Health Regulations (2005) (IHR). This binding instrument of international law entered into force on 15 June 2007.

The stated purpose and scope of the IHR 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." Because the IHR are not limited to specific diseases, but are applicable to health risks, irrespective of their origin or source, they will follow the evolution of diseases and the factors affecting their emergence and transmission. The IHR also require States to strengthen core surveillance and response capacities at the primary, intermediate and national level, as well as at designated international ports, airports and ground crossings.

The International Health Regulations (IHR), a legally binding agreement between 196 States Parties, whose aim is to prevent, protect against, control, and provide a public health response to the international spread of disease, deserve critical examination with regard to their applicability. The emergence and spread of the new mysterious hemorrhagic fever may constitute a public health emergency of international concern (PHEIC) and is therefore notifiable to the World Health Organization under the IHR notification requirement.

IHR (2005) is coordinated by the World Health Organization (WHO) and aims to keep the world informed about public health risks and events. As an international treaty, the IHR (2005) is legally binding; all countries must report events of international public health importance. Countries reference IHR (2005) to determine how to prevent and control global health threats while keeping international travel and trade as open as possible.

IHR (2005) requires that all countries have the ability to do the following:

· Detect: Make sure surveillance systems and laboratories can detect potential threats

· Assess: Work together with other countries to make decisions in public health emergencies

· Report: Report specific diseases, plus any potential international public health emergencies, through participation in a network of National Focal Points

· Respond: Respond to public health events

IHR (2005) also includes specific measures countries can take at ports, airports and ground crossings to limit the spread of health risks to neighboring countries, and to prevent unwarranted travel and trade restrictions.

One of the most important aspects of IHR (2005) is the requirement that countries detect and report events that may constitute a potential public health emergency of international concern (PHEIC) for this matter we are referring to the hemorrhagic fever.

Under IHR (2005), a PHEIC is declared by the World Health Organization if the situation meets 2 of 4 criteria:

· Is the public health impact of the event serious?

· Is the event unusual or unexpected?

· Is there a significant risk of international spread?

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

So as soon as the fever was identified in the tropical resorts as an event of concern, there must be an assessment of the public health risks of the event within 48 hours. If the event is determined to be notifiable under the IHR, this must be reported to WHO within 24 hours.

The example case of the mysterious hemorrhagic fever is highly applicaple to be a notifiable disease under IHR. The mentioned case appears to hit the tropical resort which is mostly visited by tourists thus making the disease a public health concern. The tourists might easily spread the disease all over the globe. This needs to be reported and ensure that all necessary measures to detect it early, manage and contain it within the area of disease eruption.

As noted, the number of tourists has decreased and economically this has an impact to the affected country. This in some cases might pose hesitation to report among the affected state fearing that it might scare the tourists and hence impact the member state economically. However, the risk of spread outweighs the economic risks. If the disease is not reported, other member states might fail to support. As it is mentioned as the scope of IHR "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."

Some diseases always require reporting under the IHR, no matter when or where they occur, while others become notifiable when they represent an unusual risk or situation.

The world threat posed by the spread of hemorrhagic fever cannot be addressed by individual countries alone, but requires a coordinated international response. Recognizing the applicability of the IHR to this outbreak will serve as a “wake-up call” and strengthen global surveillance and response, which could in turn contribute to containing the spread of the fever. Notifications of events should serve as alerts and can be an important instrument in the chain of “the global early warning function, the purpose of which is to provide international support to affected countries and information to other countries if needed”. The immediate consequence of notification is to initiate an “exclusive dialogue between the notifying State Party and WHO concerning the event at issue” and to make a joint risk assessment. The dissemination of information through the WHO Event Information System (EIS) could expediently increase awareness in multiple countries, allow early implementation of screening measures for persons at risk (e.g., international hospital transfers), and prevent the establishment of new strains in unaffected countries. IHR can also facilitate the international dissemination of appropriate measures to counter the spread of hemorrhagic fever.

Applying the outbreak of hemorrhagic fever to IHR may face obstacles as well, for instance: Even if WHO and a majority of States Parties consider that the fever should be addressed under the IHR, technical, financial, and political obstacles might interfere. Notification of an event to WHO depends on it being detected (requiring a functioning health system and adequate laboratory capacities), and reported to the National IHR Focal Point. There is a concern that many States Parties are far from being compliant with the IHR's minimum core capacity requirements for surveillance and response. Even if relevant information filters through to the national level, notification decisions may be under political control which in many cases cannot be interfered with.

The IHR framework provides a global surveillance infrastructure and orchestrates an appropriate public health response. The IHR are ultimately “owned” by the States Parties, some of whom increasingly understand the extent and urgency of the threats posed by emerging disease outbreaks. However, it is up to WHO to provide leadership on the role of the IHR.

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