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What is an international health emergency and what are its consequences?

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The activation this Saturday of the international maximum alert for the monkey pox by the director general of the World Health Organization (WHO), Tedros Adhanom Ghebreyesusafter more than 16,000 cases (five of them fatal) have already been declared in 75 countries, many of them in Europe, it marks the seventh time that the WHO has declared an international health emergency.

In this article we review what it means and what consequences the declaration of a “Public Health Emergency of International Concern” (PHEIC) entails.

What is an international health emergency?

The World Health Organization (WHO) defines an international health emergency as “an extraordinary event that constitutes a public health risk from other states through the international spread of disease and that potentially requires a coordinated international response.”

This definition implies a situation that is presented as follows:

  • It is a sittuation serious, sudden, unusual either unexpected.

  • Have implications for public health beyond the national borderl of the affected State.

  • May require a immediate international action.

What is the purpose of declaring a health emergency?

The highest priority is contain the outbreak as quickly as possible so that it does not spread to more areas of that country and to other countries that until then are safe from the pandemic. On the other hand, the Emergency Committee issues a series of temporary recommendations to the rest of the countries to prevent this outbreak from reaching their territories.

After the declaration of a PHEIC, the role of the WHO is then to coordinate and support the affected countries, and those that may potentially be affected, to try to reduce the spread of the disease.

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Who decides an international health emergency?

This responsibility rests with the members of the Emergency Committee of the International Health Regulations (RSI) drawn from the IHR roster of experts established by the Director-General and, where appropriate, from other WHO expert advisory panels. The IHR Roster of Experts is made up of international experts in fields such as disease control, virology, vaccine development, or infectious disease epidemiology.

At least one member of the Emergency Committee must be an expert designated by a State Party in whose territory this health emergency occurs. These States Parties are invited to submit their views to the Emergency Committee. The Director General may also appoint one or more technical experts to advise the Committee, on his own initiative or at the request of the Committee.

How does the RSI Emergency Committee work?

The Emergency Committee is made up of international experts who provide technical advice to the WHO Director-General in the context of a “public health emergency of international concern”. The Committee provides opinions on:

  • If the event constitutes a public health emergency of international importance (PHEIC)

  • The Temporary Recommendations to be taken by the country experiencing an emergency of international concern, or by other countries, to prevent or reduce the international spread of disease and avoid unnecessary interference with international trade and travel

  • when should it end this PHEIC.

The Director General makes the final determination of a PHEIC and Temporary Recommendations to address the situation, based on advice from the Emergency Committee, information provided by States Parties, scientific experts and an assessment of the risk to human health, the risk of international spread of disease and the risk of interference with international travel.

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How often does the IHR Emergency Committee meet?

Under the IHR, Temporary Recommendations automatically expire three months after they are issued. Therefore, the Emergency Committees meet again at least every 3 months to review the current epidemiological situation and to review whether the event continues to be a public health emergency of international concern and whether it is necessary to make changes to the Temporary Recommendations.

What consequences can the declaration of a health emergency have?

In addition to the logical direct consequences at the health level that it causes to the inhabitants of the affected countries (mobility restrictions, quarantines and other health obligations and guidelines to comply with), the declaration of an international health emergency entails a large-scale impact on the domestic economy of the affected area, but also the ‘contagion’ effect that these declarations produce in the International panorama has repercussions at the tourist and commercial level.

It is for this reason that the declaration of a health emergency occurs on very few occasions and after many debates within the Emergency Committee.

What other health emergencies are still active?

With monkeypox, it is the seventh time that the WHO has declared an international emergency (a mechanism started in 2005), after having done so for influenza A in 2009, Ebola in 2014 and 2018, polio in 2014, the Zika virus in 2017 and the coronavirus that causes covid in 2020 (the latter alert level is still in force).

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