PHEIC & Decision Instrument

Dr Reuben Samuel
WHO Country Office - India
 What is a PHEIC?
PHIEC Public Health Emergency
of International Concern

An extraordinary event which is

determined, as provided in these
Regulations:

i. to constitute a public health risk to other

Member States through international
spread of disease and

ii. to potentially require a coordinated

international response.
Alert and Response Operations
Events that may constitute a
Public Health Emergency of International Concern need:

Detection

Verification

Risk assessment

Response
 Verification of events
Value of unofficial sources of information for
early alert
WHO requests for verification of potential public
health events of international importance
Member States provide initial reply within 24
hours and provision of information

On-site assessment, when necessary

Event notification
Any event that may constitute a Public Health
Emergency of International Concern (PHEIC)

Within 24 hours of assessment

By the most efficient means of communication

Continue to provide WHO with detailed information

Does NOT mean a real PHEIC

 Disease List
Four diseases (a single case is notifiable):
Smallpox, Poliomyelitis, human influenza (caused by a
new subtype), SARS
Utilization of the decision instrument:
Cholera, plague, viral haemorrhagic fevers, yellow
fever,
Diseases of regional concern: dengue fever,
meningococcal diseases
 Decision Instrument
Criteria for assessment
1. Is the public health impact of the event serious?
2. Is the event unusual or unexpected?
3. Is there a significant risk of international spread?
4. Is there a significant risk of international travel or trade
restrictions?

Answering "yes" to any two of the criteria

requires a member state to notify WHO
 Is the event serious?

Yes No

Is the event unexpected? Is the event unexpected?

Yes No Yes No

Could it (or has it) spread Could it (or has it) spread
internationally? Yes internationally?

No
Yes Risk for international
No
sanctions?
Not
Yes notified
No
at this
stage.

Notify the event under the International Health Regulations

Is the event serious?
Morbidity and mortality
Does the event have potential for high impact?
Population at risk
Cases in health staff; highly infectious
Factors affecting response e.g. war, natural
catastrophe
High population density
Immediate or potential need for external
assistance
 Is the event unexpected?
Is the cause of the event unknown?
Are the circumstances unusual?
Cases worse than usual
Treatment failures
Event unusual for place/season
Caused by eliminated/eradicated agent
Suspected or known intentional or accidental
release of chemical, biological or radiological
agent
Is the event likely to spread internationally?
Similar cases in other countries where it was
unexpected?
Factors alerting to cross-border implications?
Caused by epidemic-prone organism
Source suspected/ known to be related to food
import/export
Index case with international travel history
In area with international tourism/ traffic, person or
goods
In border areas with limited capacity for control
Is event likely to result in international travel
and trade restrictions?

Similar events previously led to restriction

on travel/ trade?
Source known or suspected food product/
goods known to be imported or exported?
In area with international tourism?
Attracted media attention?
Combinations of answers
requiring notification
Serious and unexpected
Serious and risk for international spread
Serious and risk for international
restrictions
Unexpected and risk for international
spread
Unexpected and risk for international
restrictions
Thanks