Жамият
ва
инновациялар
–
Общество
и
инновации
–
Society and innovations
Journal home page:
https://inscience.uz/index.php/socinov/index
The importance of International Health Standards in the
regulation of health issues
Roza AZKHODJAEVA
Tashkent State University of Law
ARTICLE INFO
ABSTRACT
Article history:
Received December 2023
Received in revised form
15 December 2023
Accepted 20 January 2024
Available online
25 February 2024
This article discusses the role and significance of the health
standards of IHR, the history of its occurrence, and its features.
The objectives and scope of the IHR, and the meaning of the
concept of
“
public health emergency of international
importance
”
are defined. The differences between the IHR of
1969 and 2005 are considered. The positive trends of IHR, as
well as shortcomings and problems in the implementation of
requirements, are analyzed. The final part of the article presents
conclusions and suggestions for improving the IHR.
2181-
1415/©
2024 in Science LLC.
https://doi.org/10.47689/2181-1415-vol5-iss1-pp206-211
This is an open access article under the Attribution 4.0 International
(CC BY 4.0) license (https://creativecommons.org/licenses/by/4.0/deed.ru)
Keywords:
International Health
Regulations,
international treaty,
healthcare,
law,
emergency,
WHO,
infectious diseases,
participating States,
cooperation,
Republic of Uzbekistan.
Sog
‘
liqni saqlash masalalarini tartibga solishda xalqaro
sog
‘
liqni saqlash normalarining ahamiyati
ANNOTATSIYA
Kalit so‘zlar
:
xalqaro sog
‘
liqni saqlash
qoidalari,
xalqaro shartnoma,
sog
‘
liqni saqlash,
huquq,
favqulodda vaziyat,
JSST,
yuqumli kasalliklar,
ishtirokchi davlatlar,
hamkorlik,
O
‘
zbekiston Respublikasi.
Ushbu maqolada MMSP tibbiy-sanitariya me
’
yorlarining roli
va ahamiyati, paydo bo
‘
lish tarixi va uning xususiyatlari
muhokama qilinadi. MMSPNING maqsadlari va ko
‘
lami,
“
xalqaro
ahamiyatga ega bo
‘
lgan sog
‘
liqni saqlash sohasidagi favqulodda
vaziyat
”
tushunchasining ahamiyati aniqlandi. 1969-yildan
2005-yilgacha bo
‘
lgan MMSP o
‘
rtasidagi farqlar ko
‘
rib chiqildi.
MMSPNING ijobiy tendentsiyalari, shuningdek talablarni
amalga oshirishdagi kamchiliklar va muammolar tahlil qilindi.
Maqolaning yakuniy qismida MMSPNI takomillashtirish
bo
‘
yicha xulosalar va takliflar keltirilgan.
1
PhD in Law, Lecturer, Tashkent State University of Law. E-mail: azroza@yandex.ru
Жамият
ва
инновациялар
–
Общество
и
инновации
–
Society and innovations
Issue
–
5
№
1 (2024) / ISSN 2181-1415
207
Значение международных медико
-
санитарных норм
в регулировании вопросов охраны здоровья
АННОТАЦИЯ
Ключевые слова:
международные медико
-
санитарные правила,
международный договор,
здравоохранение,
право,
чрезвычайная ситуация,
ВОЗ,
инфекционные
заболевания,
государства
-
участники,
сотрудничество,
Республика Узбекистан.
В данной статье рассматриваются роль и значение
медико
-
санитарных
норм
ММСП,
история
их
возникновения и особенности. Определены цели и сфера
применения
ММСП,
а
также
значение
понятия
«чрезвычайная ситуация в области общественного
здравоохранения международного значения». Рассмотрены
различия между ММСП 1969 года и ММСП 2005 года.
Проанализированы положительные тенденции ММСП, а
также выявлены недостатки и проблемы в реализации
требований. В заключительной части статьи представлены
выводы и предложения по совершенствованию ММСП.
There are a great many infectious diseases in the world today, and at all times they
have been the main enemies of man. History knows many examples of the devastating
effects of smallpox, plague, cholera, typhus, dysentery, measles, and influenza. Contagious
diseases appeared on Earth even before man. Humanity faced this problem back in the
prehistoric period. Viruses and bacteria destroyed millions of people, and there were no
means of protection until almost the last century.
It should be emphasized that the infectious process is one of the most complex
biological processes in nature, and infectious diseases are formidable destructive factors
for human society, causing enormous economic damage to it. Of course, the main role in
regulating cooperation between States in the fight against infectious diseases belongs to
WHO.
The original International Health Regulations (IHR) were adopted in 1969, but
their foundations can be traced back to the mid-19th century, when measures were taken
to combat the cross-border spread of plague, yellow fever, smallpox and especially
cholera with minimal interference in world trade. In 1951, WHO issued its first rules for
the prevention of infectious diseases, the International Sanitary Rules. In 1969 they were
revised into the "International Health Regulations", which dealt with six diseases:
cholera, plague, recurrent typhus, smallpox, typhoid fever and yellow fever." [1].
In 1973, at the twenty-sixth session of the World Health Assembly, it amended the
cholera issues. Due to the emergence of new infectious diseases in subsequent sessions,
WHO member States felt the need to revise the IHR. The International Health Regulations
(IHR) is an international treaty establishing binding global rules in the field of public
health in order to enhance health safety at the national, regional and international levels.
They were adopted at the 58th session of the World Health Assembly on May 23, 2005,
entered into force in 2007 and are binding on WHO member countries. [2].
One of the most important aspects of the IHR 2005 is the establishment of a global
surveillance system for public health emergencies of international importance. The IHR
2005 expands the scope of the rules, strengthens WHO's authority in the field of
surveillance and response, contains stricter surveillance and response obligations, and
applies human rights principles to public health interventions [3].
Жамият
ва
инновациялар
–
Общество
и
инновации
–
Society and innovations
Issue
–
5
№
1 (2024) / ISSN 2181-1415
208
The IHR provides a comprehensive legal framework defining the rights and
responsibilities of countries in relation to public health actions and emergencies that
potentially cross borders. As one of the basic documents of WHO, the rules are designed
to help the global community in preventing the spread of diseases and taking response
measures.
A design feature of the IHR (2005) was a dynamic, open to new infectious diseases,
described in Appendix 2, which provides a scheme and algorithm for verifying
emergency situations. All the qualitative characteristics of the IHR (2005) were designed
for early, preventive, flexible, without cumbersome procedures, screening, monitoring
and control of threats, the implementation of which posed a risk of emergency situations.
All this is initially aimed at the high potential of the effectiveness of the IHR (2005),
primarily in relation to modern, most dangerous threats and challenges, and especially
new infectious diseases, the scale of the devastating consequences of which varied
greatly prognostically, up to catastrophic for the international community. The syndrome
approach is used here as an auxiliary part of emergency verification [4]. The IHR
establishes fundamental global legal requirements for all countries regarding
international coordination in identifying, investigating and responding to public health
risks (and related issues); the rules require that all countries have the ability to identify,
assess, report and respond to public health events.
According to Article 1.1 of the IHR-2005 WHO defines any infection as a disease or
health condition that threatens or may threaten human health, regardless of its source or
origin.
Consequently, the IHR 2005 is not limited to specific infectious diseases, which
makes it possible not only to respond quickly and prevent the spread of already known
diseases but also to apply appropriate measures to new and constantly changing risks to
public health. Taking into account the trend of globalization of the spread of infections,
the steady emergence of new and the return of old infectious diseases, the growth of
migration activity of the population and trade, general urbanization, and new economic
conditions, this approach is more meaningful and preferable for practical application [5].
The purpose and scope of the IHR (Article 2) is to prevent, control, and respond to
the risks of the international spread of diseases "in ways commensurate with the risks to
public health and to avoid unnecessary interference in international transport and
trade." The scope of the IHR related to diseases is extremely wide (essentially the
"all risks" approach), covering not only infectious diseases but also risks associated with
chemical or radionuclide sources, as well as other biological risks to public health.
The rules also set out criteria for determining whether a particular event is a
"public health emergency of international importance" (PHEIC); a requirement is defined
that countries identify and report events that may constitute a potential emergency. Once
a WHO member country identifies an event as a PHEIC, it must assess the public health
risks associated with the event within 48 hours. If an event is identified as being subject
to notification by the IHR, the country must provide this information to WHO within
24 hours. [6]
By Resolution No. 220 of the Cabinet of Ministers of July 31, 2015, International
Health Regulations were introduced in the Republic of Uzbekistan. [8] The document was
adopted to organize and strengthen a comprehensive system of regulating relations
related to ensuring the sanitary and epidemiological well-being of the population of the
Жамият
ва
инновациялар
–
Общество
и
инновации
–
Society and innovations
Issue
–
5
№
1 (2024) / ISSN 2181-1415
209
republic, as well as preventing the international spread of diseases. The Ministry of
Health of the Republic of Uzbekistan with the WHO Representative Office and competent
ministries and departments conducted preparatory activities for the implementation of
the Rules in the republic.
The IHR also serves as the foundation for the global health security agenda. As
trade and travel expand globally, so do the opportunities for wider disease transmission.
The impact of infectious diseases on public health and the economy can cause
enormous harm to people and serious damage to the country's resources. As noted
above, the IHR is coordinated by WHO and aims to inform the world about public health
risks and developments. As an international treaty, the IHR is legally binding; all
countries must report on events of international importance to public health. Countries
refer to the IHR to determine how to prevent and control global health threats while
keeping international travel and trade as open as possible.
The IHR requires that all countries have the opportunity to respond in this
situation as follows:
–
ensure that surveillance systems and laboratories can detect potential threats;
–
work together with other countries to make decisions in public health
emergencies;
–
report on specific diseases as well as any potential international public health
emergencies by participating in a network of national focal points;
–
respond to public health events.
The IHR also includes specific measures that countries can take at ports, airports,
and land border crossings to limit the spread of health risks to neighboring countries, as
well as to prevent unjustified travel and trade restrictions.
In today's interconnected society, it is more important than ever to ensure that all
countries can respond to and contain threats to public health. All countries have a
responsibility to each other to build strong health systems that work to identify and
contain public health events before they spread. The IHR is forward-looking, requiring
countries to consider the possible impact of all hazards, regardless of whether they occur
naturally, accidentally, or intentionally. However, despite broader global agreement on
the importance of the IHR, only about 1/3 of the world's countries currently can assess,
identify, and respond to public health emergencies. These gaps in global preparedness
make the rest of the world vulnerable.
Current practice indicates an inconsistent level of compliance, in particular about
restrictions on travel and trade with affected countries. States may take health measures
by article 43 of the IHR that are at odds with WHO recommendations or otherwise violate
several IHR provisions, provided that they are a direct response to PHEIC or a risk to
public health, based on scientific evidence and risk assessment, proportional to the risk;
if these measures are substantially they disrupt international traffic for more than
24 hours, the State provides WHO with a justification for their use from the point of view
of public health and relevant scientific information.
The complex wording of Article 43 makes it difficult to determine whether States
may violate the IHR in implementing additional measures, and does not provide specific
guidance to States that decide to go beyond WHO recommendations or take action in
violation of certain IHR obligations.
Жамият
ва
инновациялар
–
Общество
и
инновации
–
Society and innovations
Issue
–
5
№
1 (2024) / ISSN 2181-1415
210
The dispute settlement procedures provided for in Article 56 of the IHR have also
not been applied so far, so we do not have a div of jurisprudence that could help clarify
the limits of legitimate conduct.
Therefore, some experts questioned the binding legal nature of the 2005 IHR,
given the lack of enforcement or even compliance monitoring mechanisms and the
apparent disregard by participating States of WHO recommendations. However, if it is
eventually determined (for example, by the Health Assembly or judicial authority) that
States may violate the IHR through measures provided for in Article 43 that exceed WHO
recommendations, then these recommendations become legally binding. The ambiguity
of the text and the lack of judicial practice on this issue leave the legal basis of the
accountability mechanism in Article 43 uncertain.
In addition to the listed disadvantages, it is also noted that:
•
Many developing countries are unable to identify and respond to public health
emergencies due to the banal lack of the necessary resources and appropriate
surveillance infrastructure (an additional confirmation of this is the outbreak of Ebola in
2014-2016 in West Africa);
•
Some countries may decide to act unilaterally solely in their interests, where the
collected information and biological data are not necessarily transferred to the
international community;
•
In many ways, International Health Regulations consider the interests of public
health as subordinate to the problems of state security and the state of the economy.
Therefore, their implementation measures largely amount to excessive supervision, with
significantly less attention to issues of assistance to developing countries;
•
There are no legal mechanisms to ensure compliance with the requirements
established by the IHR 2005. Thus, by imposing certain obligations on the participating
States, WHO has not provided for any liability for their violation, thereby undermining
the reliability of the implementation of the agreements reached. [11]
Thus, given the complexity and large number of variables surrounding disease
outbreaks, it is unrealistic to expect a reliable system that could provide impeccable
public health solutions, requiring general compliance and imposing self-restraint.
Nevertheless, there are serious issues of design and implementation that must be
thoroughly and urgently addressed to avoid the irreversible weakening of the integrity of
the IHR as the only and necessary legal basis for global health security.
REFERENCES:
1.
https://alphapedia.ru/w/International_Health_Regulations
2.
https://www.who.int › ihr › Intro_legislative_impl...
3.
https://barrist.ru/mezhdunarodnoe-i-rossijskoe-zakonodatelstvo-v-sfere-
obespecheniya-zashchity-ot-osobo-opasnyh-infekcij/
4.
Popova A.Yu., Toporkov V.P., Smolensky V.Yu. The effectivity of international
medico-sanitary rules in the prevention and control of emergency situations of sanitary-
epidemiological and biological character // Problems of especially dangerous infections.
2017, no. 2. P. 6.
5.
https://barrist.ru/mezhdunarodnoe-i-rossijskoe-zakonodatelstvo-v-sfere-
obespecheniya-zashchity-ot-osobo-opasnyh-infekcij/
6.
https://docs.cntd.ru/document/901947562
Жамият
ва
инновациялар
–
Общество
и
инновации
–
Society and innovations
Issue
–
5
№
1 (2024) / ISSN 2181-1415
211
7.
Statement following the second meeting of the Emergency Committee under the
International Health Regulations in connection with the 2019 Novel Coronavirus
outbreak URL: https://www.who.int/ru/news-room/detail/30-01-2020-statement-on-
the-second-meeting-of-the-international-health-regulations-(2005)-emergency-
committee-regarding-the-outbreak-of-novel-coronavirus-(2019).
8.
Decree of the Cabinet of Ministers dated July 31, 2015 No. 220 “On measures to
implement the International Health Regulations in the Republic of Uzbekistan”. URL:
https://lex.uz/docs/2716476.
9.
International
Health
Regulations
(IHR).
URL:
https://www.cdc.gov/globalhealth/healthprotection/ghs/ihr/index.html#:~:text=As%2
0an%20international%20treaty%2C%20the,trade%20as%20open%20as%20possible.
10.
Gian Luca Burci. The Outbreak of COVID-19 Coronavirus: are the International
Health Regulations fit for purpose? URL: https://www.ejiltalk.org/the-outbreak-of-covid-
19-coronavirus-are-the-international-health-regulations-fit-for-purpose/.
11.
https://barrist.ru/mezhdunarodnoe-i-rossijskoe-zakonodatelstvo-v-sfere-
obespecheniya-zashchity-ot-osobo-opasnyh-infekcij/