Page 20 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

18 Chapter 1
tional travel and trade, the World Health Assembly (WHA) adopted the revised IHR in May 2005 (4). The IHR require all State Parties to develop and maintain capacities to “detect, assess, notify and report events” (Article 5), and to “re- spond promptly and effectively to public health risks and public health emergen- cies of international concern” (Article 13).
Since the introduction of the IHR, the Netherlands has notified nine events to the WHO, among which MERS-CoV infections in two travelers returning from Saudi Arabia in 2014, a wild poliovirus type 2 infection due to a spill incident in a Dutch vaccine manufacturing plant in 2017 and the identification of infection with a reassortant seasonal influenza A(H1N2) in a Dutch child (16-18). State Par- ties are required to report yearly to the WHO on the progress of implementation of 13 IHR core capacities through a self-assessment, nowadays called ‘State Par- ty Self-Assessment Annual Reporting Tool’ (SPAR) (article 54) (19). On European Union level, EU Decision 1082 on cross border threats to health was installed in 2013. This includes provisions for notification at EU level, and a 3-yearly up- date of preparedness and response planning on national level (article 4) (20).
The US Center for Disease Control (CDC) in collaboration with the WHO in- troduced concrete indicators for some required IHR core capacities such as sur- veillance and response, and pleaded for well-defined goals and indicators to en- able countries to monitor implementation of these capacities (21). In 2014, the IHR review committee recommended to add peer review and voluntary external evaluation. Subsequently, the extensive Ebola outbreak in West Africa in 2014- 2015 demonstrated that IHR implementation was not fully achieved in several West African countries in contrast with their self-assessments. The Review Com- mittee on the Role of the IHR in the Ebola Outbreak and Response recommended to “introduce and promote external assessment of core capacities”. Therefore, WHO developed the Monitoring & Evaluation Framework, which was adopted at the WHA in May 2018 (22). Next to the annual self-assessment, Joint External Evaluations (JEE) were introduced to assess a country’s IHR implementation by a team of external evaluators. The JEE assessment tool includes more extensive indicators for real-time surveillance through indicator and event based surveil- lance systems and response through amongst others preparedness and response plans (10). The JEE has led to further multi-sectoral and international alignment of preparedness, for example with the Global Health Security Agenda (GHSA), the World Organization for Animal Health Performance of Veterinary Services (OIE PVS) Pathway, and the Sendai Framework for Disaster Risk Reduction (23, 24). Response systems nowadays have become part of all hazard “emergency pre- paredness”, defined by WHO as the knowledge, capacities, and organizational