Guidance

International Health Regulations 2005: UK National Focal Point communications protocol

Updated 27 February 2024

Scope

1. This protocol deals with communications in relation to the International Health Regulations (IHR) 2005:

• for specific IHR purposes only, including Freedom of Information requests about those IHR purposes – it does not deal with communications with health bodies, the media or the public more generally, or with case or event management
• between certain bodies (for example the UK Heath Security Agency (UKHSA), the Department of Health and Social Care (DHSC), the devolved administrations (DAs), the UK’s overseas territories (OTs) and Crown Dependencies (CDs), and the World Health Organization (WHO)), not within those bodies

Introduction

2. The International Health Regulations are a legally binding international instrument 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 trade and traffic”.

3. On 20 May 2005 the 58th World Health Assembly adopted a revision of the previous version of the IHR formulated in 1969. The revised regulations came into force on 15 June 2007. The new IHR encompass a number of important developments that include among others increased emphasis on international notification of and communication about public health events that may have international implications.

4. The IHR 2005 define a list of diseases that must always be reported to WHO. These are:

• smallpox
• poliomyelitis due to wild-type poliovirus
• human influenza caused by a new subtype
• severe acute respiratory syndrome (SARS)

5. In addition to the list of diseases that are always notifiable, under the new IHR the State Party has an obligation to assess other events occurring within the State territory using the decision instrument at Annexe 2 and to notify WHO if they are potential Public Health Emergencies of International Concern (PHEIC). This can include non-infectious events (chemical or radiological). Annexe 2 to the IHR lists diseases that should always lead to the utilisation of the decision instrument and also refers to the need to report “other diseases that are of special national or regional concern”. Diseases of particular relevance to the UK may be included in this category in consultation between UKHSA and DHSC as necessary, although there are no current plans to do so.

6. Note that member states are also required under IHR to notify WHO if they believe that an event with international implications is occurring in another member state’s territory.

7. A full version of the IHR (2005) is available online.

National Focal Point function

8. There is a requirement outlined in Article 4 of the IHR 2005 that “each State Party shall designate or establish a National IHR Focal Point ” (NFP) that “shall be accessible at all times for communications with the WHO IHR Contact Points” and whose functions “shall include:

• sending to WHO IHR Contact Points, on behalf of the State Party concerned, urgent communications concerning the implementation of these Regulations, in particular under Articles 6 to 12; and

• disseminating information to, and consolidating input from, relevant sectors of the administration of the State Party concerned, including those responsible for surveillance and reporting, points of entry, public health services, clinics and other government departments”

9. The UK governments (including the devolved administrations) have designated UKHSA to act as the NFP for all of the UK territory (including England, Wales, Northern Ireland, Scotland, the Overseas Territories (OTs) and the Crown Dependencies (CDs)). Communications on IHR matters should not be sent directly to WHO from any other body than the NFP.

10. The Centre for Infectious Disease Surveillance and Control (CIDSC) at UKHSA Colindale leads on the UKHSA role as the NFP, with the Director of CIDSC having overall lead responsibility.

11. Paragraph 4(1) of the IHR 2005 envisages that the National IHR Focal Point, in addition to having the authority to communicate IHR related information to WHO should also provide support for and, if so decided by the member state, participate in collaborative risk assessment with WHO. The UK government expects that UKHSA as NFP will take the lead on assessing events for the UK under IHR but that this will be done in conjunction with the relevant public health authorities in the part of the UK territory affected.

12. Although under IHR member states are obliged only to report incidents that may constitute a potential PHEIC, in practice dialogue and discussion with WHO are encouraged on other events that are of international public health significance.

Communicating with the National Focal Point

13. The UK NFP is accessible to all callers via the following;

Email (automatically forwarded to the personal email accounts of the CIDSC IHR team 7 days a week)	Telephone 24/7 UKHSA Colindale duty doctor service
ihrnfp@ukhsa.gov.uk	+44(0)208 200 4400

14. Urgent matters should be directed to the NFP through the telephone contact.

15. Any incident that occurs in any part of UK territory that might have implications for international public health or trade or traffic should be discussed by the lead agency for that territory with the NFP. Furthermore, any part of UK territory that becomes aware of an incident that may be relevant under IHR in any other member state should also discuss their concerns with the NFP. Advice on the international implications of an incident can be sought at any time from the NFP and those seeking advice or reporting must ensure that they provide all the available information to the NFP to enable a judgement to be made.

Sending information to WHO

16. There are 2 broad categories of situations when the UK NFP may need to provide information to WHO:

• initiated by the UK: where an incident has been detected by the UK (either in UK territory or in another member state), that may be of relevance under IHR – in this case, the information available about the event is assessed by the UK to determine whether or not it should be reported under IHR to WHO; under IHR 2005, events that are assessed by the member state to be reportable under IHR must be notified to WHO within 24 hours of assessment
• initiated by WHO: where an incident in UK territory or involving UK nationals in another member state is suspected by WHO or another member state and WHO requests information from the UK – the UK is then obliged to provide an initial response or acknowledgement within 24 hours

17. The communications protocol varies according to the type of incident.

a) Case of disease on defined list of diseases

Where a case of disease on the defined list of diseases has been confirmed in any part of UK territory the NFP will report this case to WHO immediately (and certainly within 24 hours of confirmation). The NFP will simultaneously inform DHSC, the body that reported the case to the NFP, and all parts of the UK territory (both public health and governments) that a notification is being made. Where a case is strongly suspected but microbiological confirmation is awaited or not possible the NFP may discuss with WHO in the absence of such confirmation and will inform DHSC. If the suspected case is in any part of UK territory other than England, the NFP will also inform the relevant public health and government authorities of discussions with WHO.

b) Any other event assessed against the algorithm

For any other event that may have implications for international public health or trade/traffic the NFP will make an initial judgement as to the likely international impact of the event and will discuss this with DHSC. Where the event has occurred in any part of UK territory other than England the judgement will be determined in conjunction with the public health authority or equivalent in that part of UK territory.

The subsequent actions will depend upon the nature of the event and it is not possible to be too prescriptive in this protocol. The underlying principles are, however, the following:

I. For events that have less serious implications the NFP will usually proceed to discuss with WHO with a view to whether a formal report is required. DHSC and all involved parts of the UK territory will be kept informed of these discussions and of any formal reports made to WHO.

II. For events with serious implications that could constitute a PHEIC, the NFP (in conjunction with relevant UK public health authorities) will prepare a written report with a recommendation as to whether or not it should be formally reported as a potential PHEIC to WHO. The final decision on reporting shall, however, be taken by the Chief Medical Adviser to the UK government or a nominated deputy. If so, then the NFP will communicate accordingly with WHO within 24 hours of the assessment. Where a serious event is wholly or partly occurring in any part of the UK territory other than England, the final decision on reporting shall be taken by Chief Medical Adviser to the UK government (or a nominated deputy) in association with the CMO equivalent in the relevant part of the UK territory.

c) WHO requests information about an incident from the UK

The NFP must send an initial response or acknowledgement to a request for information from WHO within 24 hours. The NFP will conduct an initial assessment (involving all relevant UK public health authorities) to determine whether the incident is verified and what the international implications might be for public health and trade/traffic. If the event is verified and assessed as a potential PHEIC by the NFP then this shall be reported to the Chief Medical Adviser to the UK government (or nominated deputy) with a recommendation that it be notified to WHO as such in the response to the request for information. If the event is either not verifiable or is not a potential PHEIC, then the NFP will report this to DHSC and relevant authorities in any affected part of the UK territory and copy them into the formal response to WHO.

18. There are a number of international reporting systems that pre-date the IHR 2005. Any reports made to WHO from any part of UK territory under such systems should be copied to the NFP address so that the NFP may determine whether they might also be reportable under IHR 2005.

Public statements about notifications to WHO

19. The NFP will maintain electronic records of all incidents that are reported to it, and of all reports made to WHO. UKHSA will include in its Freedom of Information publication scheme a commitment to publish information about notifications to WHO (and events considered for notification but in the event not notified) annually.

20. Media handling of incidents occurring in UK territory is a matter for the relevant authorities in the affected part of the territory. However, public statements about notifications of incidents to WHO should only be made by the UK government’s Chief Medical Adviser (or a nominated deputy).

Disseminating information from WHO

21. WHO communicates with the UK NFP about a variety of global incidents of public health importance that may have relevance for UK territory. An IHR event website is used for less urgent communications, and where information needs to be passed on to the UK urgently, WHO would be expected to use either the telephone or email contacts. A team of senior leads and support scientific and administrative staff at CIDSC ensures that the website is checked every working day. Any emails from WHO on IHR matters are automatically forwarded on to the IHR team at all times.

22. CIDSC have an internal protocol for assessing and disseminating event information that comes to the NFP from WHO. Information about notified events is classified into different categories according to the relevance and importance of the event and whether any action is required to be taken.

23. Items that are for information only or which request information about implications for the UK territory are disseminated to the public health leads in all parts of the UK territory.

24. Events that require actions to be taken are disseminated to both public health and government leads for all parts of the UK territory.

25. Where WHO is advising significant actions by the UK, the NFP will inform DHSC to allow intra- and inter-governmental discussion and response to the advice. The item will then be disseminated by the NFP, with the accompanying governmental response to the advice being given, to both public health and government leads for all parts of UK territory.