Canada and the International Health Regulations: Assessment and Reporting

What is a PHEIC?

The term public health emergency of international concern (PHEIC) is defined in the International Health Regulations (IHR) (2005), as “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”. This definition implies a situation that is serious, sudden, unusual or unexpected; carries implications for public health beyond the affected country’s border; and may require immediate international action.

The requirement to report potential PHEICs encompasses all events that pose a public health risk regardless of the source, including infectious diseases, contaminated food, natural disasters, chemical agents, and radiological-nuclear events.

How to identify a potential PHEIC?

Events that may constitute a PHEIC are assessed using the IHR Annex 2 decision instrument. Events that meet the necessary criteria must be notified to the WHO under IHR Article 6.

All cases of smallpox, poliomyelitis due to wild-type poliovirus, human influenza caused by a new subtype, and severe acute respiratory syndrome (SARS) must be notified to the WHO. In addition, any event which meets at least two of the following criteria must also be reported:

1. Is the public 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 trade or travel restrictions?

Further, an event involving the following diseases shall always lead to utilization of the Annex 2 decision instrument, because they have demonstrated the ability to cause serious public health impact and to spread rapidly internationally:

• Cholera
• Pneumonic plague
• Yellow fever
• Viral haemorrhagic fevers (Ebola, Lassa, Marburg)
• West Nile fever
• Other diseases that are of special national or regional concern, e.g. dengue fever, Rift Valley fever, and meningococcal disease.

It is important to note that if the event does not meet criteria for notification under Article 6 of the IHR, other reporting requirements may still apply under the Regulations, including under Articles 7-10 and 44.

What is the IHR assessment and reporting process in Canada?

In Canada, the IHR assessment and reporting process is conducted collaboratively by technical experts from relevant federal, provincial, and territorial governments.

Article 6 and Annex 1 of the IHR state that each State Party must have the capacity to assess all reports of urgent^{Footnote 1} events occurring within its territory within 48 hours using the IHR Annex 2 decision instrument. Each State Party shall then notify the WHO, by way of the National IHR Focal Point, and within 24 hours of assessment of public health information, of all qualifying events as well as any health measure implemented in response to those events.

Any urgent public health event must be reported by a province or territory to PHAC (or Health Canada, for example, for chemical or radiological-nuclear events). Technical teams at PHAC (or Health Canada) then have 48 hours to conduct a public health assessment, working in collaboration with the reporting province or territory and the National IHR Focal Point. If it is determined that the event meets the criteria for notification under Annex 2 of the IHR, the National IHR Focal Point must notify the WHO within 24 hours of the assessment.

Following a notification, a State Party shall continue to communicate to the WHO timely, accurate, and sufficiently detailed public health information available on the notified event, where possible including case definitions, laboratory results, source and type of the risk, number of cases and deaths, conditions affecting the spread of the disease and the health measures employed, and report when necessary, the difficulties faced and support needed in responding to the potential public health emergency of international concern.

If the event does not meet the criteria for notification under IHR Article 6, other reporting requirements may still apply.

Events notified to the WHO are assessed by WHO technical teams, and assistance to respond to the event is offered to the country, if requested. The responsibility for determining whether an event is a PHEIC lies with the WHO Director-General, who is advised by a committee of experts (IHR Emergency Committee), in accordance with the criteria and the procedures set out in the Regulations.