Academic journal article Bulletin of the World Health Organization

Achieving Compliance with the International Health Regulations by Overseas Territories of the United Kingdom of Great Britain and Northern Ireland/Mise En Conformite Avec le Reglement Sanitaire International Par Les Territoires D'outre-Mer Du Royaume-Uni De Grande-Bretagne et d'Irlande Du Nord/Lograr El Cumplimiento del Reglamento Sanitario Internacional En Los Territorios De Ultramar del Reino Unido De Gran Bretana E Irlanda del Norte

Academic journal article Bulletin of the World Health Organization

Achieving Compliance with the International Health Regulations by Overseas Territories of the United Kingdom of Great Britain and Northern Ireland/Mise En Conformite Avec le Reglement Sanitaire International Par Les Territoires D'outre-Mer Du Royaume-Uni De Grande-Bretagne et d'Irlande Du Nord/Lograr El Cumplimiento del Reglamento Sanitario Internacional En Los Territorios De Ultramar del Reino Unido De Gran Bretana E Irlanda del Norte

Article excerpt

Introduction

The 2005 International Health Regulations [IHR (2005)] came into force in June 2007 for 194 countries, including all Member States of the World Health Organization (WHO). (1) The deadline for compliance was June 2012. Nine Member States, including China, Denmark, France, the Netherlands, the United Kingdom of Great Britain and Northern Ireland and the United States of America, have overseas territories with a total population of more than 15 million people (Table l). (2,3) These territories fall under the jurisdiction and sovereignty of the mainland yet are often self-governing and have their own legal and public health systems. However, each Member State has a responsibility to ensure that all parts of its territory comply with the IHR (2005).

The epidemiology of disease in overseas territories has been reported to differ from that in their respective mainland territories. (4,5) For example, epidemics of tropical diseases that are largely absent from mainland Europe persist in the Caribbean overseas territories of some European nations. (5) Some overseas territories receive a large number of holidaymakers from their respective mainlands, which increases the risk of disease being imported in both directions. It is therefore of paramount importance that all Member States with overseas territories are aware of the situation regarding full compliance with the IHR (2005).

The purpose of the IHR (2005) is "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 traffic and trade." (1) Under the revised regulations, Member States have much broader obligations to build national capacity for surveillance and response in the event of a public health emergency of international concern and to share information about such emergencies. The regulations include a code of conduct for notification and response.

The IHR (2005) requires countries to assess the ability of existing national structures, capacities and resources to meet minimum requirements for public health surveillance and response. These assessments, together with the consequent development of plans to ensure compliance with the IHR (2005), were supposed to be completed by June 2012. However, fewer than 20% of Member States met this deadline. (6)

No specific guidance on compliance with the IHR (2005) has been provided by WHO for the special circumstances of Member States with overseas territories, which indicates that compliance by overseas territories should be assessed by Member States themselves. To our knowledge, no reports have been published to date on the assessment of IHR compliance in countries with overseas territories.

The aims of this paper were: (i) to provide an overview of a gap analysis done to assess IHR compliance of the United Kingdom's overseas territories and to identify appropriate measures that could be taken to ensure compliance by June 2014; and (ii) to discuss the policy implications of the findings of the gap analysis, which may be relevant to other countries with overseas territories.

Compliance by overseas territories

Although mainland United Kingdom was almost fully compliant with the IHR by June 2012, it was recognized that compliance by the United Kingdom's overseas territories and crown dependencies required further assessment. An extension of the deadline for IHR compliance to June 2014 was therefore obtained.

The United Kingdom has 16 overseas territories and three crown dependencies (Fig. 1). These territories and dependencies are heterogeneous in terms of: (i) geography and environmental conditions (one crown dependency is located less than 70 miles from mainland United Kingdom, whereas others are some of the most remote islands in the world); (ii) population size, which ranges from zero in uninhabited territories to 95 000; and (iii) income (the per capita gross domestic product ranges from less than one tenth to nearly double that of the United Kingdom). …

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