The West Africa Ebola outbreak has shone a spotlight on lapses in the 2007 International Health Regulations (IHR) Treaty, which was intended to improve the capacity of all countries to detect, assess, notify, and respond to public health threats of international concern. Dr. Frederick Burkle, Jr, MD, of the Harvard Humanitarian Initiative and the Woodrow Wilson International Center for Scholars, advocates for a stronger Treaty and World Health Organization in his article “Global Health Security Demands a Strong International Health Regulations Treaty and Leadership From a Highly Resourced World Health Organization” in Ebola Virus and Public Health, an online Special Issue of Disaster Medicine and Public Health Preparedness, which published February 18, 2015.
SARS, or severe acute respiratory syndrome, served as an initial wake-up call to the international community. Beginning in November 2003, the previously unknown virus spread from China to 37 different countries in a matter of 10 weeks. Catalyzed by SARS, the IHR was strengthened and became a treaty in 2007, giving the World Health Organization (WHO) unprecedented authority to provide public health security during public health emergencies of international concern. Burkle explains, “The IHR had existed for many years, but was incorporated into a Treaty, and as a result, the world felt very confident and ready for the next pandemic.”
However, only 20% of the countries met their obligations under the Treaty to improve their public health protections and surveillance. Then a 2-year-old child in Meliandou, Guéckédou, Guinea, became infected with Ebola virus. It was not until March 21, 2014, that Guinea first notified WHO of the outbreak. On March 29 Liberia notified WHO of its own outbreak. On April 1 Médecins Sans Frontières warned that Ebola’s spread was “unprecedented.” On May 12, cases were reported in Conakry, the capital of Guinea with a population of 2 million, a critical turning point in the outbreak.
In his article, Burkle describes the political challenges involved in implementing the IHR Treaty and the need for support and coordination with the Global Outbreak Alert and Response Network and foreign medical teams. “The Ebola tragedy has revealed the shameful failings that occurred after SARS,” Burkle says. “We’ve got to save and revise the International Health Regulations Treaty. Treaties are the most important means we have to pull the world together. There will be another pandemic. Practitioners and health decision-makers worldwide need to break their silence and advocate for a stronger Treaty and a return of WHO authority.”