PHEIC & Decision Instrument
Dr Reuben Samuel
WHO Country Office - India
What is a PHEIC?

PHIEC –

An extraordinary event which is
determined, as provided in these
Regulations:
i.
Public Health Emergency
of International Concern
to constitute a public health risk to other
Member States through international
spread of disease and
ii. to potentially require a coordinated
international response.
Alert and Response Operations
Events that may constitute a
Public Health Emergency of International Concern need:
Detection
Verification
Risk assessment
Response
Verification of events
 Value of unofficial sources of information for
early alert
 WHO requests for verification of potential public
health events of international importance
 Member States provide initial reply within 24
hours and provision of information
 On-site assessment, when necessary
Event notification
 Any event that may constitute a Public Health
Emergency of International Concern (PHEIC)
 Within 24 hours of assessment
 By the most efficient means of communication
 Continue to provide WHO with detailed information
 Does NOT mean a real “PHEIC”
Disease List
Four diseases (a single case is notifiable):
 Smallpox, Poliomyelitis, human influenza (caused by a
new subtype), SARS
 Utilization of the decision instrument:
 Cholera, plague, viral haemorrhagic fevers, yellow
fever, …
 Diseases of regional concern: dengue fever,
meningococcal diseases…
Decision Instrument
Criteria for assessment
1. Is the public health 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 travel or trade
restrictions?
Answering "yes" to any two of the criteria
requires a member state to notify WHO
Is the event serious?
Yes
No
Is the event unexpected?
Yes
Is the event unexpected?
Yes
No
Could it (or has it) spread
internationally?
Yes
No
Could it (or has it) spread
internationally?
No
Yes
No
Risk for international
sanctions?
Yes
No
Not
notified
at this
stage.
Notify the event under the International Health Regulations
Is the event serious?
 Morbidity and mortality
 Does the event have potential for high impact?
 Population at risk
 Cases in health staff; highly infectious
 Factors affecting response e.g. war, natural
catastrophe
 High population density
 Immediate or potential need for external
assistance
Is the event unexpected?
 Is the cause of the event unknown?
 Are the circumstances unusual?
 Cases worse than usual
 Treatment failures
 Event unusual for place/season
 Caused by eliminated/eradicated agent
 Suspected or known intentional or accidental
release of chemical, biological or radiological
agent
Is the event likely to spread internationally?
 Similar cases in other countries where it was
unexpected?
 Factors alerting to cross-border implications?
 Caused by epidemic-prone organism
 Source suspected/ known to be related to food
import/export
 Index case with international travel history
 In area with international tourism/ traffic, person or
goods
 In border areas with limited capacity for control
Is event likely to result in international travel
and trade restrictions?
 Similar events previously led to restriction
on travel/ trade?
 Source known or suspected food product/
goods known to be imported or exported?
 In area with international tourism?
 Attracted media attention?
Combinations of answers
requiring notification
 Serious and unexpected
 Serious and risk for international spread
 Serious and risk for international
restrictions
 Unexpected and risk for international
spread
 Unexpected and risk for international
restrictions
Thanks