New global infectious disease reporting goes into effect today

Without much fanfare, new global rules kick in today, governing how the world responds to threats such as the spread of epidemics. The rules have been unanimously approved by all member states of the World Health Organization (WHO).

The revised International Health Regulations provide governments with guidance on a number of difficult matters in which they must balance their self-interest with their responsibility to prevent the global spread of disease. For example, should a country be required to report a potential outbreak to WHO if doing so would hurt its economy? What measures should public health officials institute to prevent the spread of disease to other countries? What right does WHO have to recommend against travelling to regions affected by disease outbreaks?

The new set of rules was fashioned after a consensus emerged that if left to act independently, countries might make decisions that could be damaging to efforts to control the spread of public health threats. Therefore, under the revised regulations, member states have voluntarily ceded new authority to WHO and accepted numerous new obligations. For example, countries are now required to report public health emergencies within twenty-four hours of their detection. If WHO believes these emergencies pose a significant threat of spreading, the organization has the authority to take prevention measures, including issuing travel advisories and instructions on quarantine. It is important to note that countries are also now required to make the necessary investments to ensure that they can both detect and respond to public health threats within their borders.

While the new rules are much needed, there are substantial obstacles many governments will face in implementing them. Federal states face particular challenges: The constitutional powers necessary to implement the health regulations may not reside at the national level of government, and federal governments may not be able to obtain the co-operation of regional governments. Canada learned this the hard way during the SARS crisis, when Ottawa did not have the authority to demand information from Ontario, yet was required to respond to WHO requests for information. The situation contributed to the costly (and possibly avoidable) travel advisory that was imposed on Toronto.

The SARS experience led to numerous public health reforms. And while much progress has been made, there is still uncertainty about key issues, such as the co-ordination of disease surveillance activities across the country and whether provinces are willing to transfer public health emergency information to the federal government.

Efforts to resolve these issues have taken more than a decade and been the focus of two auditor-general’s reports. Now, time has run out. Ottawa is now expected to report possible public health emergencies, and tuberculosis cases could fall into this category. Failure to live up to these international commitments could lead to the spread of disease from Canada to more vulnerable countries.

In many respects, Canada has been a leader in public health. But the intergovernmental challenges it faces are very real. We recognize the many efforts that have been made to date, including the special health ministers’ meeting on pandemic planning, the substantial money that Ottawa committed for this purpose in the 2006 budget and the ongoing efforts of federal and provincial public health officials. But an extra political commitment is urgently needed to energize the federal-provincial process. Now is the time to resolve any remaining disputes to ensure that Canada can meet its international commitments and protect against the international spread of disease.