David Byrne, former EU Commissioner for Public Health and Consumer Protection and Special Envoy to WHO, examines global efforts to fight communicable diseases
Stories of "bird flu" or avian influenza dominate newspaper headlines worldwide. Fears that the H5N1 virus might cross the Darwinian divide and lead to human-to-human transmission have catapulted public health to the top of the political agenda.
The health, economic and security consequences of a pandemic are widely understood and public health officials, vaccine companies and the international scientific community recognise the need to improve prevention and control measures. To plan for the possibility of a pandemic will require not only experts in the fields of influenza virology, but also those in international politics, economics and law.
In today's interconnected world, bacteria and viruses travel almost as fast as e-mail and financial flows. Dangers to public health anywhere can quickly develop into dangers to health everywhere.
Ensuring a robust international legal framework to prevent and protect against global public health threats is precisely what the World Health Organization (WHO) has established through the recent revisions of the International Health Regulations (IHR). The revised regulations were adopted by all 192 member states at the World Health Assembly in May 2005 and are expected to enter into force on June 15th, 2007.
Since its establishment in 1948, WHO's objective has been the attainment by all peoples of the highest possible level of health. In 1969 the first modern version of the IHR was drafted to monitor and control a handful of serious infections. In 1995 the World Health Assembly instructed the WHO secretariat to begin revising the IHR as they no longer provided an adequate international legal framework to deal with mounting threats.
In 2003, when Sars exploded out of China, this process became an urgent imperative. At that time, only cholera, plague and yellow fever were officially notifiable diseases. Now the IHR have been updated and redesigned to broaden the disease coverage; to increase sensitivity for outbreak detection; and to provide guidance on more effective control measures.
The key provisions of the revised IHR demand better surveillance, increased transparency and a more rapid response mechanism - three fundamental tools in handling any outbreak of communicable disease.
Member states must notify the WHO of all serious disease threats and potential international emergencies. They must meet standards for national disease surveillance and response. And they must assign a representative to the epicentre of any fast-shifting emergency, to mediate communication between national and international authorities. Failure to comply with these regulations will result in disclosure by the WHO to the international community, with predictable consequences for travel and trade, especially in food.
Member states already have access to the WHO's Global Outbreak Alert and Response Network (GOARN), which enables rapid verification and sharing of information. At European level, a similar organisation, Insight, also exists.
The rapid response to the outbreak of foot-and-mouth disease in Europe in 2002 illustrates the value of such networks: from the time the UK informed the relevant EU official, it took only one hour to notify the rest of the EU, thereby substantially containing the spread of the disease.
In addition, preparations are underway to simulate a situation of pandemic influenza in the EU to test emergency communication capabilities. Elsewhere, similar exercises have taken place to simulate smallpox outbreaks (Atlantic Storm in January 2005 and Global Mercury in 2003).
Today's greater global interdependence requires a more comprehensive and assertive approach to promoting the global rule of law. There is an urgent need for higher prioritisation of public health at national and international levels and for greater funding and reinforcement of international institutions such as the WHO. The best agents of pandemic prevention are capable states, applying the rule of law, exercising their sovereignty responsibly, dealing with internal threats before they threaten others, and acting collectively with other states.
Waiting until human-to-human transmission of avian influenza is under way will be too late. Such an eruption would spread around our world in a matter of weeks, perhaps days. The lessons of the hurricane season are clear: health is wealth and it costs less in lives and money to invest in adequate defences than to react after disaster strikes.
• On November 9-10th David Byrne will speak in Washington at the American Bar Association International Rule of Law Symposium on the rule of law relating to current efforts to improve global public health.