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Ref.: C.L.40.2024

Notification to States Parties of amendments to the International Health Regulations (2005)

The Director-General of the World Health Organization presents his compliments to States Parties to the International Health Regulations (2005) (hereinafter referred to as the “IHR”) and has the honour to refer to resolution WHA77.17 of 1 June 2024 through which the Seventy-seventh World Health Assembly adopted amendments to the IHR (hereinafter referred to as “2024 amendments”).

Through the above-mentioned resolution, the Health Assembly requested the Director-General to give prompt notification of the 2024 amendments on the understanding that, prior to such notification, the Director-General shall ensure the uniformity of the Arabic, Chinese, English, French, Russian and Spanish texts of the amendments, allowing for State Party review and input on language conformity and accuracy.

(1) The process followed to ensure language conformity and accuracy pursuant to resolution WHA77.17

Reference is made to circular letter C.L.31.2024 of 17 July 2024, through which the Director-General communicated to States Parties to the IHR the Arabic, Chinese, English, French, Russian and Spanish text of the amendments, allowing for State Party review and input on language conformity and accuracy pursuant to resolution WHA77.17.

States Parties had until 16 August 2024 to review and submit their inputs on language conformity and accuracy of the 2024 amendments. Input was submitted by 10 States Parties, and certain adjustments were made to the Arabic, Chinese, English, French, Russian and Spanish texts of the amendments, based on the input received.

(2) Notification of the 2024 amendments

This circular letter constitutes the notification of the 2024 amendments to States Parties to ... the IHR. A certified true copy of the amendments is enclosed.1

1 The text of the IHR enclosed with this circular letter reflects the amendments adopted through resolution

WHA67.13 (2014) and resolution WHA75.12 (2022). It is understood that such amendments do not apply to the States Parties that rejected the amendments adopted through the latter.

Page 2

C.L.40.2024

Pursuant to Article 59 and Article 61 of the IHR, a period of time is available to States Parties to reject or submit reservations to the 2024 amendments, should they so wish. The specified period of time will, for a particular State Party, depend on whether that State Party did or did not reject the amendments to the IHR adopted by the Seventy-fifth World Health Assembly through resolution WHA75.12 (hereinafter referred to as “2022 amendments”). The 2022 amendments entered into force on 31 May 2024 for all States Parties, except for the four States Parties which, as noted in the annual report on implementation of the IHR submitted to the Seventy-seventh World Health Assembly,2 rejected those amendments by the stated date thereof.

Consequently, the following paragraphs provide information about the applicable deadlines for submitting reservations or rejections to the 2024 amendments for both States Parties that did not reject the 2022 amendments and the four States Parties that rejected the 2022 amendments.

A. For States Parties to which the 2022 amendments apply

Pursuant to paragraph 3 of Article 55 and paragraph 2 of Article 59 of the IHR, the 2024 amendments shall enter into force 12 months after the date of this notification, i.e. on 19 September 2025.

Any State Party intending to reject or to make reservations to any of the amendments, as provided in paragraphs 1 bis and 2 of Article 59, Article 61, and paragraphs 1, 2, and 3 of Article 62 of the IHR, may notify the Director-General accordingly within a period of 10 months from the date of this notification, i.e. no later than 19 July 2025. Any rejection or reservation received thereafter shall have no effect.

Any State Party that intends to make a declaration pursuant to paragraph 3 of Article 59 of the IHR concerning its inability to adjust its domestic legislative and administrative arrangements fully, may similarly submit such a declaration to the Director-General within a period of 10 months from the date of this notification, i.e. no later than 19 July 2025.

B. For States Parties to which the 2022 amendments do not apply

Pursuant to paragraph 3 of Article 55 and paragraph 2 of Article 59 of the IHR (prior to the 2022 amendments). the above-mentioned amendments shall enter into force 24 months after the date of the present notification, i.e. on 19 September 2026.

Any such State Party intending to reject or to make reservations to any of the amendments, as provided in paragraph 1 and 2 of Article 59, Article 61, and paragraphs 1, 2, and 3 of Article 62 of the IHR (prior to the 2022 amendments), may notify the Director-General accordingly within a period of 18 months from the date of this notification, i.e. no later than 19 March 2026. Any rejection or reservation received thereafter shall have no effect.

2 Document A77/8, Implementation of the International Health Regulations (2005). Report by the

Director-General (8 April 2024), paragraph 27.

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C.L.40.2024

Any such State Party that intends to make a declaration pursuant to paragraph 3 of Article 59 of the IHR concerning its inability to adjust its domestic legislative and administrative arrangements fully, may similarly submit such a declaration to the Director-General within a period of 18 months from the date of this notification, i.e. no later than 19 March 2026.

The Director-General of the World Health Organization takes this opportunity to renew to States Parties to the International Health Regulations the assurance of his highest consideration.

GENEVA, 19 September 2024

ANNEX

Amendments adopted by the Seventy-seventh World Health Assembly through resolution

WHA77.17 (2024) are presented in underline and bold character (additions) and strike-through

(deletions). As clarified in the Circular Letter, the text of the International Health Regulations (2005)

presented below also reflects the amendments adopted through resolution WHA67.13 (2014) and

resolution WHA75.12 (2022). It is understood that such amendments do not apply to the States Parties

that rejected the amendments adopted through the latter.

INTERNATIONAL HEALTH REGULATIONS (2005)

PART I – DEFINITIONS, PURPOSE AND SCOPE, PRINCIPLES AND

RESPONSIBLE AUTHORITIES

Article 1 Definitions

1. For the purposes of the International Health Regulations (hereinafter “the IHR” or “Regulations”):

“affected” means persons, baggage, cargo, containers, conveyances, goods, postal parcels or

human remains that are infected or contaminated, or carry sources of infection or contamination, so as

to constitute a public health risk;

“affected area” means a geographical location specifically for which health measures have been

recommended by WHO under these Regulations;

“aircraft” means an aircraft making an international voyage;

“airport” means any airport where international flights arrive or depart;

“arrival” of a conveyance means:

(a) in the case of a seagoing vessel, arrival or anchoring in the defined area of a port;

(b) in the case of an aircraft, arrival at an airport;

(c) in the case of an inland navigation vessel on an international voyage, arrival at a point of

entry;

(d) in the case of a train or road vehicle, arrival at a point of entry;

“baggage” means the personal effects of a traveller;

“cargo” means goods carried on a conveyance or in a container;

“competent authority” means an authority responsible for the implementation and application of

health measures under these Regulations;

International Health Regulations (2005)

2

“container” means an article of transport equipment:

(a) of a permanent character and accordingly strong enough to be suitable for repeated use;

(b) specially designed to facilitate the carriage of goods by one or more modes of transport,

without intermediate reloading;

(c) fitted with devices permitting its ready handling, particularly its transfer from one mode of

transport to another; and

(d) specially designed as to be easy to fill and empty;

“container loading area” means a place or facility set aside for containers used in international

traffic;

“contamination” means the presence of an infectious or toxic agent or matter on a human or

animal body surface, in or on a product prepared for consumption or on other inanimate objects,

including conveyances, that may constitute a public health risk;

“conveyance” means an aircraft, ship, train, road vehicle or other means of transport on an

international voyage;

“conveyance operator” means a natural or legal person in charge of a conveyance or their agent;

“crew” means persons on board a conveyance who are not passengers;

“decontamination” means a procedure whereby health measures are taken to eliminate an

infectious or toxic agent or matter on a human or animal body surface, in or on a product prepared for

consumption or on other inanimate objects, including conveyances, that may constitute a public health

risk;

“departure” means, for persons, baggage, cargo, conveyances or goods, the act of leaving a

territory;

“deratting” means the procedure whereby health measures are taken to control or kill rodent

vectors of human disease present in baggage, cargo, containers, conveyances, facilities, goods and postal

parcels at the point of entry;

“Director-General” means the Director-General of the World Health Organization;

“disease” means an illness or medical condition, irrespective of origin or source, that presents or

could present significant harm to humans;

“disinfection” means the procedure whereby health measures are taken to control or kill infectious

agents on a human or animal body surface or in or on baggage, cargo, containers, conveyances, goods

and postal parcels by direct exposure to chemical or physical agents;

“disinsection” means the procedure whereby health measures are taken to control or kill the insect

vectors of human diseases present in baggage, cargo, containers, conveyances, goods and postal parcels;

“event” means a manifestation of disease or an occurrence that creates a potential for disease;

International Health Regulations (2005)

3

“free pratique” means permission for a ship to enter a port, embark or disembark, discharge or

load cargo or stores; permission for an aircraft, after landing, to embark or disembark, discharge or load

cargo or stores; and permission for a ground transport vehicle, upon arrival, to embark or disembark,

discharge or load cargo or stores;

“goods” mean tangible products, including animals and plants, transported on an international

voyage, including for utilization on board a conveyance;

“ground crossing” means a point of land entry in a State Party, including one utilized by road

vehicles and trains;

“ground transport vehicle” means a motorized conveyance for overland transport on an

international voyage, including trains, coaches, lorries and automobiles;

“health measure” means procedures applied to prevent the spread of disease or contamination; a

health measure does not include law enforcement or security measures;

“ill person” means an individual suffering from or affected with a physical ailment that may pose

a public health risk;

“infection” means the entry and development or multiplication of an infectious agent in the body

of humans and animals that may constitute a public health risk;

“inspection” means the examination, by the competent authority or under its supervision, of areas,

baggage, containers, conveyances, facilities, goods or postal parcels, including relevant data and

documentation, to determine if a public health risk exists;

“international traffic” means the movement of persons, baggage, cargo, containers, conveyances,

goods or postal parcels across an international border, including international trade;

“international voyage” means:

(a) in the case of a conveyance, a voyage between points of entry in the territories of more than

one State, or a voyage between points of entry in the territory or territories of the same State if

the conveyance has contacts with the territory of any other State on its voyage but only as regards

those contacts;

(b) in the case of a traveller, a voyage involving entry into the territory of a State other than

the territory of the State in which that traveller commences the voyage;

“intrusive” means possibly provoking discomfort through close or intimate contact or

questioning;

“invasive” means the puncture or incision of the skin or insertion of an instrument or foreign

material into the body or the examination of a body cavity. For the purposes of these Regulations,

medical examination of the ear, nose and mouth, temperature assessment using an ear, oral or cutaneous

thermometer, or thermal imaging; medical inspection; auscultation; external palpation; retinoscopy;

external collection of urine, faeces or saliva samples; external measurement of blood pressure; and

electrocardiography shall be considered to be non-invasive;

International Health Regulations (2005)

4

“isolation” means separation of ill or contaminated persons or affected baggage, containers,

conveyances, goods or postal parcels from others in such a manner as to prevent the spread of infection

or contamination;

“medical examination” means the preliminary assessment of a person by an authorized health

worker or by a person under the direct supervision of the competent authority, to determine the person’s

health status and potential public health risk to others, and may include the scrutiny of health documents,

and a physical examination when justified by the circumstances of the individual case;

“National IHR Authority” means the entity designated or established by the State Party at

the national level to coordinate the implementation of these Regulations within the jurisdiction of

the State Party;

“National IHR Focal Point” means the national centre, designated by each State Party, which shall

be accessible at all times for communications with WHO IHR Contact Points under these Regulations;

“Organization” or “WHO” means the World Health Organization;

“pandemic emergency” means a public health emergency of international concern that is

caused by a communicable disease and:

(i) has, or is at high risk of having, wide geographical spread to and within multiple

States; and

(ii) is exceeding, or is at high risk of exceeding, the capacity of health systems to respond

in those States; and

(iii) is causing, or is at high risk of causing, substantial social and/or economic disruption,

including disruption to international traffic and trade; and

(iv) requires rapid, equitable and enhanced coordinated international action, with whole-

of-government and whole-of-society approaches;

“permanent residence” has the meaning as determined in the national law of the State Party

concerned;

“personal data” means any information relating to an identified or identifiable natural person;

“point of entry” means a passage for international entry or exit of travellers, baggage, cargo,

containers, conveyances, goods and postal parcels as well as agencies and areas providing services to

them on entry or exit;

“port” means a seaport or a port on an inland body of water where ships on an international voyage

arrive or depart;

“postal parcel” means an addressed article or package carried internationally by postal or courier

services;

“public health emergency of international concern” means an extraordinary event which is

determined, as provided in these Regulations:

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5

(i) to constitute a public health risk to other States through the international spread of disease;

and

(ii) to potentially require a coordinated international response;

“public health observation” means the monitoring of the health status of a traveller over time for

the purpose of determining the risk of disease transmission;

“public health risk” means a likelihood of an event that may affect adversely the health of human

populations, with an emphasis on one which may spread internationally or may present a serious and

direct danger;

“quarantine” means the restriction of activities and/or separation from others of suspect persons

who are not ill or of suspect baggage, containers, conveyances or goods in such a manner as to prevent

the possible spread of infection or contamination;

“recommendation” and “recommended” refer to temporary or standing recommendations issued

under these Regulations;

“relevant health products” means those health products needed to respond to public health

emergencies of international concern, including pandemic emergencies, which may include

medicines, vaccines, diagnostics, medical devices, vector control products, personal protective

equipment, decontamination products, assistive products, antidotes, cell- and gene-based

therapies, and other health technologies;

“reservoir” means an animal, plant or substance in which an infectious agent normally lives and

whose presence may constitute a public health risk;

“road vehicle” means a ground transport vehicle other than a train;

“scientific evidence” means information furnishing a level of proof based on the established and

accepted methods of science;

“scientific principles” means the accepted fundamental laws and facts of nature known through

the methods of science;

“ship” means a seagoing or inland navigation vessel on an international voyage;

“standing recommendation” means non-binding advice issued by WHO for specific ongoing

public health risks pursuant to Article 16 regarding appropriate health measures for routine or periodic

application needed to prevent or reduce the international spread of disease and minimize interference

with international traffic;

“surveillance” means the systematic ongoing collection, collation and analysis of data for public

health purposes and the timely dissemination of public health information for assessment and public

health response as necessary;

“suspect” means those persons, baggage, cargo, containers, conveyances, goods or postal parcels

considered by a State Party as having been exposed, or possibly exposed, to a public health risk and that

could be a possible source of spread of disease;

International Health Regulations (2005)

6

“temporary recommendation” means non-binding advice issued by WHO pursuant to Article 15

for application on a time-limited, risk-specific basis, in response to a public health emergency of

international concern, so as to prevent or reduce the international spread of disease and minimize

interference with international traffic;

“temporary residence” has the meaning as determined in the national law of the State Party

concerned;

“traveller” means a natural person undertaking an international voyage;

“vector” means an insect or other animal which normally transports an infectious agent that

constitutes a public health risk;

“verification” means the provision of information by a State Party to WHO confirming the status

of an event within the territory or territories of that State Party;

“WHO IHR Contact Point” means the unit within WHO which shall be accessible at all times for

communications with the National IHR Focal Point.

2. Unless otherwise specified or determined by the context, reference to these Regulations includes

the annexes thereto.

Article 2 Purpose and scope

The purpose and scope of these Regulations are to prevent, prepare for, 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.

Article 3 Principles

1. The implementation of these Regulations shall be with full respect for the dignity, human rights

and fundamental freedoms of persons, and shall promote equity and solidarity.

2. The implementation of these Regulations shall be guided by the Charter of the United Nations

and the Constitution of the World Health Organization.

3. The implementation of these Regulations shall be guided by the goal of their universal application

for the protection of all people of the world from the international spread of disease.

4. States have, in accordance with the Charter of the United Nations and the principles of

international law, the sovereign right to legislate and to implement legislation in pursuance of their

health policies. In doing so, they should uphold the purpose of these Regulations.

Article 4 Responsible authorities

1. Each State Party shall designate or establish a, in accordance with its national law and context,

one or two entities to serve as National IHR Authority and National IHR Focal Point and, as well as

the authorities responsible within its respective jurisdiction for the implementation of health measures

under these Regulations.

International Health Regulations (2005)

7

1 bis. The National IHR Authority shall coordinate the implementation of these Regulations

within the jurisdiction of the State Party.

2. National IHR Focal Points shall be accessible at all times for communications with the WHO IHR

Contact Points provided for in paragraph 3 of this Article. The functions of National IHR Focal Points

shall include:

(a) sending to WHO IHR Contact Points, on behalf of the State Party concerned, urgent

communications concerning the implementation of these Regulations, in particular under Articles

6 to 12; and

(b) disseminating information to, and consolidating input from, relevant sectors of the

administration of the State Party concerned, including those responsible for surveillance and

reporting, points of entry, public health services, clinics and hospitals and other government

departments.

2 bis. States Parties shall take measures to implement paragraphs 1, 1 bis and 2 of this Article,

including, as appropriate, adjusting their domestic legislative and/or administrative

arrangements.

3. WHO shall designate IHR Contact Points, which shall be accessible at all times for

communications with National IHR Focal Points. WHO IHR Contact Points shall send urgent

communications concerning the implementation of these Regulations, in particular under Articles 6 to

12, to the National IHR Focal Point of the States Parties concerned. WHO IHR Contact Points may be

designated by WHO at the headquarters or at the regional level of the Organization.

4. States Parties shall provide WHO with contact details of their National IHR Authority and their

National IHR Focal Point and WHO shall provide States Parties with contact details of WHO IHR

Contact Points. These contact details shall be continuously updated and annually confirmed. WHO shall

make the contact details available to all States Parties the contact details of National IHR Focal Points

it receives pursuant to this Article.

PART II – INFORMATION AND PUBLIC HEALTH RESPONSE

Article 5 Surveillance

1. Each State Party shall develop, strengthen and maintain, as soon as possible but no later than five

years from the entry into force of these Regulations for that State Party, the capacity tocore capacities

to prevent, detect, assess, notify and report events in accordance with these Regulations, as specified in

Part A of Annex 1.

2. Following the assessment referred to in paragraph 2, Part A of Annex 1, a State Party may report

to WHO on the basis of a justified need and an implementation plan and, in so doing, obtain an extension

of two years in which to fulfil the obligation in paragraph 1 of this Article. In exceptional circumstances,

and supported by a new implementation plan, the State Party may request a further extension not

exceeding two years from the Director-General, who shall make the decision, taking into account the

technical advice of the Committee established under Article 50 (hereinafter the “Review Committee”).

After the period mentioned in paragraph 1 of this Article, the State Party that has obtained an extension

shall report annually to WHO on progress made towards the full implementation.

International Health Regulations (2005)

8

3. WHO shall assist States Parties, upon request, to develop, strengthen and maintain the core

capacities referred to in paragraph 1 of this Article.

4. WHO shall collect information regarding events through its surveillance activities and assess their

potential to cause international disease spread and possible interference with international traffic.

Information received by WHO under this paragraph shall be handled in accordance with Articles 11 and

45 where appropriate.

Article 6 Notification

1. Each State Party shall assess events occurring within its territory by using the decision instrument

in Annex 2. Each State Party shall notify WHO, by the most efficient means of communication available,

by way of the National IHR Focal Point, and within 24 hours of assessment of public health information,

of all events which may constitute a public health emergency of international concern within its territory

in accordance with the decision instrument, as well as any health measure implemented in response to

those events. If the notification received by WHO involves the competency of the International Atomic

Energy Agency (IAEA) or other intergovernmental organization(s),WHO shall, pursuant to

paragraph 1 of Article 14, immediately notify the IAEA or, as appropriate, the other competent

intergovernmental organization(s).

2. Following a notification, a State Party shall continue to communicate to WHO timely, accurate

and sufficiently detailed public health information available to it on the notified event, where possible

including case definitions, laboratory results, source and type of the risk, number of cases and deaths,

conditions affecting the spread of the disease and the health measures employed; and report, when

necessary, the difficulties faced and support needed in responding to the potential public health

emergency of international concern.

Article 7 Information-sharing during unexpected or unusual public health events

If a State Party has evidence of an unexpected or unusual public health event within its territory,

irrespective of origin or source, which may constitute a public health emergency of international

concern, it shall provide to WHO all relevant public health information. In such a case, the provisions

of Article 6 shall apply in full.

Article 8 Consultation

In the case of events occurring within its territory not requiring notification as provided in

Article 6, in particular those events for which there is insufficient information available to complete the

decision instrument, a State Party mayshould nevertheless keep WHO advised thereof through the

National IHR Focal Point and consult with WHO on appropriate health measures in a timely manner.

Such communications shall be treated in accordance with paragraphs 2 to 4 of Article 11. The State

Party in whose territory the event has occurred may request WHO assistance to assess any

epidemiological evidence obtained by that State Party.

Article 9 Other reports

1. WHO may take into account reports from sources other than notifications or consultations and

shall assess these reports according to established epidemiological principles and then communicate

information on the event to the State Party in whose territory the event is allegedly occurring. Before

taking any action based on such reports, WHO shall consult with and attempt to obtain verification from

International Health Regulations (2005)

9

the State Party in whose territory the event is allegedly occurring in accordance with the procedure set

forth in Article 10. To this end, WHO shall make the information received available to the States Parties

and only where it is duly justified may WHO maintain the confidentiality of the source. This information

will be used in accordance with the procedure set forth in Article 11.

2. States Parties shall, as far as practicable, inform WHO within 24 hours of receipt of evidence of

a public health risk identified outside their territory that may cause international disease spread, as

manifested by exported or imported:

(a) human cases;

(b) vectors which carry infection or contamination; or

(c) goods that are contaminated.

Article 10 Verification

1. WHO shall request, in accordance with Article 9, verification from a State Party of reports from

sources other than notifications or consultations of events which may constitute a public health

emergency of international concern allegedly occurring in the State’s territory. In such cases, WHO shall

inform the State Party concerned regarding the reports it is seeking to verify.

2. Pursuant to the foregoing paragraph and to Article 9, each State Party, when requested by WHO,

shall verify and provide:

(a) within 24 hours, an initial reply to, or acknowledgement of, the request from WHO;

(b) within 24 hours, available public health information on the status of events referred to in

WHO’s request; and

(c) information to WHO in the context of an assessment under Article 6, including relevant

information as described in that Article.

3. When WHO receivesUpon receiving information of an event that may constitute a public health

emergency of international concern, itWHO shall offer to collaborate with the State Party concerned in

assessing the potential for international disease spread, possible interference with international traffic

and the adequacy of control measures. Such activities may include collaboration with other standard-

setting organizations and the offer to mobilize international assistance in order to support the national

authorities in conducting and coordinating on-site assessments. When requested by the State Party,

WHO shall provide information supporting such an offer.

4. If the State Party does not accept the offer of collaboration, WHO may,and when justified by the

magnitude of the public health risk, WHO should share with other States Parties the information about

the event available to it, whilst encouraging the State Party to accept the offer of collaboration by WHO,

taking into account the views of the State Party concerned.

International Health Regulations (2005)

10

Article 11 Provision of information by WHO

1. Subject to paragraph 2 of this Article, WHO shall send to all States Parties and, as appropriate, to

relevant intergovernmental organizations, as soon as possible and by the most efficient means available,

in confidence, such public health information which it has received under Articles 5 to 10 inclusive and

which is necessary to enable States Parties to respond to a public health risk. WHO should communicate

information to other States Parties that might help them in preventing the occurrence of similar incidents.

2. WHO shall use information received under Articles 6 and 8 and paragraph 2 of Article 9 for

verification, assessment and assistance purposes under these Regulations and, unless otherwise agreed

with the States Parties referred to in those provisions, shall not make this information generally available

to other States Parties, until such time as:

(a) the event is determined to constitute a public health emergency of international concern,

including a pandemic emergency, in accordance with Article 12; or

(b) information evidencing the international spread of the infection or contamination has been

confirmed by WHO in accordance with established epidemiological principles; or

(c) there is evidence that:

(i) control measures against the international spread are unlikely to succeed because of

the nature of the contamination, disease agent, vector or reservoir; or

(ii) the State Party lacks sufficient operational capacity to carry out necessary measures

to prevent further spread of disease; or

(d) the nature and scope of the international movement of travellers, baggage, cargo,

containers, conveyances, goods or postal parcels that may be affected by the infection or

contamination requires the immediate application of international control measures.

3. WHO shall consult with the State Party in whose territory the event is occurring as to its intent to

make information available under this Article.

4. When information received by WHO under paragraph 2 of this Article is made available to States

Parties in accordance with these Regulations, WHO may also make it available to the public if other

information about the same event has already become publicly available and there is a need for the

dissemination of authoritative and independent information.

Article 12 Determination of a public health emergency of international

concern, including a pandemic emergency

1. The Director-General shall determine, on the basis of the information received, in particular from

the State(s) Party(ies) within whose territory(ies) an event is occurring, whether an event constitutes a

public health emergency of international concern, including, when appropriate, a pandemic

emergency, in accordance with the criteria and the procedure set out in these Regulations.

2. If the Director-General considers, based on an assessment under these Regulations, that a public

health emergency of international concern is occurring, the Director-General shall consult with the

State(s) Party(ies) in whose territory(ies) the event arisesis occurring regarding this preliminary

International Health Regulations (2005)

11

determination. If the Director-General and the State(s) Party(ies) are in agreement regarding this

determination, the Director-General shall, in accordance with the procedure set forth in Article 49, seek

the views of the Committee established under Article 48 (hereinafter the “Emergency Committee”) on

appropriate temporary recommendations.

3. If, following the consultation in paragraph 2 above, the Director-General and the State(s)

Party(ies) in whose territory(ies) the event arisesis occurring do not come to a consensus within 48

hours on whether the event constitutes a public health emergency of international concern, a

determination shall be made in accordance with the procedure set forth in Article 49.

4. In determining whether an event constitutes a public health emergency of international concern,

including, when appropriate, a pandemic emergency, the Director-General shall consider:

(a) information provided by the State(s) Party(ies);

(b) the decision instrument contained in Annex 2;

(c) the advice of the Emergency Committee;

(d) scientific principles as well as the available scientific evidence and other relevant

information; and

(e) an assessment of the risk to human health, of the risk of international spread of disease and

of the risk of interference with international traffic.

4 bis. If the Director-General, determines that an event constitutes a public health

emergency of international concern, the Director-General shall further determine, having

considered the matters contained in paragraph 4, whether the public health emergency of

international concern also constitutes a pandemic emergency.

5. If the Director-General, having considered the matters contained in subparagraphs (a), (c),

(d) and (e) of paragraph 4 of this Article, and following consultations with the State(s) Party(ies)

within whose territory the(ies) a public health emergency of international concern, including a

pandemic emergency, has occurred, considers that a public health emergency of international concern,

including a pandemic emergency, has ended, because it no longer meets the relevant definition in

Article 1, the Director-General shall take a decision in accordance with the procedure set out in

Article 49.

Article 13 Public health response, including equitable access to relevant health products

1. Each State Party shall develop, strengthen and maintain, as soon as possible but no later than five

years from the entry into force of these Regulations for that State Party, the capacitycore capacities to

prevent, prepare for, and respond promptly and effectively to public health risks and public health

emergencies of international concern, including a pandemic emergency, including in fragile and

humanitarian settings, as set out in Part A of Annex 1. WHO shall publish, in consultation with

Member States, guidelines to support States Parties in the development of public health response core

capacities.

International Health Regulations (2005)

12

2. Following the assessment referred to in paragraph 2, Part A of Annex 1, a State Party may report

to WHO on the basis of a justified need and an implementation plan and, in so doing, obtain an extension

of two years in which to fulfil the obligation in paragraph 1 of this Article. In exceptional circumstances

and supported by a new implementation plan, the State Party may request a further extension not

exceeding two years from the Director-General, who shall make the decision, taking into account the

technical advice of the Review Committee. After the period mentioned in paragraph 1 of this Article,

the State Party that has obtained an extension shall report annually to WHO on progress made towards

the full implementation.

3. At the request of a State Party or following its acceptance of an offer by WHO, WHO shall

collaborate in the response to public health risks and other events by providing technical guidance and

assistance and by assessing the effectiveness of the control measures in place, including the mobilization

of international teams of experts for on-site assistance, when necessary.

4. If WHO, in consultation with the States PartiesState(s) Party(ies) concerned as provided in

Article 12, determines that a public health emergency of international concern, including a pandemic

emergency, is occurring, it may offer, in addition to the support indicated in paragraph 3 of this Article,

further assistance to the State(s) Party(ies), including an assessment of the severity of the international

risk and the adequacy of control measures. Such collaboration may include the offer to mobilize

international assistance in order to support the national authorities in conducting and coordinating on-

site assessments. When requested by the State Party, WHO shall provide information supporting such

an offer.

5. When requested by WHO, States Parties should provide, to the extent possible, support to

WHO-coordinated response activities.

6. When requested, WHO shall provide appropriate guidance and assistance to other States Parties

affected or threatened by the public health emergency of international concern, including a pandemic

emergency.

7. WHO shall support States Parties, upon their request or following acceptance of an offer

from WHO, and coordinate international response activities during public health emergencies of

international concern, including pandemic emergencies, after their determination pursuant to

Article 12 of these Regulations.

8. WHO shall facilitate, and work to remove barriers to, timely and equitable access by States

Parties to relevant health products after the determination of and during a public health

emergency of international concern , including a pandemic emergency, based on public health

risks and needs. To that effect, the Director-General shall:

(a) conduct, and periodically review and update, assessments of the public health needs,

as well as of the availability and accessibility including affordability of relevant health

products for the public health response; publish such assessments; and consider the

available assessments while issuing, modifying, extending or terminating recommendations

pursuant to Articles 15, 16, 17, 18, and 49 of these Regulations;

(b) make use of WHO-coordinated mechanism(s), or facilitate, in consultation with States

Parties, their establishment as needed, and coordinate, as appropriate, with other allocation

and distribution mechanisms and networks that facilitate timely and equitable access to

relevant health products based on public health needs;

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(c) support States Parties, upon their request, in scaling up and geographically

diversifying the production of relevant health products, as appropriate, through relevant

WHO-coordinated and other networks and mechanisms, subject to Article 2 of these

Regulations, and in accordance with relevant international law;

(d) share with a State Party, upon its request, the product dossier related to a specific

relevant health product, as provided to WHO by the manufacturer for approval and where

the manufacturer has consented, within 30 days of receiving such request, for the purpose

of facilitating regulatory evaluation and authorization by the State Party.; and

(e) support States Parties, upon their request, and, as appropriate, through relevant

WHO-coordinated and other networks and mechanisms, pursuant to subparagraph 8(c) of

this Article, to promote research and development and strengthen local production of

quality, safe and effective relevant health products, and facilitate other measures relevant

for the full implementation of this provision.

9. Pursuant to paragraph 5 of this Article and paragraph 1 of Article 44 of these Regulations,

and upon request of other States Parties or WHO, States Parties shall undertake, subject to

applicable law and available resources, to collaborate with, and assist each other and to support

WHO-coordinated response activities, including through:

(a) supporting WHO in implementing actions outlined in this Article;

(b) engaging with and encouraging relevant stakeholders operating in their respective

jurisdictions to facilitate equitable access to relevant health products for responding to a

public health emergency of international concern, including a pandemic emergency; and

(c) making available, as appropriate, relevant terms of their research and development

agreements for relevant health products related to promoting equitable access to such

products during a public health emergency of international concern, including a pandemic

emergency.

Article 14 Cooperation of WHO with intergovernmental organizations and international bodies

1. WHO shall cooperate and coordinate its activities, as appropriate, with other competent

intergovernmental organizations or international bodies in the implementation of these Regulations,

including through the conclusion of agreements and other similar arrangements.

2. In cases in which notification or verification of, or response to, an event is primarily within the

competence of other intergovernmental organizations or international bodies, WHO shall coordinate its

activities with such organizations or bodies in order to ensure the application of adequate measures for

the protection of public health.

3. Notwithstanding the foregoing, nothing in these Regulations shall preclude or limit the provision

by WHO of advice, support, or technical or other assistance for public health purposes.

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PART III – RECOMMENDATIONS

Article 15 Temporary recommendations

1. If it has been determined in accordance with Article 12 that a public health emergency of

international concern, including a pandemic emergency, is occurring, the Director-General shall issue

temporary recommendations in accordance with the procedure set out in Article 49. Such temporary

recommendations may be modified or extended as appropriate, including after it has been determined

that a public health emergency of international concern, including a pandemic emergency, has ended,

at which time other temporary recommendations may be issued as necessary for the purpose of

preventing or promptly detecting its recurrence.

2. Temporary recommendations may include health measures to be implemented by the State(s)

Party(ies) experiencing the public health emergency of international concern, including a pandemic

emergency, or by other States Parties, regarding persons, baggage, cargo, containers, conveyances,

goods, including relevant health products, and/or postal parcels to prevent or reduce the international

spread of disease and avoid unnecessary interference with international traffic.

2 bis. The Director-General, when communicating to States Parties the issuance, modification or

extension of temporary recommendations, should provide available information on any

WHO-coordinated mechanism(s) concerning access to, and allocation of, relevant health products,

as well as on any other allocation and distribution mechanisms and networks.

3. Temporary recommendations may be terminated in accordance with the procedure set out in

Article 49 at any time and shall automatically expire three months after their issuance. They may be

modified or extended for additional periods of up to three months. Temporary recommendations may

not continue beyond the second World Health Assembly after the determination of the public health

emergency of international concern, including a pandemic emergency, to which they relate.

Article 16 Standing recommendations

1. WHO may make standing recommendations of appropriate health measures in accordance with

Article 53 for routine or periodic application. Such measures may be applied by States Parties regarding

persons, baggage, cargo, containers, conveyances, goods, including relevant health products, and/or

postal parcels for specific, ongoing public health risks in order to prevent or reduce the international

spread of disease and avoid unnecessary interference with international traffic. WHO may, in

accordance with Article 53, modify or terminate such recommendations, as appropriate.

2. The Director-General, when communicating to States Parties the issuance, modification or

extension of standing recommendations, should provide available information on any WHO-

coordinated mechanism(s) concerning access to, and allocation of, relevant health products as well

as on any other allocation and distribution mechanisms and networks.

Article 17 Criteria for recommendations

When issuing, modifying or terminating temporary or standing recommendations, the

Director-General shall consider:

(a) the views of the States Parties directly concerned;

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(b) the advice of the Emergency Committee or the Review Committee, as the case may be;

(c) scientific principles as well as available scientific evidence and information;

(d) health measures that, on the basis of a risk assessment appropriate to the circumstances, are

not more restrictive of international traffic and trade and are not more intrusive to persons than

reasonably available alternatives that would achieve the appropriate level of health protection;

(d bis) availability of, and accessibility to relevant health products;

(e) relevant international standards and instruments;

(f) activities undertaken by other relevant intergovernmental organizations and international

bodies; and

(g) other appropriate and specific information relevant to the event.

With respect to temporary recommendations, the consideration by the Director-General of

subparagraphs (e) and (f) of this Article may be subject to limitations imposed by urgent

circumstances.

Article 18 Recommendations with respect to persons, baggage, cargo,

containers, conveyances, goods and postal parcels

1. Recommendations issued by WHO to States Parties with respect to persons may include the

following advice:

– no specific health measures are advised;

– review travel history in affected areas;

– review proof of medical examination and any laboratory analysis;

– require medical examinations;

– review proof of vaccination or other prophylaxis;

– require vaccination or other prophylaxis;

– place suspect persons under public health observation;

– implement quarantine or other health measures for suspect persons;

– implement isolation and treatment where necessary of affected persons;

– implement tracing of contacts of suspect or affected persons;

– refuse entry of suspect and affected persons;

– refuse entry of unaffected persons to affected areas; and

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– implement exit screening and/or restrictions on persons from affected areas.

2. Recommendations issued by WHO to States Parties with respect to baggage, cargo, containers,

conveyances, goods and postal parcels may include the following advice:

– no specific health measures are advised;

– review manifest and routing;

– implement inspections;

– review proof of measures taken on departure or in transit to eliminate infection or

contamination;

– implement treatment of the baggage, cargo, containers, conveyances, goods, postal parcels

or human remains to remove infection or contamination, including vectors and reservoirs;

– the use of specific health measures to ensure the safe handling and transport of human

remains;

– implement isolation or quarantine;

– seizure and destruction of infected or contaminated or suspect baggage, cargo, containers,

conveyances, goods or postal parcels under controlled conditions if no available treatment

or process will otherwise be successful; and

– refuse departure or entry.

3. Recommendations issued by WHO to State Parties shall, as appropriate, take into account

the need to:

(a) facilitate international travel, particularly of health and care workers and persons in

life-threatening or humanitarian situations. This provision is without prejudice to Article 23

of these Regulations; and

(b) maintain international supply chains, including for relevant health products and food

supplies.

PART IV – POINTS OF ENTRY

Article 19 General obligations

Each State Party shall, in addition to the other obligations provided for under these Regulations:

(a) ensure that the core capacities set forth in Part B of Annex 1 for designated points of entry

are developed within the timeframe provided in paragraph 1 of Article 5 and paragraph 1 of

Article 13;

(b) identify the competent authorities at each designated point of entry in its territory; and

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(c) furnish to WHO, as far as practicable, when requested in response to a specific potential

public health risk, relevant data concerning sources of infection or contamination, including

vectors and reservoirs, at its points of entry, which could result in international disease spread.

Article 20 Airports and ports

1. States Parties shall designate the airports and ports that shall develop the core capacities provided

in Part B of Annex 1.

2. States Parties shall ensure that Ship Sanitation Control Exemption Certificates and Ship Sanitation

Control Certificates are issued in accordance with the requirements in Article 39 and the model provided

in Annex 3.

3. Each State Party shall send to WHO a list of ports authorized to offer:

(a) the issuance of Ship Sanitation Control Certificates and the provision of the services

referred to in Annexes 1 and 3; or

(b) the issuance of Ship Sanitation Control Exemption Certificates only; and

(c) extension of the Ship Sanitation Control Exemption Certificate for a period of one month

until the arrival of the ship in the port at which the Certificate may be received.

Each State Party shall inform WHO of any changes which may occur to the status of the listed

ports. WHO shall publish the information received under this paragraph.

4. WHO may, at the request of the State Party concerned, arrange to certify, after an appropriate

investigation, that an airport or port in its territory meets the requirements referred to in paragraphs 1

and 3 of this Article. These certifications may be subject to periodic review by WHO, in consultation

with the State Party.

5. WHO, in collaboration with competent intergovernmental organizations and international bodies,

shall develop and publish the certification guidelines for airports and ports under this Article. WHO

shall also publish a list of certified airports and ports.

Article 21 Ground crossings

1. Where justified for public health reasons, a State Party may designate ground crossings that shall

develop the core capacities provided in Part B of Annex 1, taking into consideration:

(a) the volume and frequency of the various types of international traffic, as compared to other

points of entry, at a State Party’s ground crossings which might be designated; and

(b) the public health risks existing in areas in which the international traffic originates, or

through which it passes, prior to arrival at a particular ground crossing.

2. States Parties sharing common borders should consider:

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(a) entering into bilateral or multilateral agreements or arrangements concerning prevention or

control of international transmission of disease at ground crossings in accordance with Article 57;

and

(b) joint designation of adjacent ground crossings for the core capacities in Part B of Annex

1 in accordance with paragraph 1 of this Article.

Article 22 Role of competent authorities

1. The competent authorities shall:

(a) be responsible for monitoring baggage, cargo, containers, conveyances, goods, postal

parcels and human remains departing and arriving from affected areas, so that they are maintained

in such a condition that they are free of sources of infection or contamination, including vectors

and reservoirs;

(b) ensure, as far as practicable, that facilities used by travellers at points of entry are

maintained in a sanitary condition and are kept free of sources of infection or contamination,

including vectors and reservoirs;

(c) be responsible for the supervision of any deratting, disinfection, disinsection or

decontamination of baggage, cargo, containers, conveyances, goods, postal parcels and human

remains or sanitary measures for persons, as appropriate under these Regulations;

(d) advise conveyance operators, as far in advance as possible, of their intent to apply control

measures to a conveyance, and shall provide, where available, written information concerning the

methods to be employed;

(e) be responsible for the supervision of the removal and safe disposal of any contaminated

water or food, human or animal dejecta, wastewater and any other contaminated matter from a

conveyance;

(f) take all practicable measures consistent with these Regulations to monitor and control the

discharge by ships of sewage, refuse, ballast water and other potentially disease-causing matter

which might contaminate the waters of a port, river, canal, strait, lake or other international

waterway;

(g) be responsible for supervision of service providers for services concerning travellers,

baggage, cargo, containers, conveyances, goods, postal parcels and human remains at points of

entry, including the conduct of inspections and medical examinations as necessary;

(h) have effective contingency arrangements to deal with an unexpected public health event;

and

(i) communicate with the National IHR Focal Point on the relevant public health measures

taken pursuant to these Regulations.

2. Health measures recommended by WHO for travellers, baggage, cargo, containers, conveyances,

goods, postal parcels and human remains arriving from an affected area may be reapplied on arrival, if

there are verifiable indications and/or evidence that the measures applied on departure from the affected

area were unsuccessful.

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3. Disinsection, deratting, disinfection, decontamination and other sanitary procedures shall be

carried out so as to avoid injury and as far as possible discomfort to persons, or damage to the

environment in a way which impacts on public health, or damage to baggage, cargo, containers,

conveyances, goods and postal parcels.

PART V – PUBLIC HEALTH MEASURES

Chapter I – General provisions

Article 23 Health measures on arrival and departure

1. Subject to applicable international agreements and relevant articles of these Regulations, a State

Party may require for public health purposes, on arrival or departure:

(a) with regard to travellers:

(i) information concerning the traveller’s destination so that the traveller may be

contacted;

(ii) information concerning the traveller’s itinerary to ascertain if there was any travel in

or near an affected area or other possible contacts with infection or contamination prior to

arrival, as well as review of the traveller’s health documents if they are required under these

Regulations; and/or

(iii) a non-invasive medical examination which is the least intrusive examination that

would achieve the public health objective; and

(b) inspection of baggage, cargo, containers, conveyances, goods, postal parcels and human

remains.

2. On the basis of evidence of a public health risk obtained through the measures provided in

paragraph 1 of this Article, or through other means, States Parties may apply additional health measures,

in accordance with these Regulations, in particular, with regard to a suspect or affected traveller, on a

case-by-case basis, the least intrusive and invasive medical examination that would achieve the public

health objective of preventing the international spread of disease.

3. No medical examination, vaccination, prophylaxis or health measure under these Regulations

shall be carried out on travellers without their prior express informed consent or that of their parents or

guardians, except as provided in paragraph 2 of Article 31, and in accordance with the law and

international obligations of the State Party.

4. Travellers to be vaccinated or offered prophylaxis pursuant to these Regulations, or their parents

or guardians, shall be informed of any risk associated with vaccination or with non-vaccination and with

the use or non-use of prophylaxis, in accordance with the law and international obligations of the State

Party. States Parties shall inform medical practitioners of these requirements in accordance with the law

of the State Party.

5. Any medical examination, medical procedure, vaccination or other prophylaxis which involves a

risk of disease transmission shall only be performed on, or administered to, a traveller in accordance

with established national or international safety guidelines and standards so as to minimize such a risk.

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Chapter II – Special provisions for conveyances and conveyance operators

Article 24 Conveyance operators

1. States Parties shall take all practicable measures consistent with these Regulations to ensure that

conveyance operators:

(a) comply with the health measures recommended by WHO and adopted by the State Party,

including for application on board as well as during embarkation and disembarkation;

(b) inform travellers of the health measures recommended by WHO and adopted by the State

Party, including for application on board as well as during embarkation and disembarkation;

and

(c) permanently keep conveyances for which they are responsible free of sources of infection

or contamination, including vectors and reservoirs. The application of measures to control sources

of infection or contamination may be required if evidence is found.

2. Specific provisions pertaining to conveyances and conveyance operators under this Article are

provided in Annex 4. Specific measures applicable to conveyances and conveyance operators with

regard to vector-borne diseases are provided in Annex 5.

Article 25 Ships and aircraft in transit

Subject to Articles 27 and 43 or unless authorized by applicable international agreements, no

health measure shall be applied by a State Party to:

(a) a ship not coming from an affected area which passes through a maritime canal or waterway

in the territory of that State Party on its way to a port in the territory of another State. Any such

ship shall be permitted to take on, under the supervision of the competent authority, fuel, water,

food and supplies;

(b) a ship which passes through waters within its jurisdiction without calling at a port or on the

coast; and

(c) an aircraft in transit at an airport within its jurisdiction, except that the aircraft may be

restricted to a particular area of the airport, with no embarking and disembarking or loading and

discharging. However, any such aircraft shall be permitted to take on, under the supervision of

the competent authority, fuel, water, food and supplies.

Article 26 Civilian lorries, trains and coaches in transit

Subject to Articles 27 and 43 or unless authorized by applicable international agreements, no

health measure shall be applied to a civilian lorry, train or coach not coming from an affected area which

passes through a territory without embarking, disembarking, loading or discharging.

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Article 27 Affected conveyances

1. If clinical signs or symptoms and information based on fact or evidence of a public health risk,

including sources of infection and contamination, are found on board a conveyance, the competent

authority shall consider the conveyance as affected and may:

(a) disinfect, decontaminate, disinsect or derat the conveyance, as appropriate, or cause these

measures to be carried out under its supervision; and

(b) decide in each case the technique employed to secure an adequate level of control of the

public health risk as provided in these Regulations. Where there are methods or materials advised

by WHO for these procedures, these should be employed, unless the competent authority

determines that other methods are as safe and reliable.

The competent authority may implement additional health measures, including isolation and

quarantine of the conveyances, as necessary, to prevent the spread of disease. Such additional measures

should be reported to the National IHR Focal Point.

2. If the competent authority for the point of entry is not able to carry out the control measures

required under this Article, the affected conveyance may nevertheless be allowed to depart, subject to

the following conditions:

(a) the competent authority shall, at the time of departure, inform the competent authority for

the next known point of entry of the type of information referred to under subparagraph (b); and

(b) in the case of a ship, the evidence found and the control measures required shall be noted

in the Ship Sanitation Control Certificate.

Any such conveyance shall be permitted to take on, under the supervision of the competent

authority, fuel, water, food and supplies.

3. A conveyance that has been considered as affected shall cease to be regarded as such when the

competent authority is satisfied that:

(a) the measures provided in paragraph 1 of this Article have been effectively carried out; and

(b) there are no conditions on board that could constitute a public health risk.

Article 28 Ships and aircraft at points of entry

1. Subject to Article 43 or as provided in applicable international agreements, a ship or an aircraft

shall not be prevented for public health reasons from calling at any point of entry. However, if the point

of entry is not equipped for applying health measures under these Regulations, the ship or aircraft may

be ordered to proceed at its own risk to the nearest suitable point of entry available to it, unless the ship

or aircraft has an operational problem which would make this diversion unsafe.

2. Subject to Article 43 or as provided in applicable international agreements, ships or aircraft shall

not be refused free pratique by States Parties for public health reasons; in particular, they shall not be

prevented from embarking or disembarking, discharging or loading cargo or stores, or taking on fuel,

water, food and supplies. States Parties may subject the granting of free pratique to inspection and, if a

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source of infection or contamination is found on board, the carrying out of necessary disinfection,

decontamination, disinsection or deratting, or other measures necessary to prevent the spread of the

infection or contamination.

3. Whenever practicable and subject to the previous paragraph 2 of this Article, a State Party shall

authorize the granting of free pratique by radio or other communication means to a ship or an aircraft

when, on the basis of information received from it prior to its arrival, the State Party is of the opinion

that the arrival of the ship or aircraft will not result in the introduction or spread of disease.

4. Officers in command of ships or pilots in command of aircraft, or their agents, shall make known

to the port or airport control, as early as possible before arrival at the port or airport of destination, any

cases of illness indicative of a disease of an infectious nature or evidence of a public health risk on

board, as soon as such illnesses or public health risks are made known to the officer or pilot. This

information must be immediately relayed to the competent authority for the port or airport. In urgent

circumstances, such information should be communicated directly by the officers or pilots to the relevant

port or airport authority.

5. The following shall apply if a suspect or affected aircraft or ship, for reasons beyond the control

of the pilot in command of the aircraft or the officer in command of the ship, lands elsewhere than at the

airport at which the aircraft was due to land or berths elsewhere than at the port at which the ship was

due to berth:

(a) the pilot in command of the aircraft or the officer in command of the ship or other person

in charge shall make every effort to communicate without delay with the nearest competent

authority;

(b) as soon as the competent authority has been informed of the landing, it may apply health

measures recommended by WHO or other health measures provided in these Regulations;

(c) unless required for emergency purposes or for communication with the competent

authority, no traveller on board the aircraft or ship shall leave its vicinity and no cargo shall be

removed from that vicinity, unless authorized by the competent authority; and

(d) when all health measures required by the competent authority have been completed, the

aircraft or ship may, so far as such health measures are concerned, proceed either to the airport or

port at which it was due to land or berth, or, if for technical reasons it cannot do so, to a

conveniently situated airport or port.

6. Notwithstanding the provisions contained in this Article, the officer in command of a ship or pilot

in command of an aircraft may take such emergency measures as may be necessary for the health and

safety of travellers on board. He or she shall inform the competent authority as early as possible

concerning any measures taken pursuant to this paragraph.

Article 29 Civilian lorries, trains and coaches at points of entry

WHO, in consultation with States Parties, shall develop guiding principles for applying health

measures to civilian lorries, trains and coaches at points of entry and passing through ground crossings.

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Chapter III – Special provisions for travellers

Article 30 Travellers under public health observation

Subject to Article 43 or as authorized in applicable international agreements, a suspect traveller

who on arrival is placed under public health observation may continue an international voyage, if the

traveller does not pose an imminent public health risk and the State Party informs the competent

authority of the point of entry at destination, if known, of the traveller’s expected arrival. On arrival, the

traveller shall report to that authority.

Article 31 Health measures relating to entry of travellers

1. Invasive medical examination, vaccination or other prophylaxis shall not be required as a

condition of entry of any traveller to the territory of a State Party, except that, subject to Articles 32, 42

and 45, these Regulations do not preclude States Parties from requiring medical examination,

vaccination or other prophylaxis or proof of vaccination or other prophylaxis:

(a) when necessary to determine whether a public health risk exists;

(b) as a condition of entry for any travellers seeking temporary or permanent residence;

(c) as a condition of entry for any travellers pursuant to Article 43 or Annexes 6 and 7; or

(d) which may be carried out pursuant to Article 23.

2. If a traveller for whom a State Party may require a medical examination, vaccination or other

prophylaxis under paragraph 1 of this Article fails to consent to any such measure, or refuses to provide

the information or the documents referred to in paragraph 1(a) of Article 23, the State Party concerned

may, subject to Articles 32, 42 and 45, deny entry to that traveller. If there is evidence of an imminent

public health risk, the State Party may, in accordance with its national law and to the extent necessary

to control such a risk, compel the traveller to undergo or advise the traveller, pursuant to paragraph 3 of

Article 23, to undergo:

(a) the least invasive and intrusive medical examination that would achieve the public health

objective;

(b) vaccination or other prophylaxis; or

(c) additional established health measures that prevent or control the spread of disease,

including isolation, quarantine or placing the traveller under public health observation.

Article 32 Treatment of travellers

In implementing health measures under these Regulations, States Parties shall treat travellers with

respect for their dignity, human rights and fundamental freedoms and minimize any discomfort or

distress associated with such measures, including by:

(a) treating all travellers with courtesy and respect;

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(b) taking into consideration the gender, sociocultural, ethnic or religious concerns of

travellers; and

(c) providing or arranging for adequate food and water, appropriate accommodation and

clothing, protection for baggage and other possessions, appropriate medical treatment, means of

necessary communication if possible in a language that they can understand, and other appropriate

assistance for travellers who are quarantined, isolated or subject to medical examinations or other

procedures for public health purposes.

Chapter IV – Special provisions for goods, containers and container loading areas

Article 33 Goods in transit

Subject to Article 43 or unless authorized by applicable international agreements, goods, other

than live animals, in transit without transhipment shall not be subject to health measures under these

Regulations or detained for public health purposes.

Article 34 Container and container loading areas

1. States Parties shall ensure, as far as practicable, that container shippers use international traffic

containers that are kept free from sources of infection or contamination, including vectors and reservoirs,

particularly during the course of packing.

2. States Parties shall ensure, as far as practicable, that container loading areas are kept free from

sources of infection or contamination, including vectors and reservoirs.

3. Whenever, in the opinion of a State Party, the volume of international container traffic is

sufficiently large, the competent authorities shall take all practicable measures consistent with these

Regulations, including carrying out inspections, to assess the sanitary condition of container loading

areas and containers in order to ensure that the obligations contained in these Regulations are

implemented.

4. Facilities for the inspection and isolation of containers shall, as far as practicable, be available at

container loading areas.

5. Container consignees and consignors shall make every effort to avoid cross-contamination when

multiple-use loading of containers is employed.

PART VI – HEALTH DOCUMENTS

Article 35 General rule

1. No health documents, other than those provided for under these Regulations or in

recommendations issued by WHO, shall be required in international traffic, provided however that this

Article shall not apply to travellers seeking temporary or permanent residence, nor shall it apply to

document requirements concerning the public health status of goods or cargo in international trade

pursuant to applicable international agreements. The competent authority may request travellers to

complete contact information forms and questionnaires on the health of travellers, provided that they

meet the requirements set out in Article 23.

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2. Health documents under these Regulations may be issued in non-digital format or digital

format, subject to the obligations of any State Party regarding the format of such documents

deriving from other international agreements.

3. Regardless of the format in which health documents under these Regulations have been

issued, said health documents shall conform to the Annexes, referred to in Articles 36 to 39, as

applicable, and their authenticity shall be ascertainable.

4. WHO, in consultation with States Parties, shall develop and update, as necessary, technical

guidance, including specifications or standards related to the issuance and ascertainment of

authenticity of health documents, both in digital format and non-digital format. Such

specifications or standards shall be in accordance with Article 45 regarding treatment of personal

data.

Article 36 Certificates of vaccination or other prophylaxis

1. Vaccines and prophylaxis for travellers administered pursuant to these Regulations, or to

recommendations and certificates relating thereto, shall conform to the provisions of Annex 6 and, when

applicable, Annex 7 with regard to specific diseases.

2. A traveller in possession of a certificate of vaccination or other prophylaxis issued in conformity

with Annex 6 and, when applicable, Annex 7, shall not be denied entry as a consequence of the disease

to which the certificate refers, even if coming from an affected area, unless the competent authority has

verifiable indications and/or evidence that the vaccination or other prophylaxis was not effective.

Article 37 MaritimeShip Declaration of Health

1. The master of a ship, before arrival at its first port of call in the territory of a State Party, shall

ascertain the state of health on board, and, except when that State Party does not require it, the master

shall, on arrival, or in advance of the vessel’s arrival if the vessel is so equipped and the State Party

requires such advance delivery, complete and deliver to the competent authority for that port a

MaritimeShip Declaration of Health, which shall be countersigned by the ship’s surgeon, if one is

carried.

2. The master of a ship, or the ship’s surgeon if one is carried, shall supply any information required

by the competent authority as to health conditions on board during an international voyage.

3. A MaritimeShip Declaration of Health shall conform to the model provided in Annex 8.

4. A State Party may decide:

(a) to dispense with the submission of the MaritimeShip Declaration of Health by all arriving

ships; or

(b) to require the submission of the MaritimeShip Declaration of Health under a

recommendation concerning ships arriving from affected areas or to require it from ships which

might otherwise carry infection or contamination.

The State Party shall inform shipping operators or their agents of these requirements.

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Article 38 Health Part of the Aircraft General Declaration

1. The pilot in command of an aircraft or the pilot’s agent, in flight or upon landing at the first airport

in the territory of a State Party, shall, to the best of his or her ability, except when that State Party does

not require it, complete and deliver to the competent authority for that airport the Health Part of the

Aircraft General Declaration which shall conform to the model specified in Annex 9.

2. The pilot in command of an aircraft or the pilot’s agent shall supply any information required by

the State Party as to health conditions on board during an international voyage and any health measure

applied to the aircraft.

3. A State Party may decide:

(a) to dispense with the submission of the Health Part of the Aircraft General Declaration by

all arriving aircraft; or

(b) to require the submission of the Health Part of the Aircraft General Declaration under a

recommendation concerning aircraft arriving from affected areas or to require it from aircraft

which might otherwise carry infection or contamination.

The State Party shall inform aircraft operators or their agents of these requirements.

Article 39 Ship sanitation certificates

1. Ship Sanitation Control Exemption Certificates and Ship Sanitation Control Certificates shall be

valid for a maximum period of six months. This period may be extended by one month if the inspection

or control measures required cannot be accomplished at the port.

2. If a valid Ship Sanitation Control Exemption Certificate or Ship Sanitation Control Certificate is

not produced or evidence of a public health risk is found on board a ship, the State Party may proceed

as provided in paragraph 1 of Article 27.

3. The certificates referred to in this Article shall conform to the model in Annex 3.

4. Whenever possible, control measures shall be carried out when the ship and holds are empty. In

the case of a ship in ballast, they shall be carried out before loading.

5. When control measures are required and have been satisfactorily completed, the competent

authority shall issue a Ship Sanitation Control Certificate, noting the evidence found and the control

measures taken.

6. The competent authority may issue a Ship Sanitation Control Exemption Certificate at any port

specified under Article 20 if it is satisfied that the ship is free of infection and contamination, including

vectors and reservoirs. Such a certificate shall normally be issued only if the inspection of the ship has

been carried out when the ship and holds are empty or when they contain only ballast or other material,

of such a nature or so disposed as to make a thorough inspection of the holds possible.

7. If the conditions under which control measures are carried out are such that, in the opinion of the

competent authority for the port where the operation was performed, a satisfactory result cannot be

obtained, the competent authority shall make a note to that effect on the Ship Sanitation Control

Certificate.

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PART VII – CHARGES

Article 40 Charges for health measures regarding travellers

1. Except for travellers seeking temporary or permanent residence, and subject to paragraph 2 of this

Article, no charge shall be made by a State Party pursuant to these Regulations for the following

measures for the protection of public health:

(a) any medical examination provided for in these Regulations, or any supplementary

examination which may be required by that State Party to ascertain the health status of the traveller

examined;

(b) any vaccination or other prophylaxis provided to a traveller on arrival that is not a published

requirement or is a requirement published less than 10 days prior to provision of the vaccination

or other prophylaxis;

(c) appropriate isolation or quarantine requirements of travellers;

(d) any certificate issued to the traveller specifying the measures applied and the date of

application; or

(e) any health measures applied to baggage accompanying the traveller.

2. States Parties may charge for health measures other than those referred to in paragraph 1 of this

Article, including those primarily for the benefit of the traveller.

3. Where charges are made for applying such health measures to travellers under these Regulations,

there shall be in each State Party only one tariff for such charges and every charge shall:

(a) conform to this tariff;

(b) not exceed the actual cost of the service rendered; and

(c) be levied without distinction as to the nationality, domicile or residence of the traveller

concerned.

4. The tariff, and any amendment thereto, shall be published at least 10 days in advance of any levy

thereunder.

5. Nothing in these Regulations shall preclude States Parties from seeking reimbursement for

expenses incurred in providing the health measures in paragraph 1 of this Article:

(a) from conveyance operators or owners with regard to their employees; or

(b) from applicable insurance sources.

6. Under no circumstances shall travellers or conveyance operators be denied the ability to depart

from the territory of a State Party pending payment of the charges referred to in paragraphs 1 or 2 of this

Article.

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Article 41 Charges for baggage, cargo, containers, conveyances, goods or postal parcels

1. Where charges are made for applying health measures to baggage, cargo, containers,

conveyances, goods or postal parcels under these Regulations, there shall be in each State Party only

one tariff for such charges and every charge shall:

(a) conform to this tariff;

(b) not exceed the actual cost of the service rendered; and

(c) be levied without distinction as to the nationality, flag, registry or ownership of the

baggage, cargo, containers, conveyances, goods or postal parcels concerned. In particular, there

shall be no distinction made between national and foreign baggage, cargo, containers,

conveyances, goods or postal parcels.

2. The tariff, and any amendment thereto, shall be published at least 10 days in advance of any levy

thereunder.

PART VIII – GENERAL PROVISIONS

Article 42 Implementation of health measures

Health measures taken pursuant to these Regulations shall be initiated and completed without

delay, and applied in a transparent and non-discriminatory manner.

Article 43 Additional health measures

1. These Regulations shall not preclude States Parties from implementing health measures, in

accordance with their relevant national law and obligations under international law, in response to

specific public health risks or public health emergencies of international concern, which:

(a) achieve the same or greater level of health protection than WHO recommendations; or

(b) are otherwise prohibited under Article 25, Article 26, paragraphs 1 and 2 of Article 28,

Article 30, paragraph 1(c) of Article 31 and Article 33,

provided such measures are otherwise consistent with these Regulations.

Such measures shall not be more restrictive of international traffic and not more invasive or

intrusive to persons than reasonably available alternatives that would achieve the appropriate level of

health protection.

2. In determining whether to implement the health measures referred to in paragraph 1 of this Article

or additional health measures under paragraph 2 of Article 23, paragraph 1 of Article 27, paragraph 2 of

Article 28 and paragraph 2(c) of Article 31, States Parties shall base their determinations upon:

(a) scientific principles;

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29

(b) available scientific evidence of a risk to human health, or where such evidence is

insufficient, the available information, including from WHO and other relevant intergovernmental

organizations and international bodies; and

(c) any available specific guidance or advice from WHO.

3. A State Party implementing additional health measures referred to in paragraph 1 of this Article

which significantly interfere with international traffic shall provide to WHO the public health rationale

and relevant scientific information for it. WHO shall share this information with other States Parties and

shall share information regarding the health measures implemented. For the purpose of this Article,

significant interference generally means refusal of entry or departure of international travellers, baggage,

cargo, containers, conveyances, goods, and the like, or their delay, for more than 24 hours.

4. After assessing information provided pursuant to paragraphs 3 and 5 of this Article and other

relevant information, WHO may request that the State Party concerned reconsider the application of the

measures.

5. A State Party implementing additional health measures referred to in paragraphs 1 and 2 of this

Article that significantly interfere with international traffic shall inform WHO, within 48 hours of

implementation, of such measures and their health rationale unless these are covered by a temporary or

standing recommendation.

6. A State Party implementing a health measure pursuant to paragraph 1 or 2 of this Article shall

within three months review such a measure taking into account the advice of WHO and the criteria in

paragraph 2 of this Article.

7. Without prejudice to its rights under Article 56, any State Party impacted by a measure taken

pursuant to paragraph 1 or 2 of this Article may request the State Party implementing such a measure to

consult with it, either directly, or through the Director-General, who may also facilitate

consultations between the States Parties concerned. The purpose of such consultations is to clarify

the scientific information and public health rationale underlying the measure and to find a mutually

acceptable solution. Unless otherwise agreed with the State Parties involved in the consultation,

information shared during the consultation must be kept confidential.

8. The provisions of this Article may apply to implementation of measures concerning travellers

taking part in mass congregations.

Article 44 Collaboration and, assistance and financing

1. States Parties shall undertake to collaborate with each other, to the extent possible, in:

(a) the detection and assessment of, preparedness for and response to, events as provided

under these Regulations;

(b) the provision or facilitation of technical cooperation and logistical support, particularly in

the development, strengthening and maintenance of the public healthcore capacities required

under Annex 1 of these Regulations;

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30

(c) the mobilization of financial resources, including through relevant sources and funding

mechanisms to facilitate the implementation of their obligations under these Regulations, in

particular to address the needs of developing countries; and

(d) the formulation of proposed laws and other legal and administrative provisions for the

implementation of these Regulations.

2. WHO shall collaborate with, and assist, States Parties, upon their request, to the extent possible,

in:

(a) the evaluation and assessment of their public healthcore capacities in order to facilitate the

effective implementation of these Regulations;

(b) the provision or facilitation of technical cooperation and logistical support to States Parties;

and

(c) the mobilization of financial resources to support developing countries in

buildingdeveloping, strengthening and maintaining the core capacities provided for in Annex 1.;

and

(d) the facilitation of access to relevant health products, in accordance with paragraph 8

of Article 13.

2 bis. States Parties, subject to applicable law and available resources, shall maintain or increase

domestic funding, as necessary, and collaborate, including through international cooperation and

assistance, as appropriate, to strengthen sustainable financing to support the implementation of

these Regulations.

2 ter. Pursuant to subparagraph (c) of paragraph 1 of this Article, States Parties shall undertake

to collaborate, to the extent possible, to:

(a) encourage governance and operating models of existing financing entities and funding

mechanisms to be regionally representative and responsive to the needs and national

priorities of developing countries in the implementation of these Regulations;

(b) identify and enable access to financial resources, including through the Coordinating

Financial Mechanism, established pursuant to Article 44 bis, necessary to equitably address

the needs and priorities of developing countries, including for developing, strengthening and

maintaining core capacities.

2 quater. The Director-General shall support the collaboration work in paragraph 2 bis of

this Article, as appropriate. States Parties and the Director-General shall report on its outcomes

as part of the reporting to the Health Assembly.

3. Collaboration under this Article may be implemented through multiple channels, including

bilaterally, through regional networks and the WHO regional offices, and through intergovernmental

organizations and international bodies.

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Article 44 bis Coordinating Financial Mechanism

1. A Coordinating Financial Mechanism (hereinafter “the Mechanism”) is hereby established

to:

(a) promote the provision of timely, predictable, and sustainable financing for the

implementation of these Regulations in order to develop, strengthen, and maintain core

capacities as set out in Annex 1 of these Regulations, including those relevant for pandemic

emergencies;

(b) seek to maximize the availability of financing for the implementation needs and

priorities of States Parties, in particular of developing countries; and

(c) work to mobilize new and additional financial resources, and increase the efficient

utilization of existing financing instruments, relevant to the effective implementation of

these Regulations.

2. In support of the objectives set out in paragraph 1 of this Article, the Mechanism shall, inter

alia:

(a) use or conduct relevant needs and funding gap analyses;

(b) promote harmonization, coherence and coordination of existing financing

instruments;

(c) identify all sources of financing that are available for implementation support and

make this information available to States Parties;

(d) provide advice and support, upon request, to States Parties in identifying and

applying for financial resources for strengthening core capacities, including those relevant

for pandemic emergencies; and

(e) leverage voluntary monetary contributions for organizations and other entities

supporting States Parties to develop, strengthen and maintain their core capacities,

including those relevant for pandemic emergencies.

3. The Mechanism shall function, in relation to the implementation of these Regulations, under

the authority and guidance of the Health Assembly and be accountable to it.

Article 45 Treatment of personal data

1. Health information collected or received by a State Party pursuant to these Regulations from

another State Party or from WHO which refers to an identified or identifiable person shall be kept

confidential and processed anonymously, as required by national law.

2. Notwithstanding paragraph 1, States Parties may process and disclose and process personal data

where essential for the purposes of assessing and managing a public health risk, but State Parties, in

accordance with national law, and WHO must ensure that the personal data are:

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32

(a) processed fairly and lawfully, and not further processed in a way incompatible with that

purpose;

(b) adequate, relevant and not excessive in relation to that purpose;

(c) accurate and, where necessary, kept up to date; every reasonable step must be taken to

ensure that data which are inaccurate or incomplete are erased or rectified; and

(d) not kept longer than necessary.

3. Upon request, WHO shall as far as practicable provide an individual with his or her personal data

referred to in this Article in an intelligible form, without undue delay or expense and, when necessary,

allow for correction.

Article 46 Transport and handling of biological substances, reagents

and materials for diagnostic purposes

States Parties shall, subject to national law and taking into account relevant international

guidelines, facilitate the transport, entry, exit, processing and disposal of biological substances and

diagnostic specimens, reagents and other diagnostic materials for verification and public health response

purposes under these Regulations.

PART IX – THE IHR ROSTER OF EXPERTS, THE EMERGENCY COMMITTEE AND THE

REVIEW COMMITTEE

Chapter I – The IHR Roster of Experts

Article 47 Composition

The Director-General shall establish a roster composed of experts in all relevant fields of expertise

(hereinafter the “IHR Expert Roster”). The Director-General shall appoint the members of the IHR

Expert Roster in accordance with the WHO Regulations for Expert Advisory Panels and Committees

(hereinafter the “WHO Advisory Panel Regulations”), unless otherwise provided in these Regulations.

In addition, the Director-General shall appoint one member at the request of each State Party and, where

appropriate, experts proposed by relevant intergovernmental and regional economic integration

organizations. Interested States Parties shall notify the Director-General of the qualifications and fields

of expertise of each of the experts they propose for membership. The Director-General shall periodically

inform the States Parties, and relevant intergovernmental and regional economic integration

organizations, of the composition of the IHR Expert Roster.

Chapter II – The Emergency Committee

Article 48 Terms of reference and composition

1. The Director-General shall establish an Emergency Committee that at the request of the

Director-General shall provide its views on:

(a) whether an event constitutes a public health emergency of international concern, including

a pandemic emergency;

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33

(b) the termination of a public health emergency of international concern, including a

pandemic emergency; and

(c) the proposed issuance, modification, extension or termination of temporary

recommendations.

1 bis. The Emergency Committee shall be considered an expert committee and shall be subject to

the WHO Advisory Panel Regulations, unless otherwise provided for in this Article.

2. The Emergency Committee shall be composed of experts selected by the Director-General from

the IHR Expert Roster and, when appropriate, other expert advisory panels of the Organization. The

Director-General shall determine the duration of membership with a view to ensuring its continuity in

the consideration of a specific event and its consequences. The Director-General shall select the

members of the Emergency Committee on the basis of the expertise and experience required for any

particular session and with due regard to the principles of equitable geographical representation. At least

one memberMembers of the Emergency Committee should be an include at least one expert nominated

by a State(s) Party(ies) within whose territory the event arisesis occurring.

3. The Director-General may, on his or her own initiative or at the request of the Emergency

Committee, appoint one or more technical experts to advise the Committee.

Article 49 Procedure

1. The Director-General shall convene meetings of the Emergency Committee by selecting a number

of experts from among those referred to in paragraph 2 of Article 48, according to the fields of expertise

and experience most relevant to the specific event that is occurring. For the purpose of this Article,

“meetings” of the Emergency Committee may include teleconferences, videoconferences or electronic

communications.

2. The Director-General shall provide the Emergency Committee with the agenda and any relevant

information concerning the event, including information provided by the States Parties, as well as any

temporary recommendation that the Director-General proposes for issuance.

3. The Emergency Committee shall elect its Chairperson and prepare following each meeting a brief

summary report of its proceedings and deliberations, including any advice on recommendations.

4. The Director-General shall invite the State(s) Party(ies) in whose territory the event arisesis

occurring to present its (their) views to the Emergency Committee. To that effect, the Director-General

shall notify to it the dates and the agenda of the meeting of the Emergency Committee with as much

advance notice as necessary. The State(s) Party(ies) concerned, however, may not seek a postponement

of the meeting of the Emergency Committee for the purpose of presenting its views thereto.

5. The views of the Emergency Committee shall be forwarded to the Director-General for

consideration. The Director-General shall make the final determination on these matters.

6. The Director-General shall communicate to all States Parties the determination and the

termination of a public health emergency of international concern, including a pandemic emergency,

any health measure taken by the State(s) Party(ies) concerned, any temporary recommendations,

including the supporting evidence, and the modification, extension and termination of such

recommendations, together with the composition and views of the Emergency Committee. The

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34

Director-General shall inform conveyance operators through States Parties and the relevant international

agencies of such temporary recommendations, including their modification, extension or termination.

The Director-General shall subsequently make such information and recommendations available to the

general public.

7. States Parties in whose territories the event has occurred may propose to the Director-General the

termination of a public health emergency of international concern, including a pandemic emergency,

and/or the temporary recommendations, and may make a presentation to that effect to the Emergency

Committee.

Chapter III – The Review Committee

Article 50 Terms of reference and composition

1. The Director-General shall establish a Review Committee, which shall carry out the following

functions:

(a) make technical recommendations to the Director-General regarding amendments to these

Regulations;

(b) provide technical advice to the Director-General with respect to standing

recommendations, and any modifications or termination thereof; and

(c) provide technical advice to the Director-General on any matter referred to it by the

Director-General regarding the functioning of these Regulations.

2. The Review Committee shall be considered an expert committee and shall be subject to the WHO

Advisory Panel Regulations, unless otherwise provided in this Article.

3. The Mmembers of the Review Committee shall be selected and appointed by the Director-General

from among the persons serving on the IHR Expert Roster and, when appropriate, other expert advisory

panels of the Organization.

4. The Director-General shall establish the number of members to be invited to a meeting of the

Review Committee, determine its date and duration, and convene the Committee.

5. The Director-General shall appoint members to the Review Committee for the duration of the

work of a session only.

6. The Director-General shall select the members of the Review Committee on the basis of the

principles of equitable geographical representation, gender balance, a balance of experts from developed

and developing countries, representation of a diversity of scientific opinion, approaches and practical

experience in various parts of the world, and an appropriate interdisciplinary balance.

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35

Article 51 Conduct of business

1. Decisions of the Review Committee shall be taken by a majority of the members present and

voting.

2. The Director-General shall invite Member States, the United Nations and its specialized agencies

and other relevant intergovernmental organizations or nongovernmental organizations in official

relations with WHO to designate representatives to attend the Committee sessions. Such representatives

may submit memoranda and, with the consent of the Chairperson, make statements on the subjects under

discussion. They shall not have the right to vote.

Article 52 Reports

1. For each session, the Review Committee shall draw up a report setting forth the Committee’s

views and advice. This report shall be approved by the Review Committee before the end of the session.

Its views and advice shall not commit the Organization and shall be formulated as advice to the

Director-General. The text of the report may not be modified without the Committee’s consent.

2. If the Review Committee is not unanimous in its findings, any member shall be entitled to express

his or her dissenting professional views in an individual or group report, which shall state the reasons

why a divergent opinion is held and shall form part of the Committee’s report.

3. The Review Committee’s report shall be submitted to the Director-General, who shall

communicate its views and advice to the Health Assembly or the Executive Board for their consideration

and action.

Article 53 Procedures for standing recommendations

When the Director-General considers that a standing recommendation is necessary and

appropriate for a specific public health risk, the Director-General shall seek the views of the Review

Committee. In addition to the relevant paragraphs of Articles 50 to 52, the following provisions shall

apply:

(a) proposals for standing recommendations, their modification or termination may be

submitted to the Review Committee by the Director-General or by States Parties through the

Director-General;

(b) any State Party may submit relevant information for consideration by the Review

Committee;

(c) the Director-General may request any State Party, intergovernmental organization or

nongovernmental organization in official relations with WHO to place at the disposal of the

Review Committee information in its possession concerning the subject of the proposed standing

recommendation as specified by the Review Committee;

(d) the Director-General may, at the request of the Review Committee or on the

Director-General’s own initiative, appoint one or more technical experts to advise the Review

Committee. They shall not have the right to vote;

(e) any report containing the views and advice of the Review Committee regarding standing

recommendations shall be forwarded to the Director-General for consideration and decision. The

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36

Director-General shall communicate the Review Committee’s views and advice to the Health

Assembly;

(f) the Director-General shall communicate to States Parties any standing recommendation, as

well as the modifications or termination of such recommendations, together with the views of the

Review Committee; and

(g) standing recommendations shall be submitted by the Director-General to the subsequent

Health Assembly for its consideration.

PART X – FINAL PROVISIONS

Article 54 Reporting and review

1. States Parties and the Director-General shall report to the Health Assembly on the implementation

of these Regulations as decided by the Health Assembly.

2. The Health Assembly shall periodically review the functioning of these Regulations, including

financing for their effective implementation. To that end it may request the advice of the Review

Committee, through the Director-General. The first such review shall take place no later than five years

after the entry into force of these Regulations.

3. WHO shall periodically conduct studies to review and evaluate the functioning of Annex 2. The

first such review shall commence no later than one year after the entry into force of these Regulations.

The results of such reviews shall be submitted to the Health Assembly for its consideration, as

appropriate.

Article 54 bis States Parties Committee for the Implementation of

the International Health Regulations (2005)

1. The States Parties Committee for the Implementation of the International Health

Regulations (2005) is hereby established to facilitate the effective implementation of these

Regulations, in particular of Article 44 and 44 bis. The Committee shall be facilitative and

consultative in nature only, and function in a non-adversarial, non-punitive, assistive and

transparent manner, guided by the principles set out in Article 3. To this effect:

(a) the Committee shall have the aim of promoting and supporting learning, exchange of

best practices, and cooperation among States Parties for the effective implementation of

these Regulations;

(b) the Committee shall establish a Subcommittee to provide technical advice and report

to the Committee.

2. The Committee shall be comprised of all States Parties and shall meet at least once every

two years. Terms of reference for the Committee, including the way that the Committee conducts

its business, and for the Subcommittee shall be adopted at the first meeting of the Committee by

consensus.

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37

3. The Committee shall have a Chair and a Vice-Chair, elected by the Committee from among

its State Party members, who shall serve for two years and rotate on a regional basis.1

4. The Committee shall adopt, at its first meeting, by consensus, terms of reference for the

Coordinating Financial Mechanism, established in Article 44 bis, and modalities for its

operationalization and governance and may adopt necessary working arrangements with relevant

international bodies, which may support its operation as appropriate.

Article 55 Amendments

1. Amendments to these Regulations may be proposed by any State Party or by the Director-General.

Such proposals for amendments shall be submitted to the Health Assembly for its consideration.

2. The text of any proposed amendment shall be communicated to all States Parties by the

Director-General at least four months before the Health Assembly at which it is proposed for

consideration.

3. Amendments to these Regulations adopted by the Health Assembly pursuant to this Article shall

come into force for all States Parties on the same terms, and subject to the same rights and obligations,

as provided for in Article 22 of the Constitution of the World Health Organization and Articles 59 to 64

of these Regulations, subject to the periods provided for in those Articles with respect to amendments

to these Regulations.

Article 56 Settlement of disputes

1. In the event of a dispute between two or more States Parties concerning the interpretation or

application of these Regulations, the States Parties concerned shall seek in the first instance to settle the

dispute through negotiation or any other peaceful means of their own choice, including good offices,

mediation or conciliation. Failure to reach agreement shall not absolve the parties to the dispute from

the responsibility of continuing to seek to resolve it.

2. In the event that the dispute is not settled by the means described under paragraph 1 of this Article,

the States Parties concerned may agree to refer the dispute to the Director-General, who shall make

every effort to settle it.

3. A State Party may at any time declare in writing to the Director-General that it accepts arbitration

as compulsory with regard to all disputes concerning the interpretation or application of these

Regulations to which it is a party or with regard to a specific dispute in relation to any other State Party

accepting the same obligation. The arbitration shall be conducted in accordance with the Permanent

Court of Arbitration Optional Rules for Arbitrating Disputes between Two States applicable at the time

a request for arbitration is made. The States Parties that have agreed to accept arbitration as compulsory

shall accept the arbitral award as binding and final. The Director-General shall inform the Health

Assembly regarding such action as appropriate.

1 For the purposes of this provision, the Holy See and Liechtenstein shall be regarded as belonging to the

European Region of WHO, it being understood that this arrangement is without prejudice to their status as States

Parties to the International Health Regulations (2005) that are not Members of WHO.

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38

4. Nothing in these Regulations shall impair the rights of States Parties under any international

agreement to which they may be parties to resort to the dispute settlement mechanisms of other

intergovernmental organizations or established under any international agreement.

5. In the event of a dispute between WHO and one or more States Parties concerning the

interpretation or application of these Regulations, the matter shall be submitted to the Health Assembly.

Article 57 Relationship with other international agreements

1. States Parties recognize that the IHR and other relevant international agreements should be

interpreted so as to be compatible. The provisions of the IHR shall not affect the rights and obligations

of any State Party deriving from other international agreements.

2. Subject to paragraph 1 of this Article, nothing in these Regulations shall prevent States Parties

having certain interests in common owing to their health, geographical, social or economic conditions,

from concluding special treaties or arrangements in order to facilitate the application of these

Regulations, and in particular with regard to:

(a) the direct and rapid exchange of public health information between neighbouring

territories of different States;

(b) the health measures to be applied to international coastal traffic and to international traffic

in waters within their jurisdiction;

(c) the health measures to be applied in contiguous territories of different States at their

common frontier;

(d) arrangements for carrying affected persons or affected human remains by means of

transport specially adapted for the purpose; and

(e) deratting, disinsection, disinfection, decontamination or other treatment designed to

render goods free of disease-causing agents.

3. Without prejudice to their obligations under these Regulations, States Parties that are members of

a regional economic integration organization shall apply in their mutual relations the common rules in

force in that regional economic integration organization.

Article 58 International sanitary agreements and regulations

1. These Regulations, subject to the provisions of Article 62 and the exceptions hereinafter provided,

shall replace as between the States bound by these Regulations and as between these States and WHO,

the provisions of the following international sanitary agreements and regulations:

(a) International Sanitary Convention, signed in Paris, 21 June 1926;

(b) International Sanitary Convention for Aerial Navigation, signed at The Hague,

12 April 1933;

(c) International Agreement for dispensing with Bills of Health, signed in Paris,

22 December 1934;

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39

(d) International Agreement for dispensing with Consular Visas on Bills of Health, signed in

Paris, 22 December 1934;

(e) Convention modifying the International Sanitary Convention of 21 June 1926, signed in

Paris, 31 October 1938;

(f) International Sanitary Convention, 1944, modifying the International Sanitary Convention

of 21 June 1926, opened for signature in Washington, 15 December 1944;

(g) International Sanitary Convention for Aerial Navigation, 1944, modifying the International

Sanitary Convention of 12 April 1933, opened for signature in Washington, 15 December 1944;

(h) Protocol of 23 April 1946 to prolong the International Sanitary Convention, 1944, signed

in Washington;

(i) Protocol of 23 April 1946 to prolong the International Sanitary Convention for Aerial

Navigation, 1944, signed in Washington;

(j) International Sanitary Regulations, 1951, and the Additional Regulations of 1955, 1956,

1960, 1963 and 1965; and

(k) the International Health Regulations of 1969 and the amendments of 1973 and 1981.

2. The Pan American Sanitary Code, signed at Havana, 14 November 1924, shall remain in force

with the exception of Articles 2, 9, 10, 11, 16 to 53 inclusive, 61 and 62, to which the relevant part of

paragraph 1 of this Article shall apply.

Article 59 Entry into force; period for rejection or reservations

1. The period provided in execution of Article 22 of the Constitution of the World Health

Organization for rejection of, or reservation to, these Regulations shall be 18 months from the date of

the notification by the Director-General of the adoption of these Regulations by the Health Assembly.

Any rejection or reservation received by the Director-General after the expiry of that period shall have

no effect.

1 bis. The period provided in execution of Article 22 of the Constitution of the World Health

Organization for rejection of, or reservation to, an amendment to these Regulations shall be 10 months

from the date of the notification by the Director-General of the adoption of an amendment to these

Regulations by the Health Assembly. Any rejection or reservation received by the Director-General after

the expiry of that period shall have no effect.

2. These Regulations shall enter into force 24 months after the date of notification referred to in

paragraph 1 of this Article, and amendments to these Regulations shall enter into force 12 months after

the date of notification referred to in paragraph 1bis of this Article, except for:

(a) a State that has rejected these Regulations or an amendment thereto in accordance with

Article 61;

(b) a State that has made a reservation, for which these Regulations or an amendment thereto

shall enter into force as provided in Article 62;

(c) a State that becomes a Member of WHO after the date of the notification by the Director-

General referred to in paragraph 1 of this Article, and which is not already a party to these

Regulations, for which these Regulations shall enter into force as provided in Article 60; and

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(d) a State not a Member of WHO that accepts these Regulations, for which they shall enter

into force in accordance with paragraph 1 of Article 64.

3. If a State is not able to adjust its domestic legislative and administrative arrangements fully with

these Regulations or an amendment thereto within the period set out in paragraph 2 of this Article, as

applicable, that State shall submit within the applicable period specified in paragraph 1 or 1 bis of this

Article a declaration to the Director-General regarding the outstanding adjustments and achieve them

no later than 12 months after the entry into force of these Regulations or an amendment thereto for that

State Party.

Article 60 New Member States of WHO

Any State which becomes a Member of WHO after the date of the notification by the

Director-General referred to in paragraph 1 of Article 59, and which is not already a party to these

Regulations, may communicate its rejection of, or any reservation to, these Regulations within a period

of twelve12 months from the date of the notification to it by the Director-General after becoming a

Member of WHO. Unless rejected, these Regulations shall enter into force with respect to that State,

subject to the provisions of Articles 62 and 63, upon expiry of that period. In no case shall these

Regulations enter into force in respect to that State earlier than 24 months after the date of notification

referred to in paragraph 1 of Article 59.

Article 61 Rejection

If a State notifies the Director-General of its rejection of these Regulations or of an amendment

thereto within the applicable period provided in paragraph 1 or 1 bis of Article 59, these Regulations or

the amendment concerned shall not enter into force with respect to that State. Any international sanitary

agreement or regulations listed in Article 58 to which such State is already a party shall remain in force

as far as such State is concerned.

Article 62 Reservations

1. States may make reservations to these Regulations or an amendment thereto in accordance with

this Article. Such reservations shall not be incompatible with the object and purpose of these

Regulations.

2. Reservations to these Regulations or an amendment thereto shall be notified to the

Director-General in accordance with paragraphs 1 and 1 bis of Article 59 and Article 60, paragraph 1 of

Article 63 or paragraph 1 of Article 64, as the case may be. A State not a Member of WHO shall notify

the Director-General of any reservation with its notification of acceptance of these Regulations. States

formulating reservations should provide the Director-General with reasons for the reservations.

3. A rejection in part of these Regulations or an amendment thereto shall be considered as a

reservation.

4. The Director-General shall, in accordance with paragraph 2 of Article 65, issue notification of

each reservation received pursuant to paragraph 2 of this Article. The Director-General shall:

(a) if the reservation was made before the entry into force of these Regulations, request those

Member States that have not rejected these Regulations to notify him or her within six months of

any objection to the reservation; or

International Health Regulations (2005)

41

(b) if the reservation was made after the entry into force of these Regulations, request States

Parties to notify him or her within six months of any objection to the reservation; or

(c) if the reservation was made to an amendment to these Regulations, request States Parties

to notify him or her within three months of any objection to the reservation.

States Parties objecting to a reservation to an amendment to these Regulations should provide the

Director-General with reasons for the objection.

5. After this period, the Director-General shall notify all States Parties of the objections he or she

has received with regard to reservations. In the case of a reservation made to these Regulations, unless

by the end of six months from the date of the notification referred to in paragraph 4 of this Article a

reservation has been objected to by one third of the States referred to in paragraph 4 of this Article, it

shall be deemed to be accepted and these Regulations shall enter into force for the reserving State,

subject to the reservation. In the case of a reservation made to an amendment to these Regulations, unless

by the end of three months from the date of the notification referred to in paragraph 4 of this Article, a

reservation has been objected to by one third of the States referred to in paragraph 4 of this Article, it

shall be deemed to be accepted and the amendment shall enter into force for the reserving State, subject

to the reservation.

6. If at least one third of the States referred to in paragraph 4 of this Article object to the reservation

to these Regulations by the end of six months from the date of the notification referred to in paragraph

4 of this Article or, in the case of a reservation to an amendment to these Regulations, by the end of

three months from the date of the notification referred to in paragraph 4 of this Article, the Director-

General shall notify the reserving State with a view to its considering withdrawing the reservation within

three months from the date of the notification by the Director-General.

7. The reserving State shall continue to fulfil any obligations corresponding to the subject matter of

the reservation, which the State has accepted under any of the international sanitary agreements or

regulations listed in Article 58.

8. If the reserving State does not withdraw the reservation within three months from the date of the

notification by the Director-General referred to in paragraph 6 of this Article, the Director-General shall

seek the view of the Review Committee if the reserving State so requests. The Review Committee shall

advise the Director-General as soon as possible and in accordance with Article 50 on the practical impact

of the reservation on the operation of these Regulations.

9. The Director-General shall submit the reservation, and the views of the Review Committee if

applicable, to the Health Assembly for its consideration. If the Health Assembly, by a majority vote,

objects to the reservation on the ground that it is incompatible with the object and purpose of these

Regulations, the reservation shall not be accepted and these Regulations or an amendment thereto shall

enter into force for the reserving State only after it withdraws its reservation pursuant to Article 63. If

the Health Assembly accepts the reservation, these Regulations or an amendment thereto shall enter into

force for the reserving State, subject to its reservation.

Article 63 Withdrawal of rejection and reservation

1. A rejection made under Article 61 may at any time be withdrawn by a State by notifying the

Director-General. In such cases, these Regulations or an amendment thereto, as applicable, shall enter

into force with regard to that State upon receipt by the Director-General of the notification, except where

the State makes a reservation when withdrawing its rejection, in which case these Regulations or an

amendment thereto, as applicable, shall enter into force as provided in Article 62. In no case shall these

International Health Regulations (2005)

42

Regulations enter into force in respect to that State earlier than 24 months after the date of notification

referred to in paragraph 1 of Article 59 and in no case shall an amendment to these Regulations enter

into force in respect to that State earlier than 12 months after the date of notification referred to in

paragraph 1 bis of Article 59.

2. The whole or part of any reservation may at any time be withdrawn by the State Party concerned

by notifying the Director-General. In such cases, the withdrawal will be effective from the date of receipt

by the Director-General of the notification.

Article 64 States not Members of WHO

1. Any State not a Member of WHO, which is a party to any international sanitary agreement or

regulations listed in Article 58 or to which the Director-General has notified the adoption of these

Regulations by the World Health Assembly, may become a party hereto by notifying its acceptance to

the Director-General and, subject to the provisions of Article 62, such acceptance shall become effective

upon the date of entry into force of these Regulations, or, if such acceptance is notified after that date,

three months after the date of receipt by the Director-General of the notification of acceptance.

2. Any State not a Member of WHO which has become a party to these Regulations may at any time

withdraw from participation in these Regulations, by means of a notification addressed to the

Director-General which shall take effect six months after the Director-General has received it. The State

which has withdrawn shall, as from that date, resume application of the provisions of any international

sanitary agreement or regulations listed in Article 58 to which it was previously a party.

Article 65 Notifications by the Director-General

1. The Director-General shall notify all States Members and Associate Members of WHO, and also

other parties to any international sanitary agreement or regulations listed in Article 58, of the adoption

by the Health Assembly of these Regulations.

2. The Director-General shall also notify these States, as well as any other State which has become

a party to these Regulations or to any amendment to these Regulations, of any notification received by

WHO under Articles 60 to 64 respectively, as well as of any decision taken by the Health Assembly

under Article 62.

Article 66 Authentic texts

1. The Arabic, Chinese, English, French, Russian and Spanish texts of these Regulations shall be

equally authentic. The original texts of these Regulations shall be deposited with WHO.

2. The Director-General shall send, with the notification provided in paragraph 1 of Article 59,

certified copies of these Regulations to all Members and Associate Members, and also to other parties

to any of the international sanitary agreements or regulations listed in Article 58.

3. Upon the entry into force of these Regulations, the Director-General shall deliver certified copies

thereof to the Secretary-General of the United Nations for registration in accordance with Article 102

of the Charter of the United Nations.

International Health Regulations (2005)

43

ANNEX 1

A. CORE CAPACITY REQUIREMENTS FOR SURVEILLANCE AND RESPONSE

CORE CAPACITIES

1. States Parties shall utilize existing national structures and resources to meet their core

capacitycapacities requirements under these Regulations, including with regard to:

(a) their prevention, surveillance, reporting, notification, verification, preparedness,

response and collaboration activities; and

(b) their activities concerning designated airports, ports and ground crossings.

2. Each State Party shall assess, within two years following the entry into force of these Regulations

for that State Party, the ability of existing national structures and resources to meet the minimum

requirements described in this Annex. As a result of such assessment, States Parties shall develop and

implement plans of action to ensure that these core capacities are present and functioning throughout

their territories as set out in paragraph 1 of Article 5 and, paragraph 1 of Article 13 and

subparagraph (a) of Article 19.

3. States Parties and WHO shall support assessments, planning and implementation processes under

this Annex.

4. Pursuant to Article 44, States Parties shall undertake to collaborate with each other, to the

extent possible, in developing, strengthening and maintaining core capacities.

A. CORE CAPACITIES REQUIREMENTS FOR PREVENTION,

SURVEILLANCE, PREPAREDNESS AND RESPONSE

1. At the local community level and/or primary public health response level (hereinafter the “Local

level”), each State Party shall develop, strengthen and maintain the core capacities:

The capacities:

(a) to detect events involving disease or death above expected levels for the particular time and

place in all areas within the territory of the State Party; and

(b) to report all available essential information immediately to the appropriate level of

health-care response. At the community level, reporting shall be to local community healthcare

institutions or the appropriate health personnel. At the primary public health response level,

reporting shall be to the intermediate or national response level, depending on organizational

structures. For the purposes of this Annex, essential information includes the following: clinical

descriptions, laboratory results, sources and type of risk, numbers of human cases and deaths,

conditions affecting the spread of the disease and the health measures employed; and

(c) to prepare for the implementation of, and implement immediately, preliminary control

measures immediately.;

International Health Regulations (2005) Annex 1

44

5. (d) to prepare for the provision of, and facilitate access to health services necessary

for responding to public health risks and events; and

(e) to engage relevant stakeholders, including communities, in preparing for and

responding to public health risks and events.

2. At the intermediate public health response levels The(hereinafter the “Intermediate level”),

where applicable,1 each State Party shall develop, strengthen and maintain the core capacities:

(a) to confirm the status of reported events and to support or implement additional control

measures; and

(b) to assess reported events immediately and, if found urgent, to report all essential

information to the national level. For the purposes of this Annex, the criteria for urgent events

include serious public health impact and/or unusual or unexpected nature with high potential for

spread.; and

6. (c) to coordinate with and support the Local level in preventing, preparing for and

responding to public health risks and events, including in relation to:

(i) surveillance;

(ii) on-site investigations;

(iii) laboratory diagnostics, including referral of samples;

(iv) implementation of control measures;

(v) access to health services and health products needed for the response;

(vi) risk communication, including addressing misinformation and disinformation;

and

(vii) logistical assistance (e.g. equipment, medical and other relevant supplies and

transport);

3. At the national level

Assessment and notification. TheEach State Party shall develop, strengthen and maintain the

core capacities:

(a) to assess all reports of urgent events within 48 hours; and

1 In States Parties where, because of their administrative structure, an Intermediate level either absent or not

clearly identifiable, the core capacities listed in subparagraphs (a) through (e) of this paragraph shall be understood

to be developed, strengthened or maintained either at the Local level or at the National level, as appropriate, in

accordance with national laws and context.

Annex 1 International Health Regulations (2005)

45

(b) to notify WHO immediately through the National IHR Focal Point when the assessment

indicates the event is notifiable pursuant to paragraph 1 of Article 6 and Annex 2 and to inform

WHO as required pursuant to Article 7 and paragraph 2 of Article 9.

Public health prevention, preparedness and response. TheEach State Party shall develop,

strengthen and maintain the core capacities for:

(a) to determine rapidly thedetermining control measures required to prevent domestic and

international spread;

(b) to provide support throughsurveillance;

(c) deploying specialized staff,;

(d) laboratory analysis of samples (domestically or through collaborating centres) and;

(e) logistical assistance (e.g. equipment, medical and other relevant supplies and transport);

(c) to provide(f) providing on-site assistance as required to supplement local investigations;

(d) to provide(g) developing and/or disseminating guidance for clinical case

management and infection prevention and control;

(h) access to health services and health products needed for the response;

(i) risk communication, including addressing misinformation and disinformation;

(j) providing a direct operational link with senior health and other officials to approve rapidly

and implement containment and control measures;

(e) to provide(k) providing direct liaison with other relevant government ministries;

(f) to provide(l) providing, by the most efficient means of communication available, links

with hospitals, clinics, airports, ports, ground crossings, laboratories and other key operational

areas for the dissemination of information and recommendations received from WHO regarding

events in the State Party’s own territory and in the territories of other States Parties;

(g) to establish, operate(m) establishing, operating and maintaining a national public health

emergency response plan, including the creation of multidisciplinary/multisectoral teams to

respond to events that may constitute a public health emergency of international concern; and

(n) coordinating activities nationally and supporting Local and Intermediate levels,

where applicable, in preventing, preparing for and responding to public health risks and

events; and

(h) to provide(o) providing the foregoing on a 24-hour basis.

International Health Regulations (2005) Annex 1

46

B. CORE CAPACITYCAPACITIES REQUIREMENTS FOR DESIGNATED

AIRPORTS, PORTS AND GROUND CROSSINGS

1. At all timesThe, each State Party shall develop, strengthen and maintain the core capacities:

(a) to provide access to (i) an appropriate medical service, including diagnostic facilities

located so as to allow the prompt assessment and care of ill travellers, and (ii) adequate staff,

equipment and premises;

(b) to provide access to equipment and personnel for the transport of ill travellers to an

appropriate medical facility;

(c) to provide trained personnel for the inspection of conveyances;

(d) to ensure a safe environment for travellers using point of entry facilities, including potable

water supplies, eating establishments, flight catering facilities, public washrooms, appropriate

solid and liquid waste disposal services and other potential risk areas, by conducting inspection

programmes, as appropriate; and

(e) to provide as far as practicable a programme and trained personnel for the control of vectors

and reservoirs in and near points of entry.

2. For responding to events that may constitute a public health emergency of international concern,

each State Party shall develop, strengthen and maintain the core capacities:

The capacities:

(a) to provide appropriate public health emergency response by establishing and maintaining

a public health emergency contingency plan, including the nomination of a coordinator and

contact points for relevant point of entry, public health and other agencies and services;

(b) to provide assessment of and care for affected travellers or animals by establishing

arrangements with local medical and veterinary facilities and laboratories, for their isolation,

and treatment, the analysis of their samples and other support services that may be required;

(c) to provide appropriate space, separate from other travellers, to interview suspect or affected

persons;

(d) to provide for the assessment and, if required, quarantine of suspect travellers, preferably

in facilities away from the point of entry;

(e) to apply recommended measures to disinsect, derat, disinfect, decontaminate or otherwise

treat baggage, cargo, containers, conveyances, goods or postal parcels, including, when

appropriate, at locations specially designated and equipped for this purpose;

(f) to apply entry or exit controls for arriving and departing travellers; and

(g) to provide access to specially designated equipment, and to trained personnel with

appropriate personal protection, for the transfer of travellers who may carry infection or

contamination.

International Health Regulations (2005)

47

ANNEX 2

DECISION INSTRUMENT FOR THE ASSESSMENT AND NOTIFICATION OF

EVENTS THAT MAY CONSTITUTE A PUBLIC HEALTH EMERGENCY OF

INTERNATIONAL CONCERN

1 As per WHO case definitions. 2 The disease list shall be used only for the purposes of these Regulations.

Events detected by national surveillance system (see Annex 1)

A case of the following

diseases is unusual or

unexpected and may have

serious public health

impact, and thus shall be

notified:1,2

– Smallpox

– Poliomyelitis due to

wild-type polioviruses

– Human influenza

caused by a new

subtype

– Severe acute

respiratory syndrome

(SARS).

An event involving the

following diseases shall

always lead to utilization

of the algorithm, because

they have demonstrated

the ability to cause serious

public health impact and to

spread rapidly

internationally:2

– Cholera

– Pneumonic plague

– Yellow fever

– Viral haemorrhagic

fevers (Ebola, Lassa,

Marburg)

– West Nile fever

– Other diseases that are

of special national or

regional concern, e.g.

dengue fever, Rift

Valley fever, and

meningococcal disease.

Any event of potential

international public health

concern, includingand

those of unknown causes

or sources, in particular

clusters of cases of severe

acute respiratory disease

of unknown or novel

cause, and those involving

other events or diseases

than those listed in the box

on the left and the box on

the right shall lead to

utilization of the

algorithm.

Is the public health impact of the event

serious?

Yes

No

Is the event unusual or unexpected?

Is the event unusual or unexpected?

Yes

No No Yes

Is there a significant risk

of international spread?

Yes

No

Is there a significant risk

of international spread?

Yes

No

Is there a significant risk of international

travel or trade restrictions?

Yes

No Not notified at this stage.

Reassess when more

information becomes

available.

OR OR

EVENT SHALL BE NOTIFIED TO WHO UNDER THE INTERNATIONAL HEALTH

REGULATIONS

International Health Regulations (2005) Annex 2

48

EXAMPLES FOR THE APPLICATION OF THE DECISION INSTRUMENT FOR THE

ASSESSMENT AND NOTIFICATION OF EVENTS THAT MAY CONSTITUTE A PUBLIC

HEALTH EMERGENCY OF INTERNATIONAL CONCERN

The examples appearing in this Annex are not binding and are for indicative guidance purposes to

assist in the interpretation of the decision instrument criteria.

DOES THE EVENT MEET AT LEAST TWO OF THE FOLLOWING CRITERIA?

Is t

h e p

u b

li c

h ea

lt h

i m

p a

ct o

f th

e ev

en t

se r io

u s?

I. Is the public health impact of the event serious?

1. Is the number of cases and/or number of deaths for this type of event large for the given place,

time or population?

2. Has the event the potential to have a high public health impact?

THE FOLLOWING ARE EXAMPLES OF CIRCUMSTANCES THAT CONTRIBUTE TO HIGH

PUBLIC HEALTH IMPACT:

✓ Event caused by a pathogen with high potential to cause epidemic (infectiousness of the agent, high

case fatality, multiple transmission routes or healthy carrier).

✓ Indication of treatment failure (new or emerging antibiotic resistance, vaccine failure, antidote

resistance or failure).

✓ Event represents a significant public health risk even if no or very few human cases have yet been

identified.

✓ Cases reported among health staff.

✓ The population at risk is especially vulnerable (refugees, low level of immunization, children,

elderly, low immunity, undernourished, etc.).

✓ Concomitant factors that may hinder or delay the public health response (natural catastrophes,

armed conflicts, unfavourable weather conditions, multiple foci in the State Party).

✓ Event in an area with high population density.

✓ Spread of toxic, infectious or otherwise hazardous materials that may be occurring naturally or

otherwise that has contaminated or has the potential to contaminate a population and/or a large

geographical area.

3. Is external assistance needed to detect, investigate, respond and control the current event, or

prevent new cases?

THE FOLLOWING ARE EXAMPLES OF WHEN ASSISTANCE MAY BE REQUIRED:

✓ Inadequate human, financial, material or technical resources – in particular:

– insufficient laboratory or epidemiological capacity to investigate the event (equipment,

personnel, financial resources);

– insufficient antidotes, drugs and/or vaccine and/or protective equipment, decontamination

equipment, or supportive equipment to cover estimated needs;

– existing surveillance system is inadequate to detect new cases in a timely manner.

IS THE PUBLIC HEALTH IMPACT OF THE EVENT SERIOUS?

Answer “yes” if you have answered “yes” to questions 1, 2 or 3 above.

Annex 2 International Health Regulations (2005)

49

Is t

h e

ev en

t u

n u

su a

l o

r u

n ex

p ec

te d

?

II. Is the event unusual or unexpected?

4. Is the event unusual?

THE FOLLOWING ARE EXAMPLES OF UNUSUAL EVENTS:

✓ The event is caused by an unknown agent or the source, vehicle, route of transmission is unusual

or unknown.

✓ Evolution of cases more severe than expected (including morbidity or case fatality) or with

unusual symptoms.

✓ Occurrence of the event itself unusual for the area, season or population.

5. Is the event unexpected from a public health perspective?

THE FOLLOWING ARE EXAMPLES OF UNEXPECTED EVENTS:

✓ Event caused by a disease/agent that had already been eliminated or eradicated from the State

Party or not previously reported.

IS THE EVENT UNUSUAL OR UNEXPECTED?

Answer “yes” if you have answered “yes” to questions 4 or 5 above.

Is t

h er

e a

s ig

n if

ic a

n t

ri sk

o f

in te

rn a

ti o

n a

l

sp re

a d

?

III. Is there a significant risk of international spread?

6. Is there evidence of an epidemiological link to similar events in other States?

7. Is there any factor that should alert us to the potential for cross border movement of the

agent, vehicle or host?

THE FOLLOWING ARE EXAMPLES OF CIRCUMSTANCES THAT MAY PREDISPOSE

TO INTERNATIONAL SPREAD:

✓ Where there is evidence of local spread, an index case (or other linked cases) with a history

within the previous month of:

– international travel (or time equivalent to the incubation period if the pathogen is

known);

– participation in an international gathering (pilgrimage, sports event, conference, etc.);

– close contact with an international traveller or a highly mobile population.

✓ Event caused by an environmental contamination that has the potential to spread across

international borders.

✓ Event in an area of intense international traffic with limited capacity for sanitary control or

environmental detection or decontamination.

IS THERE A SIGNIFICANT RISK OF INTERNATIONAL SPREAD?

Answer “yes” if you have answered “yes” to questions 6 or 7 above.

R is

k o

f in

te rn

a ti

o n

a l

re st

ri ct

io n

s?

IV. Is there a significant risk of international travel or trade restrictions?

8. Have similar events in the past resulted in international restriction on trade and/or

travel?

9. Is the source suspected or known to be a food product, water or any other goods that might

be contaminated that has been exported/imported to/from other States?

10. Has the event occurred in association with an international gathering or in an area of

intense international tourism?

11. Has the event caused requests for more information by foreign officials or international

media?

IS THERE A SIGNIFICANT RISK OF INTERNATIONAL TRADE OR

TRAVEL RESTRICTIONS?

Answer “yes” if you have answered “yes” to questions 8, 9, 10 or 11 above.

States Parties that answer “yes” to the question whether the event meets any two of the four criteria

(I-IV) above, shall notify WHO under Article 6 of the International Health Regulations.

In tern

a tio

n a

l H ea

lth R

eg u

la tio

n s (2

0 0

5 )

5 0 ANNEX 3

MODEL SHIP SANITATION CONTROL EXEMPTION CERTIFICATE/SHIP SANITATION CONTROL CERTIFICATE

1 (a) Evidence of infection or contamination, including: vectors in all stages of growth; animal reservoirs for vectors; rodents or other species that could carry human disease, microbiological, chemical

and other risks to human health; signs of inadequate sanitary measures. (b) Information concerning any human cases (to be included in the MaritimeShip Declaration of Health).

2 Results from samples taken on board. Analysis to be provided to ship’s master by most expedient means and, if re-inspection is required, to the next appropriate port of call coinciding with the

re-inspection date specified in this certificate.

Sanitation Control Exemption Certificates and Sanitation Control Certificates are valid for a maximum of six months, but the validity period may be extended by one month if inspection cannot be

carried out at the port and there is no evidence of infection or contamination.

A n

n ex

3

In

tern a

tio n

a l H

ea lth

R eg

u la

tio n

s (2 0

0 5

)

5 1

ATTACHMENT TO MODEL SHIP SANITATION CONTROL EXEMPTION CERTIFICATE/SHIP SANITATION

CONTROL CERTIFICATE

Areas/facilities/systems inspected1

Evidence found

Sample results Documents reviewed

Control measures applied

Re-inspection date

Comments regarding conditions found

Food

Source

Storage

Preparation

Service

Water

Source

Storage

Distribution

Waste

Holding

Treatment

Disposal

Swimming pools/spas

Equipment

Operation

Medical facilities

Equipment and medical devices

Operation

Medicines

Other areas inspected

1 Indicate when the areas listed are not applicable by marking N/A.

International Health Regulations (2005)

52

ANNEX 4

TECHNICAL REQUIREMENTS PERTAINING TO CONVEYANCES AND

CONVEYANCE OPERATORS

Section A Conveyance operators

1. Conveyance operators shall prepare for, as appropriate, and facilitate:

(a) inspections of the cargo, containers and conveyance;

(b) medical examinations of persons on board;

(c) application of other health measures under these Regulations, including on board as well

as during embarkation and disembarkation; and

(d) provision of relevant public health information requested by the State Party.

2. Conveyance operators shall provide to the competent authority a valid Ship Sanitation Control

Exemption Certificate or a Ship Sanitation Control Certificate or a MaritimeShip Declaration of Health,

or the Health Part of an Aircraft General Declaration, as required under these Regulations.

Section B Conveyances

1. Control measures applied to baggage, cargo, containers, conveyances and goods under these

Regulations shall be carried out so as to avoid as far as possible injury or discomfort to persons or

damage to the baggage, cargo, containers, conveyances and goods. Whenever possible and appropriate,

control measures shall be applied when the conveyance and holds are empty.

2. States Parties shall indicate in writing the measures applied to cargo, containers or conveyances,

the parts treated, the methods employed, and the reasons for their application. This information shall be

provided in writing to the person in charge of an aircraft and, in case of a ship, on the Ship Sanitation

Control Certificate. For other cargo, containers or conveyances, States Parties shall issue such

information in writing to consignors, consignees, carriers, the person in charge of the conveyance or

their respective agents.

International Health Regulations (2005)

53

ANNEX 5

SPECIFIC MEASURES FOR VECTOR-BORNE DISEASES

1. WHO shall publish, on a regular basis, a list of areas where disinsection or other vector control

measures are recommended for conveyances arriving from these areas. Determination of such areas shall

be made pursuant to the procedures regarding temporary or standing recommendations, as appropriate.

2. Every conveyance leaving a point of entry situated in an area where vector control is

recommended should be disinsected and kept free of vectors. When there are methods and materials

advised by the Organization for these procedures, these should be employed. The presence of vectors

on board conveyances and the control measures used to eradicate them shall be included:

(a) in the case of aircraft, in the Health Part of the Aircraft General Declaration, unless this

part of the Declaration is waived by the competent authority at the airport of arrival;

(b) in the case of ships, on the Ship Sanitation Control Certificates; and

(c) in the case of other conveyances, on a written proof of treatment issued to the consignor,

consignee, carrier, the person in charge of the conveyance or their agent, respectively.

3. States Parties should accept disinsecting, deratting and other control measures for conveyances

applied by other States if methods and materials advised by the Organization have been applied.

4. States Parties shall establish programmes to control vectors that may transport an infectious agent

that constitutes a public health risk to a minimum distance of 400 metres from those areas of point of

entry facilities that are used for operations involving travellers, conveyances, containers, cargo and

postal parcels, with extension of the minimum distance if vectors with a greater range are present.

5. If a follow-up inspection is required to determine the success of the vector control measures

applied, the competent authorities for the next known port or airport of call with a capacity to make such

an inspection shall be informed of this requirement in advance by the competent authority advising such

follow-up. In the case of ships, this shall be noted on the Ship Sanitation Control Certificate.

6. A conveyance may be regarded as suspect and should be inspected for vectors and reservoirs if:

(a) it has a possible case of vector-borne disease on board;

(b) a possible case of vector-borne disease has occurred on board during an international

voyage; or

(c) it has left an affected area within a period of time where on-board vectors could still carry

disease.

7. A State Party should not prohibit the landing of an aircraft or berthing of a ship in its territory if

the control measures provided for in paragraph 3 of this Annex or otherwise recommended by the

Organization are applied. However, aircraft or ships coming from an affected area may be required to

land at airports or divert to another port specified by the State Party for that purpose.

8. A State Party may apply vector control measures to a conveyance arriving from an area affected

by a vector-borne disease if the vectors for the foregoing disease are present in its territory.

International Health Regulations (2005)

54

ANNEX 6

VACCINATION, PROPHYLAXIS AND RELATED CERTIFICATES

1. Vaccines or other prophylaxis specified in Annex 7 or recommended under these Regulations

shall be of suitable quality; those vaccines and prophylaxis designated by WHO shall be subject to its

approval. Upon request, the State Party shall provide to WHO appropriate evidence of the suitability of

vaccines and prophylaxis administered within its territory under these Regulations.

2. Persons undergoing vaccination or other prophylaxis under these Regulations shall be provided

with an international certificate of vaccination or prophylaxis (hereinafter the “certificate”) in the form

specified in this Annex. No departure shall be made from the model of the certificate specified in this

Annex.

3. Certificates under this Annex are valid only if the vaccine or prophylaxis used has been approved

by WHO.

4. Certificates under this Annex issued in non-digital format must be signed in the hand ofby the

clinician, who shall be a medical practitioner or other authorized health worker, supervising the

administration of the vaccine or prophylaxis. TheSuch certificates must also bear the official stamp of

the administering centre; however, this shall not be an accepted substitute for the signature. Regardless

of the format in which they have been issued, certificates must bear the name of the clinician

supervising the administration of the vaccine or prophylaxis, or of the relevant authority

responsible for issuing the certificate or overseeing the administering centre.

5. Certificates shall be fully completed in English or in French. They may also be completed in

another language, in addition to either English or French.

6. Any amendment of this certificate, or erasure, or failure to complete any part of it, may render it

invalid.

7. Certificates are individual and shall in no circumstances be used collectively. Separate certificates

shall be issued for children.

8. AFor certificates under this Annex issued in non-digital format, a parent or guardian shall

sign the certificate when the child is unable to write. The signature of an illiterateA person who is

unable to sign shall be indicated in the usual manner by the person’s mark and the indication by another

that this is the mark of the person concerned, which shall be considered their signature. With respect

to persons with a guardian, the guardian shall sign the certificate on their behalf.

9. If the supervising clinician is of the opinion that the vaccination or prophylaxis is contraindicated

on medical grounds, the supervising clinician shall provide the person with reasons, written in English

or French, and where appropriate in another language in addition to English or French, underlying that

opinion, which the competent authorities on arrival should take into account. The supervising clinician

and competent authorities shall inform such persons of any risk associated with non-vaccination and

with the non-use of prophylaxis in accordance with paragraph 4 of Article 23.

Annex 6 International Health Regulations (2005)

55

10. An equivalent document issued by the Armed Forces to an active member of those Forces shall

be accepted in lieu of an international certificate in the form shown in this Annex if:

(a) it embodies medical information substantially the same as that required by such a form;

and

(b) it contains a statement in English or in French and where appropriate in another language

in addition to English or French recording the nature and date of the vaccination or prophylaxis

and to the effectindicating that it is issued in accordance with this paragraph.

International Health Regulations (2005) Annex 6

56

MODEL INTERNATIONAL CERTIFICATE OF VACCINATION OR

PROPHYLAXIS

This is to certify that [name] ..................................., date of birth ..................., sex ...............................,

nationality ...................................., national identification document, if applicable .............................

whose signature follows1 ……………………………………............, or, if applicable:

name of the parent or guardian ………………………………..

signature of the parent or guardian1 ………………………………..

has on the date indicated been vaccinated or received prophylaxis against:

(name of disease or condition) ………………………………………………….

in accordance with the International Health Regulations.

Vaccine or

prophylaxis Date

Name of supervising clinician, or

relevant authority responsible for

issuing this certificate, or for

overseeing the administering centre

Signature and

professional status

of supervising

clinician1

Manufacturer and batch

No. of vaccine or

prophylaxis

Certificate valid

from ....... until

............

Official stamp of

administering centre1

1.

2.

This certificate is valid only if the vaccine or prophylaxis used has been approved by the World

Health Organization.

This certificate in non-digital format must be signed in the hand ofby the clinician, who shall be

a medical practitioner or other authorized health worker, supervising the administration of the vaccine

or prophylaxis. The certificate must also bear the official stamp of the administering centre; however,

this shall not be an accepted substitute for the signature. Regardless of the format in which this

certificate has been issued, it must bear the name of the clinician supervising the administration

of the vaccine or prophylaxis, or of the relevant authority responsible for issuing the certificate or

overseeing the administering centre.

Any amendment of this certificate, or erasure, or failure to complete any part of it, may render it

invalid.

The validity of this certificate shall extend until the date indicated for the particular vaccination

or prophylaxis. The certificate shall be fully completed in English or in French. The certificate may also

be completed in another language on the same document, in addition to either English or French.

1 Only applies to certificates issued in non-digital format.

International Health Regulations (2005)

57

ANNEX 7

REQUIREMENTS CONCERNING VACCINATION OR PROPHYLAXIS FOR

SPECIFIC DISEASES1

1. In addition to any recommendation concerning vaccination or prophylaxis, the following diseases

are those specifically designated under these Regulations for which proof of vaccination or prophylaxis

may be required for travellers as a condition of entry to a State Party:

Vaccination against yellow fever.

2. Recommendations and requirements for vaccination against yellow fever:

(a) For the purpose of this Annex:

(i) the incubation period of yellow fever is six days;

(ii) yellow fever vaccines approved by WHO provide protection against infection starting

10 days following the administration of the vaccine;

(iii) this protection continues for the life of the person vaccinated; and

(iv) the validity of a certificate of vaccination against yellow fever shall extend for the

life of the person vaccinated, beginning 10 days after the date of vaccination.

(b) Vaccination against yellow fever may be required of any traveller leaving an area where

the Organization has determined that a risk of yellow fever transmission is present.

(c) If a traveller is in possession of a certificate of vaccination against yellow fever which is

not yet valid, the traveller may be permitted to depart, but the provisions of paragraph 2(h) of this

Annex may be applied on arrival.

(d) A traveller in possession of a valid certificate of vaccination against yellow fever shall not

be treated as suspect, even if coming from an area where the Organization has determined that a

risk of yellow fever transmission is present.

(e) In accordance with paragraph 1 of Annex 6 the yellow fever vaccine used must be approved

by the Organization.

(f) States Parties shall designate specific yellow fever vaccination centres within their

territories in order to ensure the quality and safety of the procedures and materials employed.

(g) Every person employed at a point of entry in an area where the Organization has determined

that a risk of yellow fever transmission is present, and every member of the crew of a conveyance

using any such point of entry, shall be in possession of a valid certificate of vaccination against

yellow fever.

1 The Amended by the Sixty-seventh World Health Assembly, through resolution WHA67.13 (2014), adopted

amendments as to Annex 7, paras. 2 (a) subparagraphs (iii) and (iv). These amendments of Section 2(a) in resolution

WHA67.13, 24 May 2014. This amendment entered into force for all IHR (2005) States Parties to the International Health

Regulations (2005) as of 11 July 2016.

International Health Regulations (2005) Annex 7

58

(h) A State Party, in whose territory vectors of yellow fever are present, may require a traveller

from an area where the Organization has determined that a risk of yellow fever transmission is

present, who is unable to produce a valid certificate of vaccination against yellow fever, to be

quarantined until the certificate becomes valid, or until a period of not more than six days,

reckoned from the date of last possible exposure to infection, has elapsed, whichever occurs first.

(i) Travellers who possess an exemption from yellow fever vaccination, signed by an

authorized medical officer or an authorized health worker, may nevertheless be allowed entry,

subject to the provisions of the foregoing paragraph of this Annex and to being provided with

information regarding protection from yellow fever vectors. Should the travellers not be

quarantined, they may be required to report any feverish or other symptoms to the competent

authority and be placed under surveillance.

International Health Regulations (2005)

59

ANNEX 8

MODEL OF MARITIMESHIP DECLARATION OF HEALTH

To be completed and submitted to the competent authorities by the masters of ships arriving from foreign ports.

Submitted at the port of ………………………………………….... Date …………

Name of ship or inland navigation vessel ……........……....… Registration/IMO No ...................arriving from ……..….…sailing to

............... (Nationality)(Flag of vessel) ……………………………………. Master’s name

.............................................................................................. Gross tonnage (ship) ……………..

Tonnage (inland navigation vessel) …………………

Valid Sanitation Control Exemption/Control Certificate carried on board? Yes ............ No …......... Issued at ….....…..…… date

…….......... Re-inspection required? Yes ……. No …….

Has ship/vessel visited an affected area identified by the World Health Organization? Yes ..... No ….. Port and date of visit

………........

List ports of call from commencement of voyage with dates of departure, or within past thirty days, whichever is shorter:

....................................................................................................................................................................................................

Upon request of the competent authority at the port of arrival, list crew members, passengers or other persons who have joined

ship/vessel since international voyage began or within past thirty days, whichever is shorter, including all ports/countries visited in

this period (add additional names to the attached schedule):

(1) Name …………………………………joined from: (1) ……….…..……....(2)…....…..…..……....(3)……………………..

(2) Name …………………………………joined from: (1) ……………...........(2)………………........(3)……………………..

(3) Name …………………………………joined from: (1) …………………...(2)…….....…...………(3)……………………..

Number of crew members on board ………… Number of passengers on board …………….

Health questions

(1) Has any person died on board during the voyage otherwise than as a result of accident? Yes .... No ….. If yes, state

particulars in attached schedule. Total no. of deaths ..........

(2) Is there on board or has there been during the international voyage any case of disease which you suspect to be of an

infectious nature? Yes ........ No …..... If yes, state particulars in attached schedule.

(3) Has the total number of ill passengers during the voyage been greater than normal/expected? Yes .... No ….. How many

ill persons? ..........

(4) Is there any ill person on board now? Yes ........ No …..... If yes, state particulars in attached schedule.

(5) Was a medical practitioner consulted? Yes ....... No …... If yes, state particulars of medical treatment or advice provided

in attached schedule.

(6) Are you aware of any condition on board which may lead to infection or spread of disease? Yes........ No…..... If yes,

state particulars in attached schedule.

(7) Has any sanitary measure (e.g. quarantine, isolation, disinfection or decontamination) been applied on board? Yes.......

No…... If yes, specify type, place and date ........................................................................................ ...............................

(8) Have any stowaways been found on board? Yes ....... No …... If yes, where did they join the ship (if known)?

....................................

(9) Is there a sick animal or pet on board? Yes ......... No ........

Note: In the absence of a surgeon, the master should regard the following symptoms as grounds for suspecting the existence of

a disease of an infectious nature:

(a) fever, persisting for several days or accompanied by (i) prostration; (ii) decreased consciousness; (iii) glandular

swelling; (iv) jaundice; (v) cough or shortness of breath; (vi) unusual bleeding; or (vii) paralysis.

(b) with or without fever: (i) any acute skin rash or eruption; (ii) severe vomiting (other than sea sickness);

(iii) severe diarrhoea; or (iv) recurrent convulsions.

I hereby declare that the particulars and answers to the questions given in this Declaration of Health (including the schedule)

are true and correct to the best of my knowledge and belief.

Signed ………………………………………….

Master

Countersigned ………………………………………….

Ship’s Surgeon (if carried)

Date ……………………………………………

International Health Regulations (2005) Annex 8

60

ATTACHMENT TO MODEL OF MARITIMESHIP DECLARATION OF HEALTH

Name Class or

rating Age Sex Nationality

Port, date joined

ship/vessel

Nature of

illness

Date of onset

of symptoms

Reported to

a port

medical

officer?

Disposal of

case1

Drugs,

medicines or

other

treatment

given to

patient

Comments

1 State: (1) whether the person recovered, is still ill or died; and (2) whether the person is still on board, was

evacuated (including the name of the port or airport), or was buried at sea.

International Health Regulations (2005)

61

ANNEX 9

THIS DOCUMENT IS PART OF THE AIRCRAFT GENERAL DECLARATION,

PROMULGATED BY THE INTERNATIONAL CIVIL AVIATION ORGANIZATION

HEALTH PART OF THE AIRCRAFT GENERAL DECLARATION1

Declaration of Health

Name and seat number or function of persons on board with illnesses other than airsickness or the effects of accidents, who may be suffering from a communicable disease (a fever – temperature

38°C/100 °F or greater – associated with one or more of the following signs or symptoms, e.g. appearing obviously unwell; persistent coughing; impaired breathing; persistent diarrhoea; persistent

vomiting; skin rash; bruising or bleeding without previous injury; or confusion of recent onset,

increases the likelihood that the person is suffering a communicable disease) as well as such cases of illness disembarked during a previous stop…………………...................................................................

……………………………………………………………………………………………………...…...

Details of each disinsecting or sanitary treatment (place, date, time, method) during the flight. If

no disinsecting has been carried out during the flight, give details of most recent disinsecting ……………………………………………………………………………….…………………………

…………………………………………………..………………………………………..………….…

Signature, if required, with time and date

Crew member concerned

1 This version of the Aircraft General Declaration entered into force on 15 July 2007. The full document may be

obtained from the website of the International Civil Aviation Organization at http://www.icao.int.

Saatja: <[email protected]>

Saadetud: 19.09.2024 18:08

Teema: WHO: C.L.40.2024 (IHR notification of amendments)

Dear States Parties to the International Health Regulations (2005),Please

find attached, in the six official languages, C.L.40.2024 regarding the

notification of amendments to the International Health Regulations

(2005).Best regards,Department of Governing BodiesWorld Health

Organization***DO NOT RESPOND TO THIS E-MAIL. YOU WILL NOT RECEIVE A

REPLY***