Skip to main content
    • Aa
    • Aa

The New International Health Regulations: Considerations for Global Public Health Surveillance


Global public health surveillance is critical for the identification and prevention of emerging and reemerging infectious diseases. The World Health Organization recently released revised International Health Regulations (IHR) that serve as global legislation and provide guidelines for surveillance systems. The IHR aim to identify and prevent spread of these infectious diseases; however, there are some practical challenges that limit the usability of these regulations. IHR requires Member States to build necessary infrastructure for global surveillance, which may not be possible in underdeveloped countries. A large degree of freedom is given to each individual government and therefore different levels of reporting are common, with substantial emphasis on passive reporting. The IHR need to be enforceable and enforced without impinging on government autonomy or human rights. Unstable governments and developing countries require increased assistance in setting up and maintaining surveillance systems. This article addresses some challenges and potential solutions to the ability of national governments to adhere to the global health surveillance requirements detailed in the IHR. The authors review some practical challenges such as inadequate surveillance and reporting infrastructure, and legal enforcement and maintenance of individual human rights. (Disaster Med Public Health Preparedness. 2007;1:117–121)

Corresponding author
Address correspondence to John S. Brownstein, Children’s Hospital Boston, Harvard Medical School, Boston, MA 02215(e-mail: Reprint requests to 1 Autumn St, Room 541, Boston, MA 02215.
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. H Feldmann , M Czub , S Jones , et alEmerging and re-emerging infectious diseases. Med Microbiol Immunol. 2002;191:6374.

2. DL Heymann , GR. Rodier Hot spots in a wired world: WHO surveillance of emerging and re-emerging infectious diseases. Lancet Infect Dis. 2001;1 (5):345353.

5. ME. Wilson Travel and the emergence of infectious diseases. Emerg Infect Dis. 1995;1:3946.

6. DL Heymann , GR. Rodier Global surveillance of communicable diseases. Emerg Infect Dis. 1998;4:362365.

7. JP. Woodall Global surveillance of emerging diseases: the ProMED-mail perspective. Cad Saude Publica. 2001;17 (Suppl):147154.

8. LO. Gostin International infectious disease law: revision of the World Health Organization’s International Health Regulations. JAMA. 2004;291:26232627.

10.How is WHO responding to global public health threats? PLoS Med. 2007;4:e197.

11. MG Baker , DP. Fidler Global public health surveillance under new international health regulations. Emerg Infect Dis. 2006;12:10581065.

12. LO Gostin , R Bayer , AL. Fairchild Ethical and legal challenges posed by severe acute respiratory syndrome: implications for the control of severe infectious disease threats. JAMA. 2003;290:32293237.

16. LO. Gostin Pandemic influenza: public health preparedness for the next global health emergency. J Law Med Ethics. 2004;32:565573.

17. JS Gear , GA Cassel , AJ Gear , et alOutbreake of Marburg virus disease in Johannesburg. BMJ. 1975;4:489493.

20. T Ramamurthy , S Garg , R Sharma , et alEmergence of novel strain of Vibrio cholerae with epidemic potential in southern and eastern India. Lancet. 1993;341:703704.

21. PM Sharp , E Bailes , RR Chaudhuri , CM Rodenburg , MO Santiago , BH. Hahn The origins of acquired immune deficiency syndrome viruses: where and when? Philos Trans R Soc Lond B Biol Sci. 2001;356:867876.

22. KD Mandl , JM Overhage , MM Wagner , et alImplementing syndromic surveillance: a practical guide informed by the early experience. J Am Med Inform Assoc. 2004;11:141150.

24. M Van Herp , V Parque , E Rackley , N. Ford Mortality, violence and lack of access to healthcare in the Democratic Republic of Congo. Disasters. 2003;27:141153.

25. PB. Spiegel HIV behavioural surveillance surveys in conflict and post-conflict situations: A call for improvement. Global Public Health. 2006;1:147156.

29. J. Woodall Official versus unofficial outbreak reporting through the Internet. Int J Med Inform. 1997;47:3134.

30. DL Heymann , G. Rodier Global surveillance, national surveillance, and SARS. Emerg Infect Dis. 2004;10:173175.

32. TW Grein , KB Kamara , G Rodier , et alRumors of disease in the global village: outbreak verification. Emerg Infect Dis. 2000;6:97102.

33. NM M’Ikanatha , DD Rohn , C Robertson , et alUse of the internet to enhance infectious disease surveillance and outbreak investigation. Biosecur Bioterror. 2006;4:293300.

35. M. Hugh-Jones Global awareness of disease outbreaks: the experience of ProMED-mail. Public Health Rep. 2001;116 (Suppl 2):2731.

36. J Woodall , CH. Calisher ProMED-mail: background and purpose. Emerg Infect Dis. 2001;7 (3):563.

37. LC Madoff , JP. Woodall The internet and the global monitoring of emerging diseases: lessons from the first 10 years of ProMED-mail. Arch Med Res. 2005;36:724730.

40. M. Larkin Technology and public health: Healthmap tracks global diseases. Lancet Infect Dis. 2007;7:91.

44. M Brodie , RE Flournoy , DE Altman , RJ Blendon , JM Benson , MD. Rosenbaum Health information, the Internet, and the digital divide. Health Aff (Millwood). 2000;19:255265.

46. I Arita , M Nakane , K Kojima , N Yoshihara , T Nakano , A. El-Gohary Role of a sentinel surveillance system in the context of global surveillance of infectious diseases. Lancet Infect Dis. 2004;4:171177.

47. PJ Guerin , RF Grais , JA Rottingen , AJ. Valleron Using European travellers as an early alert to detect emerging pathogens in countries with limited laboratory resources. BMC Public Health. 2007;7:8.

48. BR. Bloom Lessons from SARS. Science. 2003;300:701.

49. NS Deodhar , VL Yemul , K. Banerjee Plague that never was: a review of the alleged plague outbreaks in India in 1994. J Public Health Policy. 1998;19:184199.

50. DP. Fidler Emerging trends in international law concerning global infectious disease control. Emerg Infect Dis. 2003;9:285290.

51. U Schuklenk , KM. Gartland Confronting an influenza pandemic: ethical and scientific issues. Biochem Soc Trans. 2006;34 (Pt 6):11511154.

52. D. Butler Disease surveillance needs a revolution. Nature. 2006;440:67.

53. C Beyrer , V Suwanvanichkij , LC Mullany , et alResponding to AIDS, tuberculosis, malaria, and emerging infectious diseases in Burma: dilemmas of policy and practice. PLoS Med. 2006;3:e393.

54. H. Koh Why do nations obey international law? Yale Law J. 1997;106:25992659.

55. DP. Fidler Globalization, international law, and emerging infectious diseases. Emerg Infect Dis. 1996;2:7784.

56. JH. Tanne Tuberculosis case exposes flaws in international public health systems. BMJ. 2007;334:1187.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Disaster Medicine and Public Health Preparedness
  • ISSN: 1935-7893
  • EISSN: 1938-744X
  • URL: /core/journals/disaster-medicine-and-public-health-preparedness
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 2
Total number of PDF views: 15 *
Loading metrics...

Abstract views

Total abstract views: 192 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 26th May 2017. This data will be updated every 24 hours.