Current situation, issues and challenges

Member States of the WHO European Region are diverse in terms of geographical and population sizes, economic performance, epidemiological and risk profiles, health system maturity and other factors that might influence their health emergency preparedness and response capacity. The Region is also home to major global air and sea transportation hubs that enable the movement of passengers and cargo around the world. Several Member States also have overseas territories, which introduce additional challenges to ensuring health emergency preparedness across the Region.

Since the entry into force of the IHR (2005) in 2007, WHO has been actively assisting States Parties in further developing IHR (2005) core capacities and, where necessary, has coordinated and assisted in the provision of essential services to States Parties and vulnerable populations affected by emergencies. In the WHO European Region, most States Parties have made good progress in implementing the IHR (2005), but multiple challenges remain.

The information-sharing network under the IHR (2005) is one of the key elements of success in the Region’s overall health security. National IHR Focal Points (NFPs) notify WHO of any potential public health events of international concern. On average, 55% of events detected by WHO in 2017 were reported by NFPs, an increase from just 24% in 2007. The timeliness of information sharing has also improved and the use of the Event Information System, through which event-related information is disseminated to NFPs, has increased continuously over the past 10 years.

States Parties have made efforts to encourage sectors other than health to contribute to assessments, planning and interventions aimed at strengthening preparedness and response capacities under the IHR (2005). Nevertheless, effective multisectoral collaboration remains a challenge in many countries. In some States Parties, IHR implementation is perceived as being the sole responsibility of the national health sector. Insufficient legislation or authority to fully operationalize IHR (2005) requirements and to convene the necessary sectors often hinders the effective operation of the NFPs. Legislation outlining roles and responsibilities during emergency situations often lacks the necessary provisions for coordinating an effective and timely response.

Surveillance systems are frequently under-resourced and do not allow for reliable and timely detection, assessment and notification of potential public health events of international concern. Furthermore, formal mechanisms for sharing data between sectors, such as agriculture, veterinary, environment and trade, are often insufficient. Workforce capacity remains limited, particularly in the areas of diagnosis, clinical management, investigation and response.

Laboratory capacity and collaboration through networks has improved in Member States of the WHO European Region, particularly for disease-specific programmes, such as poliomyelitis, measles and rubella, tuberculosis, HIV/AIDS and influenza. However, national public health laboratories and national networks in some Member States of the Region have not yet reached adequate capacity.

An emphasis on strengthening public health capacities at points of entry has improved arrangements for the management of infectious disease, and many States Parties have developed multisectoral public health emergency response plans at designated points of entry. Nevertheless, coordination between national health surveillance mechanisms, the NFPs and the various sectors and authorities operating at the points of entry is often insufficient.

The importance of establishing public health emergency operation centres to coordinate health interventions during emergencies has been recognized and acted on in many, but not all, States Parties. Similarly, risk communication capacity in compliance with IHR (2005) requirements has been scaled up. Yet, the coordination among agencies during the response, to ensure sustained human and financial resources and engagement with communities, needs to be improved.

A lack of accurate information on the status of IHR (2005) capacities and implementation at the country level is a challenge, which impedes the further needs-based capacity development that is required. In 2016, in the European Region, only 35 of 55 States Parties fulfilled their annual IHR (2005) reporting obligations. In 2016 and 2017 States Parties and WHO have taken steps to build a more accurate picture of capacities using other forms of assessment to complement the obligatory annual reporting.