Countries Ordered to Report Disease Outbreaks

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International law requires nations to report outbreaks of only three diseases: cholera, plague and yellow fever. That's changing under sweeping new regulations approved this week that require nations to tell the World Health Organization about any outbreak with the potential to spread across borders.


In Geneva this week, the nations of the world voted to give the World Health Organization sweeping new powers. Currently, WHO requires nations to report outbreaks of only three diseases: cholera, plague and yellow fever. The new rules take affect in two years, and they'll help the world cope with nasty surprises like SARS and pandemic flu. NPR's Richard Knox has this report.

RICHARD KNOX reporting:

Anthrax, avian flu, Ebola, Marburg fever, SARS, even smallpox and polio--nations don't have to notify the WHO about any of these or many others. And if something new shows up, as SARS did in 2002, or if terrorists mount an attack with germs or radioactivity, the WHO just has to hope it finds out because nations have no obligation to tell.

Dr. MAX HARDIMAN (World Health Organization): The fact that we didn't have any regulations before meant that nobody knew what authority WHO had or hadn't.

KNOX: Dr. Max Hardiman of the WHO guided a five-year process that led to this week's approval of new international health regulations. There are pages and pages of legalese, but Hardiman says the document also contains lists of plain-language questions to help a nation decide when it must report an outbreak.

Dr. HARDIMAN: Is it unexpected or unusual? Is it happening in a tourist center? Is it happening very close to a big international airport? Is it happening among people who are likely to be traveling, refugees or in a particularly high-risk population, where there may be low immunity or undernourished? Is it failing to respond to therapy?

KNOX: The new regulations didn't get much public attention. They're pretty inside stuff. But Larry Gostin of Georgetown University says they're a landmark in international law.

Mr. LARRY GOSTIN (Georgetown University): This is quite revolutionary, these new regulations. They transform everything. I think they will make WHO relevant for the first time in a long time, maybe the first time ever in a legal sense.

KNOX: Not only will every nation have to report any disease that might spread beyond its borders, it's also obligated to let WHO experts in to investigate. And nations are expected to build up their own ability to monitor, detect and diagnose disease. And if they don't do these things? Well, WHO can't send in troops, but Gostin says that doesn't mean it's powerless.

Mr. GOSTIN: You have a regime of international law, which has moral force and has political force. So if a country said no, there would be enormous legal and political pressure on them.

KNOX: If necessary, the WHO can impose travel restrictions. It can require travelers to be screened. And probably most important, if a nation won't report an outbreak, WHO will have authority to circumvent official sources. It can call in its own sources of information, say, from e-mailing scientists and news media. Gostin says that may be unprecedented.

Mr. GOSTIN: This is, I think, the first significant diminution of governmental sovereignty. It does set a principle that governments can be circumvented.

KNOX: Surprisingly, the new regs were adopted by consensus. And all nations, except Taiwan, are members of the WHO. That means even China, which was slow to report SARS, didn't dissent and neither did the United States.

Mr. GOSTIN: The Bush administration is not known for its happiness with international law, and it would take something really important to make them sign on the way they have. And I think what has been politically salient to them is anthrax, SARS, pandemic flu and HIV/AIDS. They would have looked very foolish not to have gone along with it.

KNOX: WHO officials hope nations won't wait two years for the new rules to take effect, not when everybody's worried about pandemic flu. Richard Knox, NPR News.

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