The lack of effective international efforts to address many of the factors that encourage the emergence and spread of infectious diseases (e.g., migration, environmental change, antimicrobial resistance, and armed conflict) increases the potential significance of the IHR 2005 to the future of global health, Fidler argues. He notes that the emergence of influenza A (H1N1) has brought the IHR 2005 renewed political attention and appreciation of its value, and it has demonstrated the WHO’s ability to implement the regulations in a crisis. However, the IHR 2005 must weather far more severe crises than this epidemic to date, Fidler concludes, as well as a host of global trends that threaten to derail advances toward global public health governance.


David Heymann, M.D.1

World Health Organization

Communicating Disease Risk: Then and Now

The 2003 outbreak of SARS was an event of singular importance in demonstrating the need for global public health governance. It began when a physician, who had treated patients with an unknown respiratory disease in the Guangdong Province of China, traveled to Hong Kong on February 21, 2003. From his visit to Hong Kong, the disease that was eventually named SARS began to spread around the world. When the WHO was alerted about the outbreak of an unknown respiratory disease in Hong Kong on March 12, there was only one way to provide 194 ministers of health throughout the world with the information about this threat simultaneously: a press release. It soon became clear that the message had been received: on March 14, the health ministries of Canada and Singapore reported to WHO that persons in their countries who had recently traveled to Hong Kong had a similar disease.

Early Saturday morning, March 15, in Geneva, the WHO duty officer received a call from the Singapore health ministry. A medical doctor who had treated the patients in Singapore had traveled to the United States for a medical conference and was on a return flight to Frankfurt, Germany. WHO was asked to help this medical doctor get medical care in Frankfurt and this was accomplished. At the same time it became evident that the disease was spreading internationally, and, once again, the most effective method of communicating this recent development simultaneously was by press release—one that gave the disease a name, provided a case definition,


At the time of the workshop, Dr. Heymann was Assistant Director-General for Communicable Diseases and Representative of the Director-General for Polio Eradication at the World Health Organization; however, at the time of publication he is Chairman of the Health Protection Agency.

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