Revisions to the International Health Regulations.

We appreciate the attention The Lancet (Nov 6, p 1639) has given to the process at WHO to revise the International Health Regulations (IHR). We agree that surveillance and response capacities are both essential to control public-health emergencies effectively. Your comments on pandemic influenza rightly address the need to revise the current IHR while at the same time promoting vaccine development.

The Editorial is incorrect, however, when it states, “The new IHR include no predefined lists of diseases; instead states are required to notify WHO of ‘all events potentially constituting a public health emergency.’” The draft regulations, which were the subject of negotiations in Geneva on Nov 1–12, 2004, contain a list of specific diseases for notification to WHO.

The approach taken, detailed in Annex 2 of the draft IHR, contains a list of specific diseases, including severe acute respiratory syndrome (SARS), poliomyelitis, and smallpox, which require immediate notification to WHO and a separate list of diseases that trigger the use of an algorithm. The algorithm is used to ascertain when a potential event is sufficiently serious to require notification to WHO.

Many WHO member states, including the USA, are convinced about the importance of integrating a list of diseases into the algorithm for notification to WHO of potential public-health emergencies. In fact, WHO is expected to convene an expert group to refine the proposed algorithm and integrated disease list for the next meeting of the negotiating group in February, 2005.