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U.S. Department of Health and Human Services

The U.S. International Health Regulations National Focal Point

The U.S. International Health Regulations National Focal Point (U.S. IHR NFP) was established in July 2007 within in the Office of the Assistant Secretary for Preparedness and Response through the U.S. government interagency IHR implementation effort.

Since 2007, the U.S. IHR NFP has led day-to-day IHR-relevant event assessment, reporting and coordination efforts on hundreds of public health events, including emerging/reemerging diseases, such as Zika and Ebola virus, foodborne illnesses, contaminated medical products, and vaccine preventable diseases, among others. The work of the U.S. IHR NFP has contributed to global health security policy development and recognition that communicating the evidence-based possibility of a major public health event is critical to protecting U.S. and global populations from future public health threats.

The U.S. NFP is a three-part structure composed of:

  • The IHR Program in the Division of International Health Security, which provides policy and procedural oversight for all IHR obligations (both core and expanded NFP functions).
  • The Assistant Secretary for Preparedness and Response, who provides overall leadership and serves as the approval authority for all official IHR communications.
  • The HHS Secretary’s Operations Center (SOC) managed by the ASPR Office of Emergency Management, which provides 24/7/365 situational awareness and communications nationally and internationally in close coordination with operation centers of other federal departments and agencies.
Figure 1: 
U.S. National Focal Point Structure

Graphic of the U.S. International Health Regulations National Focal Point structure, described in the previous text.

NFP Structure and Essential Functions

IHR Program

The IHR Program is responsible for the day-to-day operations and management of procedures for communication and coordination of the three components of the U.S. IHR NFP. IHR Program Action Officers staff the IHR Program and operate under a 24/7/365 duty schedule to ensure continual monitoring of and timely response to domestic and international public health events.

The IHR Program oversees all core U.S. NFP activities, such as:

  • Notifying potential public health emergencies of international concern (PHEIC) to the WHO
  • Triaging and directing IHR-related communications to U.S. departments and agencies and other domestic partners and stakeholders
  • Preparing and disseminating official IHR-related messages to relevant domestic and international stakeholders
  • Coordinating and facilitating communications and information sharing between U.S. departments and agencies, the WHO/Pan American Health Organization and other countries’ NFPs in order to facilitate efficient public health communications and information sharing

IHR Program specific responsibilities include:

  • Overseeing and coordinating federal U.S. government assessment of events that may constitute potential PHEICs
  • Collaborating with U.S. government technical agencies to perform public health risk assessment using Annex 2 of the IHR
  • Identifying and resolving U.S. government policy issues related to international public health reporting
  • Overseeing domestic IHR obligations and coordinating IHR-relevant policies, positions, and process  implementation efforts
  • Coordinating the U.S. government in monitoring and evaluation of IHR capacities, and annually reporting on the status of domestic IHR capacities to WHO
  • Advising U.S. government interagency leadership and technical staff on IHR-relevant policy
  • Coordinating IHR-relevant efforts with international partners, organizations, and the U.S. government
  • Leading efforts on bilateral policy exchanges with foreign NFPs

Assistant Secretary for Preparedness and Response

The ASPR serves as the Message Authorizing Official for all official communications to WHO on behalf of the HHS Secretary and the U.S. government in compliance with the IHR. Such messages include notifications of public health events and status reports. The ASPR must approve public health risk assessments provided by the technical experts from other U.S. government departments or agencies prior to the U.S. NFP sending out notifications of a potential PHEIC to the WHO.

HHS Secretary’s Operations Center

The HHS Secretary’s Operations Center (SOC),following existing IHR-relevant protocols established by the ASPR Office of Emergency Management, in collaboration with the IHR Program, maintains 24/7/365 situational awareness and communication capabilities for the U.S. IHR NFP. The SOC allows the U.S. NFP to receive and transmit communications as needed. The SOC serves a vital role in receiving and routing communications properly during a public health emergency, as well as maintaining general, public health situational awareness.

The Role of the State, Local and Territorial Health Officials in the U.S. Government and for IHR Notifications to WHO

State, local and territorial health officials, including state epidemiologists and the state and local public health event detection and notification/reporting systems they manage, are integral components of the federal IHR notification process. State, local and territorial health officials are responsible for ensuring notification of nationally notifiable diseases/conditions to the federal government. Under the existing agreement with the U.S. CDC, some nationally notifiable conditions are categorized further as immediate, urgent, or extremely urgent to better define notification timelines and processing requirements.

The notification process for immediate, urgent, or extremely urgent nationally notifiable diseases/conditions can be found in the Council for State and Territorial Epidemiologists (CSTE) position paper, Process Statement for Immediately Nationally Notifiable Conditions (09-SI-04). Conditions or situations judged by state health officials to require immediate notification, but not formally listed as immediately notifiable, may also be notified through the existing notification process.

Assessing and Communicating Potential Public Health Emergencies of International Concern

Recognizing the evidence-based possibility of a major public health threat is critical to protecting U.S. and global populations from future public health threats. Since 2007, globally there have been hundreds of potential PHEICs notified to the WHO. Officially declared PHEICs are a rare occurrence and only four actual PHEICs have been declared by the WHO Director General, who is the sole authority for declaring a PHEIC. The four declared PHEICs were:

  • 2009’s pandemic influenza H1N1
  • 2014’s West African Ebola virus outbreak
  • 2014’s polio outbreak
  • 2015’s Zika virus outbreak in the Americas, Asia, Oceania, and Pacific Islands

Official reporting of potential PHEICS requires technical event/risk assessments from U.S. government departments and agencies, like the CDC, U.S. Food and Drug Administration, U.S. Department of Defense, U.S. Department of Agriculture, U.S. Department of the Interior, and others, WHO notification assessment using Annex 2 of the IHR, as well as official interagency clearance, and approval from the ASPR. In the United States, individual federal departments and agencies maintain their own internal structures and policies for interagency coordination related to public health surveillance, detection, and assessment of potential events, and communication of those events to the NFP. Federal agencies also have ongoing health security collaborations with U.S. state governments and other subnational health departments, non-governmental agencies in the United States, and governmental and non-governmental organizations outside of the United States, including the WHO. 

Figure 2:  Information Flow through the United States IHR Focal Point

Information Flow through the United States IHR Focal Point.
Between July 2007, when the United States formally adopted the revised IHR, and November 2016, the IHR Program coordinated the review and communication of 95 potential PHEICs and other public health events deemed reportable to the WHO. Hundreds of other NFP messages, notifications, and information sharing incidents have occurred as well. The chart below provides some information on the frequency and types of events notified by the U.S. IHR NFP to WHO.

Figure 3:  Timeline of International Health Regulations “Article 6” or “Article 7” notifications sent by the United States National Focal Point to the World Health Organization (WHO), August 2007 through September 2016.

Timeline of International Health Regulations “Article 6” or “Article 7” notifications sent by the United States National Focal Point to the World Health Organization (WHO), August 2007 through September 2016.

Monitoring Implementation of IHR Capacities in the United States

All WHO member countries are required to monitor and report their national progress made in implementing the IHR. As an extension of its NFP responsibilities, the U.S. IHR NFP organizes and manages the interagency process to monitor and evaluate national core capacities to prevent, detect, assess, report, and mitigate potential public health emergencies, whether naturally occurring, accidental, or man-made. 

The IHR Program developed and manages the U.S. government annual IHR assessment process, as one of the expanded functions of the U.S. IHR NFP, to fulfill the annual obligation to report on the status of domestic capacities to prevent, detect, assess, report, and mitigate potential public health emergencies, whether naturally occurring, accidental, or man-made. The IHR Program convenes federal policy and technical subject matter experts – representing more than 20 U.S. government departments and agencies – for consultations and domestic data review using the IHR questionnaire as the guide. This currently serves as the annual U.S. government forum that assesses domestic compliance and maintenance of IHR capacities in the United States.

In 2012, the U.S. communicated its compliance with the core capabilities of the IHR (2005) outlined in the IHR Core Capacity Monitoring Framework. Currently, the USG has met the IHR core capacity requirements based on the WHO annual IHR assessment questionnaire, affirmatively answering 98% of questions in the assessment.

To further support the annual review and continuous monitoring of U.S. domestic IHR capacities, ASPR’s IHR Program began aligning performance and program measures from the combined CDC Public Health Emergency Preparedness (PHEP) cooperative agreement and the ASPR Hospital Preparedness Program (HPP) with the IHR core capacities (table below). As a result, the U.S. government is better able to visualize and understand the growth and expansion of state and local elements of the U.S. public health system in the context of the IHR core capacities.

As the global framework for monitoring and evaluation of IHR capacities continues to be improved and refined, most recently with the development and implementation of the IHR Joint External Evaluation (JEE), the U.S. IHR NFP continues engagement in efforts to support strengthening and informing the global IHR Monitoring and Evaluation framework, as well as ensure monitoring and evaluation of domestic capacities.

Learn more about IHR Monitoring and Evaluation>>>

  • This page last reviewed: February 15, 2017