Bulletin of the World Health Organization
Volume 92, Number 5, May 2014, 309-384
http://www.who.int/bulletin/volumes/92/5/en/

Editorial
International Health Regulations (2005): taking stock
Isabelle Nuttall a
a. Department of Global Capacities, Alert and Response, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland.
Bulletin of the World Health Organization 2014;92:310. doi: http://dx.doi.org/10.2471/BLT.14.138990
Excerpt
In 2007, the coming into force of the revised International Health Regulations (2005)1 [IHR (2005)] – the most powerful, far-reaching instrument of international law ever conceived to protect people’s health – was met with excitement. The purpose behind the IHR (2005) was to prevent and detect international health threats with minimal disruption to travel, trade and the economy. A simple logic lay at the heart of the IHR (2005): in an interconnected, interdependent world, a threat in one country puts all countries at risk.
Today, international public health threats, be they infectious or not, are harder to prevent and detect because of the mass movement of people, goods and animals facilitated by faster, cheaper modes of travel and complex trade systems. In the last couple of years alone, emerging pathogens such as avian influenza viruses A(H7N9) and A(H10N8) and the Middle East respiratory syndrome coronavirus have for the first time been reported to cause human disease. Three out of four new diseases affecting humans emerge at the human–animal interface.
To ensure compliance with IHR (2005), countries were given until June 2012 to develop systems with capacity in several core areas: legislation and policy; coordination and IHR national focal points; preparedness, surveillance and response; risk communication; human resources; laboratory practice; and points of entry. However, the magnitude of the work led more than 100 countries to request a two-year extension for building up capacity in these domains. In June 2014 this extension period will be over and further requests for extension are expected. What does this mean?
…In terms of the IHR, it is time to take stock of the capacities amassed so far and those that still need to be developed. Countries have yet to implement their concrete plans to meet the capacity requirements of the IHR (2005). Some target capacities call for substantial investment, either from national budgets or international cooperation, and hence renewed financial commitments; others could probably be achieved through improved cost–effectiveness and collaboration between different sectors, including the animal and human health sectors. WHO is also striving, through its programme of reform, to serve its Member States better and in a more coordinated manner so that we can all live in a more secure and prosperous world.

Perspectives
Health system cost of delivering routine vaccination in low- and lower-middle income countries: what is needed over the next decade?
Patrick Lydon a, Gian Gandhi b, Jos Vandelaer b & Jean-Marie Okwo-Bele a
a. Immunization, Vaccines and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
b. United Nations Children’s Fund, New York, United States of America.
(Submitted: 12 September 2013 – Revised version received: 23 January 2014 – Accepted: 31 January 2014 – Published online: 07 February 2014.)
Bulletin of the World Health Organization 2014;92:382-384. doi: http://dx.doi.org/10.2471/BLT.13.130146
Excerpt
On the eve of the 40th anniversary of launching of the Expanded Programme on Immunization (EPI) in 1974, during the twenty-seventh World Health Assembly (WHA), fundamental questions about the level of financing needed to sustain achievements and scale up the EPI in low- and lower-middle income countries continue to permeate the discourse on the economics of immunization. The answer to this question is all the more important in light of the fact that at the sixty-fifth WHA in 2012, ministers of health embraced the Global Vaccine Action Plan (GVAP) – a 10-year global strategic plan for immunization.1 But how much – and in what areas – are the investments needed for this decade?
Today, improved transparency in pricing information allows for relatively accurate vaccine cost estimates.2 Unfortunately, trends in the health system costs of delivering vaccination beyond the cost of the vaccines themselves continue to be poorly understood…