Implementation of the IHR Joint External Evaluation: Taiwan's Experiences

Lo, Yi-Chun

T he beginning of the 21st century has been marked by a series of epidemics and pandemics, including extensively drug-resistant tuberculosis (XDRTB) worldwide, anthrax in the United States, severe acute respiratory syndrome (SARS) in East Asia and Canada, avian influenza [A(H5N1) and A(H7N9)] in Southeast Asia and China, Middle East respiratory syndrome (MERS) in the Middle East and South Korea, Ebola virus disease in West Africa, and, most recently, Zika virus disease in the Americas. These emerging infectious diseases as a global health burden are thought to be driven, at least partly, by the emergence and spread of new pathogens; globalization of travel, food, and medicines; the rise of antimicrobial resistance; and intentional engineering or accidental release of biohazard agents. 1 The morbidity, mortality, and economic impact of such public health threats can be enormous. For example, the Ebola outbreak in West Africa during 2014-15 was estimated to have resulted in approximately 28,000 human cases, at least 11,000 deaths, and economic loss of more than $30 billion. 2, 3 In response to international public health emergencies such as SARS, the World Health Organization (WHO) established the International Health Regulations (IHR) (2005) , which require that all countries have the capability to detect, assess, report, and respond-that is, detect potential threats through surveillance systems and laboratories, make decisions in public health emergencies, report specific diseases and any potential international public health emergencies, and respond to public health events. 4 However, the WHO reported that by 2012, fewer than 20% of the countries had met the IHR goals, and by 2014, only approximately 30% of the countries were fully prepared to detect and respond to an outbreak. 5 In the wake of the Ebola outbreak in West Africa, several high-level panel reports highlighted the pitfalls of relying solely on a government's voluntary self-assessment to measure core capacities. [6] [7] [8] The panels unanimously recommended that all countries should commit to participate in regular, independent peer review or external assessment of their core capacities. In the 68th World Health Assembly in 2015, the IHR Review Committee on Second Extensions for Establishing National Public Health Capacities and on IHR Implementation recommended that countries move from exclusive self-evaluation to approaches that combine selfevaluation, peer review, and voluntary external evaluations involving a combination of domestic and independent experts. 5 In light of this, WHO, in collaboration with the Global Health Security Agenda (GHSA) launched in February 2014, developed the Joint External Evaluation ( JEE) process and JEE tool in February 2016 as part of the IHR (2005) Monitoring and Evaluation framework. 9 The JEE tool integrated the GHSA assessment tool, which was intended to assess country capacity to prevent, detect, and respond to public health threats independently of whether they are naturally occurring, deliberate, or accidental. Countries are encouraged to request a JEE mission to help them identify the most urgent needs in their health system with the expectation that the JEE can help engage with stakeholders and partners to support a country's preparedness for outbreaks and health emergencies. Bangladesh, Ethiopia, Liberia, Mozambique, Pakistan, Tanzania, and the United States were among the first countries to have completed and published an extern