The revised regulations reflect a growing understanding that the best way to prevent the global spread of diseases is to detect and contain them while they are still local. WHO member states have obligations to rapidly assess and alert the global community about potential disease threats as well as to prevent and control the spread of disease inside and beyond their borders. Compared with the previous regulations, adopted in 1969 (12), IHR (2005) expands the scope of internationally reportable diseases and events, provides criteria for identifying novel epidemic events, and specifies conditions for involvement of the international community in outbreak responses. The revision includes the following 5 substantive changes.

Because weak national public health capabilities undermine efforts to strengthen global public health security, IHR (2005) imposes substantial responsibilities on countries to improve public health capacity and infrastructure. However, despite the broad new goals included in IHR (2005), improvements in global public health security will depend on what member states are actually able to do. Success will rely on the capacity and performance of national public health systems (15), anchored by strong national public health institutes (NPHIs). Low-resource countries, which are particularly vulnerable to emerging threats, will be particularly challenged by the IHR (2005) requirements and the need to ensure an appropriate and coordinated public health response to health emergencies.

Many countries have been well served by centralizing their public health expertise and activities within 1 institution or network of institutions that provides leadership and coordination for public health ( 18; unpub. data). Examples include the US Centers for Disease Control and Prevention, the National Public Health Institute of Finland, and the Chinese Center for Disease Control and Prevention. These NPHIs are usually governmental or quasi-governmental agencies with a central focus and organizational structure that allow coordination of national public health service delivery and ensure a country’s ability to detect, investigate, and respond to public health emergencies. The core functions of an NPHI have been defined (unpub. data) and include evaluation and analysis of health status; public health surveillance, problem investigation, and control of risks and threats to public health; and public health research.

Given the scope and range of their activities, NPHIs are a vital asset to health development and security and will have a critically important role in implementing IHR (2005), whether as national focal points or as operational partners in fulfilling the requirements of the regulations. Unfortunately, however, many countries still either have no NPHIs or have institutes with severely limited capacities and capabilities relative to the need. Even in countries with strong NPHIs, unpredictable and rapidly evolving health threats can quickly overwhelm capacity and inhibit a timely and complete response.

A new organization, the International Association of National Public Health Institutes (IANPHI, www.ianphi.org), was created to address these gaps through the enhancement and proliferation of NPHIs throughout the world. Founded in 2006 by 39 NPHI directors who recognized the importance of strong national public health capacity and the mutual benefits of shared information, experience, and expertise, IANPHI aims to be a catalyst for sustained improvements in public health capacity and infrastructure globally. With the partnership of WHO and funding first from the Rockefeller Foundation and now from the Bill and Melinda Gates Foundation, the organization focuses on strengthening public health capacity in low-resource countries by strengthening NPHIs and on providing tools and a context that will support all NPHIs. IANPHI is also a professional association for NPHI directors; it fosters leadership development and advocacy for public health and collaborates with WHO.

Since early 2006, the founding members have continued to expand the network and put their shared vision into practice. IANPHI is managed by an executive board and a secretariat located both in Finland and in the United States. With nearly 50 current members and an ambitious agenda for collaboration, service, and growth, IANPHI is committed to a vision of a robust and fully integrated global network of NPHIs equipped to address critical public health challenges. Its mission is to strengthen and reinvigorate existing NPHIs, create new NPHIs where none exist, and provide funded grants to support NPHI capacity development priorities.

IANPHI achieves its service mission through a 3-part approach of advocacy, technical assistance, and linkages. IANPHI advocates for NPHI development and proliferation through partnerships with key global health organizations, such as WHO. Through these partnerships, IANPHI ensures that NPHIs are considered in major global public health initiatives and that public health and the work of NPHIs are included in efforts to strengthen health systems.

Assistance to NPHIs in low-resource countries is provided through 3 grant programs. A short-term technical assistance program helps countries quickly resolve priority gaps in NPHI capability and infrastructure. A medium-term capacity-building program helps NPHIs address high-priority needs for up to 3 years. IANPHI’s long-term grant program, the most intensive of the assistance efforts, will help create NPHIs in low-resource countries that currently lack a central public health focus. With funding from a $20 million grant from the Bill and Melinda Gates Foundation, the organization is committed to implementing 60 NPHI development projects by 2011.

As of June 2007, IANPHI had awarded technical assistance grants to public health institutes in 5 nations. The new awards include 3 short-term grants to NPHIs in Thailand, Uganda, and Iran to support training and infrastructure development. A medium-term grant to the Nigerian Institute of Medical Research will support sustainable improvements in disease surveillance, outbreak investigation, and emergency preparedness and strengthen linkages with other groups working to advance public health in the country; special focus will be on public health laboratory capacity building and integration of surveillance, epidemiology, and laboratory programs. Colombia’s Institutos Nacional de Salud was awarded a medium-term grant to establish a pilot chronic disease study site to generate, collect, and disseminate chronic disease data by using multiple mechanisms. The activities are designed to yield a sustainable network of surveillance and research sites to guide national-level public health decision making.

The cornerstone of the IANPHI approach is a peer-assistance model for NPHI strengthening and enhancement, with an emphasis on countries without NPHIs or with NPHIs in their early stages. Experts from IANPHI member institutes provide technical assistance and project support targeted at critical NPHI needs. Teams are guided by the Framework for the Creation and Development of NPHIs (www.ianphi.org/?action=arkisto&RYHMA=47&ID=&valittu=8), a product of IANPHI in partnership with WHO. The Framework provides a working definition of an NPHI and suggests a process for creating or enhancing an institute. By defining the critical characteristics of an NPHI, IANPHI hopes to bring specificity to the organization’s vision, align efforts to assist low-resource countries in building NPHIs, and provide benchmarks and resources to help any country assess and improve the functioning of its NPHI. To that end, IANPHI has also developed an NPHI toolkit (www.sph.emory.edu/IANPHI), which provides access to a variety of Web-based information resources for countries, NPHIs, and IANPHI peer-assistance teams to use as they work to assess, develop, and improve NPHIs and build public health capacity around the world.

Through strategies to define and develop core public health functions and to share expertise, IANPHI helps NPHIs sharpen their focus and raise standards of performance. IANPHI also links NPHIs through annual meetings, regional events, leadership development activities, research seed grants, and communication outlets including a website, newsletter, and listserv. By fostering an international community of public health leadership, IANPHI helps NPHIs gain the benefits of shared information, experience, and expertise to address public health threats and opportunities. Through its grant program and other activities, IANPHI aims to help national governments develop organizational infrastructures to devise and implement comprehensive public health priorities, meet global public health goals, develop workforce capacity, effectively absorb donor funds, address emerging threats, and improve the health of their populations (18).

In today’s global environment, every country confronts similar challenges in keeping its population healthy and preventing the cross-border spread of disease. SARS demonstrated this dramatically in 2003, and the ongoing challenges posed by avian influenza have focused attention on the need for global pandemic influenza preparedness. Polio has reemerged in countries that had virtually eradicated it, while HIV/AIDS and other diseases continue to threaten the stability of communities around the world. Recent examples of emerging and reemerging diseases of global significance are the resurgence of dengue in tropical and subtropical areas of the world; the spread and establishment of Japanese encephalitis and West Nile viruses in new habitats and environments; and the reoccurrence and spread of chikungunya virus in India, East Africa, and several Indian Ocean islands (19,20). As life expectancy increases worldwide, issues related to noncommunicable conditions are also becoming increasingly common to all. By working within the collaborative framework provided by IHR (2005), countries can benefit through improved national and international surveillance; improved systems for rapid detection of and response to public health emergencies; standardized rules for evaluation, control, and resolution of urgent events; and mechanisms to increase national and local public health security.

Nonetheless, the success of IHR (2005) and other global public health initiatives such as the Millennium Development Goals depends on strong national public health systems with competent, well-trained staff and well-equipped facilities. By targeting the core of public health systems, especially in low-resource countries that currently lag behind in public health capacity and infrastructure, IANPHI will play a key role in improving the capacity of countries to effectively detect, investigate, and respond to public health emergencies. The result will be better control of endemic diseases such as HIV/AIDS, acute lower respiratory tract infections, diarrheal diseases, measles, tuberculosis, malaria, and the neglected tropical diseases. These efforts will strengthen the practice of public health worldwide, yield global public health benefits of disease control and prevention, and ultimately accelerate social and economic development in the poorest countries of the world and progress toward achieving the Millenium Development Goals.