17 POINTS OF ENTRY AND BORDER HEALTH

States Parties must designate international airports and ports (and, where justified for public health reasons, a State Party may designate ground crossings) at which it must implement and maintain core public health capacities required to prevent, detect and manage a variety of public health risks using a multisectoral approach (IHR Annex 1B). The management of health threats and events at points of entry (PoE) requires effective communication and collaboration among many sectors, including health, foreign affairs, customs, interior affairs, security, transport, tourism and migration, among others. In addition, States Parties must also have effective multisectoral capacities at the national level to decide upon the adequate use of travel-related measures during a health emergency.

IMPACT:

Timely detection of and effective response to any potential hazards that occur at or may be spread via PoE.

MONITORING AND EVALUATION:

(1) Routine core capacities (as prescribed in the IHR Annex 1B 1) are implemented at all times at all designated PoEs with an all hazard and multisectoral approach, integrated into national surveillance systems, exercised (as appropriate), reviewed, evaluated, updated and improved on a regular basis. (2) All PoE health emergency contingency plans for all hazard events are developed and integrated into national emergency response plans, exercised (as appropriate), reviewed, evaluated and updated on a regular basis. (4) A risk-based approach is taken toward the use of international travel-related measures during health emergencies. (3) National multisectoral process and mechanisms to determine the adoption of international travel related measures on a risk-based manner are being implemented at national and subnational levels, including guidelines and SOPs for their implementation, and are exercised (as appropriate), reviewed, evaluated and updated on a regular basis or in response to an event or emergency.

Benchmark 17.1

Routine core capacities at PoEs are in place

Objective To have established routine capacities at designated PoEs

01 NO CAPACITY

  1. Country has not undertaken a strategic risk assessment to designate individual PoEs.

02 LIMITED CAPACITY

  1. Conduct strategic risk and capacity assessments to inform and prioritize selection of key PoEs for IHR designation. *
  2. Designate PoEs according to IHR requirements and identify competent authorities at designated PoE. *
  3. Identify key relevant stakeholders for establishing and maintaining core capacities at each designated PoE in a multisectoral manner. *
  4. Develop a plan to establish and maintain all the routine capacities prescribed in the IHR Annex 1B. *
  5. Establish some capacities at some designated PoEs such as the development and implementation of SOPs and training packages for routine capacities, the provision of adequate resources including space, equipment and premises for the management of public health events, and resources for the inspection of conveyances and the control of vectors and reservoirs in and near PoEs as per the requirements in IHR Annex 1B. *
  6. Participation by all relevant stakeholders across sectors (e.g. transport, customs, migration, law enforcement, environment, veterinary services, food safety) to inform decisions on their potential designation under the IHR

03 DEVELOPED CAPACITY

  1. Allocate sustainable funds for the implementation of the plan to have all routine capacities prescribed in IHR Annex 1B in place and functioning in at least some designated PoEs, for all hazards, including biological. *
  2. Conduct regular trainings to ensure that all relevant staff at some designated PoEs are knowledgeable about the SOPs for the establishment and maintenance of core capacities for all hazards, and that these are functional, as per IHR Annex 1B. *
  3. Integrate surveillance activities in at least some designated PoEs within the national surveillance system for all hazards, including biological. *
  4. Conduct regular M&E exercises, such as SimEx/AAR/IAR (as relevant), to assess the functionality and sustainability of core capacities at some designated PoEs. *
  5. Sharing of information and pooling of available resources regularly by key stakeholders in relevant sectors with the public health sector to maintain routine core capacities at some PoEs.

04 DEMONSTRATED CAPACITY

  1. Allocate adequate resources to maintain routine capacities for all hazard prevention, detection and response at all designated PoEs. *
  2. Implement the plan to have all routine capacities prescribed in IHR Annex 1B in place and functioning in all designated PoEs and for all hazards. *
  3. Develop and implement SOPs for the establishment and maintenance of functional core capacities as per Annex 1B and train and assign staff at all designated PoEs to respond to routine public health events for all hazards. *
  4. Integrate all designated PoEs into the national surveillance systems for all hazards with the involvement of relevant sectors. *
  5. Formalize agreements with neighbouring countries for rapid and secured sharing of data and information on health risks and emergency events at and around PoEs, in particular at ground crossings in high risk areas and where communities adjacent to borders are deeply integrated. *
  6. Support from finance ministry and foreign affairs ministry to mobilize national resources, and external resources if needed, to maintain the routine capacities at all designated PoEs.

05 SUSTAINABLE CAPACITY

  1. Mobilize staff and provide sustainable funds for the regular implementation of M&E activities to ensure the continuous functionality of all core capacities at all designated PoEs. *
  2. Use results from M&E, SimEx/AAR/IAR (as relevant) to fill any existing gaps identified in the operationalization of core capacities at all designated PoEs. *
  3. Share information and experiences on the continuous improvement and maintenance of routine capacities at PoEs by engaging the country in peer-to-peer learning programmes at the subnational, national and international levels *

Benchmark 17.2

Effective public health response at PoEs are in place

Objective To strengthen capacity for effective public health response at PoEs

01 NO CAPACITY

  1. Public health emergency contingency plans for each designated point of entry to respond to health emergencies are not in place or are in the process of being developed.

02 LIMITED CAPACITY

  1. Identify designated PoEs that do not have a multisectoral health emergency contingency plan in place, or where a plan is under development, and identify and convene all relevant stakeholders that need to be involved in the development of the multisectoral health emergency contingency plan at each designated PoE. *
  2. Review and map the relevant laws, guidance and SOPs related to the response to a health emergency caused by a biological hazard in at least some designated PoEs including in relation to sensitive issues such as: information sharing, management of personal data, implementation of measures such as quarantine or closure of borders, etc. *
  3. Conduct a public health risk assessment at/around some designated PoEs, including both sides of the border in the case of ground crossings, to identify priority biological hazards as well as vulnerable populations that may be at higher risk. *
  4. Develop a multisectoral health emergency contingency plan for events caused by biological hazards, including SOPs and guidance following risk assessment, in at least some designated PoEs according to IHR Annex 1. *
  5. Identify surge capacity to respond to a potential cross-border emergency public health threat at/around PoEs and document the means to mobilize such surge capacity in the PoE multisectoral health emergency contingency plan and/or SOPs. *
  6. Train border health staff on the multisectoral health emergency contingency plan and related guidance and SOPs for responding to events due to biological hazards in some designated PoEs, and develop a regular training programme to promote continuous learning and refresher training for border health staff and possible surge staff. *
  7. Allocate all necessary resources and associated funding, including human resources, infrastructure, equipment and other materials, for the implementation of the emergency contingency plan during response to a health emergency caused by biological hazards in some designated PoEs. *
  8. Participation, by all relevant stakeholders across sectors, in the development and implementation of the PoE multisectoral health emergency contingency plan for biological hazards, including through the identification of the necessary resources for the implementation of cross-sectoral actions, the allocation of surge staff when needed and the implementation of training programmes.

03 DEVELOPED CAPACITY

  1. Develop a multisectoral health emergency contingency plan for biological hazards in all designated PoEs with guidance and SOPs for responding to public health events caused by biological hazards. *
  2. Integrate all designated PoEs, and some nondesignated PoEs, into the national surveillance system to ensure the timely sharing of information to inform the public health response. *
  3. Integrate all designated PoEs into the national emergency preparedness and response plan with the involvement of relevant sectors and services. *
  4. Allocate resources including funds to all designated PoEs for implementation of the plan during public health events caused by biological hazards. *
  5. Demonstrate capacity to apply health measures related to travellers at PoEs and PoE environment for early detection, assessment and containment of public health risks, isolation and safe transfer of sick travellers to appropriate medical facilities at all designated PoEs. *
  6. Organize regular trainings on and demonstrate knowledge of the required health related documents and the correct use of information for detecting, reporting, assessing and providing first control measures to public health events, according to type and kind of conveyances. *
  7. Provide recommendations by relevant stakeholders to update, or develop new legislation or policies if required, to ensure that the PoE multisectoral health emergency contingency plans are well integrated into other emergency response plans at the PoE, subnational and national levels.
  8. Organize and support advocacy initiatives across relevant sectors for synchronized management of health emergencies at PoEs through training, raising awareness of communities and sensitizing partners and journalists to ensure that accurate information and education messages are disseminated across these networks.

04 DEMONSTRATED CAPACITY

  1. Include all hazards (chemical, biological, radiological and nuclear) in the multisectoral health emergency contingency plan in all designated PoEs and integrate into national emergency response plans. *
  2. Train staff of all designated PoEs on guidance and SOPs for responding to events due to any type of hazard, including care of affected animals and referral mechanism in collaboration with the animal sector. *
  3. Allocate resources including funds to all designated PoEs for implementation of the plan during any type of hazard event, including care of affected animals and referral mechanism to veterinary services. *
  4. Demonstrate capacity to apply all recommended health measures to travellers, animals and cargo, conveyances including to disinfect, de-rat, disinsect, decontaminate or otherwise treat baggage, cargo, containers, conveyances, goods and postal parcels. *
  5. Establish isolation units to isolate and quarantine suspected human or animal cases of communicable diseases and establish a strategic stockpile of essential medical countermeasures based on the health emergency risk assessment conducted at all designated PoEs. *
  6. Constitute a roster of trained staff ready to be deployed as surge at PoEs to support rapid implementation of emergency activities in line with national and international recommendations. *
  7. Establish a PHEOC at major designated PoEs with material and functional equipment, updated SOPs and staff trained. *
  8. Conduct SimEx/AAR/IAR (as relevant) at regular intervals to test and review response capacities of all designated PoEs and document results. *
  9. Involvement of relevant sectors in the implementation of the plan, including in the design and implementation of related trainings and the identification of surge staff.
  10. Identification by the animal health sector of veterinary centres to provide diagnostic tests, assessment and recommended measures related to affected animals identified at PoEs.

05 SUSTAINABLE CAPACITY

  1. Demonstrate action to address recommendations for improvement based on the results of SimEx/AAR/IAR (as relevant). *
  2. Update the PoE multisectoral health emergency contingency plan and related mechanisms, guidance and SOPs based on findings from evaluations and tests. *
  3. Share best practices for continuous improvement with all relevant stakeholders. *
  4. Communicate public health risks and related mitigation measures to multisectoral partners operating at PoEs, including conveyance and PoE facility operators. *
  5. Support research programmes to generate evidence on capacities required to manage health emergencies at PoEs. *
  6. Share experiences from capacity development for the management of health emergencies at PoEs and engage the country in peer-to-peer learning programmes at the subnational, national and international levels. *
  7. Draft, review and/or test joint strategies and procedures with neighbouring countries for the management of cross border or international health emergencies at designated PoEs. *
  8. Support by relevant sectors to communicate public health risks and related mitigation measures in a joint and coherent manner at the level of PoE.
  9. Involvement of all relevant stakeholders to support research programmes and sharing of experiences on all hazard health emergency response at PoEs.

Benchmark 17.3

An effective multisectoral mechanism for risk-based approach to international travel related measures is in place

Objective To strengthen multisectoral capacities for applying a risk-based approach to the use of international travel related measures during health emergencies

01 NO CAPACITY

  1. National multisectoral mechanism to conduct risk-based approaches for strategic planning for international travel-related measures, including prevention, detection/investigation, response and recovery is not available, is ad hoc or underdevelopment.

02 LIMITED CAPACITY

  1. Identify and map key stakeholders for the development and implementation of international travel-related measures including prevention, detection/ investigation, response and recovery in relevant sectors (health, transportation, migration, customs, tourism, etc.) taking into consideration the entire traveller pathway from departure to transit and destination. *
  2. Develop a national multisectoral strategy and advisory committee with ToRs (with identified roles and responsibilities) to streamline public health risk assessments, the implementation of recommended international travel-related risk mitigation measures (e.g. screening, contact tracing, quarantine, testing, immunization requirements, etc.), and risk communication. *
  3. Review existing mechanisms for conducting risk assessments to inform travel related measures and related policy and legal documentation in the country. *
  4. Identify gaps and methods to streamline the risk assessment and communication processes for international travel related threats which may require the use of travel-related measures. *
  5. Develop a training package for multisectoral staff to operationalize international travel related measures at PoEs, national and subnational levels. *
  6. Develop a RCCE strategy to explain the rationale underpinning international travel related measures, create feedback loop mechanisms with affected populations and increase trust in the overall response. *
  7. Identify cadre requirement/service requirement in health sector at designated PoEs to implement international travel related measures. *
  8. Document and test communication procedures between PoE and health authorities (through MoUs/other protocols). Document, share and regularly update, contact details. *

03 DEVELOPED CAPACITY

  1. Develop or update legislation (relevant to screening, quarantine, testing, contact tracing, etc.) to enable the implementation of international travel related measures based on identified risk level. *
  2. Convene the advisory committee/multisectoral stakeholder committee regularly and on occasions of at risk warnings to implement relevant international travel related measures with rational collective decision-making. *
  3. Develop SOPs/guidance for the operationalization of risk-based international travel-related measures when required at national, subnational and PoE levels. *
  4. Identify all relevant partners/agencies (from the public and private sector) that will be involved in or affected by international travel related measures, maintain a database including contacts and introduce the strategy and related SOP/guidance for active implementation. *
  5. Operationalize the training package for multisectoral staff to implement international travel related measures at PoE, national and subnational levels when required. *
  6. Provide adequate health staff and identify surge capacity for designated PoEs and other relevant health institutes as well as logistics (such as entry and exit screening, testing laboratories, etc.) for the implementation of international travel related measures. *
  7. Identify designated centres to provide travel health assessments, immunization based on travel requirements and prophylaxis as required. *
  8. Identify a focal point (unit/department/team) in the health ministry to coordinate with public health staff at designated PoEs, relevant multisectoral stakeholders and international agencies to receive early warnings for the implementation, calibration and lifting of risk-based international travel related measures.
  9. Contribute (by relevant sectors) to the collective decision-making, implementation and communication of risk-based international travel related measures at national and subnational levels and at PoEs, as required.

04 DEMONSTRATED CAPACITY

  1. Identify multisectoral stakeholders/institutes/agencies at the subnational level to implement risk-based approach for international travel related measures and maintain a database including contact details. *
  2. Conduct trainings on SOPs/guidelines for relevant multisectoral staff at all levels including the subnational level. *
  3. Establish quick communication channels with relevant multisectoral stakeholders at all levels including subnational level. *
  4. Implement risk-based strategies/SOPs/guidelines on national multisectoral process for international travel related measures at the subnational level while continuing functioning at the national level. *
  5. Implement appropriate RCCE practices to share information on the public health risk and mitigation measures, including international travel-related measures, with all relevant stakeholders including the general public. *
  6. Develop an M&E system to monitor the process and assess effectiveness and impact of the international travel measures implemented, including any potential unintended consequences. *
  7. Conduct regular risk assessments to update and adjust international travel-related measures, applying new information on their effectiveness and impact as it becomes available. *
  8. Conduct SimEx regularly on different components of international travel related measures (such as entry/exist screening, contact tracing, quarantine) at different levels with involvement of multisectoral staff. *
  9. Actively participate (by all relevant actors) in the decision-making and implementation of international travel-related measures at national and subnational levels.
  10. Share information on effectiveness and impact of international travel measures by all relevant stakeholders to ensure timely course correction.

05 SUSTAINABLE CAPACITY

  1. Conduct and document SimEx/AAR/IAR (as relevant) at least annually at premises of designated PoEs for entry/exit screening, communication, testing, transport for referral hospitals, etc. using risk-based scenarios with multisectoral stakeholders. *
  2. Conduct regular monitoring of the functionality and evaluation of the effectiveness and impact of risk-based international travel related measures within country. *
  3. Update SOPs/guidelines based on results of SimEx/AAR/IAR (as relevant), addressing identified gaps. *
  4. Continue implementation of national multisectoral processes and mechanisms to determine the adoption of international travel related measures at all levels and that they are exercised (as appropriate), reviewed, evaluated and updated on a regular basis, in response to an event or emergency. *
  5. Provide regular updates from risk assessment teams with an all hazard approach to timely initiate relevant international travel related measures commensurate with risk level, with multisectoral involvement. *
  6. Maintain good collaboration with regional and global networks/agencies for early warning and travel health. *
  7. Identify best practices and share among multisectoral teams at all levels and with international platforms for peer learning. *
  8. Update legislations and plans in relevant sectors to support sustainable implementation.

* Participation and contribution of other sectors to action.

Tools

  • International Health Regulations (2005): assessment tool for core capacity requirements at designated airports, ports and ground crossings. Geneva: World Health Organization; 2009 (https://apps.who.int/iris/handle/10665/70839).
    This document was developed to support States Parties in assessing existing capacities and capacity needs at points of entry when deciding which airports, ports and ground crossings to designate under Article 20.1 and Annex 1B. It includes an Excel spreadsheet file model for IHR core capacities assessment at ports, airports and ground crossings.
  • Coordinated public health surveillance between points of entry and national health surveillance systems: advising principles. 1st edition. Geneva: World Health Organization; 2014 (https://apps.who.int/iris/handle/10665/144805).
    This document provides steps for implementing/strengthening communication mechanisms and defines criteria for deciding what and how events
    should be reported between points of entry and the national health surveillance system.

  • Handbook for the management of public health events in air transport: updated with information on Ebola virus disease and Middle East respiratory syndrome coronavirus. Geneva: World Health Organization; 2016 (https://apps.who.int/iris/handle/10665/204628).
    This document is complementary to other WHO publications addressing risk assessment at a national level, contingency planning at points of entry, establishment of capacities and application of emergency plans at the airport level.

  • Handbook for management of public health events on board ships. Geneva: World Health Organization; 2016 (https://apps.who.int/iris/ handle/10665/205796).
    This document aims to provide technical advice to competent authorities at the port level for management of public health events aboard ships. It complements other WHO publications addressing risk assessment at the national level; contingency planning at ports, airports and ground crossings; and establishment of capacities and application of emergency plans at the port level.
  • Handbook for inspection of ships and issuance of ship sanitation certificates. Geneva: World Health Organization; 2011 (https://apps.who.int/iris/ handle/10665/44594).
    This handbook is based on the IHR (2005) provisions regarding ship inspections and issue of Ship Sanitation Certificates. It provides guidance for preparing and performing inspection, completing the certificates and applying public health measures within the framework of the IHR (2005).
  • Vector surveillance and control at ports, airports, and ground crossings. Geneva: World Health Organization; 2016 (https://apps.who.int/iris/ handle/10665/204660).
    This handbook provides technical advice for developing a comprehensive programme for systematic monitoring of disease vectors and integrated vector control at points of entry, based on IHR requirements.
  • WHO interim guidance for Ebola event management at points of entry. Geneva: World Health Organization; 2014 (https://apps.who.int/iris/ handle/10665/131827).
    Technical guidance set on Ebola virus disease preparedness and response aims to: (i) provide early detection of potentially infected persons; (ii) assist in implementing WHO recommendations related to Ebola management; and (iii) prevent the international spread of the disease while allowing authorities to avoid unnecessary restrictions and delays at points of entry.
  • Technical considerations for implementing a risk-based approach to international travel in the context of COVID-19: Interim guidance, 2 July 2021. Geneva: World Health Organization; 2021 (https://www.who.int/publications/i/item/WHO-2019-nCoV-Risk-based-international-travel-2021.1).
  • WHO Guide to ship sanitation. Third edition. Geneva: World Health Organization; 2011 (https://apps.who.int/iris/handle/10665/43193).
    The primary aim of the revised guide to ship sanitation is to present the public health significance of ships in terms of disease and to highlight the
    importance of applying appropriate control measures.

  • Guide to hygiene and sanitation in aviation. 3rd Edition. Geneva: World Health Organization; 2009 (https://apps.who.int/iris/handle/10665/44164).
    This document addresses water and cleaning and disinfection of facilities with guidelines that provide procedures and quality specifications that are to
    be achieved.

  • International Health Regulations (2005): a guide for public health emergency contingency planning at designated points of entry. Geneva: World Health Organization; 2012 (https://www.who.int/publications/i/item/9789290615668).
    This guide was designed to assist WHO Member States, both large and small, to bridge the gap between the legal requirements of IHR and the pragmatic readiness and response capacity for public health emergencies at designated points of entry.
  • Handbook for public health capacity-building at ground crossings and cross-border collaboration. Geneva: World Health Organization; 2020 (https:// www.who.int/publications/i/item/handbook-for-public-health-capacity-building-at-ground-crossings-and-cross-border-collaboration).
  • WHO aircraft disinfection methods and procedures. Geneva: World Health Organization; 2021 (https://www.who.int/publications/i/ item/9789240014459).
  • Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).
  • WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
  • Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).
  • Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/ handle/10665/333419)