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The global spread of severe acute respiratory syndrome highlighted the need to detect and control disease outbreaks at their source, as envisioned by the 2005 revised International Health Regulations (IHR). June 2012 marked the initial deadline by which all 194 World Health Organization (WHO) member states agreed to have IHR core capacities fully implemented for limiting the spread of public health emergencies of international concern. Many countries fell short of these implementation goals and requested a 2-year extension. The degree to which achieving IHR compliance will result in global health security is not clear, but what is clear is that progress against the threat of epidemic disease requires a focused approach that can be monitored and measured effi ciently. We developed concrete goals and metrics for 4 of the 8 core capacities with other US government partners in consultation with WHO and national collaborators worldwide. The intent is to offer an example of an approach to implementing and monitoring IHR for consideration or adaptation by countries that complements other frameworks and goals of IHR. Without concrete metrics, IHR may waste its considerable promise as an instrument for global health security against public health emergencies. T global spread of severe acute respiratory syndrome highlighted the need to detect and control disease outbreaks at their source (1,2). The 2005 revised International Health Regulations (IHR) were established as a legally binding agreement providing a framework for improving detection, reporting, and response to public health emergencies of international concern (public health emergencies) (3). The global implementation of IHR began on June 15, 2007, and in an unusual episode of international consensus, all 194 WHO member states ratifi ed the agreement. When implemented, IHR should improve global capacity to detect, assess, notify, and respond to public health threats. Properly and fully implemented, IHR should usher in a new global era of international communication, cooperation, and unprecedented security against the epidemic threats that have plagued humanity since ancient times. But there is a problem. After enactment of the revised IHR in June 2007, all member countries were required to develop and implement a minimum of core public health capacities by June 2012, the 5-year anniversary of IHR’s enforcement. Many countries did not meet the deadline and have requested a 2-year extension. In an era of limited resources, competing priorities, and political challenges, achievement of the IHR implementation goals, even with an extension, will be a challenge. Focusing efforts toward IHR implementation and capacity building and enabling all countries to measure progress toward IHR implementation is, therefore, essential. Toward this end, concrete goals and metrics for 4 of the 8 core capacities were developed by the WHO Collaborating Center for IHR Implementation of National Surveillance and Response Capacity at the Centers for Disease Control and Prevention with other US government partners in consultation with WHO and national collaborators worldwide (Table 1). This approach is in alignment with WHO’s IHR framework and facilitates measurement of implementation activities. The framework focuses on 4 of the core capacities (human resources, surveillance, laboratory, and response) and builds on WHO’s IHR Monitoring Framework by defi ning simple standards for these capacities (4). The focus on these 4 capacities should not imply that they are more important than other capacities (legislation, policy, and fi nancing; coordination; advocacy and national focal point communications; preparedness; and risk communication) because implementation of IHR International Health Regulations— What Gets Measured Gets Done Kashef Ijaz, Eric Kasowski, Ray R. Arthur, Frederick J. Angulo, and Scott F. Dowell PERSPECTIVE 1054 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 18, No. 7, July 2012 Author affi liations: World Health Organization Collaborating Center for International Health Regulations Implementation of National Surveillance and Response Capacity, Atlanta, Georgia, USA; and Centers for Disease Control and Prevention, Atlanta DOI: http://dx.doi.org/10.3201/eid1807.120487 International Health Regulations requires implementation of all 8 capacities. The intent is to assist partner countries in better focusing efforts, to improving effi ciency at IHR implementation, and to better monitoring and evaluating progress. Focusing on the subset of IHR core capacities also will provide a foundation for an all-hazards approach for addressing public health emergencies regardless of cause. We describe the rationale, targets, and defi nitions for these 4 goals and means by which countries can use the data collected through monitoring and evaluation indicators for measuring progress related to these 4 core capacities. Human Resources A well-trained cadre of public health professionals at the national health authorities at a country’s central and local levels is needed for timely detection and response to public health emergencies. There is a worldwide shortage of public health professionals who are trained in public health practice and have had competency-based public health fi eld experience. Building the cadre of fi eld-trained epidemiologists available to monitor disease trends, inform decision makers about potential disease threats, and guide response during a public health emergency should be one of the fi rst priorities in implementing the IHR. The aim of the human resource goal is to ensure adequate numbers of trained personnel for response to a public health emergency. Specifi c targets to measure progress toward completion of this goal are a fully adopted national workforce plan and >1 trained fi eld epidemiologist per 200,000 population who are active in the public health sector (5). Although the workforce plan cannot ensure that trained professionals remain in the public health sector, it will at least indicate a government’s commitment to public health through stability of the public health workforce. These concrete indicators enable measurement of incremental progress and are specifi c enough to enable tracking of success and clear documentation of failure. Surveillance Disease surveillance is a cornerstone of public health practice. It provides for systematic and ongoing collection of data that help identify and detect disease-related aberrations that might constitute public health emergencies. Additionally, surveillance for key disease syndromes provides the foundation for interpreting signals of possible emergencies and early notifi cation of outbreaks of potentially devastating diseases (6). The following 5 syndromes have internationally recognized standards for syndromic surveillance: severe acute respiratory syndrome, acute neurologic syndrome, acute hemorrhagic fever, acute watery diarrhea with dehydration, and jaundice with fever (7,8). The metrics focus on the ability to detect public health emergencies with a target of documenting that >3 of these syndromes have surveillance systems in place that meet the respective international standards. These metrics will assist countries in ensuring that efforts at disease surveillance are effective and that systemic incentives are appropriately aligned to provide early warning for a potential public health emergency. The 3 syndromes chosen will depend on national disease control priorities. These surveillance systems should include early warning surveillance data and laboratory fi ndings, which should be analyzed by trained epidemiologists. Information for syndromic surveillance collected at the clinic or hospital level can help generate villageand district-level alerts. An alert investigation unit can then investigate these alerts, including an in-depth epidemiologic analysis. On the basis of the outcome of the analysis, rapid Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 18, No. 7, July 2012 1055 Table 1. Goals, targets, and intended use for 4 core capacities for focusing International Health Regulations implementation Capacity Goal Target/measure Intended use Human resources Ensure adequate numbers of trained personnel are available to support the response to a public health emergency A national workforce plan and 1 trained field epidemiologist for every 200,000 persons Document that a workforce plan exists and is maintained and updated, and monitor annual progress toward the goal of 1 trained field epidemiologist for every 200,000 persons. Surveillance Ensure that surveillance systems capable of detecting selected potential public health emergencies in any part of the country are established and functioning Surveillance infrastructure that demonstrates the ability to detect >3 of 5 syndromes indicative of a potential public health emergency of international concern Monitor and evaluate the effectiveness of the surveillance system, and identify areas for improvement within the country’s public health surveillance infrastructure. Laboratory Ensure access to laboratory diagnostic capabilities that can identify a range of emerging epidemic pathogens by using the full spectrum of basic laboratory testing methods Ability to perform 10 core diagnostic tests for confirmation of indicator pathogens from any part of the country Assess/measure capacity for detection will by using external/internal quality assurance for each of the 10 core tests and indicator pathogens using standard methods. Response Ensure countries have adequate rapid response capacity for public health emergencies At least 1 functioning rapid response team per major administrative unit Maintain an adequate number of rapid response teams with the necessary training, appropriate personnel, and regular outbreak responses.