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Grading
WHO grading of public health events and emergencies
The world faces an increasing number of emergencies with health consequences from all hazards, including infectious disease outbreaks, conflicts, natural disasters, chemical or radio-nuclear spills and food contamination.
Many emergencies can be complex, with more than one cause, and can have significant public health, social, economic and political impacts. WHO has specific responsibilities and accountabilities for emergency operations under the International Health Regulations (IHR) (2005) and within the global humanitarian system as the Interagency Standing Committee (IASC) Global Health Cluster Lead Agency.
These responsibilities begin with early detection and risk assessment or situation analysis of a public health event or emergency. Events or emergencies requiring an operational response by WHO are referred for grading.
This page describes the grading process, definitions of various grades, and the criteria for grading. WHO uses three levels of emergency grades; emergencies that continue for more than six months may be defined as protracted crises, which also have three grades.
Grading is an internal activation procedure that triggers WHO emergency procedures and activities for the management of the response.
The grading assigned to an acute emergency indicates the level of operational response required by WHO for that emergency. WHO’s immediate operational response to acute events and emergencies is not dependent on grading. If the risk assessment or situation analysis indicates the need for an operational response, WHO immediately repurposes the country office(s), initiates response activities and then proceeds to grading within a maximum of 24 hours of the analysis. Protracted emergencies (that persist for longer than 6 months) are assigned protracted grades to indicate the level of operational response to be sustained by WHO over a prolonged, often indefinite period.
Purpose of grading
Grading is conducted to:
- inform the Organization of the level of WHO’s operational response to an emergency and the need for mobilization of internal and external resources;
- activate WHO’s incident management system (IMS) and emergency SOPs;
- determine the need for a surge of additional human and material resources;
- permit the use of resources from the CFE above US$ 50 000;
- convey to partners, donors and other stakeholders WHO’s assessment of the scale of unmet needs within the health sector and, by extension, the requirement for additional international resources.
Triggers for grading
The following criteria trigger the grading process:
- any public health event with a risk assessed as high or very high;
- any public health event where the RRA indicates a likely need for an operational response by WHO;
- any request for emergency assistance from a Member State
Timing of grading
For acute events, the grading exercise should be conducted within 24 hours of an RRA that characterizes the event as high or very high risk and indicates the likely need for an operational response by WHO. For slower-onset events due, for example, to conflict or drought, grading may happen several days after initial assessment and where applicable, use information from the PHSA to support decision-making.
WHO levels for graded emergencies
Ungraded
The operational response does not exceed the usual country-level cooperation of the country office with the Member State. The event continues to be monitored as required.
Grade 1
An event requiring a limited response by WHO, which exceeds the usual country-level cooperation that the country office has with the Member State. Organizational or external support required by the country office is minimal. The provision of support to the country office is coordinated by an incident manager counterpart in the regional office.
Grade 2
An event requiring a moderate response by WHO. The level of response required by WHO always exceeds the capacity of the country office. Organizational or external support required by the country office is moderate. The provision of support to the country office is coordinated by an incident manager in the regional office. An incident manager counterpart is also appointed at headquarters to assist with the coordination of Organization- wide support as required.
Grade 3
An event requiring a major to maximal WHO response. Organizational and external support required by the country office entails the mobilization of Organization-wide assets.
The provision of support to the country office is coordinated by an incident manager at regional office level. An incident manager is also appointed at headquarters to assist with the coordination of Organization-wide technical and operational support. The Executive Director of WHE and any involved regional directors may agree to coordinate the event from headquarters. For events or emergencies involving multiple regions, an incident manager at headquarters will coordinate the response across the regions.
System-wide scale up by the IASC automatically results in the declaration of a WHO Grade 3 emergency, if not already activated.