Ireland is in breach of the World Health Organization's International Health Regulations (IHR) on contagious disease control by failing to designate a 'competent authority' at its ports and airports, according to documents seen by RTÉ News.
The documents also show that Ireland has been non-compliant for approximately a decade, despite high-level discussions on the issue between the Health Service Executive, Department of Health and Department of Transport.
Under the IHR a 'competent authority' at points of entry must be designated to monitor the risk of dangerous contagious diseases entering the State.
Ireland has no such designated competent authority points of entry to the country.
Ireland reported substantial compliance in most other areas of the IHR, which were updated in 2005 to improve international pandemic preparedness in the wake of the 2002-4 SARS epidemic.
In a statement, the Department of Health said that the non-compliance with the IHR does not affect Ireland’s pandemic response at ports and airports in any practical way. The statement said that checks are carried out by health officers under existing domestic law and other regulations.
In the records, released under Freedom of Information, senior HSE staff expressed concern that the failure to designate a competent authority at points of entry was also a breach of EU cross-border regulations, which require IHR compliance.
In a document dated January 2020, Dr John Cuddihy, the Health Surveillance Protection Centre’s interim director, reported that no competent authority existed at Dublin, Cork and Shannon airports.
The ports of Dublin, Cork, Rosslare, Limerick and Waterford also record no designated competent authority.
The Health Protection Surveillance Centre, which is part of the HSE, is the WHO's "national focal point" or point of contact on IHR compliance in Ireland and submits an annual self-assessment report on compliance with the regulations.
Ireland's most recent self-assessments on IHR compliance, submitted to the WHO in 2018 and 2019, reported no capacity to identify risk at points of entry (PoE).
A section on PoE in the 2019 report marked 'additional comments’ recorded that: "The issue of competent authority for Ports and Airports is under active consideration at present in Ireland."
The Department of Health said in statements that discussions between the department, the HSE and the Department of Transport on designating competent authorities at the ports have stopped due to the Covid-19 crisis.
"The designation of a competent authority or competent authorities has been the subject of ongoing discussion … these discussions have been temporarily suspended due to the current pandemic", one statement said.
"[The] issue has had no impact on the pandemic response", the department said in a separate statement.
HSPC documents released under Freedom of Information reveal the discussions between the HSE, Department of Health and Department of Transport on designating a competent authority, had been "ongoing" for almost a decade, before being stopped last year.
The International Health Regulations describe the role of a competent authority as: "An authority responsible for the implementation and application of health measures."
Obligations include monitoring people and freight, keeping port facilities in a "sanitary condition", decontamination of parcels, including "de-ratting".
Other obligations include preliminary medical examinations of people by "an authorised health worker" and assessing potential risk to others.
The IHRs also require isolation and holding facilities at points of entry to allow "public health observation" and "contact tracing". Facilities at ports to isolate ships' crews and entire ships are also required under the regulations.
A HSE source said the lack of a designated competent authority did not affect the ability to provide holding areas or medical treatment at entry points to people who are suspected of being seriously ill.
Emails from 2016 show that the HSE believed the port authorities were the appropriate 'competent authority', however no agreement was reached on the matter with the Department of Transport.
One early meeting between public health officials and Dublin Airport in mid-2012 describe difficulties between the two sides.
Dr Margaret Fitzgerald, Director of Public Health HSE East, reported to the HSPC that she had held "a very diminishing meeting with Dublin Airport, where the engagement on IHR was "suboptimal".
An exchange of emails from May 2016 between chair of the HSE’s Port Health Network Dr Mairin Boland and Deputy Chief Medical Officer Dr Colette Bonner reveal the dispute over where responsibility lay for points of entry remained unresolved.
Health authorities still believed port and airport authorities should be designated as the competent authorities.
Dr Boland quoted a 2012 letter from Chief Medical Officer Dr Tony Holohan to HSE Assistant National Director Dr Kevin Kelleher, in which he stated that "those who have responsibility for the operation of points of entry are the competent authorities ... (emphasis in original)".
The following month, June 2016, Dr Boland requested a meeting between the HSE Port Health Network and the Department of Health to discuss who held responsibility as the "competent authority" and the need for a statutory instrument to underwrite the division of responsibility.
She wrote that "certain things are not clear currently eg oversight; whether HSE can require standards in preparedness, governance, quality".
Dr Boland also said in her email that the ports were not reporting on compliance with the IHRs.
"The ports aren’t currently reporting etc on compliance ... ". She also informed Dr Bonner that "there is some discrepancy around roles and responsibilities".
The HSE Port Health Network, which Dr Boland chaired, comprised HSE Public Health, Environmental Health, the National Ambulance Service and "emergency management", according to the correspondence.
On 20 March 2017, Dr Boland wrote again to the Chief Medical Officer’s office at the Department of Health describing the need to designate competent authorities as urgent and reminded the department that compliance with the IHRs was also a requirement of EU cross-border regulations.
"We wish to highlight the urgency to clarify this area of competent authority and to identify roles and responsibilities of all," she wrote.
A HSE source said that the urgency expressed in the emails reflected the "frustration" of staff concerned with achieving full implementation of the IHRs, rather than anxiety over vulnerability to serious contagious diseases.
In November 2018, Dr Boland wrote again to the Deputy Chief Medical Officer, this time Dr Ronan Glynn, to say she had been informed by the Health Protection Unit at the Department of Health that the matter had been raised with the Director General of the HSE.
In December 2018, Dr Glynn wrote to the HSPC’s Dr Mary O’Riordan saying he had "committed" to the HSE to "bring some clarity" to the designation of a competent authority for the ports.
Asked why the issue remained unresolved, the HSE said in a statement: "There have been a number of scheduled meetings between HSE and Dept of Health on this with some correspondence.
"The understanding developed and agreed verbally at meetings has not been set out in writing by the Dept of Health.
"The understanding is that the Dept of Health is the Competent Authority under IHR, and the Dept of Health devolves responsibility to the HSE to act as competent authority.
"Common understanding would need to be agreed within HSE and DTTAS [Dept of Transport], and resources and costs would need to be identified."
The WHO describes the IHRs as "an instrument of international law that is legally-binding on 196 countries".
However, a HSE source said that the WHO is aware discussions have been suspended and that Ireland is not facing any sanction or fine.