MEIG Highlights 4 février 2021

Highlight 4/2021 – Strengthening the International Health Regulations to Meet Future Challenges: Lessons from Covid-19

Cerya Paramita, 4 February 2021

(Unsplash/ Martin Sanchez)

The leading international legal framework to control infectious disease was created in 1969 when the World Health Assembly, the decision-making body of the World Health Organization, adopted the International Health Regulations (IHR). The legally binding instrument aims to deliver a surveillance system, reporting and response to infectious diseases requiring a coordinated global response. In this early version, the agreement was limited to only three conditions: cholera, plague and yellow fever.

As more and more infectious diseases emerged, the IHR was deemed no longer sufficient, and the public has made calls for a review of the regulations. But it was not until the outbreak of SARS in 2005 that revisions finally took place.

Drawing lessons from the original version’s insufficiency, the ‘new’ IHR came with a broad category called Public Health Emergency of International Concern (PHEIC). This category encompasses “any extraordinary event that may constitute a public health risk to other countries through the international spread of disease and may require a coordinated international response.” It also binds its signatories to strengthen their domestic capabilities to deal with infectious diseases and requires that its implementation respects people’s dignity, human rights, and fundamental freedom. The WHO works within this framework to support its member states in building their capacities.

Then the coronavirus hit in late 2019, and the IHR is once again put to the test. It soon became apparent that the IHR is not well-equipped to deal with global pandemic despite the revision. Covid-19 has laid out to us at least three possible areas of IHR improvements.

First, the reporting mechanism. The current IHR relies heavily on states notification about the emergence of a potential pandemic. Although WHO may consider information from non-state sources, it does not have the mandate to conduct an independent investigation where necessary. There is a need to strengthen the surveillance system and establish clear public health emergency levels for which mandatory reporting is required.

Second, public monitoring system of state measures. This mechanism is built on the Universal Periodic Review practice in the Human Rights area and will allow for a review at states’ compliance with IHR and WHO guidance. However, it should be kept in mind that such a mechanism focuses on how to draw lessons from each other and build solidarity rather than merely naming and shaming.

Third, funding and budgeting aspect. The IHR should allow the creation of a global funding mechanism and give incentives for early reporting by committing to the rapid disbursement of funds to assist countries affected by the PHEIC. Also, the WHO needs to be empowered and adequately funded to carry out its mandate. Relying on one single party to shoulder a significant financial burden is not a sustainable option. Besides, it defies the essence of multilateralism itself.

IHR revision in the above-proposed areas is tough to negotiate. It is always a difficult negotiation where state sovereignty is involved. But, it does not mean that there is no room for compromise and consensus. Then again, a global pandemic is a collective matter as it concerns the lives of all people inhabiting the earth.

Today, the Covid-19 tally has reached more than 100 million confirmed cases, including more than 2.2 million deaths. It has affected every country in the world and fundamentally changed the way we live. Researchers worldwide have warned that human impacts on the environment will continue to cause the emergence of new infectious diseases. Hence, the next global pandemic is simply a question of when.

The decision is now in the hands of sovereign states. Are they willing to make a choice?

Cerya Paramita, Strengthening the International Health Regulations to Meet Future Challenges: Lessons from Covid-19, Highlight 4/2021, available at

The views expressed in the MEIG Highlights are personal to the author and neither reflect the positions of the MEIG Programme nor those of the University of Geneva.


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