INTERNATIONAL HEALTH REGULATIONS
WHAT IS THE ISSUE?
The IHR are a binding international legal instrument revised in 2005 to prevent, detect and provide a public health response to the international spread of disease, while averting unnecessary interference with international traffic and trade. During the Covid-19 pandemic there was widespread lack of compliance with the IHR by states, particularly on preparedness, but also on the role and authority of National Focal Points (NFPs), legal frameworks for IHR implementation, notification and alert systems, information sharing, and adoption of disproportionate unilateral measures, among others.
WHAT WAS DONE BEFORE COVID-19 TO ADDRESS THIS ISSUE?
Following the West African Ebola crisis in 2014, several reports recommended that governments increase resource allocation, improve the preparedness of public health systems and support IHR compliance verification mechanisms. In 2016, the WHO’s Joint External Evaluation (JEE) process was established as a voluntary external assessment of countries’ progress in the achievement of its targets. The evaluation consistently found low levels of preparedness across countries of all income levels. Furthermore, countries were to elaborate a National Action Plan for Health Security (NAPHS) after the JEE. Only sixty countries had done so when Covid-19 emerged, and it is not clear how far they had implemented their plans before Covid-19.
WHAT HAVE COVID-19 INTERNATIONAL REVIEW PANELS RECOMMENDED TO ADDRESS THIS PROBLEM? *
To improve IHR compliance, some panels suggest responsibility for implementation should be elevated to the highest levels of government ⁴. Some emphasize the need for improved accountability arrangements ³ ⁴, and many suggest that the regulations themselves be revisited ¹ ³.
Other recommendations touch upon specific aspects of the IHR. Many review panels agreed on the need for better mechanisms for assessing and managing the impacts of trade and travel restrictions ¹ ² ³. Others concern the declaration of a Public Health Emergency of International Concern (PHEIC), suggesting that the Emergency Committee should be more transparent in how it works and the recommendations it issues ² ³ ⁴.
WHICH REFORMS ARE UNDER DISCUSSION?
Many aspects of the 74th World Health Assembly (WHA) resolution on strengthening WHO preparedness and response aim to support countries to better implement the IHR. There are growing calls for amendments to the IHR, to improve assessments of IHR compliance and national capacities, as well as proposals to develop new legal frameworks that could extend far beyond its scope. The IHR Review Committee issued its report in May 2021, and its recommendations will be considered in the coming months.
* This section is derived from a systematic comparison (available here) of recommendations from four international reviews: ¹ the Global Preparedness Monitoring Board (GPMB), ² the Independent Panel for Pandemic Preparedness and Response (IPPPR), ³ the Independent Oversight and Advisory Committee (IOAC) for the WHO Health Emergencies Programme, and ⁴ the International Health Regulations (2005) Review Committee.