Since 1948, the World Health Organization (WHO), an agency of the United Nations, has worked to manage international health issues and emergencies. But in order to do so, the WHO must have the cooperation of the nations that make up the world in the first place, which is where the International Health Regulations (IHR) come in. An agreement between 196 countries and addressing over 400 diseases and conditions, nations that are a part of the IHR are legally bound to report public health events. But how did the IHR come to be, why is it so important, and how does it work?
First, some background: while the current IHR was last revised in 2005, the idea of an international public health agreement has its origins decades earlier. Beginning in 1969, the first iteration of the IHR focused only on six diseases: cholera, plague, relapsing fever, smallpox, typhoid fever, and yellow fever. Since then, the IHR has evolved to encompass over 400 conditions, now including diseases such as mpox, COVID-19, and Ebola. This expansion reflects the ever-changing global health landscape, with new threats constantly emerging.
Under the IHR, member countries are required to adhere to three steps: detect, assess and report, and respond. Detecting involves utilizing surveillance systems, such as data collection and lab testing, to detect public health events quickly. If and when a public health event is detected, it must be assessed as a “public health emergency of international concern”, and if so, then reported to the WHO. The process of determining this involves the country asking the following four questions: whether the public health impact of the event is serious, whether the event is unusual or unexpected, whether there is a significant risk of international spread, and whether there is a significant risk of international travel or trade restrictions. If the event meets these requirements, it must be reported to WHO. Last (but certainly not least), WHO and the country reporting it will respond to the public health event.
Over the past nine years, every one of the 196 countries that make up the IHR has reported at least one public health event, a testament to this policy’s impact. According to the Centers for Disease Control, it takes as little as 36 hours for disease to spread from a remote village to a major metropolis. Thanks to the IHR, WHO has been able to prevent health risks from spreading to other countries and restrictions in trade and travel from being implemented.
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