The World Health Organisation (WHO), established in 1948 as a specialised agency of the United Nations, is currently the global body in charge of governing the risk of pandemics. It does this mainly through a governance mechanism called the International Health Regulations (IHR), the goal of which is to stop public health events that have the potential to spread internationally with minimal interference of travel and trade. The IHR first came into force in 1969, with an initial focus on four infectious diseases – Cholera, Plague, Yellow Fever and Smallpox.
Revised in 2005, the IHR now acknowledge that many more diseases than the four originally covered may spread internationally, and that many cannot be stopped at international borders, as was demonstrated by the spread of HIV in the 1980s and SARS in 2003. Emphasis is therefore placed now on the requirement that countries rapidly detect and respond to outbreaks and other public health events with potential to spread internationally. The revised version of the IHR also includes a global safety mechanism that calls for collaborative action should a public health event be assessed as at risk of spreading internationally.
The governance of pandemics typically involves collaboration between the WHO, ministries of health and public health institutions.
The governance of pandemics typically involves collaboration between the WHO, ministries of health and public health institutions. Some nations have established Centres for Disease Control (CDC) whose role is to monitor transmissible public health events. Some of those, including the US CDC and Public Health England, provide international support to developing countries, helping them strengthen their capacity to better detect and respond to public health events. When an outbreak occurs, other national institutions, hospitals in particular, play a major role in early detection and containment.
The IHR are a binding agreement under international law, and as such provide a framework for national legislation and responsible national and international action. But like all international law and treaties, there is no enforcement mechanism. Under the IHR, countries are required to strengthen eight core capacities in public health that are deemed necessary for rapid detection of and response to a disease outbreak. Each year countries are required to do a self-assessment of their core public health capacity, and to report the outcome of their assessment to the WHO. However, there is no sanction for non-reporting, and many countries do not report. As part of the IHR (2005) Monitoring and Evaluation Framework, the Joint External Evaluation (JEE) was developed as a mechanism where a country’s core capacity in public health is assessed by a group of international experts. All countries may request such an evaluation through the WHO on a voluntary basis. The tool was made available in 2016 and to date, over 79 countries have done so.
The revised IHR provide a decision tree which can be used by countries to determine whether a public health event in their country has the potential for international spread, and should therefore be reported as a potential public health emergency of international importance (PHEIC). The WHO Director General then conducts a risk assessment. For this, they can ask for a recommendation from an emergency committee set up under the auspices of the IHR, and/or from other experts from around the world. If the Director General decides that the event is a PHEIC, the WHO must provide emergency recommendations aimed at curbing international spread, and review those recommendations every three months until the PHEIC has been declared over.
After the recent Ebola outbreak in West Africa, an external review of the revised IHR was conducted, and recommendations from that review are now being considered by the World Health Assembly of the WHO.
Head and Senior Fellow, Centre on Global Health Security, Chatham House, Professor of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine