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. 2016 Jun;94(2):264-313.
doi: 10.1111/1468-0009.12186. Epub 2016 May 11.

The International Health Regulations: The Governing Framework for Global Health Security

Lawrence O Gostin  1 , Rebecca Katz  2
Affiliations

The International Health Regulations: The Governing Framework for Global Health Security

Lawrence O Gostin et al. Milbank Q. 2016 Jun.

Abstract

Policy Points:

  1. The International Health Regulations (IHR) are the governing framework for global health security yet require textual and operational reforms to remain effective, particularly as parallel initiatives are developed.

  2. The World Health Organization (WHO) is the agency charged with oversight of the IHR, and its leadership and efficient functioning are prerequisites for the effective implementation of the IHR.

  3. We reviewed the historical origins of the IHR and their performance over the past 10 years and analyzed all of the ongoing reform panel efforts to provide a series of politically feasible recommendations for fundamental reform.

  4. This article offers proposals for fundamental reform—with politically feasible pathways—of the IHR, their operations and implementation, WHO oversight, and State Party conformance.

Context: The International Health Regulations (IHR) have been the governing framework for global health security for the past decade and are a nearly universally recognized World Health Organization (WHO) treaty, with 196 States Parties. In the wake of the Ebola epidemic, major global commissions have cast doubt on the future effectiveness of the IHR and the leadership of the WHO.

Methods: We conducted a review of the historical origins of the IHR and their performance over the past 10 years and analyzed all of the ongoing reform panel efforts to provide a series of politically feasible recommendations for fundamental reform.

Findings: We propose a series of recommendations with realistic pathways for change. These recommendations focus on the development and strengthening of IHR core capacities; independently assessed metrics; new financing mechanisms; harmonization with the Global Health Security Agenda, Performance of Veterinary Services (PVS) Pathways, the Pandemic Influenza Preparedness Framework, and One Health strategies; public health and clinical workforce development; Emergency Committee transparency and governance; tiered public health emergency of international concern (PHEIC) processes; enhanced compliance mechanisms; and an enhanced role for civil society.

Conclusions: Empowering the WHO and realizing the IHR's potential will shore up global health security—a vital investment in human and animal health—while reducing the vast economic consequences of the next global health emergency.

Keywords: International Health Regulations; World Health Organization reform; crisis management; emergency response; global health security.

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Figures

Figure 1
Figure 1
The IHR Balancing Dynamic: Commerce, Public Health, and Human Rights
Figure 2
Figure 2
IHR Monitoring Framework: Core Capacities
Figure 3
Figure 3
IHR Timeline
Figure 4
Figure 4
IHR Process for Global Governance of Disease
Figure 5
Figure 5
IHR Implementation 2012 and 2014
Figure 6
Figure 6
Theoretical Framework: Early Detection Leads to Rapid Response and Reduced Morbidity and Mortality
Figure 7
Figure 7
Pathway to Strong, Measured, Funded, and Sustained IHR Core Capacities
See this image and copyright information in PMC

References

    1. WHO. International Health Regulations (2005) . 2nd edition. Geneva, Switzerland: World Health Organization; 2008. http://whqlibdoc.who.int/publications/2008/9789241580410_eng.pdf. Accessed June 29, 2015.
    1. WHO. Report of the Ebola Interim Assessment Panel. July 2015. http://who.int/csr/resources/publications/ebola/report‐by‐panel.pdf. Accessed July 30, 2015.
    1. WHO. 2014 Ebola virus disease outbreak and follow‐up to the Special Session of the Executive Board on Ebola. May 23, 2015. http://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_ACONF5‐en.pdf. Accessed June 29, 2015.
    1. Moon S, Sridhar D, Pate MA, et al. Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard‐LSHTM Independent Panel on the Global Response to Ebola. Lancet. 2015;386(10009):2204‐2221. - PMC - PubMed
    1. Commission on a Global Health Risk Framework for the Future. The Neglected Dimension of Global Security: A Framework to Counter Infectious Disease Crises. Washington, DC: National Academy of Medicine; 2016. www.nam.edu/GHRF. Accessed January 30, 2016. - PubMed

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