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0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}</style><table class="box-More_citations_needed plainlinks metadata ambox ambox-content ambox-Refimprove" role="presentation"><tbody><tr><td class="mbox-text"><div class="mbox-text-span">This article needs additional citations for <a href="/wiki/Wikipedia:Verifiability" title="Wikipedia:Verifiability">verification</a>. Please help <a href="/wiki/Special:EditPage/International_Health_Regulations" title="Special:EditPage/International Health Regulations">improve this article</a> by <a href="/wiki/Help:Referencing_for_beginners" title="Help:Referencing for beginners">adding citations to reliable sources</a>. Unsourced material may be challenged and removed. Find sources: <a rel="nofollow" class="external text" href="https://www.google.com/search?as_eq=wikipedia&q=%22International+Health+Regulations%22">"International Health Regulations"</a> – <a rel="nofollow" class="external text" href="https://www.google.com/search?tbm=nws&q=%22International+Health+Regulations%22+-wikipedia&tbs=ar:1">news</a> · <a rel="nofollow" class="external text" href="https://www.google.com/search?&q=%22International+Health+Regulations%22&tbs=bkt:s&tbm=bks">newspapers</a> · <a rel="nofollow" class="external text" href="https://www.google.com/search?tbs=bks:1&q=%22International+Health+Regulations%22+-wikipedia">books</a> · <a rel="nofollow" class="external text" href="https://scholar.google.com/scholar?q=%22International+Health+Regulations%22">scholar</a> · <a rel="nofollow" class="external text" href="https://www.jstor.org/action/doBasicSearch?Query=%22International+Health+Regulations%22&acc=on&wc=on">JSTOR</a> (May 2022) (<a href="/wiki/Help:Maintenance_template_removal" title="Help:Maintenance template removal">Learn how and when to remove this message</a>)</div></td></tr></tbody></table> The International Health Regulations (IHR), first adopted by the <a href="/wiki/World_Health_Assembly" title="World Health Assembly">World Health Assembly</a> in 1969 and last revised in 2005, are legally binding rules that only apply to the WHO that is an instrument that aims for international collaboration "to prevent, protect against, control, and provide a <a href="/wiki/Public_health" title="Public health">public health</a> response to the international spread of disease in ways that are commensurate with and restricted to public health risks and that avoid unnecessary interference with international traffic and trade".<a href="#cite_note-WHORevisionsIHR-1">[1]</a><a href="#cite_note-WHO2019-2">[2]</a><a href="#cite_note-MedicineHealth2010-3">[3]</a> The IHR is the only international legal treaty with the responsibility of empowering the World Health Organization (WHO) to act as the main global <a href="/wiki/Disease_surveillance" title="Disease surveillance">surveillance system</a>.<a href="#cite_note-4">[4]</a><a href="#cite_note-5">[5]</a> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:World_Health_Organization_Logo.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/26/World_Health_Organization_Logo.svg/220px-World_Health_Organization_Logo.svg.png" decoding="async" width="220" height="67" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/26/World_Health_Organization_Logo.svg/330px-World_Health_Organization_Logo.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/26/World_Health_Organization_Logo.svg/440px-World_Health_Organization_Logo.svg.png 2x" data-file-width="512" data-file-height="157"></a><figcaption>Logo of the World Health Organization</figcaption></figure> In 2005, following the <a href="/wiki/2002%E2%80%932004_SARS_outbreak" title="2002–2004 SARS outbreak">2002–2004 SARS outbreak</a>, several changes were made to the previous revised IHRs originating from 1969.<a href="#cite_note-WHORevisionsIHR-1">[1]</a><a href="#cite_note-MedicineHealth2010-3">[3]</a> The 2005 IHR came into force in June 2007, with 196 binding countries that recognised that certain public health incidents, extending beyond disease, ought to be designated as a <a href="/wiki/Public_Health_Emergency_of_International_Concern" class="mw-redirect" title="Public Health Emergency of International Concern">Public Health Emergency of International Concern</a> (PHEIC), as they pose a significant global threat.<a href="#cite_note-MullenJune2020-6">[6]</a> Its first full application was in response to the <a href="/wiki/2009_swine_flu_pandemic" title="2009 swine flu pandemic">swine flu pandemic of 2009</a>.<a href="#cite_note-MedicineHealth2010-3">[3]</a> <div id="toc" class="toc" role="navigation" aria-labelledby="mw-toc-heading"><input type="checkbox" role="button" id="toctogglecheckbox" class="toctogglecheckbox" style="display:none"><div class="toctitle" lang="en" dir="ltr"><h2 id="mw-toc-heading">Contents</h2><label class="toctogglelabel" for="toctogglecheckbox"></label></div> <ul> <li class="toclevel-1 tocsection-1"><a href="#History">1 History</a> <ul> <li class="toclevel-2 tocsection-2"><a href="#Origins">1.1 Origins</a></li> <li class="toclevel-2 tocsection-3"><a href="#Early_history">1.2 Early history</a></li> <li class="toclevel-2 tocsection-4"><a href="#21st_century_developments">1.3 21st century developments</a></li> </ul> </li> <li class="toclevel-1 tocsection-5"><a href="#Public_Health_Emergency_of_International_Concern_(PHEIC)">2 Public Health Emergency of International Concern (PHEIC)</a></li> <li class="toclevel-1 tocsection-6"><a href="#IHR_Experts_Roster">3 IHR Experts Roster</a></li> <li class="toclevel-1 tocsection-7"><a href="#Pro-tem_structure">4 Pro-tem structure</a> <ul> <li class="toclevel-2 tocsection-8"><a href="#IHR_Emergency_Committee">4.1 IHR Emergency Committee</a></li> <li class="toclevel-2 tocsection-9"><a href="#IHR_Review_Committee">4.2 IHR Review Committee</a></li> </ul> </li> <li class="toclevel-1 tocsection-10"><a href="#Criticism_of_international_health_regulations">5 Criticism of international health regulations</a> <ul> <li class="toclevel-2 tocsection-11"><a href="#Core_capacity">5.1 Core capacity</a></li> <li class="toclevel-2 tocsection-12"><a href="#Trade_and_travel">5.2 Trade and travel</a></li> <li class="toclevel-2 tocsection-13"><a href="#Outbreak_reporting">5.3 Outbreak reporting</a></li> </ul> </li> <li class="toclevel-1 tocsection-14"><a href="#Joint_External_Evaluations_(JEE)">6 Joint External Evaluations (JEE)</a></li> <li class="toclevel-1 tocsection-15"><a href="#See_also">7 See also</a></li> <li class="toclevel-1 tocsection-16"><a href="#References">8 References</a></li> <li class="toclevel-1 tocsection-17"><a href="#External_links">9 External links</a></li> </ul> </div> </section><div class="mw-heading mw-heading2 section-heading" onclick="mfTempOpenSection(1)"><h2 id="History">History</h2> <a role="button" href="/w/index.php?title=International_Health_Regulations&action=edit&section=1" title="Edit section: History" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div><section class="mf-section-1 collapsible-block" id="mf-section-1"> <div class="mw-heading mw-heading3"><h3 id="Origins">Origins</h3> <a role="button" href="/w/index.php?title=International_Health_Regulations&action=edit&section=2" title="Edit section: Origins" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> The original International Health Regulations (IHR) were adopted in 1969. However, its underpinnings can be traced to the mid-19th century, when measures to tackle the spread of plague, yellow fever, smallpox and particularly cholera across borders, with as little interference to global trade and commerce, were debated.<a href="#cite_note-MedicineHealth2010-3">[3]</a><a href="#cite_note-Budd2009-7">[7]</a><a href="#cite_note-Howard-Jones-8">[8]</a> To address the realisation that countries varied with regards to their sanitary regulations and quarantine measures, the first of these series of early <a href="/wiki/International_sanitary_conferences" class="mw-redirect" title="International sanitary conferences">international sanitary conferences</a> was convened in Paris in 1851. This was in the same year that <a href="/wiki/Telegraphic_communications" class="mw-redirect" title="Telegraphic communications">telegraphic communications</a> became established between London and Paris. 12 nations attended this conference, of which 11 were European states and three would sign the resulting convention. In the 19th century. there were 10 of these conferences.<a href="#cite_note-Budd2009-7">[7]</a><a href="#cite_note-Howard-Jones-8">[8]</a> 1948: the <a href="/wiki/World_Health_Organization" title="World Health Organization">World Health Organization</a> Constitution was founded.<a href="#cite_note-Howard-Jones-8">[8]</a> 1951: the WHO issued its first infectious disease prevention regulations, the <a href="/wiki/International_Sanitary_Regulations" class="mw-redirect" title="International Sanitary Regulations">International Sanitary Regulations</a> (ISR 1951), which focussed on six quarantinable diseases; <a href="/wiki/Cholera" title="Cholera">cholera</a>, <a href="/wiki/Plague_(disease)" title="Plague (disease)">plague</a>, <a href="/wiki/Relapsing_fever" title="Relapsing fever">relapsing fever</a>, <a href="/wiki/Smallpox" title="Smallpox">smallpox</a>, <a href="/wiki/Typhoid" class="mw-redirect" title="Typhoid">typhoid</a> and <a href="/wiki/Yellow_fever" title="Yellow fever">yellow fever</a>.<a href="#cite_note-Van-Tam2010-9">[9]</a> 1969: the ISR were revised and renamed the 'International Health Regulations'.<a href="#cite_note-Van-Tam2010-9">[9]</a> <div class="mw-heading mw-heading3"><h3 id="Early_history">Early history</h3> <a role="button" href="/w/index.php?title=International_Health_Regulations&action=edit&section=3" title="Edit section: Early history" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> 1973: the Twenty-Sixth <a href="/wiki/World_Health_Assembly" title="World Health Assembly">World Health Assembly</a> amended the IHR (1969) in relation to provisions on cholera.<a href="#cite_note-:0-10">[10]</a> 1981: in view of the global eradication of smallpox, the Thirty-fourth World Health Assembly amended the IHR (1969) to exclude smallpox in the list of <a href="/wiki/Notifiable_diseases" class="mw-redirect" title="Notifiable diseases">notifiable diseases</a> subject to the IHR (1969).<a href="#cite_note-:0-10">[10]</a> 1995: during the Forty-Eighth World Health Assembly, the WHO and Member States agreed on the need to revise the IHR (1969). Several challenges were placed against the backdrop of the increased travel and trade characteristic of the 20th century. The revision of IHR (1969) came about because of its inherent limitations, most notably: <ul><li>narrow scope of notifiable diseases (<a href="/wiki/Cholera" title="Cholera">cholera</a>, <a href="/wiki/Plague_(disease)" title="Plague (disease)">plague</a>, <a href="/wiki/Yellow_fever" title="Yellow fever">yellow fever</a>). The past few decades had seen the emergence and re-emergence of <a href="/wiki/Infectious_disease" class="mw-redirect" title="Infectious disease">infectious diseases</a>. The emergence of "new" infectious agents <a href="/wiki/Ebola" title="Ebola">Ebola</a> Hemorrhagic Fever in <a href="/wiki/Zaire" title="Zaire">Zaire</a> (modern-day Democratic Republic of Congo) and the re-emergence of cholera and plague in <a href="/wiki/South_America" title="South America">South America</a> and <a href="/wiki/India" title="India">India</a>, respectively;</li> <li>dependence on official country notification; and</li> <li>lack of a formal internationally coordinated mechanism to prevent the international spread of disease.</li></ul> <div class="mw-heading mw-heading3"><h3 id="21st_century_developments">21st century developments</h3> <a role="button" href="/w/index.php?title=International_Health_Regulations&action=edit&section=4" title="Edit section: 21st century developments" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> In 2005, a values statement document entitled "The Principles Embodying the IHR" was published and said inter alia:<a href="#cite_note-11">[11]</a> <ol><li>With full respect for the dignity, human rights and fundamental freedom of persons;</li> <li>Guided by the Charter of the <a href="/wiki/United_Nations" title="United Nations">United Nations</a> and the Constitution of the World Health Organization;</li> <li>Guided by the goal of their universal application for the protection of all people of the world from the international spread of disease;</li> <li>States have, in accordance with the Charter of the United Nations and the principles of international law, the sovereign right to legislate and to implement legislation in pursuance of their health policies. In doing so, they should uphold the purpose of these Regulations.</li></ol> On 15 June 2007, the IHR (2005) entered into force, and were binding as of June 2020 on 196 States Parties, including all 194 Member States (countries) of WHO.<a href="#cite_note-MullenJune2020-6">[6]</a> In 2010, at the Meeting of the States Parties to the <a href="/wiki/Biological_Weapons_Convention" title="Biological Weapons Convention">Convention on the Prohibition of the Development, Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and Their Destruction</a> in <a href="/wiki/Geneva" title="Geneva">Geneva</a>,<a href="#cite_note-opbw-12">[12]</a> the <a href="/wiki/Sanitary_epidemiological_reconnaissance" title="Sanitary epidemiological reconnaissance">sanitary epidemiological reconnaissance</a> was suggested as a well-tested means for enhancing the monitoring of infections and <a href="/w/index.php?title=Parasitic_agents&action=edit&redlink=1" class="new" title="Parasitic agents (page does not exist)">parasitic agents</a>. The aim of this recommendation was to prevent and minimize the consequences of natural outbreaks of dangerous infectious diseases, as well as the threat of alleged use of biological weapons against BTWC States Parties. The conference also noted the significance of the sanitary epidemiological reconnaissance in assessing the sanitary-epidemiological situation, organizing and conducting preventive activities, indicating and identifying <a href="/w/index.php?title=Pathogenic_biological_agents&action=edit&redlink=1" class="new" title="Pathogenic biological agents (page does not exist)">pathogenic biological agents</a> in the environmental sites, conducting laboratory analysis of biological materials, suppressing hotbeds of infectious diseases, and providing advisory and practical assistance to local health authorities. In January 2018, a group of WHO bureaucrats published an article in the <a href="/wiki/British_Medical_Journal" class="mw-redirect" title="British Medical Journal">British Medical Journal on Global Health</a> entitled "Strengthening global health security by embedding the International Health Regulations requirements into national health systems", in which the authors argued that "the <a href="/wiki/Western_African_Ebola_virus_epidemic" class="mw-redirect" title="Western African Ebola virus epidemic">2014 Ebola</a> and <a href="/wiki/2015%E2%80%9316_Zika_virus_epidemic" title="2015–16 Zika virus epidemic">2016 Zika</a> outbreaks, and the findings of a number of high-level assessments of the global response to these crises, [clarified] that there is a need for more joined-up thinking between health system strengthening activities and health security efforts for prevention, alert and response."<a href="#cite_note-kluge18-13">[13]</a> </section><div class="mw-heading mw-heading2 section-heading" onclick="mfTempOpenSection(2)"><h2 id="Public_Health_Emergency_of_International_Concern_(PHEIC)">Public Health Emergency of International Concern (PHEIC)</h2> <a role="button" href="/w/index.php?title=International_Health_Regulations&action=edit&section=5" title="Edit section: Public Health Emergency of International Concern (PHEIC)" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div><section class="mf-section-2 collapsible-block" id="mf-section-2"> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Public_health_emergency_of_international_concern" title="Public health emergency of international concern">Public health emergency of international concern</a></div> A Public Health Emergency of International Concern, or <a href="/wiki/PHEIC" class="mw-redirect" title="PHEIC">PHEIC</a>, is defined in the IHR (2005) as, "an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response".<a href="#cite_note-WHO2019-2">[2]</a> This definition implies a situation that is: <ul><li>serious, sudden, unusual or unexpected;</li> <li>carries implications for public health beyond the affected State's national border; and</li> <li>may require immediate international action.</li></ul> Since 2007, the WHO Director-General has declared public health emergencies of international concern in response to the following:<a href="#cite_note-MullenJune2020-6">[6]</a><a href="#cite_note-14">[14]</a> <ul><li>2009 H1N1 <a href="/wiki/Swine_flu_pandemic" class="mw-redirect" title="Swine flu pandemic">swine flu pandemic</a></li> <li>2014 setbacks in global <a href="/wiki/Polio_eradication" title="Polio eradication">polio eradication</a> efforts</li> <li>2013–2016 <a href="/wiki/Western_African_Ebola_virus_epidemic" class="mw-redirect" title="Western African Ebola virus epidemic">Western African Ebola virus epidemic</a></li> <li>2016 <a href="/wiki/Zika_virus" title="Zika virus">Zika virus</a> outbreak</li> <li>2018–19 <a href="/wiki/Kivu_Ebola_epidemic" title="Kivu Ebola epidemic">Kivu Ebola epidemic</a></li> <li>2019–23 <a href="/wiki/COVID-19_pandemic" title="COVID-19 pandemic">COVID-19 pandemic</a></li> <li>2022 <a href="/wiki/2022_monkeypox_outbreak" class="mw-redirect" title="2022 monkeypox outbreak">monkeypox outbreak</a></li> <li>2024 <a rel="nofollow" class="external text" href="https://www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern">mpox clade 1b outbreak</a></li></ul> </section><div class="mw-heading mw-heading2 section-heading" onclick="mfTempOpenSection(3)"><h2 id="IHR_Experts_Roster">IHR Experts Roster</h2> <a role="button" href="/w/index.php?title=International_Health_Regulations&action=edit&section=6" title="Edit section: IHR Experts Roster" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div><section class="mf-section-3 collapsible-block" id="mf-section-3"> The IHR Experts Roster, which is regulated by Article 47 of the IHR, is tended by <a href="/wiki/DGWHO" class="mw-redirect" title="DGWHO">DGWHO</a>, who "shall establish a roster composed of experts in all relevant fields of expertise... In addition, [s/he] shall appoint one member at the request of each State Party." </section><div class="mw-heading mw-heading2 section-heading" onclick="mfTempOpenSection(4)"><h2 id="Pro-tem_structure">Pro-tem structure</h2> <a role="button" href="/w/index.php?title=International_Health_Regulations&action=edit&section=7" title="Edit section: Pro-tem structure" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div><section class="mf-section-4 collapsible-block" id="mf-section-4"> <div class="mw-heading mw-heading3"><h3 id="IHR_Emergency_Committee">IHR Emergency Committee</h3> <a role="button" href="/w/index.php?title=International_Health_Regulations&action=edit&section=8" title="Edit section: IHR Emergency Committee" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Public_Health_Emergency_of_International_Concern" class="mw-redirect" title="Public Health Emergency of International Concern">Public Health Emergency of International Concern</a></div> In order to declare a PHEIC, the <a href="/wiki/WHO#Director-General" class="mw-redirect" title="WHO">WHO Director-General</a> is required to take into account factors which include the risk to human health and international spread as well as advice from an internationally made up committee of experts, the <a href="/wiki/IHR_Emergency_Committee" class="mw-redirect" title="IHR Emergency Committee">IHR Emergency Committee</a> (EC), one of which should be an expert nominated by the State within whose region the event arises.<a href="#cite_note-WHO2019-2">[2]</a> Rather than being a standing committee, the EC is created <a href="/wiki/Ad_hoc" title="Ad hoc">ad hoc</a>.<a href="#cite_note-Kamradt-Scott2019-15">[15]</a> Until 2011, the names of IHR EC members were not publicly disclosed; in the wake of reforms now they are. These members are selected according to the disease in question and the nature of the event. Names are taken from the <a href="/wiki/IHR_Experts_Roster" class="mw-redirect" title="IHR Experts Roster">IHR Experts Roster</a>. The Director-General takes the EC's advice following their technical assessment of the crisis using legal criteria and a predetermined algorithm after a review of all available data on the event. Upon declaration of the PHEIC, the EC then makes recommendations on what actions the Director-General and Member States should take to address the crisis.<a href="#cite_note-Kamradt-Scott2019-15">[15]</a> The recommendations are temporary and require three-monthly reviews.<a href="#cite_note-WHO2019-2">[2]</a> <div class="mw-heading mw-heading3"><h3 id="IHR_Review_Committee">IHR Review Committee</h3> <a role="button" href="/w/index.php?title=International_Health_Regulations&action=edit&section=9" title="Edit section: IHR Review Committee" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> The formation of an IHR Review Committee is the responsibility of the DGWHO. They are selected from the IHR Experts Committee, and "when appropriate, other expert advisory panels of the Organization." Furthermore, the DGWHO "shall establish the number of members to be invited to a meeting, determine its date and duration, and convene the Committee." "The DGWHO shall select the members of the Review Committee on the basis of the principles of equitable geographical representation, gender balance, a balance of experts from developed and developing countries, representation of a diversity of scientific opinion, approaches and practical experience in various parts of the world, and an appropriate interdisciplinary balance." </section><div class="mw-heading mw-heading2 section-heading" onclick="mfTempOpenSection(5)"><h2 id="Criticism_of_international_health_regulations">Criticism of international health regulations</h2> <a role="button" href="/w/index.php?title=International_Health_Regulations&action=edit&section=10" title="Edit section: Criticism of international health regulations" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div><section class="mf-section-5 collapsible-block" id="mf-section-5"> Revisions to the International Health Regulations in 2005 were meant to lead to improved global health security and cooperation. However, the WHO's perceived delayed and inadequate response to the <a href="/wiki/Western_African_Ebola_virus_epidemic" class="mw-redirect" title="Western African Ebola virus epidemic">West African Ebola epidemic</a> brought renewed international scrutiny to the International Health Regulations. By 2015, 127 of the 196 countries were unable to meet the eight core public health capacities and report public health events as outlined.<a href="#cite_note-16">[16]</a> Numerous published reports by high-level panels have assessed the International Health Regulations for inadequacies and proposed actions that can be taken to improve future responses to outbreaks.<a href="#cite_note-17">[17]</a> One publication reviewed seven of these major reports and identified areas of consensus on action.<a href="#cite_note-18">[18]</a> The seven reports noted inadequate compliance with WHO's International Health Regulations as a major contributor to the slow response to Ebola. They found three major obstacles that contributed to poor compliance:[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <ul><li>countries' core capacities,</li> <li>unjustified trade and travel restrictions, and</li> <li>inability to ensure that governments report outbreaks quickly.</li></ul> <div class="mw-heading mw-heading3"><h3 id="Core_capacity">Core capacity</h3> <a role="button" href="/w/index.php?title=International_Health_Regulations&action=edit&section=11" title="Edit section: Core capacity" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> The IHR requires countries to assess their disease surveillance and response capacities and to identify if they can adequately meet their requirements. The seven Ebola reports universally agree that the country's self-assessment capabilities are insufficient and that verification measures need to be improved upon. A significant problem is the inadequate level of core capacities in some countries, and the question of how to build upon them has been frequently raised. The reports make several recommendations to encourage governments to increase investment in outbreak identification and response programs. These include technical help from external sources conditional on mobilizing domestic resources, external financing for low income countries, pressure from the international community to increase investment, and considering outbreak preparedness as a factor in the International Monetary Fund's country economic assessments, which influence governments' budget priorities and access to capital markets. Another avenue under discussion is reform of Article 44 of the IHR, potentially through a new pandemic convention.<a href="#cite_note-19">[19]</a> <div class="mw-heading mw-heading3"><h3 id="Trade_and_travel">Trade and travel</h3> <a role="button" href="/w/index.php?title=International_Health_Regulations&action=edit&section=12" title="Edit section: Trade and travel" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> The second issue frequently raised is ensuring that restrictions on trade and travel during outbreaks are justified.<a href="#cite_note-20">[20]</a> Because of increased attention and concern from the public and the media, many governments and private companies restricted trade and travel during the Ebola outbreak, though many of these measures were not necessary from a public health standpoint. These restrictions worsened financial repercussions and made the work of aid organizations sending support to affected regions more difficult. There was broad consensus across the reports that bringing such restrictions to a minimum is critical to avoid further harm to countries experiencing outbreaks. Moreover, if governments assume that reporting will lead to inappropriate travel and trade restrictions, they may be hesitant to notify the international community about the outbreak. Potential solutions raised included the WHO and the UN more assertively "naming and shaming" countries and private companies that impose unjustified restrictions on WHO working with the World Trade Organization, International Civil Aviation Organization, and International Maritime Organization to develop standards and enforcement mechanisms for trade and travel restrictions.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <div class="mw-heading mw-heading3"><h3 id="Outbreak_reporting">Outbreak reporting</h3> <a role="button" href="/w/index.php?title=International_Health_Regulations&action=edit&section=13" title="Edit section: Outbreak reporting" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div> The third compliance issue relates to countries' obligation to rapidly report outbreaks. The reports recommend strengthening this obligation by WHO publicizing when countries delay reporting suspected outbreaks. In contrast, mechanisms ensuring that countries rapidly receive operational and financial support as soon as they do report were also recommended. A novel approach to encourage early notification is the World Bank's Pandemic Emergency Financing Facility. This was created to provide rapid financing for the control of outbreaks and to protect countries from the devastating economic effects of outbreaks via an insurance program.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] </section><div class="mw-heading mw-heading2 section-heading" onclick="mfTempOpenSection(6)"><h2 id="Joint_External_Evaluations_(JEE)">Joint External Evaluations (JEE)</h2> <a role="button" href="/w/index.php?title=International_Health_Regulations&action=edit&section=14" title="Edit section: Joint External Evaluations (JEE)" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div><section class="mf-section-6 collapsible-block" id="mf-section-6"> A Joint External Evaluation (JEE) is "a voluntary, collaborative, multisectoral process to assess country capacities to prevent, detect and rapidly respond to public health risks whether occurring naturally or due to deliberate or accidental events". The JEE helps countries to identify critical gaps within their <a href="/wiki/Biosecurity" title="Biosecurity">biosecurity</a> systems<a href="#cite_note-21">[21]</a> in order to improve them and help prevent, detect and quickly respond to public health risks (whether natural, accidental or deliberate) in the future.<a href="#cite_note-22">[22]</a> Developed as a result of the IHR Review Committee on Second Extensions for Establishing National Public Health Capacities and on IHR Implementation, WHO, in collaboration with partners and initiatives, developed the JEE process and published the first edition of the tool in 2016.<a href="#cite_note-23">[23]</a> A second edition was published in 2018.<a href="#cite_note-24">[24]</a> A JEE of Australia's capacity following the 2013–2016 <a href="/wiki/Western_African_Ebola_virus_epidemic" class="mw-redirect" title="Western African Ebola virus epidemic">Western African Ebola virus epidemic</a> showed that the nation had very high level of capacity of response. Australia's National Action Plan for Health Security 2019-2023 was developed to help to implement the recommendations from the JEE.<a href="#cite_note-25">[25]</a> </section><div class="mw-heading mw-heading2 section-heading" onclick="mfTempOpenSection(7)"><h2 id="See_also">See also</h2> <a role="button" href="/w/index.php?title=International_Health_Regulations&action=edit&section=15" title="Edit section: See also" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div><section class="mf-section-7 collapsible-block" id="mf-section-7"> <ul><li><a href="/wiki/Epidemic" title="Epidemic">Epidemic</a></li> <li><a href="/wiki/Pandemic" title="Pandemic">Pandemic</a></li> <li><a href="/wiki/Pandemic_treaty" class="mw-redirect" title="Pandemic treaty">Pandemic treaty</a></li></ul> </section><div class="mw-heading mw-heading2 section-heading" onclick="mfTempOpenSection(8)"><h2 id="References">References</h2> <a role="button" href="/w/index.php?title=International_Health_Regulations&action=edit&section=16" title="Edit section: References" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div><section class="mf-section-8 collapsible-block" id="mf-section-8"> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-WHORevisionsIHR-1">^ <a href="#cite_ref-WHORevisionsIHR_1-0">a</a> <a href="#cite_ref-WHORevisionsIHR_1-1">b</a> <style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.emro.who.int/international-health-regulations/about/background.html">"WHO EMRO | Background | About | International Health Regulations"</a>. www.emro.who.int. Retrieved 2 August 2020.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.emro.who.int&rft.atitle=WHO+EMRO+%7C+Background+%7C+About+%7C+International+Health+Regulations&rft_id=http%3A%2F%2Fwww.emro.who.int%2Finternational-health-regulations%2Fabout%2Fbackground.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AInternational+Health+Regulations" class="Z3988"> </li> <li id="cite_note-WHO2019-2">^ <a href="#cite_ref-WHO2019_2-0">a</a> <a href="#cite_ref-WHO2019_2-1">b</a> <a href="#cite_ref-WHO2019_2-2">c</a> <a href="#cite_ref-WHO2019_2-3">d</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.who.int/news-room/q-a-detail/what-are-the-international-health-regulations-and-emergency-committees">"What are the International Health Regulations and Emergency Committees? Q&A"</a>. www.who.int. 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Retrieved 24 May 2020.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Department+of+Health&rft.atitle=Australia%27s+Human+Biosecurity+Portal+%E2%80%93+International+Obligations&rft.date=2017-09-27&rft_id=https%3A%2F%2Fwww1.health.gov.au%2Finternet%2Fmain%2Fpublishing.nsf%2FContent%2Fohp-biosec-international-obligations.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3AInternational+Health+Regulations" class="Z3988"> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20200614021854/https://extranet.who.int/sph/docs/file/2458">National Action Plan for Health Security 2019-2023, December 2018</a> </li> </ol></div></div> </section><div class="mw-heading mw-heading2 section-heading" onclick="mfTempOpenSection(9)"><h2 id="External_links">External links</h2> <a role="button" href="/w/index.php?title=International_Health_Regulations&action=edit&section=17" title="Edit section: External links" class="cdx-button cdx-button--size-large cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--icon-only cdx-button--weight-quiet "> edit </a> </div><section class="mf-section-9 collapsible-block" id="mf-section-9"> <ul><li><a rel="nofollow" class="external text" href="https://www.who.int/csr/ihr/current/en/index.html">International Health Regulations (1969)</a>. Third Annotated Edition, WHO, 1983</li> <li><a rel="nofollow" class="external text" href="https://www.who.int/ihr/publications/9789241580496/en/">International Health Regulations (2005)</a>. WHO. Geneva. 2006</li> <li>World Health Organization, Communicable Diseases Surveillance and Response, Epidemic and Pandemic Alert and Response <a rel="nofollow" class="external text" href="https://www.who.int/csr/ihr/howtheywork/faq/en/index.html">Frequently Asked Questions about International Health Regulations</a></li> <li><a rel="nofollow" class="external text" href="http://www.stimson.org/ihr/">IHR 2005: From the Global to the Local</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20141110173931/http://www.stimson.org/ihr/">Archived</a> 2014-11-10 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a></li> <li>Lawrence O. Gostin, <a rel="nofollow" class="external text" href="http://jama.ama-assn.org/cgi/content/full/291/21/2623?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=international+health+regulations&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT">International Infectious Disease Law, Revision of the World Health Organization's International Health Regulations</a>, Journal of the American Medical Association, June 2, 2004, at 2623.</li></ul>    </section></div> <noscript><img src="https://login.wikimedia.org/wiki/Special:CentralAutoLogin/start?type=1x1&useformat=mobile" alt="" width="1" height="1" style="border: none; position: absolute;"></noscript> <div class="printfooter" data-nosnippet="">Retrieved from "<a dir="ltr" href="https://en.wikipedia.org/w/index.php?title=International_Health_Regulations&oldid=1244887153">https://en.wikipedia.org/w/index.php?title=International_Health_Regulations&oldid=1244887153</a>"</div></div> </div> <div class="post-content" id="page-secondary-actions"> </div> </main> <footer class="mw-footer minerva-footer" role="contentinfo"> <a class="last-modified-bar" href="/w/index.php?title=International_Health_Regulations&action=history"> <div class="post-content last-modified-bar__content"> Last edited on 9 September 2024, at 19:38 </div> </a> <div class="post-content footer-content"> <div id='mw-data-after-content'> <div class="read-more-container"></div> </div> <div id="p-lang"> <h4>Languages</h4> <section> <ul id="p-variants" class="minerva-languages"></ul> <ul class="minerva-languages"><li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%A7%D9%84%D9%84%D9%88%D8%A7%D8%A6%D8%AD_%D8%A7%D9%84%D8%B5%D8%AD%D9%8A%D8%A9_%D8%A7%D9%84%D8%B9%D8%A7%D9%84%D9%85%D9%8A%D8%A9" title="اللوائح الصحية العالمية – Arabic" lang="ar" hreflang="ar" data-title="اللوائح الصحية العالمية" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target">العربية</a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Reglament_Sanitari_Internacional" title="Reglament Sanitari Internacional – Catalan" lang="ca" hreflang="ca" data-title="Reglament Sanitari Internacional" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target">Català</a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Internationale_Gesundheitsvorschriften" title="Internationale Gesundheitsvorschriften – German" lang="de" hreflang="de" data-title="Internationale Gesundheitsvorschriften" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target">Deutsch</a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D9%85%D9%82%D8%B1%D8%B1%D8%A7%D8%AA_%D8%A8%DB%8C%D9%86%E2%80%8C%D8%A7%D9%84%D9%85%D9%84%D9%84%DB%8C_%D8%A8%D9%87%D8%AF%D8%A7%D8%B4%D8%AA" title="مقررات بین‌المللی بهداشت – Persian" lang="fa" hreflang="fa" data-title="مقررات بین‌المللی بهداشت" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target">فارسی</a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/R%C3%A8glement_sanitaire_international" title="Règlement sanitaire international – French" lang="fr" hreflang="fr" data-title="Règlement sanitaire international" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target">Français</a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D5%84%D5%AB%D5%BB%D5%A1%D5%A6%D5%A3%D5%A1%D5%B5%D5%AB%D5%B6_%D5%BD%D5%A1%D5%B6%D5%AB%D5%BF%D5%A1%D6%80%D5%A1%D5%AF%D5%A1%D5%B6_%D5%B0%D5%A1%D5%B4%D5%A1%D5%B1%D5%A1%D5%B5%D5%B6%D5%A1%D5%A3%D5%AB%D6%80" title="Միջազգային սանիտարական համաձայնագիր – Armenian" lang="hy" hreflang="hy" data-title="Միջազգային սանիտարական համաձայնագիր" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target">Հայերեն</a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Peraturan_Kesehatan_Internasional" title="Peraturan Kesehatan Internasional – Indonesian" lang="id" hreflang="id" data-title="Peraturan Kesehatan Internasional" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target">Bahasa Indonesia</a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%AA%D7%A7%D7%A0%D7%95%D7%AA_%D7%94%D7%91%D7%A8%D7%99%D7%90%D7%95%D7%AA_%D7%94%D7%91%D7%99%D7%9F-%D7%9C%D7%90%D7%95%D7%9E%D7%99%D7%95%D7%AA" title="תקנות הבריאות הבין-לאומיות – Hebrew" lang="he" hreflang="he" data-title="תקנות הבריאות הבין-לאומיות" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target">עברית</a></li><li 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