International Health Regulations

The International Health Regulations (IHR) are the legally binding international treaty framework administered by the World Health Organization that governs how member states prevent, detect, and respond to acute public health risks capable of crossing borders. The regulations were last comprehensively revised in 2005, replacing the original 1969 text that covered only a narrow list of quarantinable diseases. The 2005 revision introduced the concept of the Public Health Emergency of International Concern (PHEIC) as the highest formal alert tier, requiring member states to maintain core surveillance and response capacities.

In June 2024, the 77th World Health Assembly adopted a package of amendments to the IHR that entered into force in mid-2025. The most significant change was the creation of a new Pandemic Emergency tier above the PHEIC, intended for events with pandemic potential that require a more coordinated international response. The amendments also clarified Temporary Recommendations, strengthened equity provisions, and introduced new reporting obligations for pathogens of pandemic potential. The IHR's Emergency Committee mechanism provides expert advice to the WHO Director-General on whether an event constitutes a PHEIC and on what Temporary Recommendations to issue.

The IHR binds 196 state parties, including all WHO member states. Compliance is monitored through the Joint External Evaluation framework. Enforcement mechanisms are weak: the regulations rely on diplomatic pressure, peer review, and reputational incentives rather than sanctions, which creates persistent gaps between formally stated obligations and actual state behaviour, particularly on travel and trade restrictions.

The IHR framework has been central to the 2026 Bundibugyo Ebola response. On 17 May 2026, the WHO Director-General declared a PHEIC without convening an IHR Emergency Committee and stated explicitly that the outbreak did not meet the new Pandemic Emergency tier criteria introduced by the 2024 amendments . The United States imposed travel and entry bans on nationals from DRC, Uganda, and South Sudan on 18 May, which WHO's Temporary Recommendations, issued four days later, explicitly advised against. The IHR's inability to enforce compliance with its own Temporary Recommendations was exposed when a major member state acted contrary to them with no formal consequence . Separately, the 79th World Health Assembly deferred adoption of the Pandemic Agreement's Pathogen Access and Benefit-Sharing annex to WHA80 in 2027, leaving the IHR as the primary operative legal instrument for the outbreak .