New Amendments to International Health Regulations Enter Into Force Globally

A landmark moment in global health governance arrived today as the latest amendments to the International Health Regulations (IHR) formally entered into force, strengthening the world’s collective ability to prepare for and respond to health emergencies. The move reflects hard-earned lessons from the COVID-19 pandemic and signals a renewed international commitment to solidarity and cooperation in protecting populations from cross-border health threats.

A Framework Rooted in History

The IHR provide a binding legal framework guiding 196 States Parties, including all 194 WHO Member States, on their rights and obligations when dealing with public health risks. Recognizing that infectious diseases and other hazards know no borders, the regulations aim to coordinate global surveillance, reporting, and response.

Their origins date back to the 19th century, when the expansion of maritime trade and travel accelerated the spread of cholera, plague, and yellow fever. Governments introduced quarantine measures and began developing treaties to contain outbreaks. This culminated in the adoption of the International Sanitary Regulations in 1951, later renamed the IHR following the establishment of WHO. Over the decades, the framework has been revised to reflect evolving health threats, with the most recent comprehensive revision in 2005 after the SARS outbreak.

Key Amendments Adopted in 2024

The new amendments were agreed by consensus at the Seventy-seventh World Health Assembly in Geneva in 2024. They include several innovations designed to improve the global health architecture:

• Creation of a new global alert level — “pandemic emergency”: This tier goes beyond the existing designation of a Public Health Emergency of International Concern (PHEIC) and will be triggered when a health risk escalates into, or threatens to become, a pandemic with widespread impacts on societies and health systems.

• National IHR Authorities: Governments must now designate a dedicated national authority responsible for implementing IHR provisions and coordinating with WHO and other States Parties.

• Equity in access to medicines and financing: The amendments include commitments to strengthen global solidarity in ensuring equitable distribution of medical products, vaccines, and countermeasures during crises.

• Enhanced cooperation and transparency: Provisions encourage faster data sharing, streamlined communication, and collaboration across borders to avoid delays in response.

Lessons from COVID-19

The devastating impact of COVID-19 served as the primary catalyst for these reforms. The pandemic revealed weaknesses in early warning systems, inequities in access to vaccines and treatments, and challenges in coordinating global supply chains. WHO Member States recognized that a stronger, more flexible regulatory framework was necessary to prevent a repeat of the chaos experienced in 2020–2021.

“The strengthening of the International Health Regulations represents a historic commitment to protect future generations from the devastating impact of epidemics and pandemics,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “We know that no one is safe until everyone is safe. The IHR amendments reaffirm our shared responsibility and solidarity in the face of global health risks.”

Complementing the WHO Pandemic Agreement

The IHR amendments are part of a broader effort to reinforce pandemic preparedness. At the same Assembly, Member States adopted the WHO Pandemic Agreement, a parallel legal instrument aimed at improving cooperation in areas such as pathogen sharing, equitable access to countermeasures, and financing mechanisms. Negotiations are ongoing on an annex covering Pathogen Access and Benefit Sharing (PABS).

Sovereignty and Implementation

Under the IHR, countries retain their sovereign right to implement national health policies and legislations. WHO serves as the Secretariat, providing technical guidance and coordination support, but cannot compel States to act.

Eleven of the 196 States Parties rejected the 2024 amendments. For these countries, earlier versions of the IHR will continue to apply, though rejections may be withdrawn at any time. WHO has pledged to assist Member States, on request, in integrating the new provisions into domestic legal frameworks and strengthening institutional capacities.

Looking Forward

As global mobility, trade, and climate change increase the risks of infectious disease spread, the IHR amendments are expected to play a crucial role in strengthening resilience against future epidemics and pandemics. Health experts emphasize that the reforms provide not only a legal structure but also a moral statement: that international cooperation, transparency, and solidarity remain the cornerstone of global health security.

The challenge ahead will be ensuring that all countries, regardless of income or capacity, can implement these measures effectively. Without equitable access to resources and sustained political will, the promise of the strengthened IHR could fall short.

Still, with the amendments now in force, governments and WHO have taken a decisive step toward building a safer, fairer, and healthier future for all.