By: Lauren Tonti<\/p>\n
Containing a pandemic is a titanic task, requiring the cooperation of modern-day Titans. On March 11, 2020, the World Health Organization (\u201cWHO\u201d) declared a global pandemic of COVID-19<\/a>, a respiratory disease spread by airborne pathogens from the coronavirus family. Infecting nearly 1,500,000 individuals<\/a> across 184 countries as of April 9, 2020, and killing over 90,000 worldwide, COVID-19 has tested the tools of global health governance that are designed to protect populations. One such tool is the International Health Regulations (\u201cIHR\u201d). As a multinational agreement binding 196 Member States to monitor and report international health threats, the IHR<\/a> seeks to coordinate a balanced public health response, while minimizing disruption to international travel and trade and upholding human rights. Mandating protocols to detect, assess, and report<\/a> outbreaks, the IHR requires Member States to implement core capacities<\/a> designed to equip national disease outbreak responses. Importantly, the IHR also gives the WHO\u2019s Director-General the power to declare a public health emergency of international concern<\/a> (\u201cPHEIC\u201d), which mobilizes coordinated international action. Indeed, states shoulder much of the responsibility to generate and report the public health metrics required to trigger any PHEIC notification. The IHR reflects an accumulation of the lessons that past pandemics have taught the global community. But as the world watches COVID-19 take its toll, the future of these regulations remains uncertain.<\/p>\n The present coronavirus is not the world\u2019s first duel with a pandemic. The bubonic plague, a series of cholera outbreaks, and the Spanish flu are among the most notorious pandemics in recorded history. Each bout with pandemic illness has taught the international community hard-fought lessons that stakeholders used to adjust laws accordingly. Such lessons informed the evolution of this global health governance tool.<\/p>\n The 1892 International Sanitary Convention<\/a> embodies some of the earliest concerted efforts of international powers to combat European cholera outbreaks under a unified framework. Furthering these principles, the International Sanitary Regulations<\/a> were adopted by Member States of the newly-founded WHO in 1951, later revised and renamed as the International Health Regulations in 1969. The IHR of 1969<\/a> focused on six major diseases<\/a>, including cholera, plague, yellow fever, smallpox, relapsing fever, and typhus. A series of illnesses across the globe prompted minor revisions <\/a>throughout the subsequent decades before the AIDS epidemic and the SARS outbreak necessitated major revisions<\/a> in 2005.<\/p>\n The 2005 revisions broadened the IHR\u2019s scope<\/a> beyond the six major diseases, aiming to encompass biological, chemical, and nuclear incidents, as well as zoonotic diseases and food safety concerns. The 2005 IHR revisions recommend best practices for international traffic at points of entry, reflecting modern globalized traffic and trade. The revisions increased the WHO\u2019s investigational capacities and encouraged the observance of human rights in protecting public health. However, the latest round of revisions, which came into effect in 2007, failed to increase the instrument\u2019s enforcement power. Current enforcement mechanisms rely on public shaming<\/a> techniques that highlight damaged international reputations, increased national mortality, economic disruptions, and public outrage.<\/p>\n Since the revisions, the world has confronted Ebola, swine flu, and Zika virus. While a mix of hard and soft law<\/a> direct health governance, the IHR is certainly one of the most multinational and tangible instruments available. At present, it has guided the global response to COVID-19.<\/p>\n As a fast-spreading, severe acute respiratory syndrome, COVID-19 matches the profile of notifiable diseases<\/a> for which the IHR was designed. Yet, in response to COVID-19, there have been numerous violations of the IHR mandates, showing that the preventive mechanisms enshrined in IHR have failed<\/a>\u2014in large part due to national discretion.<\/p>\n Despite extended compliance deadlines<\/a>, n<\/a>o WHO Member State is in complete compliance <\/a>with the IHR\u2019s core competencies. Europe achieved the highest level of compliance at 72%<\/a> <\/u>across all competencies, according to the WHO\u2019s State Parties Self-Assessment Annual Reporting Tool (\u201cSPAR\u201d). Notably, however, the SPAR has been criticized<\/a> for its lack of independent validation. National evaluation of compliance is also seen as inconsistent<\/a>. Nonetheless, if these metrics are the \u201cindisputable baseline[s] for preparedness,\u201d<\/a> Member States were at marked disadvantages from the outset of COVID-19. Whether because of inadequate funding, resources, or sheer lack of will, nations\u2019 inhibited core capacities hurt the global COVID-19 response.<\/p>\n The COVID-19 epidemic bears witness to several direct IHR infractions<\/a>, particularly Articles 6 and 7, governing reporting, and Article 43, regarding the implementation of protective measures.<\/p>\n While the IHR mandates national reporting and monitoring of notifiable disease outbreaks, China, a WHO Member State, was accused of censoring<\/a><\/u> and withhold<\/a>ing<\/u> information<\/a> at the outbreak\u2019s outset<\/a>, violating its duties in IHR Articles 6 and 7<\/a>. Since the disease\u2019s progression, reports have surfaced that China\u2019s disease management tactics, such as censorship and mass quarantine<\/a>, violate human rights, civil liberties, and IHR Article 3<\/a>\u2019s explicit call for respecting \u201cdignity, human rights and fundamental freedoms of persons.\u201d<\/p>\n In violation of IHR Article 43<\/a>, which instructs disease management tactics to be grounded in available scientific evidence, numerous nations implemented travel bans<\/a> barring travelers from endemic regions and closed national borders to non-citizens in the name of disease containment. Such tactics<\/a>, which usually only yield benefits at the very preliminary stages of an outbreak, have proven detrimental<\/a> to disease control efforts, especially as less restrictive yet similarly effective<\/a> disease containment protocols were available. Moreover, in enacting such restrictions, nations disregarded guidance repeatedly issued by the WHO<\/a>, yet another Article 43 violation.<\/p>\n While the IHR affords nations the prerogative to enact additional disease containment, Member States must report the extraordinary measures they have taken to the WHO. Perpetuating violations, only 32% of the 72 Member States implementing coronavirus travel restrictions reported<\/a> these measures in a timely fashion to the WHO during the outbreak.<\/p>\n Unfortunately, the trends of forsaking WHO guidance while implementing additional bans that disrupted travel and trade are all repeat offenses, as the same types of infractions<\/a> occurred during the Ebola and swine flu outbreaks<\/a>. These infractions reflect a severe \u201ccrisis of confidence in the [International Health] Regulations.\u201d<\/a><\/p>\n Political pressure<\/a> appears to have impeded the IHR\u2019s functionality. Critics argue that the WHO had sufficient evidence to declare COVID-19 a PHEIC as early as January 23, 2020<\/a>, though the Director-General did not officially do so until a week later. Taiwan claims<\/a> the WHO failed to act upon its officials reports to the WHO in December 2019 of human-to-human coronavirus transmission. Additionally, while the WHO stated that it is not in the business of shaming Member States for missteps, it has praised China<\/a> for what many call draconian measures. Critics call such politically motivated support a \u201cdeception\u201d<\/a> that gave the global community \u201ca false sense of assurance\u201d<\/a> about COVID-19\u2019s manageability.<\/p>\n As COVID-19 continues to rage, the IHR\u2019s future becomes less certain. As death counts surge, confidence in the IHR sinks. In the scrutiny likely to follow this pandemic, many will likely wonder whether the IHR adequately fit modern tendencies. This criticism will not be novel. Scholars predicted such difficulties.<\/p>\n Before COVID-19 struck, scholars called for revisions, as the Ebola outbreak alone revealed challenges for the IHR. Lawrence O. Gostin<\/a>, in symphony with other leading public health scholars, has long advocated for another IHR revision. Scholars suggest fundamental modifications<\/a> to financing, harmonization, evaluation metrics, core capacities, compliance, the role of civil society, human resource utilization, transparency, and more that will fortify the instrument for modern-era pandemic response.<\/p>\nThe IHR: An Instrument Informed by Past Pandemics<\/strong><\/h1>\n
At Present: IHR vs. COVID-19<\/strong><\/h1>\n
Nations\u2019 Lack of Core Capacities Hurt COVID-19 Response<\/em><\/h2>\n
Member States Violated Key IHR Provisions<\/em><\/h2>\n
Political Pressures Pose Impediments<\/em><\/h2>\n
What Future for the IHR?<\/strong><\/h1>\n