NR 553 Week 5 Global Health Governance Write-Up Example

Governance Write-Up: The 2005 International Health Regulations, What Their Text Obliges a State to Do, Whether Those Obligations Bind, and What Actually Happens When a State Ignores Them

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College of Nursing, Chamberlain University

NR 553: Global Health

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Month Day, Year

Governance Write-Up: The 2005 International Health Regulations, What Their Text Obliges a State to Do, Whether Those Obligations Bind, and What Actually Happens When a State Ignores Them

The Instrument

The 2005 International Health Regulations were adopted by the World Health Assembly in May 2005 and entered into force in June 2007, replacing an earlier version that covered only a few named diseases (World Health Organization, 2016). They are the main international legal instrument for preventing and responding to the international spread of disease. Gostin and Katz (2016) describe them as the governing framework for global health security. This write-up examines what the text requires, whether it binds and what happens when states do not comply, using the Ebola epidemic of 2014 as a test.

Binding, or Merely Adopted

Unlike a World Health Assembly resolution or a code of practice, the International Health Regulations are legally binding on the states that are party to them, which include nearly every country in the world. They were adopted under the WHO Constitution's provision allowing the Assembly to adopt regulations that enter into force for all member states except those that reject them or enter reservations within a set period. A small number of states entered reservations or statements of understanding; the United States, for example, entered a reservation related to its federal system. For almost all states, therefore, the obligations below are legal obligations, not recommendations. That settles an important point early: noncompliance is a breach of international law, not merely a failure to follow advice.

What the Text Obliges States to Do

Build core capacities. States must develop the capacity to detect, assess, report and respond to public health events, including surveillance and laboratory capacity, and at designated points of entry such as airports and ports.

Notify. Each state must assess events in its territory using a decision instrument in an annex to the Regulations and notify WHO within 24 hours of assessing any event that may amount to an international public health emergency.

Share information. States must continue to share public health information with WHO about notified events.

Limit additional measures. States may take health measures beyond WHO's recommendations, but measures that significantly interfere with international traffic, defined to include refusing entry or departure to travelers or delaying them for more than 24 hours, must be based on scientific principles and evidence, and the state must inform WHO and provide its public health rationale.

The Regulations also give WHO powers: the Director-General can determine that an event is a public health emergency of international concern, advised by an Emergency Committee, and can issue temporary recommendations on measures states should take. Those recommendations are not binding.

The Consequence of Ignoring It

The Regulations contain no sanctions. There is no fine, no suspension of membership and no enforcement body. A dispute between states about the Regulations is to be settled by negotiation or other peaceful means, and arbitration is available only if the states agree. WHO's main tool is information: it can publish information about an event, share information states have not made public in some circumstances, and ask states that impose additional measures to justify them. In practice, the consequence of ignoring the Regulations is, at most, being named.

The Ebola epidemic tested this. Guinea notified WHO promptly once the disease was confirmed, meeting the notification obligation, though the disease had spread for months before it was recognized, reflecting the weakness of core capacities that the Regulations required but that had not been built (WHO Ebola Response Team, 2014). Later in the epidemic, dozens of countries imposed travel restrictions on the affected countries, including entry bans on travelers, that went beyond WHO's temporary recommendations, which advised against general travel and trade bans. Many of those countries did not provide WHO with the public health rationale the Regulations require (Gostin & Katz, 2016). WHO could ask; it could not compel.

Why States Comply at All

Given the absence of sanctions, it is worth asking why most states comply most of the time. Compliance brings technical support from WHO and partners during an outbreak, protects a state's reputation, and makes other states more likely to share information in return. States also share an interest in early warning. But the incentives are uneven. The costs of notification, including trade and travel restrictions, fall on the reporting state, while the benefits are shared. That asymmetry explains why the article limiting additional measures matters so much: it is the only part of the text that tries to protect reporting states from being punished for reporting, and it is the part most often ignored.

Three Tests for the Regulations

The Ebola epidemic suggests three tests of whether the Regulations are working. First, do states have the core capacities the Regulations require, including laboratories able to confirm dangerous pathogens? In 2014, Guinea, Liberia and Sierra Leone did not, and the Regulations provided no mechanism or funding to make sure they did. Second, do states notify promptly? Guinea notified within days of confirmation, which suggests the notification obligation can work when a disease is recognized. Third, do other states refrain from measures that punish reporting countries? In 2014, many did not.

The Regulations pass the second test, fail the first and fail the third. That pattern is consistent with an instrument whose cheapest obligations are met and whose costly obligations depend on resources and restraint. Any reform that strengthens only notification, without funding capacity and limiting punitive measures, would leave the two weaker tests where they are.

Assessment

The International Health Regulations are a binding instrument with strong obligations on paper and weak consequences in practice. Their strength is in establishing shared rules and a system for notification and response that nearly every state has accepted. Their weakness is that the obligations most costly to states, building capacity and refraining from excessive restrictions, depend on goodwill and funding rather than enforcement. Proposals since the Ebola and COVID-19 experiences have focused on strengthening compliance, financing core capacities and increasing transparency. For nurses in global health work, the practical lesson is that the Regulations shape what governments report and when, but a local health worker who recognizes an unusual cluster remains the first and most important part of the system.

Understanding the limits of the Regulations also helps a clinician explain to patients and communities why international action can seem slow, and why local reporting still matters.

References

Gostin, L. O., & Katz, R. (2016). The International Health Regulations: The governing framework for global health security. Milbank Quarterly, 94(2), 264-313. https://doi.org/10.1111/1468-0009.12186

WHO Ebola Response Team. (2014). Ebola virus disease in West Africa: The first 9 months of the epidemic and forward projections. New England Journal of Medicine, 371(16), 1481-1495. https://doi.org/10.1056/NEJMoa1411100

World Health Organization. (2016). International Health Regulations (2005) (3rd ed.).