An Analysis of International Health Regulations Emergency Committees and Public Health Emergency of International Concern Designations

Abstract

Nine public health events have been assessed for the potential declaration of a Public Health Emergency of International Concern (PHEIC). According to the World Health Organization (WHO) International Health Regulations (IHR), a PHEIC is defined as an extraordinary event that constitutes a public health risk to other states through international spread and requires a coordinated international response. The WHO Director-General convenes Emergency Committees (ECs) to provide their advice on whether an event constitutes a PHEIC. The EC rationales have been continuously criticised for being non-transparent and contradictory to the IHR. This first comprehensive analysis of EC rationale provides recommendations to increase clarity of EC decisions which will strengthen the IHR and WHO’s legitimacy in future outbreaks.

A total of 66 EC statements were reviewed from the nine public health outbreaks of influenza A, Middle East respiratory syndrome coronavirus, polio, Ebola virus disease, Zika, yellow fever and coronavirus disease-2019 (COVID-19). Statements were analysed to determine which of the three IHR criteria were noted as contributing towards the EC’s justification on whether to recommend to the WHO Director-General that a PHEIC be declared and what language was used to explain their decision.

Interpretation of the criteria were often vague and applied inconsistently. ECs often failed to describe and justify which criteria had been satisfied. Guidelines must be developed for the standardised interpretation of IHR core criteria. The ECs must clearly identify and justify which criteria have contributed to their rationale for or against PHEIC declaration. Striving for more consistency and transparency in EC justifications would benefit future deliberations and provide more understanding and support for the process.

Keywords: Public Health Emergency of International Concern (PHEIC), Emergency Committee, International Health Regulations (IHR), Global Health