June 22, 2022
U.S. Proposals to Amend the International Health Regulations
Background
called the Emergency Committee, makes recommendations
Since 1980, outbreaks of new and long-standing infectious
to the Director-General on how to control the event and
diseases have been occurring with greater frequency and
whether to declare a PHEIC. The composition of each
causing higher numbers of human infections. The World
Emergency Committee varies per outbreak. The IHR
Health Assembly (WHA), the governing body of the World
Emergency Committee for Pneumonia Due to the Novel
Health Organization (WHO), has occasionally amended a
Coronavirus 2019-nCoV, for example, was composed of 15
long-standing set of rules called the International Health
scientists from around the world, including an official from
Regulations (IHR) to address this growing global threat. In
the U.S. Centers for Disease Control and Prevention
January 2022, the United States introduced amendments to
(CDC). Though the Director-General usually follows the
the Regulations that sought to broaden the ways in which
advice of Emergency Committees, the Director-General
WHO could respond to public health threats and increase
makes final determinations on the event.
the pace of such responses. Congressional deliberations of
these amendments focused on the potential implications of
A PHEIC declaration alerts countries to implement public
implementation and whether adoption of the amendments
health emergency responses, as outlined in IHR (2005). The
would require congressional consent since the United States
Regulations provide the framework for the response and
consented to be legally bound by the Regulations through
Member States develop their own implementation plans. In
an executive agreement. This In Focus addresses common
upholding IHR (2005), the Regulations specify that
questions regarding the IHR, including the role of Congress
Member States have “the sovereign right to legislate and to
and the status of U.S.-proposed amendments to the
implement legislation in pursuance of their health policies.”
Regulations.
As such, a PHEIC declaration does not automatically
restrict travel or impose specific quarantine requirements,
International Health Regulations
for example.
In 1969, WHA adopted the IHR to stop the spread of six
diseases (cholera, plague, yellow fever, smallpox, relapsing
Following a PHEIC declaration, countries may take a
fever, and typhus) through quarantine and other infectious
number of actions, including heightening surveillance,
disease control measures. The WHA amended the IHR
reporting incidence of the relevant disease to the WHO, and
several times, most comprehensively in 2005. The 2005
allocating resources for domestic or international responses.
edition, known as IHR (2005), expanded methods for
On behalf of the United States, former U.S. Department of
controlling infectious disease outbreaks beyond quarantine
Health and Human Services (HHS) Secretary Alex Azar,
and broadened the type of public health events that would
for example, “declared a public health emergency for the
require international coordination. The Regulations provide
entire United States to aid the nation’s healthcare
an overarching legal framework that defines the rights and
community in responding to 2019 novel coronavirus”
obligations of parties to the agreement (which includes the
following the WHO PHEIC declaration for Coronavirus
United States and all other WHO Member States) in
Disease 2019 (COVID-19). A declaration can also enable
handling public health events and emergencies that have the
WHO to access certain emergency funding during an
potential to cross borders. They also outline criteria for
outbreak, such as that provided through the United Nations
declaring a public health emergency of international
concern (PHEIC) and requirements for Member States to
(U.N.) Central Emergency Response Fund and the World
Bank Pandemic Emergency Financing Facility.
report public health events;
designate National IHR Focal Points for communication
Frequently Asked Questions
with WHO; and
How were the IHR adopted and amended?
establish and maintain core capacities for surveillance
and response.
Articles 21 and 22 of the WHO Constitution authorize
WHA to adopt regulations to prevent the spread of
IHR (2005) compliance is measured through a self-
infectious diseases, among other things. WHA developed
assessment questionnaire that WHO sends to Member
and amended the IHR pursuant to this authority.
States.
Article 55 of IHR (2005) specifies that any WHO Member
Public Health Emergency of International Concern
or the WHO Director-General may submit amendments to
Following the emergence of an event that might be deemed
be considered by WHA. If WHA adopts any amendments,
a PHEIC, the WHO Director-General convenes an
Article 59 of IHR (2005), as amended, specifies that WHO
international team of independent experts to analyze
Member States have 10 months to notify their intent to
available information on the event and consider the views
reject all or some of the regulations or to accept them
of the State Party where the event is occurring. The team,
subject to reservations. A “reservation” functions as a
https://crsreports.congress.gov
U.S. Proposals to Amend the International Health Regulations
partial adoption of the Regulations. For states accepting
were expected to be considered at the 75th WHA in May
IHR amendments, the amendments take effect 12 months
2022. The amendments introduced by the Biden
after their initial adoption.
Administration built on the aforementioned Roadmap,
congressional calls for strengthening IHR (2005)
When did the United States become a party to the
compliance, and feedback from the WHO Working Group
IHR, and are the Regulations a treaty?
on Strengthening WHO Preparedness and Response to
In 1948, Congress passed a joint resolution authorizing the
Health Emergencies.
President to accept membership for the United States in
WHO. Through an “executive agreement,” the United
What did the amendments propose?
States accepted to be legally bound by the IHR. An
The amendments were primarily aimed at expanding the
executive agreement is an international agreement based on
capacity of WHO to respond to public health events,
constitutional authority conferred on the executive branch
including to
(e.g., executive authority over foreign affairs). Although an
permit WHO to develop an early warning system and
executive agreement is a type of treaty from an
to issue a public health alert for events that are not
international law perspective, it does not qualify as a treaty
deemed a PHEIC;
for purposes of the U.S. Constitution’s Treaty Clause,
which requires Senate advice and consent.
enable WHO to issue a PHEIC and other alerts should
a Member State where the event is occurring decline to
How does WHO monitor IHR (2005)
cooperate;
implementation?
require the Member State that rejected WHO
IHR (2005) requires all Member States to have developed
consultation to provide a rationale for its decision;
minimum public health capacities to detect acute public
permit a WHO Regional Director to declare a public
health events in a timely manner, assess and report to WHO
health emergency of regional concern;
through their National IHR Focal Point health events that
may constitute a PHEIC, and respond to public health risks
direct countries to provide WHO-convened experts
investigating a possible PHEIC “short term access to
and emergencies. WHO monitors State Party progress in
these areas through the issuance and analysis of self-
relevant sites ... in compliance with national law”; and
assessment questionnaires.
establish a Compliance Committee to oversee and
report on global IHR (2005) compliance.
How does WHO enforce IHR?
As noted, IHR (2005) does not provide WHO with
What is the status of the U.S.-proposed
enforcement authority; instead, IHR (2005) specifies that
amendments?
implementation must follow national decisionmaking
The 75th WHA did not consider the U.S.-proposed
processes. If a WHO Member State asserts another is not
amendments. Instead, it adopted amendments to shorten the
adhering to IHR obligations, that Member State may raise
period of time in which countries could implement and
the issue with the other Member State, privately or during
object to any IHR amendments. The WHA also decided to
WHA sessions. A WHO Member State could also initiate
establish a Working Group on IHR amendments “to discuss
dispute settlement procedures set out in Article 56 of IHR
targeted amendments to address specific and clearly
(2005). To date, no WHO Member State has ever invoked
identified issues, challenges, including equity, technological
the Article 56 process against another Member State.
or other developments, or gaps that could not effectively be
addressed otherwise but are critical to supporting effective
Why did the United States propose amendments
implementation and compliance of the International Health
to IHR (2005)?
Regulations …” The Working Group is to propose a
In the first year of the COVID-19 pandemic, the Trump
package of targeted amendments for consideration no later
Administration criticized what it called WHO’s delayed
than the 77th Health Assembly in 2024.
acknowledgement that COVID-19 was spreading via
human-to-human transmission and WHO’s inability to
Does the Administration require congressional
investigate fully the origins of the pandemic. Several
approval to propose or adopt IHR amendments?
Members of Congress also criticized the WHO response
The executive branch retains authority to introduce IHR
and called for a range of actions, including withdrawing
amendments without congressional consent. If Congress
from WHO, holding China accountable for failing to
wishes to exercise greater control over U.S. proposals for or
comply with IHR (2005) in a timely fashion, strengthening
positions on IHR amendments, it could consider requiring
WHO, and boosting global disease surveillance capacity
the Administration to notify and consult with Congress
within and outside of WHO. The Trump Administration,
about such proposals. Congress could also consider placing
after announcing in 2020 the intent to withdraw the United
conditions on the use of appropriated funds or enact a Sense
States from WHO, released a “WHO Roadmap” to
of Congress expressing support for or concern about
“strengthen the WHO by increasing accountability and its
particular amendments.
ability to be impartial and objective, [and] improve
transparency and its overall effectiveness, by providing it
Tiaji Salaam-Blyther, Acting Section Research Manager
with a more comprehensive set of tools that are fit-for-
Nina M. Hart, Legislative Attorney
purpose to address new and emerging threats.” At the 150th
Session of the WHO Executive Board in January 2022, the
IF12139
United States introduced amendments to IHR (2005) that
https://crsreports.congress.gov
U.S. Proposals to Amend the International Health Regulations
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https://crsreports.congress.gov | IF12139 · VERSION 1 · NEW