May 9, 2016

Empowering the World Health Organization and Realizing the Potential of the International Health Regulations

New York, New York, May 9, 2016 – The announcement in April that the WHO had begun the process of electing its next Director-General could mark renewed effort to strengthen the enforcement of the International Health Regulations (IHR). In the wake of the recent Ebola crisis, several major global commissions questioned the efficacy of the IHR, which, for over the last decade, have served as the governing framework for global health security. These commissions expressed concerns with the leadership structure of the World Health Organization (WHO), the agency that oversees IHR.

In a new Early View Milbank Quarterly study, Lawrence O. Gostin, of the O’Neill Institute for National and Global Health Law and Georgetown Law, and Rebecca Katz, of George Washington University, present a clear and comprehensive description of the IHR, evaluate the recent global commission reports evaluating them, and offer proposals for fundamental reform and strengthening of the IHR, particularly for strong national health system core capacities. “Empowering the WHO and realizing the IHR’s potential will shore up global health security – a vital investment in human and animal health, while reducing the vast economic consequences of the next global health emergency,” they write.

Study Focus

The study reviews the historical origins of the IHR and its performance over the past 10 years, including how its regulations changed as it focused on HIV/AIDS (1995), SARS (2002), H1N1 (2009), MERS (2012), and polio, Ebola, and Zika (2014 to 2016). The researchers note that the past decade “has revealed an urgent need to improve the IHR’s text, but failure to effectively implement the regulations has become far more important. State parties, in particular… have failed to comply with their international obligations.”

With the process now underway to elect a new WHO Director-General, Gostin says that member states should put forth and empower a strong leader who, among other things, will strengthen the enforcement of the IHR, adding, “Governments around the world, including the United States, have flaunted the IHR by erecting unnecessary travel and trade restrictions and quarantines that violate human rights. It is simply unacceptable to have a global health treaty that is not properly implemented and enforced. There ought to be consequences for failing to safeguard public health by implementing measures guided by science.”


The authors propose “a series of recommendations with realistic pathways for change.” The recommendations focus on the development and strengthening of IHR core capacities; independently assessed metrics; new financing mechanisms; harmonization with the Global Health Security Agenda, Performance of Veterinary Services (PVS) Pathways, the Pandemic Influenza Preparedness Framework, and One Health strategies; public health and clinical workforce development; Emergency Committee transparency and governance; tiered public health emergency of international concern (PHEIC) processes; enhanced compliance mechanisms; and an enhanced role for civil society.

About The Milbank Quarterly
Continuously published since 1923, The Milbank Quarterly features peer-reviewed original research, policy review, and analysis from academics, clinicians, and policymakers. The Quarterly’s multidisciplinary approach and commitment to applying the best empirical research to practical policymaking offers in-depth assessments of the social, economic, historical, legal, and ethical dimensions of health and health care policy. The Milbank Quarterly is published in March, June, September, and December on behalf of the Milbank Memorial Fund by John Wiley & Sons.

Contact: O’Neill Institute: Karen Teber /

Judith Zimmer/