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Protecting global health security through the International Health Regulations: requirements and challenges

International Health Regulations, the principle document governing the response to public health emergencies that pose an international threat, were revised in 2005 and became binding international law on June 15, 2007.1 These new regulations, unanimously approved by the World Health Assembly, differ in important ways from previous versions (Table 1) and represent a major step forward in protecting global public health security.2,3 Despite their importance, countries will face several challenges to implementing the regulations. Many developing countries lack the capacity to detect and respond to public health emergencies, and developed countries may choose to act unilaterally. Decentralized states such as Canada will also face specific challenges to implementation. In May 2008, the Auditor General of Canada issued a report highlighting areas in which Canada has had difficulty complying with the new regulations.4

In this article, we describe how the regulations provide new guidance to member states on preparing for and responding to public health emergencies, some of the challenges to compliance with the regulations, and Canada’s role in helping to ensure their successful implementation.

Features of the revised regulations

The goal of the revised International Health Regulations are to protect against the international spread of epidemics and other public health emergencies without unnecessary interference with international travel and trade. To achieve this objective, the regulations provide new guidance to member states on several matters (Figure 1). The fundamental premise of the regulations is that preparation and early detection and response are essential to protect against global health emergencies. The regulations therefore require member states to assess their core capacity for effective public health surveillance and response within 2 years and meet requirements for core capacity within the subsequent 3 years.5

Ensuring that public health emergencies are reported in a timely manner to the World Health Organization (WHO) is a priority of the new regulations. The previous version of the regulations covered only 3 specific diseases: plague, cholera and yellow fever (Table 1).6 The revised regulations instead introduce the concept of a “public health emergency of international concern.” To assist countries in determining what events should be reported, the new regulations provide a mechanism to evaluate whether events are potential international threats.3,7 Member states are required, within 48 hours, to assess any event occurring within their territory and to determine whether it may be a public health emergency using an algorithm (see Appendix 1, available online at /44/DC1).8 An outbreak of certain diseases, such as SARS (severe acute respiratory syndrome), will always be considered a potential public health emergency of international concern.


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