Public Health Emergency of International Concern

Public Health Emergency of International Concern. It is the highest level of alert that can be declared by the World Health Organization under the International Health Regulations (2005). This formal declaration signifies an extraordinary event that constitutes a public health risk to other states through the international spread of disease and potentially requires a coordinated global response. The purpose is to prompt immediate international action to contain a health threat before it becomes a full-blown pandemic.

Definition and criteria

A Public Health Emergency of International Concern is defined as an extraordinary event determined to constitute a public health risk to other states through the international spread of disease and to potentially require a coordinated international response. The decision to declare one is based on an assessment of four key criteria outlined in the International Health Regulations (2005). These criteria include whether the event is serious, unusual, or unexpected; carries implications for public health beyond the affected state’s border; and may require immediate international action. The assessment is made by the WHO Director-General upon the advice of an Emergency Committee of international experts. The committee evaluates the risk to human health, the risk of international spread, and the risk of interference with international traffic.

Declaration process

The process for declaring a Public Health Emergency of International Concern is governed by the legally binding International Health Regulations (2005), which were adopted by the World Health Assembly. The process typically begins when the World Health Organization is notified of a potential threat, often through official channels from a member state or via reports from the Global Outbreak Alert and Response Network. The Director-General of the World Health Organization convenes an Emergency Committee, whose members are selected from the IHR Roster of Experts. This committee provides technical advice and a recommendation on whether the event constitutes a Public Health Emergency of International Concern. Following the committee's advice, the Director-General makes the final determination and issues temporary recommendations to states parties, which are reviewed every three months. The declaration is communicated to all member states and the public.

Historical examples

Since the revised International Health Regulations (2005) came into force, several Public Health Emergencies of International Concern have been declared. The first was for the 2009 swine flu pandemic caused by the H1N1 virus. Subsequent declarations were made for the 2014 polio declaration, the 2014 Ebola outbreak in West Africa, the 2015–16 Zika virus epidemic, the 2018–20 Kivu Ebola epidemic, the COVID-19 pandemic, and the 2022–2023 mpox outbreak. The 2014 Ebola outbreak in West Africa, primarily affecting Guinea, Sierra Leone, and Liberia, was a major test of the regulations. The declaration for COVID-19 pandemic in January 2020, following the initial outbreak in Wuhan, Hubei, China, led to unprecedented global health measures and the eventual development of vaccines by entities like Pfizer and Moderna.

Criticism and challenges

The declaration of a Public Health Emergency of International Concern has faced criticism and operational challenges. Critics argue that the process can be politicized, with concerns about undue influence from member states like the People's Republic of China or economic considerations. The declaration for the 2009 swine flu pandemic was later criticized as an overreaction by some, including the Council of Europe. Conversely, the initial delay in declaring the 2014 Ebola outbreak in West Africa was seen by organizations like Médecins Sans Frontières as a failure that cost lives. Other challenges include inconsistent compliance by member states with the International Health Regulations (2005), a lack of sustainable financing for outbreak response, and the difficulty of balancing public health recommendations with their socioeconomic impact, including potential stigmatization of affected regions.

Legal and financial implications

A declaration of a Public Health Emergency of International Concern carries significant legal and financial implications under the International Health Regulations (2005). Legally, it does not automatically impose new restrictions on states but authorizes the World Health Organization to issue temporary, non-binding recommendations. These can include advice on travel, trade, and border measures, which states are obligated to justify if they implement additional, more restrictive measures. Financially, a declaration often triggers the release of emergency funds from mechanisms like the WHO Contingency Fund for Emergencies and can mobilize resources from donors such as the World Bank and the Coalition for Epidemic Preparedness Innovations. It also activates global supply chains for medical countermeasures and can influence markets and airline policies. The declaration aims to catalyze a coordinated international financial response, as seen with the Access to COVID-19 Tools Accelerator.