The International Health Regulations and beyond.

The international community has joined together to form a world trade system based on the rule of law. Although imperfect, the world trade system contains enforceable norms designed to facilitate international economic activity. Infectious diseases pose as great a threat to the well being of nations. Yet, global health governance remains weak or nonexistent. As The Lancet Infectious Diseases has noted, global health governance is burdened by antiquated international law assumptions. First, countries often insist on maintaining their sovereignty in matters of health. As a result, governments may fail to adhere to international health norms or cooperate with international agencies such as the WHO. Second, most international public-health law is concerned with horizontal governance—ie, the regulation of travel and trade among sovereign nations. Consequently, international law often entails border controls rather than globally established health rules that require, for example, strong national public-health capacities. Finally, the powerful high-income countries have inordinate influence on the global health agenda. Their concern is primarily to prevent movement of infections from the developing to the developed world rather than to alleviate endemic diseases in poorer regions such as HIV, malaria, and tuberculosis. Powerful countries also have failed to provide the technical assistance and resources necessary to improve health in developing countries. To overcome the problems of rigid sovereignty, horizontal governance, and entrenched power the international community should consider a new conception for global health based on the rule of international law. WHO’s proposed revision of the International Health Regulations (IHRs), if expanded according to six principles (panel), could serve as a model for effective public-health governance. The stated goal of the revised IHRs is to “provide security against the international spread of disease while avoiding unnecessary interference with international traffic”. The IHRs should stress the salience of global health and WHO’s essential functions to achieve that purpose. WHO should dedicate itself to the protection and promotion of global health. Wherever possible, health rules should respect travel and trade, but assuring global health remains WHO’s primary function. The current IHRs are limited to three infectious diseases: cholera, plague, and yellow fever. This narrow scope impedes WHO in effectively dealing with modern health threats ranging from HIV/AIDS to bioterrorism. The revised IHRs cover “all events potentially constituting a public health emergency of international concern”. This new approach is preferable because it is flexible, future-oriented, and covers all hazards (radiological, chemical, and biological), whether naturally occurring, accidental, or intentional. WHO should continually specify the kinds of health conditions encompassed within this broad definition. Failure to do so could give member states an excuse not to report