Trade, foreign policy, diplomacy and health

8. International Health Regulations and Epidemic Control

Johan Giesecke

Problems with the IHR

  • Only covers cholera, plague, yellow fever
  • Contains no incentive for reporting an outbreak
  • WHO can only act on information officially given by a Member State
  • Ineffective in controlling protectionist over-reaction to outbreaks
  • Separation of WHO and WTO

The main problems with the present version of the IHR are that: (1) it only covers the three diseases mentioned, whilst well-known ones like meningococcal meningitis or haemorrhagic fevers, or new ones like avian influenza or Nipah virus, are not addressed at all; (2) it contains no incentive for reporting an outbreak; (3) the WHO can only act on information officially given by a Member State; and (4) it has been ineffective in controlling protectionist over-reaction to outbreaks.

However, perhaps most problematic is that even if giving the WHO responsibility for the IHR may have secured a good scientific public health input to rules and procedures, it has estranged the people involved in agreements on international trade from the process; most of whom are now not even aware of the existence of this international legislation. Among other things, this has lead to the risk of international spread of disease through trade now being debated and assessed in committees of the WTO, an arena where public health experts have little influence. We are thus seeing a separation of the two worlds of public health and traffic, a movement counter to the spirit behind the International Sanitary Conferences of 150 years ago.

Ideally, the IHR should give the WHO three main functions: 1. Alert the world of potentially dangerous outbreaks. 2. If needed, coordinate international action to control them early. 3. Restrain over-reaction in the form of quarantine rules or trade barriers that lack a scientific public health foundation. However, there are severe restrictions on the capability of the WHO to fulfil each of these functions.