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On September 19, 2025, amendments to the International Health Regulations (IHR) came into effect. These rules bind 196 States Parties (the 194 WHO Member States, along with two non-members). Under these rules, each country retains the authority to legislate for its own population, but commits to act in ways that protect the wider international community from disease threats.
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Sanitary beginnings & regulations
The concept has its roots in 19th century Europe, when cholera outbreaks along trade routes prompted the first International Sanitary Conference in Paris in 1851. These conferences created rules for quarantine and information exchange. Over the next century, they led to a series of conventions, including specific agreements on aerial navigation and maritime health during the World Wars. Following the creation of the WHO in 1948, these fragmented conventions were consolidated into the International Sanitary Regulations of 1951. They covered six diseases: cholera, plague, yellow fever, smallpox, relapsing fever, and typhus. Their focus remained on shipping, ports, and border certificates, reflecting the priorities of the time.
IHR of 1969 and 2005
In 1969, the regulations were renamed the International Health Regulations. The scope was narrowed to three diseases – cholera, plague, and yellow fever. Certificates of vaccination and quarantine requirements remained central, but the narrow disease list soon proved outdated. The outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003 demonstrated the weaknesses of the older system. In 2005, the World Health Assembly (WHA) adopted a completely revised IHR. This version applies to any “public health emergency of international concern,” not just to specific diseases. It required notification to the WHO within 24 hours, mandated development of “core capacities” in disease detection and response, and required each States Party to establish a system for round-the-clock communication.
Amendment procedure
The technical process of amendment is set out in Article 55 of the IHR. Amendments may be proposed by any State Party or by the WHO Director-General. They are then circulated to all State Parties for consideration. Adoption requires a majority decision of the World Health Assembly, which is the forum where all 196 States Parties are represented. Once adopted, the amendments are transmitted to all States Parties by the Director-General. Under Article 59, they enter into force after a fixed period, unless a country expressly rejects them under Article 61. A country may also enter reservations under Article 62. The 2024 amendments were adopted through consensus at the 77th WHA, rather than by a formal vote. This means no Member State opposed them strongly enough to require voting, allowing the text to be accepted collectively. The resolution WHA77.17 (2024), adopted several amendments.
Emergency and review committees
The IHR also established technical committees to guide decision-making. The Emergency Committee, created under Article 48, is composed of international experts chosen for their relevance to the event at hand. It advises the WHO Director-General on whether an event constitutes a public health emergency of international concern or a pandemic emergency, and on the temporary recommendations that should follow. The Review Committee, created under Article 50, is another expert body. It provides technical advice on proposed amendments, on the content of standing recommendations, and on any other questions referred by the Director-General.
Pandemic emergency defined
The 2024 amendments add a new legal category: Pandemic Emergency. This is defined as a public health emergency of international concern caused by a communicable disease that has, or is at high risk of having, wide geographical spread to and within multiple States, and that overwhelms health systems with significant social and economic disruption requiring rapid, equitable, and enhanced international action with the potential need for a whole-of-government and whole-of-society response. This definition now sits alongside the existing “public health emergency of international concern.” WHO has clarified that negotiations on a separate pandemic agreement, being conducted by an intergovernmental negotiating body, continue independently. The legal definition of pandemic emergency, however, already enters into force through these IHR amendments.
National IHR Authority
The amendments require every country to establish a National IHR Authority, distinct from the Focal Point. While the Focal Point is mainly a channel of communication, the Authority will have responsibility for coordinating implementation of the regulations across ministries and sectors, ensuring coherence between health, transport, trade, and security agencies. For India, this will mean formal designation of such an authority by the Union Ministry of Health and Family Welfare, (or any nodal ministry as designated by GoI) with likely involvement of Parliament in updating public health laws. India will need to reinforce its disease surveillance networks, laboratory infrastructure, and rapid response mechanisms, while also enacting measures to protect personal data during emergencies.
Monitoring and evaluation
To ensure compliance, the WHO and States Parties use Joint External Evaluations (JEE). These are voluntary but collaborative reviews in which international experts work with national authorities to assess readiness across key areas such as surveillance, laboratory systems, risk communication, and health workforce. The results help identify gaps and priorities for investment, strengthening the ability of countries to meet their IHR obligations. From cholera quarantines in the 1850s to the sanitary regulations of 1951, from the disease-specific rules of 1969 to the broad system of 2005, and now the detailed amendments of 2024, the IHR have continuously adapted. With 196 States Parties now bound, a new definition of pandemic emergency has entered the global health dictionary.
(Dr. C. Aravinda is an academic and public health physician. The views expressed are personal. aravindaaiimsjr10@hotmail.com)
Published – October 01, 2025 06:34 am IST
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