In the wake of the COVID-19 pandemic and its unprecedented global impact, the international community has intensified scrutiny over the mechanisms that govern the declaration of public health emergencies. Central to this scrutiny is the World Health Organization (WHO) and its regulatory power articulated through the International Health Regulations (IHR) of 2005, the legal framework designed to prevent and respond to acute public health risks. A new study by Zhang and Guo, published in Global Health Research and Policy in 2025, provides a groundbreaking analysis of how the WHO’s authority to determine a Public Health Emergency of International Concern (PHEIC) has been institutionalized, particularly focusing on the role of the amended IHR’s tiered approach.
The concept of “tiering” in the context of the IHR refers to the gradation or classification of health emergencies, which carries significant implications for how the WHO mobilizes resources, issues guidance, and coordinates international responses. The study “To tier or not to tier: the institutionalization of the World Health Organization’s power to determine pandemic emergency in the amended International Health Regulations (2005),” by Zhang and Guo, dissects this tiering mechanism to reveal the complex interplay between legal authority, political dynamics, and health diplomacy.
Integral to understanding the institutionalization process is the history and evolution of the IHR. Originally adopted in 1969 as a narrow framework focusing on a few diseases, the revised IHR (2005) vastly expanded the scope to encompass any event that may constitute a public health emergency of international concern. This reform was in large part a response to the emergent health threats of the 21st century, including SARS, H1N1 influenza, and later, the COVID-19 crisis. Zhang and Guo meticulously chart this historical trajectory to explain how the WHO’s role transitioned from passive information gathering to an active, authoritative agent with the power to declare a PHEIC.
Zhang and Guo argue that the tiering system embedded within the amended IHR serves as a critical instrument for legitimizing and operationalizing the WHO’s emergency powers. This tiered classification allows the organization to modulate its response based on severity, geographical spread, and the potential international impact of health threats. The authors make clear that tiering is not merely an administrative convenience but a manifestation of the WHO’s increasing institutional capacity and political clout in global health governance.
Significantly, the paper underscores the political and diplomatic tensions involved in the declaration of health emergencies. The decision to designate an event as a PHEIC can have profound implications for affected states, including travel restrictions, trade sanctions, and economic disruption. Zhang and Guo illustrate how these considerations influence both WHO deliberations and member states’ reactions, framing the tiering process as a balancing act between scientific evidence and geopolitical realities.
The analysis dives deep into the procedural steps involved in the WHO’s determination process. The authors elucidate the roles of the Emergency Committee, expert panels, and the Director-General, highlighting how the revised IHR codifies the delegation of responsibilities and enhances transparency. A particularly insightful aspect of the study is the examination of how institutional norms and routines have become embedded within the WHO’s architecture, facilitating more consistent and timely emergency declarations.
Moreover, Zhang and Guo critique the challenges that the WHO faces in maintaining scientific objectivity while navigating competing political pressures. They draw on case studies, including the 2009 H1N1 influenza pandemic and the Ebola outbreaks, to illustrate how the tiering framework sometimes confronted criticism for either delayed or overly cautious declarations. The analysis suggests that while the tiering mechanism offers a structured approach, its implementation remains contingent upon the organizational culture and political environment within which the WHO operates.
Advancing their argument, the authors explore the implications of tiering for global health security. The tiered IHR approach fosters a graduated response that optimizes coordination among international actors and facilitates resource mobilization. This institutional design enhances global preparedness and resilience by ensuring that response levels are commensurate with threat magnitude, encouraging member states to comply with recommended measures, and minimizing unnecessary alarmism.
Delving into technical details, Zhang and Guo analyze the operational metrics used to assess whether an event qualifies for different tiers. These include epidemiological indices such as transmissibility, case fatality rate, and cross-border spread potential. They also consider the role of real-time data analytics and risk communication strategies that inform tier classification. The paper highlights how advances in technology and surveillance systems have augmented the WHO’s capacity to rapidly assess and categorize emerging health threats.
The study further explores how the tiering system has influenced the WHO’s interaction with other international bodies such as the World Trade Organization and the United Nations Security Council. This multidimensional institutional embedding allows the WHO to leverage broader diplomatic and economic mechanisms, thereby amplifying its authority while navigating inter-agency jurisdictional overlaps.
Zhang and Guo’s work is especially relevant in light of ongoing debates about the WHO’s reform and the calls for enhancing its mandate ahead of future pandemics. They argue convincingly that institutionalizing the tiered approach is a pivotal step in strengthening global health governance but caution that further reforms must address remaining gaps, including political interference, funding constraints, and the need for robust enforcement mechanisms.
The authors also speculate on the future trajectory of the IHR and WHO’s emergency powers. They suggest that increasing digital integration, including AI-driven surveillance, and improved global data-sharing networks could refine the tiering system further, allowing more nuanced and dynamic emergency assessments. However, these technical advances must be matched by political will to ensure that the WHO remains autonomous and authoritative.
On a broader scale, the paper situates the tiering institutionalization within the evolving paradigm of transnational health governance. Zhang and Guo posit that the tiering mechanism reflects a shift towards a more layered and flexible international legal order that can adapt quickly to health crises while maintaining legitimacy among diverse stakeholders.
In conclusion, Zhang and Guo’s research offers a compelling examination of how the WHO’s power to declare pandemics has been formalized through the tiered amendments to the International Health Regulations. Their detailed and critical study sheds light on the operational, legal, and political dynamics that shape global health emergency declarations. This vital contribution not only advances academic understanding but also informs policymakers and health practitioners grappling with the complex realities of pandemic governance in an interconnected world.
Their findings underscore the necessity for ongoing vigilance, transparency, and capacity building within the WHO framework to ensure that the international community is prepared for the next global health emergency. As pandemics continue to pose existential threats, the institutional mechanisms to detect, classify, and respond to such threats remain pivotal for safeguarding public health worldwide.
Subject of Research: The institutionalization of the World Health Organization’s authority to declare pandemic emergencies via the amended International Health Regulations (2005), with a focus on the tiered emergency classification system.
Article Title: To tier or not to tier: the institutionalization of the World Health Organization’s power to determine pandemic emergency in the amended International Health Regulations (2005).
Article References:
Zhang, Y., Guo, Y. To tier or not to tier: the institutionalization of the World Health Organization’s power to determine pandemic emergency in the amended International Health Regulations (2005). Global Health Research and Policy 10, 40 (2025). https://doi.org/10.1186/s41256-025-00438-6
Image Credits: AI Generated
