The World Health Organization’s authority to declare an international health crisis has entered a new institutional phase. Amendments to the International Health Regulations (2005), adopted by the World Health Assembly in June 2024, created a formal category known as a “pandemic emergency.” The change gives governments and public-health agencies a more precise framework for recognizing outbreaks that threaten multiple countries, while preserving the existing designation of a public health emergency of international concern, or PHEIC. The reform is intended to correct weaknesses exposed by COVID-19, when delayed reporting, fragmented national responses, unequal access to vaccines and limited transparency allowed a respiratory virus to spread globally before coordinated measures were fully activated. At the same time, the new system has intensified a debate over how much authority the WHO should possess when an outbreak begins to cross borders.
Under the amended regulations, a pandemic emergency is not a completely separate mechanism from a PHEIC. Instead, it is a higher-risk form of international emergency nested within the same legal structure. The WHO director-general may determine that an event constitutes a pandemic emergency when it is caused by an infectious disease, has—or is at significant risk of having—wide geographical spread across states, is overwhelming or threatening to overwhelm health systems, and requires rapid, coordinated international action. The designation also considers the likelihood of major social or economic disruption and the need for intensified global cooperation. This technical threshold is designed to distinguish a pathogen with pandemic potential from a serious but geographically contained outbreak. It is a form of risk classification, not a declaration that a pandemic has already reached every region of the world.
The decision-making process remains centered on the WHO director-general, but it is structured through expert consultation. When an outbreak may meet the criteria for a PHEIC or pandemic emergency, the director-general can convene an Emergency Committee composed of specialists in epidemiology, virology, clinical medicine, public health, law and other relevant fields. The committee reviews surveillance data, transmission patterns, disease severity, health-system pressure, genetic changes in the pathogen and the capacity of affected states to respond. Its advice is not automatically binding, and the director-general retains the final authority to issue the determination. This arrangement institutionalizes the WHO’s role as a global risk assessor while acknowledging that the evidence available during an emerging outbreak is often incomplete, rapidly changing and geographically uneven.
The new designation matters because timing is a biological variable in epidemic control. For many viruses, especially those transmitted through the respiratory tract, each delay in detection or intervention can produce a geometric increase in infections. The effective reproduction number, commonly represented as Rt, describes how many people one infected person transmits the pathogen to under current conditions. If Rt remains above one, case numbers grow; if it falls below one, transmission contracts. Early international coordination can reduce Rt through testing, isolation, vaccination, treatment, ventilation, protective equipment and targeted travel or border measures. The amendments therefore connect legal recognition with operational urgency. A pandemic emergency is meant to trigger faster sharing of information, laboratory samples, genomic sequences, countermeasures and technical guidance before exponential growth makes containment substantially more difficult.
The reform also creates a clearer two-level emergency architecture. A PHEIC remains the broad international alert for an event that poses a public-health risk through international spread and may require a coordinated response. A pandemic emergency signals that the threat has an additional combination of features: sustained cross-border transmission, a pathogen capable of causing extensive disruption, pressure on health systems and a need for immediate collective action. This “tiering” is intended to avoid treating every international outbreak as if it carried the same level of danger. However, the categories do not function like automatic switches. They rely on expert interpretation, epidemiological evidence and political judgment. A pathogen can be highly transmissible but cause mostly mild disease, or cause severe disease while remaining difficult to transmit. The legal framework must therefore evaluate several biological and societal variables simultaneously.
The amended regulations also respond to one of the most damaging lessons of COVID-19: a global alert does not guarantee a global response. The text introduces stronger expectations for cooperation, including the exchange of relevant health information, support for developing countries and improved access to medical products. It recognizes the importance of technology transfer, financing, laboratory capacity, surveillance networks and supply chains for vaccines, diagnostics and treatments. These provisions are especially significant because pathogens do not distribute their risks according to national wealth, while scientific tools often do. During the coronavirus pandemic, vaccine supply, sequencing capacity and intensive-care resources were concentrated unevenly across regions. A declaration issued from Geneva could identify a common threat, but it could not by itself manufacture doses, compel companies to share technology or ensure that lower-income countries received countermeasures at the same speed as wealthier states.
The amended rules also require each country to establish or designate a national IHR authority capable of coordinating communication with the WHO and domestic institutions. Such authorities are intended to improve the flow of outbreak information between laboratories, hospitals, ministries and international agencies. The change reflects a technical reality of modern surveillance: early signals often emerge from local clinicians, wastewater monitoring, animal-health systems or genomic laboratories before they become visible in national statistics. A functioning national authority can connect these streams and transmit verified information quickly. Yet implementation will depend on staffing, financing, laboratory infrastructure and political independence. The regulations do not create a global enforcement agency, and WHO recommendations generally do not override national law. States retain control over their public-health measures, although they are expected to justify actions that are more restrictive than the WHO’s advice and to avoid unnecessary interference with international traffic and trade.
That limitation has made sovereignty central to the debate surrounding the amendments. Critics have warned that a broader WHO role could allow an international body to influence domestic lockdowns, travel restrictions or vaccination policies. Supporters counter that the amended regulations do not authorize the WHO to order citizens into quarantine, impose vaccines or directly manage national health systems. The organization can issue temporary and standing recommendations, coordinate technical assistance and communicate its assessment of the threat, but governments remain responsible for implementation. The practical power of a pandemic emergency declaration is therefore partly legal and partly political. It can shape access to financing, align surveillance systems and create pressure for cooperation, but its effectiveness depends on whether states trust the assessment and act on it.
For scientists, the most consequential question is whether the new system will improve detection without encouraging either complacency or alarm. A designation made too late can allow a virus to establish transmission networks that are expensive or impossible to dismantle. A designation made too early, on weak evidence, could reduce credibility and encourage governments to disregard future warnings. The WHO’s challenge will be to communicate uncertainty while explaining why action may be justified before all biological details are known. That requires transparent criteria, publication of the evidence considered by expert committees, clear distinctions between hazard and risk, and regular reassessment as new data emerge. The amended IHR provide a more explicit framework for those judgments, but they cannot eliminate the scientific uncertainty inherent in the first weeks of an outbreak.
The institutionalization of pandemic emergency status ultimately represents an attempt to convert the lessons of COVID-19 into a repeatable international procedure. It gives the WHO a defined mechanism for identifying when an outbreak has moved beyond an ordinary PHEIC and requires a more urgent, coordinated response. Yet the declaration itself is only the beginning of pandemic governance. Its value will be measured by what follows: how quickly countries share samples and sequences, how equitably vaccines and antivirals are distributed, whether health systems receive support before they collapse, and whether governments coordinate rather than compete. The amended regulations may provide a sharper instrument for global health diplomacy, but the instrument will work only if nations supply the scientific data, political trust and material resources needed to use it.
Subject of Research: The institutionalization of the WHO’s authority to determine a pandemic emergency under the amended International Health Regulations (2005).
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: World Health Organization, International Health Regulations (2005), as amended by the World Health Assembly in 2024; World Health Organization, amendments to the International Health Regulations adopted on 1 June 2024; World Health Organization, guidance on public health emergencies of international concern and pandemic emergencies.
Image Credits: AI Generated
Keywords: World Health Organization, WHO, pandemic emergency, PHEIC, International Health Regulations, infectious disease, viral outbreaks, pandemic preparedness, global health governance, epidemiological surveillance
