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

DOI: https://doi.org/10.1186/s41256-025-00438-6

Understanding the amendments to the International Health Regulations enacted in 2005 is necessary to comprehend the WHO’s evolving role. The IHR (2005), legally binding on all WHO member states, were designed as a global legal instrument to help countries prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide. Previous versions of the IHR were limited in scope, more procedural than proactive. The 2005 amendments marked a decisive shift by expanding the WHO’s mandate to act swiftly and decisively during outbreaks of new or re-emerging diseases, establishing a novel legal framework that not only standardized reporting but also institutionalized the WHO’s authority to assess threats and escalate responses.

Zhang and Guo’s analysis focuses on the institutional mechanisms by which the WHO’s emergency powers are tiered—meaning whether and how outbreaks are classified along a graduated scale of severity that justifies different levels of intervention. This tiering process is not merely a technical procedural step; it reflects an intricate balance between scientific evidence, political considerations, and international collaboration. The crux of the dilemma revolves around whether the WHO should employ a tiered approach in declaring emergencies or adopt a binary system—a declaration or no declaration—in order to optimize effectiveness, clarity, and legitimacy.

What becomes immediately clear from the article is that the institutionalization of the WHO’s power to designate a pandemic emergency reveals profound tensions embedded in global health governance. The tiered approach offers nuance, allowing for differentiated responses according to threat magnitude, yet it may risk diluting urgency or creating confusion. Conversely, a non-tiered, all-or-nothing declaration approach provides unambiguous signals but might engender premature alarm or political resistance from states wary of economic and social ramifications.

Zhang and Guo meticulously trace how the amended IHR institutionalized procedural thresholds—standardized criteria, evidence requirements, expert committees, and emergency committees—that operationalize the WHO’s emergency powers. These mechanisms codify how evidence of disease spread, severity, and public health implications are assessed, thereby embedding scientific rigor into what is otherwise a highly politicized and consequential decision. Importantly, the article emphasizes the role of the Emergency Committee (EC), a group of independent experts whose deliberations shape the WHO Director-General’s final call on declaring a PHEIC.

The article further dissects how politics inevitably entangles with science within these institutional frameworks. The power to declare a public health emergency affects not only global health outcomes but international relations, trade, travel, and national sovereignty. Many states might resist declarations fearing severe economic consequences or stigmatization, thus exerting diplomatic pressures on the WHO. The WHO itself faces the challenge of balancing its technical mandate while navigating competing geopolitical interests—an often tenuous position reflected in the IHR’s design which both empowers and shackles its emergency decision-making capacity.

In evaluating tiered versus non-tiered models, Zhang and Guo delve into historical case studies ranging from the 2009 H1N1 influenza pandemic to the ongoing challenges witnessed during the COVID-19 crisis. They highlight how the WHO’s adoption of tiered alerts during H1N1 allowed calibrated responses but also attracted criticism for perceived overreaction, which arguably eroded some public trust and political capital. Meanwhile, the COVID-19 pandemic underscored problems stemming from delays in PHEIC declarations and ambiguous risk communication, fueling debates about whether the existing tiered system sufficiently supports timely and effective interventions.

Beyond descriptive analysis, the article proposes that institutionalizing the WHO’s powers within IHR (2005) shaped both the procedural legitimacy and operational constraints of global emergency declarations. The tiering decision is not an abstract bureaucratic design but a pivotal institutional determinant influencing the dynamics of international cooperation, compliance, and public perception. The authors stress that the legal codification of these powers offers a critical lens to better understand why—and how—the WHO exercises discretionary authority in emergency situations.

Furthermore, Zhang and Guo advocate for enhanced transparency and clarity in tiering criteria, underscoring that ambiguity can weaken the WHO’s leadership role. The authors argue that clearer scientific benchmarks, coupled with robust communication strategies, could improve both the timeliness and acceptance of emergency declarations. Establishing predictable patterns of response would help mitigate political interference and reassure member states, fostering stronger commitment to collaborative global health security.

The article also sheds light on the institutional interplay between WHO’s emergency powers and national public health systems. While the IHR binds states legally, enforcement remains complex, depending heavily on states’ capacities, political will, and trust in WHO’s expertise. The tiering system thus also serves as an institutional interface linking global mandates with national sovereignty, necessitating delicate negotiation between respecting state autonomy and ensuring collective security.

Zhang and Guo conclude that the decision to tier or not—and how to calibrate that process—is ultimately a question of governance philosophy as much as legal design. It requires reconsidering the WHO’s role not simply as a technical agency but as a complex international institution mediating science, politics, law, and diplomacy. The amended IHR (2005) represent a significant institutional milestone but one whose operationalization remains fraught with challenges and opportunities for reform.

Public health experts and policymakers alike will find Zhang and Guo’s work essential reading in navigating the post-pandemic world. As countries reckon with the lessons from COVID-19 and prepare for future threats, the institutional mechanisms driving WHO’s emergency declarations will be under intense scrutiny. The nuanced institutional analysis in this article prompts global health governance actors to rethink the trade-offs embedded in the tiering model, fostering dialogue about how to optimize rapid, coordinated, and effective responses without sacrificing legitimacy or political feasibility.

Moreover, the article implicitly signals that reforms to the IHR and WHO emergency powers must evolve in tandem with advances in epidemiological science, data analytics, and real-time global health surveillance technologies. Innovations in digital disease detection, genomics, and artificial intelligence will increasingly shape how and when pandemics are detected, evaluated, and responded to. Institutional frameworks, including tiering mechanisms, must therefore be flexible, dynamic, and anticipatory to ensure responsiveness in an accelerating epidemiological landscape.

This institutional inquiry also highlights the crucial role of communication and trust. Robust emergency declaration systems require not only legal authority and scientific sophistication but public and political buy-in. Missteps in declaring—or failing to declare—public health emergencies can undermine trust, dampen compliance with control measures, and weaken the credibility of the WHO itself. Consequently, effective institutionalization must embed both procedural rigor and communicative transparency as core pillars.

Ultimately, Zhang and Guo provide a foundational contribution by revealing that the seemingly bureaucratic question of tiering pandemic emergencies encapsulates profound institutional dilemmas and power negotiations at the heart of global health governance. Their article crystallizes an urgent imperative for the international community to reassess and reinforce the WHO’s emergency powers to foster a more resilient and equitable global health security architecture.

In a world where the next pandemic threat looms at the intersection of biology, politics, and technology, understanding the institutional architecture of the WHO’s mandate is a matter of paramount urgency. This in-depth exploration by Zhang and Guo invites scholars, policymakers, and global citizens to engage rigorously with how the international system can better anticipate, adjudicate, and manage health crises that transcend borders and imperatives.

Subject of Research: Institutionalization of the WHO’s power to determine pandemic emergencies 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:
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). glob health res policy 10, 40 (2025). https://doi.org/10.1186/s41256-025-00438-6

Image Credits: AI Generated