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

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