In the labyrinthine world of global health governance, few entities wield influence as pivotal—and as contested—as the World Health Organization (WHO). Their authority to declare a Public Health Emergency of International Concern (PHEIC) sets the stage for rapid international responses, mobilizing resources, and shaping policy across nations. Yet, beneath this apparent decisiveness lies a complex institutional evolution shaped by legal frameworks, political dynamics, and the ever-shifting landscape of international health crises. In their groundbreaking article published in Global Health Research and Policy, Zhang and Guo illuminate a critical but often overlooked dimension of this evolution: the institutionalization of the WHO’s power to determine a pandemic emergency under the amended International Health Regulations (IHR) of 2005. Their exploration probes the question central to global health diplomacy and effectiveness—To tier or not to tier?
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
