Future Needs of International Health Regulations in a Globalized World

The COVID-19 pandemic exposed critical gaps in our global health architecture. While the world had frameworks like the International Health Regulations in place, the pandemic revealed that having rules on paper isn’t enough. As we look toward the future, strengthening these regulations has become not just a health priority but an economic and moral imperative for nations worldwide.

Strengthening global health systems for equitable protection 🔗

The most glaring lesson from COVID-19 is that weak health systems anywhere pose a threat everywhere. Low- and middle-income countries faced disproportionate challenges in detecting and containing outbreaks, not due to lack of effort but lack of resources. The pandemic resulted in over 7 million confirmed deaths and pushed an additional 70 million people into extreme poverty between 2020 and 2023.

The economic toll tells an even starker story. The IMF estimated cumulative losses from the pandemic reached $13.8 trillion through 2024. As IMF First Deputy Managing Director Gita Gopinath noted, health security is economic security. This massive economic impact underscores why investing in global health preparedness cannot be viewed as charity but as essential infrastructure for economic stability.

Building equitable health systems requires addressing fundamental inequalities in health infrastructure. Many countries lack the basic surveillance systems, laboratory capacity, and trained workforce needed to detect outbreaks early. The 2022 WHO/World Bank report estimated that international financing needs to increase by between $10.5 billion to $15 billion per year, alongside increased domestic financing. While this seems substantial, it pales in comparison to the trillions lost during pandemics.

The Pandemic Fund and sustainable financing 🔗

Recognizing these gaps, the international community launched the Pandemic Fund in 2022. This multilateral financing mechanism focuses exclusively on strengthening pandemic prevention, preparedness, and response capacities in low- and middle-income countries. As of November 2024, the fund had awarded $885 million in grants, catalyzing an additional $6 billion from international and domestic partners for 47 projects covering 75 countries.

However, sustainable financing requires more than one-time allocations. Countries need predictable, flexible funding streams that allow them to build and maintain core capacities over time. The current model of emergency funding that appears only during crises perpetuates the cycle of panic and neglect that has characterized pandemic preparedness for decades.

Enhancing preparedness and response mechanisms 🔗

Despite years of planning, the world remained dangerously unprepared for COVID-19. The 2021 Global Health Security Index found that no country scored in the top tier for preparedness, and the average country score was just 38.9 out of 100. Perhaps most concerning, nearly two-thirds of countries had not published and implemented an overarching national public health emergency response plan for diseases with epidemic or pandemic potential.

The gaps extend beyond planning documents. Only about one-third of countries have the basic capacity to handle public health emergencies effectively. Seventy percent of countries show insufficient health capacity in clinics, hospitals, and community health centers, including inadequate human resources and facilities. This means that when an outbreak occurs, most countries lack the fundamental infrastructure to respond quickly.

From assessment to action 🔗

The International Health Regulations require countries to develop core capacities for surveillance and response, but compliance has been uneven. While the IHR are legally binding on 196 countries, many nations struggle to meet these obligations due to resource constraints and competing priorities.

The 2024 amendments to the IHR represent a shift toward addressing these implementation challenges. These amendments emphasize equity and solidarity, moving the regulations from a purely technical instrument to one that addresses the inherently political issues of resource distribution and international cooperation. The amendments include new provisions requiring WHO to facilitate timely and equitable access to health products during emergencies.

Long-term capacity-building must become the norm rather than the exception. This means moving beyond annual assessments to continuous improvement cycles. Countries need support not just to identify gaps but to systematically address them through multi-year plans with dedicated funding and technical assistance.

Balancing rights and responsibilities through equity and coordination 🔗

The principle of equity lies at the heart of effective pandemic response. COVID-19 starkly illustrated what happens when vaccine nationalism and resource hoarding prevail over global solidarity. While high-income countries quickly secured vaccines, low-income countries struggled to protect even their healthcare workers. By late 2021, only 4 percent of people in low-income countries were fully vaccinated compared to 70 percent in high-income countries.

The updated IHR amendments place equity front and center. The 2025 WHO Pandemic Agreement, adopted in May 2025, complements these amendments by establishing principles and targets for pandemic prevention, preparedness, and response with equity as a key driver. The agreement promotes an all-of-government and whole-of-society approach within countries.

Coordinated action across borders 🔗

Global partnerships are essential to successful IHR implementation. In our closely interdependent world, no country can protect its citizens from pandemic threats alone. Partnership requires countries to share technical skills and resources, support capacity strengthening at all levels, and help each other during crises.

Coordination must also extend across sectors within countries. Health, agriculture, travel, trade, education, and defense sectors all play roles in pandemic preparedness. Building coherent alert and response systems that span these sectors allows countries to rapidly mobilize required resources when outbreaks occur.

The challenge of balancing national sovereignty with collective responsibility remains contentious. Countries understandably want to protect their populations first, but history shows that virus variants and antimicrobial resistance know no borders. What happens in one country inevitably affects others. The IHR framework must evolve to better incentivize early reporting and transparent information sharing while protecting countries from punitive travel and trade restrictions.

Accountability and transparency 🔗

Future iterations of the IHR need stronger accountability mechanisms. Inadequate compliance with IHR obligations contributed to COVID-19 becoming a protracted global health emergency. Countries must make IHR implementation a priority at the highest levels of government, integrating it into broader resilient health system building through a whole-of-government approach.

Transparency builds trust, and trust proved crucial during the pandemic. The GHS Index found that 161 countries have low to moderate levels of public confidence in their government, which undermined compliance with public health measures in many places. Strengthening governance, building public trust, and ensuring transparent communication must be central to preparedness efforts.

The international community has made progress since COVID-19 exposed our vulnerabilities. The 2024 IHR amendments, the 2025 Pandemic Agreement, and new financing mechanisms like the Pandemic Fund represent important steps forward. However, the gap between commitments and implementation remains wide. Translating these frameworks into concrete improvements in health security will determine whether we are truly better prepared for the next pandemic.

What do you think? How can countries balance national interests with global health security needs? What mechanisms would best ensure that wealthy nations support capacity-building in lower-income countries without creating dependency?

References

1. https://www.worldbank.org/en/topic/pandemics
2. https://www.imf.org/en/News/Articles/2022/04/05/pr22104-new-imf-staff-paper-strategy-to-manage-the-long-term-risks-of-covid-19
3. https://ghsindex.org/
4. https://www.paho.org/en/topics/international-health-regulations
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC12228423/
6. https://www.who.int/news-room/questions-and-answers/item/pandemic-prevention–preparedness-and-response-accord
7. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01911-5/fulltext