International Health Regulations (IHR)

The United States is party to the International Health Regulations (IHR) (2005), a legally binding agreement, along with all 196 Member States of WHO. The IHR (2005) require that countries conduct surveillance for potential international health threats of all kinds and report those to WHO in a timely manner. The IHR also requires that countries prepare for and respond effectively to contain disease outbreaks and other health hazards before they negatively affect trade and travel, and cooperate with one another to develop coordinated surveillance, communications, and response capabilities.

U.S. IHR National Focal Point (NFP)

The IHR (2005) created a global surveillance network for rapid information sharing among countries on public health emergencies with international implications through IHR National Focal Points (NFPs). Under the IHR (2005), each country is required to designate or establish a NFP that is always accessible for IHR-related communications with the World Health Organization (WHO) and relevant sectors within the country.

The U.S. IHR NFP was established through a U.S. government interagency process in July 2007, where the HHS Secretary’s Operation Center, Office of Global Affairs (OGA), and the Assistant Secretary for Preparedness and Response (ASPR) constitute the three major components of the NFP. The U.S. IHR NFP Program, located in OGA, coordinates across the U.S. government on event assessments and notifications; manages and develops IHR NFP policies, procedures, and programmatic work; and leads IHR monitoring and evaluation for the U.S. The HHS Secretary’s Operation Center monitors IHR communications on a 24/7/365 basis and works closely with the U.S. IHR NFP program to rapidly process and send out communications. The Assistant Secretary for Preparedness and Response (ASPR) serves as the Authorizing Official for formal communications and notifications to the WHO on behalf of the USG.

States Party Self-Assessment Annual Reporting (SPAR) Tool

To effectively ensure implementation of the IHR (2005), State Parties use the SPAR tool to annually report on 35 indicators for the 15 IHR capacities needed to detect, assess, notify, report, and respond to public health risks and acute events of domestic and international concern. The U.S. IHR NFP leads the SPAR process for the U.S. and engages with USG partners to ensure the U.S. submission obtains information from all sectors involved in implementing IHR core capacities.

Secretary’s Challenge on Equity

In response to Executive Order 13985, the Secretary for Health and Human Services (HHS) challenged every HHS operating division and staff division to generate and submit equity-focused policy ideas to help the Department better serve underserved communities. The Secretary’s Challenge, operated by Health Disparities Council Policy Lab, asks operating divisions and staff divisions to submit two to three actions, which could have been new ideas or expansions of existing efforts, that could be undertaken by themselves or in coordination with other divisions in the next one to two years.

The U.S. IHR NFP’s project proposal titled “Promoting Equity Using the World Health Organization (WHO) International Health Regulations Monitoring and Evaluation Tools” was selected as a winning proposal and aims to build on WHO’s interest in promoting equity beyond gender equity in the context of IHR-related assessment tools by improving the measurement of gender equity gaps in the context of health emergencies at the domestic, regional, and global levels based on relevant laws, policies, and programs using the IHR Monitoring & Evaluation Framework tools and close engagement with USG, WHO, and other international partners.

Links and Resources

WGIHR

In January 2022, the United States put forward 13 amendments to the IHR 2005. In May 2022, the World Health Assembly adopted the first U.S. proposed targeted amendment to Article 59 (with corresponding technical adjustments) which allowed for the entry into force of future IHR amendments to be one year from adoption rather than two years. The 75th World Health Assembly (WHA75) directed Member States to work on a package of targeted IHR (2005) amendments through the Working Group on amendments to the International Health Regulations (WGIHR) and provide a package of amendments to be considered by the 77th World Health Assembly (WHA77). The agreement to focus on targeted amendments that are intended to strengthen the IHR (2005) is based on Member State consensus that the current IHR (2005) provide a strong foundation even if certain elements of the instrument require updating.

In proposing these amendments to the IHR (2005), the United States aims to provide clearer and more actionable steps for detection, reporting, and responding to outbreaks with potential of crossing international borders. The United States is working with Member States to enhance their core capacities and capabilities in surveillance, assessment, notification, and reporting of public health events to prevent future potential international health emergencies.

The Office of Global Affairs is working with other Departments and Agencies to ensure that the final amendments ultimately strengthen IHR implementation. The United States will continue work with partners from all six WHO regions to further develop and streamline the proposed amendments to the IHR (2005) through the negotiations of the Working Group on amendments to the International Health Regulations (WGIHR).