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The World Health Organization (WHO) and its global health security treaty, the International Health Regulations (2005) (IHR) have lost the world's confidence after the West African Ebola epidemic. The epidemic led to several high-level reviews of the IHR and global health security more broadly. Here, we propose a series of recommendations for operational and legal reforms to enhance the functioning of the FCGH. It is critical that WHO act on them quickly, before the window of opportunity for fundamental reform closes.

WHO should ensure that all states fulfill their obligations to develop national core surveillance and response capacities, including through funding, possibly through additional assessed contributions, and an independent peer-review assessment process, with assessments identifying gaps and strategies and financing to fill those gaps. Civil society could also participate in ensure the validity of assessments. Independent assessments will improve confidence in the IHR, as would increasing the transparency of Emergency Committees deliberations, supplemented by an independent body to review disease data and offer recommendations to the WHO Director-General.

States might more promptly notify WHO of events that may constitute public health emergencies of international concern with enhanced training and if the IHR's decision instrument is amended to make more diseases automatically notifiable. WHO should also further encourage and facilitate reporting from non-governmental sources. A harmonized, gradient system for health emergencies would also bring greater clarity to disease response, while maintaining the power of a declaration of a public health emergency of international concern.

To improve compliance with temporary recommendations and deter harmful additional measures, WHO could use public pressure, acknowledging compliance while publicly naming states parties and businesses that fail to comply, along with requesting justification for additional measures. States could use dispute mediation, arbitration, or other legal procedures, such as through the World Trade Organization, to discourage harmful trade and travel restrictions. And to advance a One Health approach, based on the links between human, animal, and environmental health, WHO should increase its use of cooperative agreements with other intergovernmental bodies, while integrating the Pandemic Influenza Pandemic Framework with the IHR to encourage equitable sharing of vaccines and therapies.

Publication Citation

386 Lancet 2222 (2015)