An analysis of International Health Regulations Emergency Committees and Public Health Emergency of International Concern Designations

Lucia Mullen, Lucia Mullen, Christina Potter, Christina Potter, Lawrence O. Gostin, Anita Cicero, Anita Cicero, Jennifer B. Nuzzo, Jennifer B. Nuzzo

Research output: Contribution to journalArticlepeer-review


Introduction Nine events have been assessed for potential declaration of a Public Health Emergency of International Concern (PHEIC). A PHEIC is defined as an extraordinary event that constitutes a public health risk to other states through international spread and requires a coordinated international response. The WHO Director-General convenes Emergency Committees (ECs) to provide their advice on whether an event constitutes a PHEIC. The EC rationales have been criticised for being non-transparent and contradictory to the International Health Regulations (IHR). This first comprehensive analysis of EC rationale provides recommendations to increase clarity of EC decisions which will strengthen the IHR and WHO's legitimacy in future outbreaks. Methods 66 EC statements were reviewed from nine public health outbreaks of influenza A, Middle East respiratory syndrome coronavirus, polio, Ebola virus disease, Zika, yellow fever and coronavirus disease-2019. Statements were analysed to determine which of the three IHR criteria were noted as contributing towards the EC's justification on whether to declare a PHEIC and what language was used to explain the decision. Results Interpretation of the criteria were often vague and applied inconsistently. ECs often failed to describe and justify which criteria had been satisfied. Discussion Guidelines must be developed for the standardised interpretation of IHR core criteria. The ECs must clearly identify and justify which criteria have contributed to their rationale for or against PHEIC declaration. Conclusion Striving for more consistency and transparency in EC justifications would benefit future deliberations and provide more understanding and support for the process.

Original languageEnglish (US)
Article numbere002502
JournalBMJ Global Health
Issue number6
StatePublished - Jun 15 2020


  • health policy
  • public health
  • review

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

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