international health regulations international health regulations the international health regulations (ihr), first adopted by the world health assembly in 1969 and last revised in 2005, are a legally binding rules that only apply to the who that is an instrument that aims for international collaboration "to prevent, protect against, control, and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks and that avoid unnecessary interference with international traffic and trade". the ihr is the only international legal treaty with the responsibility of empowering the world health organization (who) to act as the main global surveillance system. logo of the world health organization in 2005, following the 2002–2004 sars outbreak, several changes were made to the previous revised ihrs originating from 1969. the 2005 ihr came into force in june 2007, with 196 binding countries that recognised that certain public health incidents, extending beyond disease, ought to be designated as a public health emergency of international concern (pheic), as they pose a significant global threat. its first full application was in response to the swine flu pandemic of 2009. history the original international health regulations (ihr) were founded in 1969, but its underpinnings can be traced to the mid-19th century, when measures to tackle the spread of plague, yellow fever, smallpox and particularly cholera across borders, with as little interference to global trade and commerce, were debated. to address the realisation that countries varied with regards to their sanitary regulations and quarantine measures, the first of these series of early international sanitary conferences, convened in paris in 1851, in the same year that telegraphic communications became established between london and paris and when 12 nations attended, of which 11 were european states and three signed the resulting convention. the 19th century witnessed 10 of these conferences. in 1948, the world health organization constitution came about. in 1951, the who issued their first infectious disease prevention regulations, the international sanitary regulations (isr 1951), which focussed on six quarantinable diseases; cholera, plague, relapsing fever, smallpox, typhoid and yellow fever. in 1969, the isr were revised and renamed the 'international health regulations'. in 1973, the twenty-sixth world health assembly amended the ihr (1969) in relation to provisions on cholera. in 1981, in view of the global eradication of smallpox, the thirty-fourth world health assembly amended the ihr (1969) to exclude smallpox in the list of notifiable diseases. in 1995, during the forty-eighth world health assembly, the who and member states agreed on the need to revise the ihr (1969). several challenges were placed against the backdrop of the increased travel and trade characteristic of the 20th century. the revision of ihr (1969) came about because of its inherent limitations, most notably: narrow scope of notifiable diseases (cholera, plague, yellow fever). the past few decades have seen the emergence and re-emergence of infectious diseases. the emergence of “new” infectious agents ebola hemorrhagic fever in zaire (modern-day democratic republic of congo) and the re-emergence of cholera and plague in south america and india, respectively; dependence on official country notification; and lack of a formal internationally coordinated mechanism to prevent the international spread of disease. in 2005, a values statement document entitled "the principles embodying the ihr" was published and said inter alia: with full respect for the dignity, human rights and fundamental freedom of persons; guided by the charter of the united nations and the constitution of the world health organization; guided by the goal of their universal application for the protection of all people of the world from the international spread of disease; states have, in accordance with the charter of the united nations and the principles of international law, the sovereign right to legislate and to implement legislation in pursuance of their health policies. in doing so, they should uphold the purpose of these regulations. on 15 june 2007, the ihr (2005) entered into force, and were binding as of june 2020 on 196 states parties, including all 194 member states (countries) of who. in 2010, at the meeting of the states parties to the convention on the prohibition of the development, production and stockpiling of bacteriological (biological) and toxin weapons and their destruction in geneva, the sanitary epidemiological reconnaissance was suggested as well-tested means for enhancing the monitoring of infections and parasitic agents, for practical implementation of the ihr (2005) with the aim was to prevent and minimize the consequences of natural outbreaks of dangerous infectious diseases as well as the threat of alleged use of biological weapons against btwc states parties. the significance of the sanitary epidemiological reconnaissance is pointed out in assessing the sanitary-epidemiological situation, organizing and conducting preventive activities, indicating and identifying pathogenic biological agents in the environmental sites, conducting laboratory analysis of biological materials, suppressing hotbeds of infectious diseases, providing advisory and practical assistance to local health authorities. in january 2018, a group of who bureaucrats published an article in the british medical journal on global health entitled "strengthening global health security by embedding the international health regulations requirements into national health systems", in which the authors argued that "the 2014 ebola and 2016 zika outbreaks, and the findings of a number of high-level assessments of the global response to these crises, that there is a need for more joined-up thinking between health system strengthening activities and health security efforts for prevention, alert and response." public health emergency of international concern (pheic) main article: public health emergency of international concern a public health emergency of international concern, or pheic, is defined in the ihr (2005) as, “an extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a coordinated international response”. this definition implies a situation that is: serious, sudden, unusual or unexpected; carries implications for public health beyond the affected state's national border; and may require immediate international action. since 2007, the who director-general has declared public health emergencies of international concern in response to the following: 2009 h1n1 swine flu pandemic 2014 setbacks in global polio eradication efforts 2013–2016 western african ebola virus epidemic 2016 zika virus outbreak 2018–19 kivu ebola epidemic 2019–23 covid-19 pandemic 2022 monkeypox outbreak ihr experts roster the ihr experts roster, which is regulated by article 47 of the ihr, is tended by dgwho, who "shall establish a roster composed of experts in all relevant fields of expertise... in addition, shall appoint one member at the request of each state party." pro-tem structure ihr emergency committee