Spotlight: International Health Regulations (2005)

Ten years ago, the international community joined together to create a new, comprehensive framework to prevent the spread of infectious diseases and other health threats. These are known as the International Health Regulations (2005) (IHR).

A historical perspective

As early as the 14th Century, people used quarantine to keep diseases like the plague from spreading across borders.[i] In more recent times, there have been a series of agreements between countries to address the potential spread of disease, beginning with the International Sanitary Convention in 1892 and continuing until today with the International Health Regulations (IHR).[ii]

The IHR, revised in 2005, are used by countries to prevent and control public health threats while avoiding unnecessary interference with international travel and trade.[iii]

Lessons from recent outbreaks

The ideas behind the IHR (2005) are not new. We have known for a very long time that what affects one country can affect other parts of the world. This is especially true today, when we are so closely connected to everyone else. And global health security is not just a health issue; a crisis such as HIV or Ebola can devastate economies and stall future development, and the impact of this devastation reaches farther and wider than ever.[iv] As the world broadens, our responsibility to each other broadens along with it.

Before the outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003, previous international agreements had been designed to address specific diseases and public health situations. However, the SARS outbreak made the world aware that we now face threats that might not be foreseeable, from newly emerging diseases to chemical or radiological hazards to bioterrorism.

A modern solution

After SARS, the IHR were revised to address these modern threats and to cover “all events potentially constituting a public health emergency of international concern (PHEIC).”  While the previous version of the regulations required countries only to report incidents of cholera, plague, and yellow fever, the revised IHR remain more flexible and future-oriented, requiring countries to consider the possible impact of all hazards, whether they occur naturally, accidentally, or intentionally.[v]

The IHR represent an obligation for all 196 WHO Member States to work together for global health security.[vi] The regulations require that all countries have the ability to detect, assess, report and respond to public health events.

As part of their commitment to the IHR, participating countries agreed to comply with these rules by 2012. However, by 2012, fewer than 20% of countries had met IHR goals. By 2014, only about 1/3 of participating countries (64 countries) reported fully achieving the core capacities.[vii]

Taking concrete steps

One way in which CDC is helping countries reach the goals of the IHR is through our work in global health security. CDC assumes a lead role in IHR implementation as it relates to human disease. Our main focus is on detection, prevention, and control. One major role for CDC is to support existing health monitoring systems that identify and report. We collaborate with local, state, and federal public health authorities to improve the ability of national health monitoring systems to report possible pubic heath emergencies of international concern (PHEICs) under IHR provisions.


CDC is currently working with its partners to actualize the IHR through the Global Health Security Agenda. The GHS Agenda is “an effort by nations, international organizations, and civil society to accelerate progress toward a world safe and secure from infectious disease threats; to promote global health security as an international priority; and to spur progress toward full implementation of the IHR.”[viii]

We are only as safe as the most fragile state, which is why it is crucial to continue helping all countries comply with the IHR. Learn more about the IHR and the work CDC is doing every day to prevent and respond to public health emergencies.


[i] Heymann, David L et al., Global health security: the wider lessons from the west African Ebola virus disease epidemic;

The Lancet , Vol. 385 , Issue 9980 , 1884 – 1901

[ii] Katz R, Fischer J. The Revised International Health Regulations:  A Framework for Global Pandemic Response. Global Health Governance, Volume 3, Number 2, Spring 2010

[iv] Heymann, David L et al., Global health security: the wider lessons from the west African Ebola virus disease epidemic;

The Lancet , Vol. 385 , Issue 9980 , 1884 – 1901

[v] Gostin, Lawrence, The International Health Regulations and beyond; The Lancet, Vol. 4, Issue 10, 606–607

[vii] Katz R, Dowell S.  Time for an International Health Regulations Review Conference. Lancet Global Health 2015. Published Online May 8, 2015.  July 2015. Vol 3(7), e352-353

[viii] CDC. Global Health Security Agenda. Page accessed 6/19/15.