THE rapid spread of Covid-19 has paralysed the world. However, communicable diseases like SARS, MERS, swine flu, Ebola and Zika fever have also been a cause of global distress in the past. Repeated outbreaks of infections across national borders demonstrate the need for effective global cooperation to adopt preventive measures that restrict the spread of such diseases at the outset.

The primary and only international legal instrument dealing with infectious diseases are the International Health Regulations of 2005, created under the auspices of the World Health Assembly and the WHO, in response to the SARS outbreak in 2002.

Previously, the global health security regime was governed by the IHR of 1969, which recognised only three diseases: cholera, plague and yellow fever.

The revised regulations are binding on 196 nations. The IHR provides a robust framework to counter any Public Health Emergency of International Concern, which also includes the spread of contagious diseases. The main purpose of these regulations is to control and respond to risks of international disease transmission. The regulations make it mandatory on state parties to notify the outbreak of any infectious disease, which may constitute a PHEIC to WHO in order to contain and impede outbreaks. For this purpose, states are required to designate national focal points available round the clock to relay urgent communication and reporting to WHO.

Why have nations failed to implement the 2005 regulations?

The state parties are required to develop and enhance core public health capabilities for surveillance and response against harmful contagions. These regulations make it binding on nations to chalk out national action plans for influenza pandemic preparedness and to have essential health and sanitary services and equipment at international airports, seaports and ground crossings along their borders.

The IHR further empowers WHO to issue temporary recommendations in the event of PHEIC regarding timely and efficient public health responses. Such recommendations include reviewing travel histories of people in affected areas, placing suspected infectious persons under observation, implementing quarantine, contact tracing, screening of travellers from affected areas, along with refusing entry to suspected or affected people to national territories. The IHR in 2005 gave contracting states an initial two years to meet the requirements and provisions of the regulations by evaluating their existing health structures and resources.

The advent of Covid-19 and its subsequent spread to 199 countries illustrates the lack of implementation and adherence to these regulations. The responsibility of complying with the directives contained in the IHR rests with state parties, and progress on implementation has been sluggish despite the two-year deadline. According to a study conducted by the British Medical Journal, 119 countries including some of the most developed ones were unable to meet the key requirements prescribed by the regulations.

The duties assumed by the states under the IHR require resources, commitment and a spirit of cooperation. The lack of a regulatory and national legal framework is one of the main reasons why its implementation has been obstructed at the national and local level. Most public health authorities aim for early detection and response against infectious diseases but lack the political backing and resources essentially required to achieve this.

Another impediment in the way of effective execution of IHR regulations is the lack of financial resources required to develop public health capacities. The scarcity of monetary resources required to overhaul the health system of nations, especially developing ones, is exacerbated by the fact that the regulations created no formal fund to help such countries. Lack of economic assistance by global financial institutions to support initiatives to become IHR-compliant poses a significant hurdle.

The most noteworthy challenge, however, lies in the absence of any enforcement mechanism to guarantee adherence to the provisions of the IHR. The regulations do not specify any type of sanctions on states that fail to comply with its binding measures. Compliance with IHR predominantly lies on national governments and national leaders’ ability to recognise that averting public health threats is for their own benefit.

Although the IHR provides a starting point for the global battle against contagious diseases, the inherent flaws in the scheme hamper its efficacy. The current Covid-19 crisis has once again highlighted the need for enhanced international cooperation to strengthen global health security. World leaders need to chalk out a comprehensive strategy to counter the ever-increasing threat posed by infectious diseases, as the world has now witnessed that health security is inextricably linked to national security and economic prosperity.

The writer is a lawyer.

Twitter: @usamamaalik1

Published in Dawn, April 15th, 2020