Public Health Emergency of International Concern

A Public Health Emergency of International Concern (PHEIC) is an emergency declaration formally announced by the World Health Organization (WHO) in response to a crisis of international proportions that can affect people’s health. Such a declaration may require immediate action at a global level against the international spread of disease. A PHEIC is subject to the International Health Regulations (IHR), which require those states involved to promptly respond to the crisis at hand. PHEICs are decided upon by a governing body of international experts known as the IHR Emergency Committee, a group formed in the aftermath of the 2002–2004 SARS outbreak. The declaration is reviewed on a tri-monthly basis and renewed as needed. However, certain disease outbreaks can be declared a PHEIC without the approval of the IHR. Alongside infectious disease, a PHEIC can also be declared in response to outbreaks of public health hazards such as chemical agents or radioactive materials.

Overview

A PHEIC is determined per the stipulations provided in the International Health Regulations (IHR). The IHR were adopted by the Health Assembly in 1969 in an effort to prevent the spread of disease across national borders. Following the chaotic global outbreak of severe acute respiratory syndrome (SARS) that lasted between 2002 and 2004, revisions were made to the IHR to account for such global emergencies. A new IHR was adopted at the 58th World Health Assembly in May 2005. The IHR 2005 was an international agreement among 196 countries committed to upholding global health security. WHO was deemed the coordinating body of this agreement.

The new IHR introduced a novel health designation, which it called a Public Health Emergency of International Concern (PHEIC). WHO was in charge of determining when a PHEIC could be declared, and provided the defining characteristics of the event. The IHR defines a PHEIC 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.” PHEICs are declared in the event of serious, sudden, unusual, or unexpected global health crises that have the potential to affect large amounts of the global population and may require immediate action on the part of the international community.

When a situation is under consideration as a PHEIC, WHO’s first action is to consult the leading health authorities of the region or regions where the health event is occurring. If WHO and state authorities determine the crisis is a prospective PHEIC, WHO then assembles a group of international health experts known as the Emergency Committee to examine the crisis and make recommendations. These recommendations are weighed against scientific evidence and principles, which helps WHO determine the overall risk to human health and the potential virulence and spreadability of the disease.

WHO declared a PHEIC seven times between 2009 and 2025. A PHEIC was declared in 2009 following the outbreak of H1N1 influenza, informally known as the "swine flu." In 2014, two were declared for a polio outbreak in the Middle East and an Ebola outbreak in West Africa. While the Ebola epidemic was resolved by 2016 and was no longer a PHEIC, the rise in polio cases remained a concern into the mid-2020s. In 2016, WHO declared a PHEIC for the Zika virus outbreak. Another was declared in 2019 following the Ebola outbreak in the Democratic Republic of Congo. From 2020 to 2023, WHO declared the novel coronavirus disease (COVID-19) outbreak a PHEIC, and from 2022 to 2023, the Mpox (formerly monkeypox) outbreak also became a PHEIC.

Bibliography

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