The International Health Regulations (IHR) form the basis of the World Health Organization's governing framework for global health security and have a key role in preventing the international spread of disease. The COVID-19 pandemic rightfully brought the 'fitness for purpose' of the IHR (2005) into question, spurring WHO Member States to embark on a process of amending and improving the Regulations. This process concluded in mid-2024, with a package of substantive amendments adopted through Member State consensus. Global commentary during the COVID-19 pandemic spotlighted issues with both the letter and spirit of the Regulations, but one unifying theme was that of non-compliance. As such, much of the debate in the lead up to the amendment negotiations focused on the need for stronger enforcement and accountability mechanisms. However, the distinction between true IHR breaches and legitimate deviations was often ignored. Instead, these were frequently lumped together under the banner of 'non-compliance,' and with a predominantly negative slant; often as prelude to justification that stronger rules (and perhaps even punitive measures) were needed. The subtext was that the same rules must apply to all. There is little doubt that a legally binding instrument must have robust accountability mechanisms to underpin global collaboration and prevent pandemics. However, New Zealand's COVID-19 pandemic response - considered among the best in the world - illustrates why the balance between uniform compliance and State Party flexibility had to remain an essential consideration during the IHR amendment negotiations.
Bullen et al. (Mon,) studied this question.