Introduction

Summary

On 30 January 2020, Dr Tedros Adhanom Ghebreyesus, Director General (DG) of the World Health Organization (WHO) declared the novel coronavirus outbreak (COVID-19) to be a Public Health Emergency of International Concern (PHEIC), using his authority derived from the International Health Regulations (IHR) (2005). The IHR are the singular binding legal treaty governing global health security. In his press conference, he stated:

We have witnessed the emergence of a previously unknown pathogen, which has escalated into an unprecedented outbreak and which has been met by an unprecedented response…. We do not know what sort of damage this virus could do if it were to spread in a country with a weaker health system. We must act now to help countries prepare for that possibility.

He continued:

I am declaring a PHEIC over the global outbreak of novel coronavirus. The main reason for this declaration is not because of what is happening in China, but because of what is happening in other countries. Our greatest concern is the potential for the virus to spread to countries with weaker health systems and which are ill prepared to deal with it. Let me be clear, this declaration is not a vote of no confidence in China.

This statement helpfully highlights the key tensions within the PHEIC mechanism: is the PHEIC a tool of international law to be enacted whenever the objective criteria are met, or a political, normative device within the securitization of health to get governments to pay attention to a health emergency, or does the PHEIC fall ambiguously between the two? COVID-19 was declared a PHEIC on the recommendation of the IHR Emergency Committee (EC), advice accepted by the DG, which believed: that the outbreak was unusual or unprecedented; that it posed a public health risk to other states through the international spread of disease; and that it might require a coordinated international response. These are the three criteria for a PHEIC, as prescribed at Article 1 of the IHR.

Yet, beyond a legal instrument, DG Tedros recognized the extent of the normative power within the PHEIC mechanism. A week prior, DG Tedros had (upon the advice of the EC) delayed declaring COVID-19 a PHEIC, despite it appearing that the criteria to do so were met.