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Summary

A global approach to addressing health issues and emergencies is provided by the United Nation’s World Health Organization (WHO), which was established in 1946. The WHO has a Constitution and issues International Health Regulations (IHR).  Its membership is open to all Members of the United Nations and Associate Members. The WHO’s objective is the attainment by all peoples of the highest level of health.  

Following a severe acute respiratory syndrome (SARS) pandemic in 2003, the WHO and its Member States updated the WHO mechanisms for preventing and controlling pandemics.  In 2005, the WHO commenced a Pandemic Preparedness Program that requires the Member States to create national preparedness plans.  Also in 2005, the World Health Assembly agreed on new IHR that create an international pandemic risk management system by requiring the Member States to report on an expanded list of diseases and public emergencies, to control the entry and exit of travelers and goods, and to take other precautionary measures in accordance with WHO recommendations.  The system was put to the test in the A(H1N1) virus influenza that emerged in Mexico in April 2009 and quickly reached global dimensions.  Since that time, the WHO has instituted the Pandemic Influenza Preparedness (PIP) Framework to improve preparedness for and response to pandemic influenza and has replaced the 2009 guidance with the 2013 Pandemic Influenza Risk Management WHO Interim Guidance.

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I.  Structure of the World Health Organization

The World Health Organization (WHO), established on July 22, 1946, is an agency of the United Nations (UN) responsible for handling global health issues.[1]  Any Member State of the UN may become a WHO member by accepting its Constitution.[2]  Territories may be admitted to the WHO as Associate Members if an application is made on their behalf by the Member State or other authority responsible for the territory’s international relations.[3]  At present, there are 194 Member States of the WHO.[4]  

The WHO’s governing organs are the World Health Assembly, the Executive Board, and the Secretariat.[5]

A.  World Health Assembly

The World Health Assembly (WHA), the WHO’s supreme decision-making body, is composed of delegates representing the Member States.[6]  The WHA meets in a regular annual session and special sessions, as necessary.[7]  The WHA is responsible for the WHO’s policy-making programs and budget. 

The WHA has the authority to adopt regulations concerning sanitary and quarantine requirements and other procedures designed to prevent the international spread of disease; nomenclatures for disease, causes of death, and public health practices; standards for international diagnostic procedures; standards for the safety, purity, and potency of biological, pharmaceutical, and similar products moving in international commerce; and the advertising and labeling of biological, pharmaceutical, and similar products moving in international commerce.[8]  Regulations come into force for all Members after due notice of their adoption has been given, except for such Members that have notified the Director-General of their rejection or reservations within the period stated in the notice.[9]

The WHA also has the authority to make recommendations to Members on any matter within the competence of the WHO.[10]

B.  Executive Board

The Executive Board is the executive organ of the WHA.[11]  It is composed of thirty-four health experts designated by, but not representing, their governments.[12]  The Executive Board forwards recommendations on the Director-General’s programs to the WHA,[13] advises on questions referred to it by the WHA, and implements the WHA’s decisions and policies.  It is also empowered to take emergency measures in case of epidemics or disasters.[14]

C.  Secretariat

The Secretariat comprises the Director-General and roughly eight thousand other technical and administrative staff.[15]  The Director-General appoints the staff of the Secretariat,[16] and prepares and submits to the Executive Board the financial statements and budget estimates of the organization.[17] 

D.  Regional Offices

The WHO has six geographical regions: Africa, the Americas, Eastern Mediterranean, Europe, Southeast Asia, and Western Pacific.[18]  Each has its own organization consisting of a regional committee representing the Member States and Associate Members in the region concerned, and a regional office staffed by experts in various fields of health.[19]

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II.  WHO Departments

The WHO departments most directly concerned with responding to health emergencies, including infectious disease epidemics or pandemics, are described below.

The Health Security and Environment (HSE) Department works within the WHO and with partners and countries to strengthen national and global capacities necessary for detecting, being prepared for, preventing, and responding to health security risks and emergencies; to enhance national and global readiness for health security emergencies; and “to provide global leadership and guidance when major infectious disease outbreaks and other health security emergencies occur.”[20]  The HSE’s strategic priorities for 2014–2017 include mounting an effective response to any major new epidemic, pandemic, or food-related health security risk; attaining the core capacities set forth in the International Health Regulations (IHR) by all countries; developing “a global strategic plan for antimicrobial drug resistance with clearly defined roles for all major sectors and WHO and implementing the key roles for WHO”; implementing the Codex Alimentarius and the Pandemic Influenza Preparedness (PIP) Framework; and adopting “a significantly stronger and more effective approach for global surveillance for major pandemic and epidemic infectious disease.”[21]

The HIV/AIDS, TB, Malaria and Neglected Tropical Diseases (HTM) Department “helps countries to prevent, reduce and mitigate the health impact of these diseases, which are a major factor affecting development.” [22]  The department’s objectives are “to develop norms, standards and policies to foster new solutions” for prevention of “these high-burden diseases”; to assemble the requisite expertise to combat the diseases; “to develop innovative frameworks for public health action against these diseases” and provide support for strengthening the health system; and to encourage leaders and civil society to promote “increased and sustained investment in countering these diseases.”[23]

The Health Systems and Innovation (HSI) Department covers the areas of essential medicines and health products; health statistics and information systems (HSIS); health systems governance and financing; health workforce; knowledge, ethics and research; service delivery and safety; and the WHO Centre for Health Development, Kobe.[24]  One example of the activities covered by the essential medicines and health products section was promoting an agreement during the ninth African Vaccine Regulatory Forum (November 3–7, 2014) on a collaborative mechanism to fast-track approvals for clinical trials and registration of potential Ebola therapies and vaccines.[25]  The mechanism is to cover the following:

• Clear pathways and timelines for expedited ethical and regulatory review of clinical trial applications and approval of products;

• Agreement on timelines and joint safety and efficacy assessments of the new products to fast-track national registration;

• Endorsement of a panel of safety experts for expedited review of safety data of new products with relevant communication to National Regulatory Authorities . . . ;

• Technical assistance from the [WHO] to facilitate these processes.[26]

The Polio and Emergencies (PEC) Department has among its objectives the worldwide eradication of polio; the coordination and implementation of health responses to humanitarian emergencies and disasters; and the strengthening of the WHO’s work “in and with countries, with a special emphasis on fragile states and situations.”[27]  The department, which is in charge of the WHO’s technical assistance to countries, has “the main Organization-wide elements of the WHO country support function, that aim at tailoring WHO country collaboration to the needs and capacities of all its Member States.”[28]  The PEC/POL leads the Global Polio Eradication Initiative, a public-private partnership that has reduced the incidence of polio by 99% over the last two decades.[29] 

The PEC also handles the humanitarian aspects of emergency preparedness and response by coordinating activities “to reduce the health impact of emergencies by leading the development of global strategies, identifying best practices, providing evidence to inform global policies, analyzing health trends, and providing technical guidance.”[30]  In addition, during health emergencies, the PEC is responsible for coordinating the health actors and mobilizing the capacities of WHO and its partners “to ensure the surge to country level of expert staff, logistics, finances, and medicines/supplies for emergency response.”[31]

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III.  Areas of Priority

The WHO has six main priorities for providing leadership.  These include universal health coverage; health-related Millennium Development Goals; noncommunicable diseases, such as cancer, heart disease, and mental health disorders; social, economic, and environmental determinants; access to medical products; and the International Health Regulations (2005).[32]

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IV.  International Health Regulations (2005)

The International Health Regulations (2005) (IHR),[33] which the 194 WHO Member States have agreed to implement, were adopted by the WHA under the authority of the WHO Constitution, which gives the WHA the power to adopt regulations “designed to prevent the international spread of disease,” and that thereupon “enter into force for all WHO Member States that do not affirmatively opt out of them within a specified time period.”[34]

The IHR are a binding instrument of law developed in response to the exponential “growth in international travel and trade, and the emergence or re-emergence of international disease threats and other health risks. . . .”[35]  Accordingly, the IHR’s stated purpose and scope are “to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade.”[36]  The IHR require states to enhance their core surveillance of and response capacities to disease threats at all levels—primary, intermediate, and national, and also at designated international ports, airports, and ground crossings.  In addition, they provide for a series of health documents, such as ship sanitation certificates and an international certificate of vaccination or prophylaxis for travelers.[37]

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V.  Monitoring and Alert Systems 

The WHO has a monitoring and response system for influenza that, since the adoption of the PIP Framework in May 2011 (described in Part VI(A), below) has been called the Global Influenza Surveillance and Response System (GISRS).  (This system was formerly known as the Global Influenza Surveillance Network (GISN), which dates back to 1952.)[38]  The system operates through a network of National Influenza Centres, “national institutions designated by national Ministries of Health and recognized by WHO.”[39]  The GISRS keeps track of the evolution of influenza viruses and offers recommendations on such matters as “laboratory diagnostics, vaccines, antiviral susceptibility and risk assessment,” and “also serves as a global alert mechanism for the emergence of influenza viruses with pandemic potential.”[40]

In 1997, the WHO established an Outbreak Verification System to gather information, verify reports of, and track infectious disease outbreaks.[41]  In addition, the WHO regularly distributes to certain public health officials and scientists an Outbreak Verification List as a means of following up on reports of various outbreaks of disease.[42]

In 2000, the WHO established the Global Outbreak Alert and Response Network (GOARN), which is a network of surveillance systems that “includes a number of formal and informal sources.”[43]  The WHO gathers this raw intelligence and converts it into “meaningful intelligence,” using six main criteria “to determine whether a reported disease event constitutes a cause for international concern.”[44]  Information on incoming reports and rumors, their epidemiological significance, and decisions on the actions needed are stored in an electronic event management system.  The system “records key information, decisions and actions by WHO and its partners.”[45]  The Global Alert and Response Team includes “WHO Country Offices, WHO sub-Regional Response Teams, WHO Regional Offices, the Alert and Response Operations Centre team in Geneva and disease specialists.”[46]  The Team responds to “incoming reports of suspected outbreaks, reports of unknown disease, outbreaks undergoing verification and outbreaks at various stages of containment.”[47]

The Department of Pandemic and Epidemic Diseases is responsible for developing “strategies, initiatives, and mechanisms to address priority emerging and re-emerging epidemic diseases, thereby reducing their impact on affected populations and limiting their international spread.”[48]

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VI.  Outbreaks and Responses

A.  Pandemic Influenza Preparedness Plan

At the Fifty-sixth Annual Meeting of the World Health Assembly in Geneva on May 28, 2003, the WHO adopted two resolutions concerning SARS and infectious diseases control.  Member states were urged to take action to enhance, support, and strengthen national, regional, and international efforts to address the SARS outbreak.  The Director-General was requested to take measures falling within the infectious diseases group and take into account reports from sources other than official notification; to alert the international community to the presence of a public threat that may constitute a serious threat to neighboring countries or to international health; and to collaborate with national authorities in assessing the severity of the threat and the adequacy of control measures, and, when necessary, in conducting on-the-spot studies by a WHO team, with the purpose of ensuring that appropriate control measures were being employed. 

The first global conference on SARS, held June 18–19, 2003, in Kuala Lumpur, Malaysia, was convened by the WHO to provide technical guidance for the ongoing and long-term response to SARS.  At the time, an adequate point-of-care diagnostic test was still not available for SARS and remained a top priority.[49]  Even now, although research is being done to develop laboratory tests to improve diagnostic tests for SARS and other respiratory pathogens, “no specific clinical or laboratory findings can distinguish with certainty SARS-CoV disease from other respiratory illnesses rapidly enough to inform management decisions that must be made soon after the patient presents to the healthcare system,”  and so early clinical recognition of the disease “still relies on a combination of clinical and epidemiologic features.”[50]

Following the pandemic outbreak of SARS in 2003, the WHO member states deliberated on how to prevent and control new pandemics.  In 2005, the WHO commenced a Pandemic Influenza Preparedness Plan that required the Member States to devise a national pandemic plan and submit it to the WHO.  This plan was last revised in 2009[51] and contains the WHO phases of pandemic alert.[52]  They progress from level 1, characterized by animal infections and only a few human infections, to levels 5 and 6, characterized by widespread human infection that, in level 6, reaches global proportions.[53]  The system was put to the test in the A(H1N1) influenza virus that emerged in Mexico in April 2009 and quickly reached global dimensions.[54]     

On May 24, 2011, the WHA adopted the Pandemic Influenza Preparedness (PIP) Framework.[55]  The stated objective of the PIP Framework is

to improve pandemic influenza preparedness and response, and strengthen the protection against the pandemic influenza by improving and strengthening the WHO global influenza surveillance and response system (“WHO GISRS”), with the objective of a fair, transparent, equitable, efficient, effective system for, on an equal footing:

(i)    the sharing of H5N1 and other influenza viruses with human pandemic potential; and

(ii)   access to vaccines and sharing of other benefits.[56]

The PIP Framework applies to influenza viruses with human pandemic potential, such as H5N1; it does not apply to seasonal flu viruses, noninfluenza pathogens, or other biological material that may be contained in clinical specimens shared under the Framework.[57]

In 2013, the Pandemic Influenza Risk Management WHO Interim Guidance replaced the 2009 Pandemic Influenza Preparedness and Response guidance document.[58]Key features of the new guidance include the following:

• Focus upon risk assessment at national level to guide national level actions

• Revised approach to global phases

• Flexibility through uncoupling of national actions from global phases

• Inclusion of principles of emergency risk management for health

• New and updated annexes on planning assumptions, ethical considerations, whole-of-society approach, business continuity planning, representative parameters for core severity indicators, and containment measures.[59]

As a result of lessons learned from the influenza A(H1N1) 2009 pandemic, the 2013 Guidance revises WHO’s approach to global phases of pandemic events.[60]  The phases include the interpandemic phase (the period between influenza pandemics); the alert phase (when influenza caused by a new subtype has been identified in humans); the pandemic phase (the period of global spread); and the transition phase (the de-escalation phase).[61]  These global phases are to be used to describe a new influenza subtype’s spread, “taking account of the disease it causes, around the world,” and are “clearly uncoupled from risk management decisions and actions at the country level.”[62]  

The Guidance points out that “[t]he global phases and their application in risk management are distinct from (1) the determination of a PHEIC [Public Health Emergency of International Concern] under the IHR (2005) and (2) the declaration of a pandemic.”[63]  The WHO Director-General is responsible for determining a PHEIC, under article 12 of the IHR; that determination leads to the communication of temporary recommendations.[64]  The Director-General may also declare a pandemic “during the period of spread of human influenza caused by a new subtype, and appropriate to the situation.”[65]

The Guidance is based on “all-hazards emergency risk management for health” (ERMH) principles, “thereby aligning pandemic risk management with the strategic approach adopted by WHO, in accordance with World Health Assembly resolution 64.10,” to strengthen national health emergency and disaster management capabilities.[66]  The Resolution, among other measures, urges Member States to (1) strengthen health emergency and disaster risk-management programs as part of their national and subnational health systems, supported by related legislation and its effective enforcement; (2) integrate such programs (including disaster risk reduction) into national or subnational health plans and “institutionalize capacities for coordinated health and multisectoral action to assess risks, proactively reduce risks, and prepare for, respond to, and recover from, emergencies, disasters and other crises; and (3) develop programs “on safe and prepared hospitals that ensure: that new hospitals and health facilities are located and built safely so as to withstand local hazards; that the safety of existing facilities is assessed and remedial action is taken; and that all health facilities are prepared to respond to internal and external emergencies.”[67]

B.  Recent Developments and Concerns

In 2013, humans were found for the first time to have been infected with the avian influenza A(H7N9) virus.  Since providing the first notification of such an infection in late March 2013, China has been reporting to the WHO on cases of subsequent human infection with the virus.[68]  The virus is a subgroup of H7 viruses, normally found among birds.  Previous reports of human infections with other H7 subgroups (H7N2, H7N3, and H7N7) have come from Australia, Canada, Italy, Mexico, the Netherlands, the United Kingdom, and the United States.[69] 

On October 22, 2014, the WHO Emergency Committee, convened by the WHO Director-General under the IHR, held its third meeting on the Ebola virus disease outbreak in West Africa, in advance of the three-month date of expiration of temporary recommendations the WHO had issued on August 8, 2014, and their extension on September 22.[70]  The meeting was held because of the increase in the number of cases in Guinea, Liberia, and Sierra Leone, and the incidence of new cases in Spain and the United States.[71]  As of the date of the meeting, the number of total cases stood at 9,936, with 4,877 deaths, and “[c]ases continue to increase exponentially in Guinea, Liberia, and Sierra Leone” with the situation in these countries remaining to be “of great concern.”[72]  According to the statement, “[t]he key lessons learned to control the outbreak include the importance of leadership, community engagement, bringing in more partners, paying staff on time, and accountability.  WHO, UN partners, and the international community have scaled up their support in these three countries.”[73]  At the same time, the Committee noted that the Ebola outbreaks in Nigeria and Senegal had been declared over as of October 20 and 17, respectively.

On October 23, 2014, the WHO convened a meeting of high-ranking government representatives from countries affected by the Ebola virus along with representatives from their development partners, civil society, regulatory agencies, vaccine manufacturers, and funding agencies “to discuss and agree on how to fast-track testing and deployment of vaccines in sufficient numbers to impact the Ebola epidemic.”[74]  The government representatives included officials from the ministries of health and of foreign affairs from Canada, China, the European Union, France, Germany, Guinea, Italy, Japan, Liberia, Mali, Nigeria, Norway, the Russian Federation, Sierra Leone, Switzerland, the United Kingdom, and the United States.[75]  The meeting reached consensus on a number of key commitments—namely, (1) results from phase 1 clinical trials of most advanced vaccines are expected to be available in December 2014, and efficacy trials are to begin in the affected countries during this timeframe; (2) pharmaceutical companies developing the vaccines will increase production capacity so that millions of doses will be available in 2015, and regulatory authorities in the countries where the vaccines are manufactured and in Africa will support this goal by working under very short deadlines; and (3) community engagement “should be scaled up urgently in partnership between local communities, national governments, NGOs and international organizations.”[76]

At the same time, The New York Times reported that “WHO has been badly weakened by budget cuts in recent years, hobbling its ability to respond in parts of the world that need it most.  Its outbreak and emergency response units have been slashed, veterans who led previous fights against Ebola and other diseases have left, and scores of positions have been eliminated. . . .”[77]  The unit specializing in pandemic and epidemic diseases now “has only 52 regular employees,” although the number can be increased during outbreaks, and the WHO’s regional emergency outbreak experts, who were experienced in fighting Ebola, “were cut from more than a dozen to three.”[78]  Moreover, a separate WHO section that handles emergency response “was whittled ‘to the bone’ during the budget cuts—to 34 staff members from about 94.”[79]  As a result, Dr. Margaret Chan, the WHO Director-General stated that “[t]he W.H.O. simply did not have the staffing or ability to flood the Ebola zone with help.”[80]

Prepared by Wendy Zeldin
Senior Legal Research Analyst*
February 2015


* Most of this report was originally prepared by George E. Glos, former Special Group Leader, July 2003; it was supplemented in 2009 by Edith Palmer, former Senior Foreign Law Specialist, and was again updated for the purposes of the present report.

[1] World Health Organization (WHO), Summary Report on Proceedings Minutes and Final Acts of the International Health Conference Held in New York from 19 June to 22 July 22 1946, Official Records of the World Health Organization No. 2, 9 U.N.T.S. 3 (June 1948), http://apps.who.int/iris/bitstream/10665/85573/1/Official_record2_ eng.pdf?ua=1.

[2] Constitution of the World Health Organization, http://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1 (last visited Oct. 29, 2014).  The Constitution was adopted as one of the Final Acts of the 1946 International Health Conference; the text is also available in the Summary Report cited above in note 1, supra.

[3] Countries, WHO, http://www.who.int/countries/en/ (last visited Oct. 30, 2014).

[4] Id.

[5] For additional information, see About WHO, http://www.who.int/about/en (last visited Oct. 28, 2014), and Governance, WHO, http:www.who.int/governance/en (last visited Oct. 28, 2014).  See also World Health Organization Organigram (Sept. 25, 2014), http://www.who.int/about/structure/WHO_organigram_ 25092014.pdf?ua=1.

[6] WHO Constitution art. 10.

[7] Id. art. 13.

[8] Id. art. 21.

[9] Id. art. 22.

[10] Id. art. 23.

[11] Id. art. 28.

[12] Id. art. 24.

[13] Id. arts. 26 & 28.

[14] Id. art. 28; see also WHO, Rules of Procedure of the Executive Board of the World Health Organization as at April 2014, http://www.who.int/governance/EB_rules_of_procedure_rev2014-en.pdf?ua=1.

[15] WHO Constitution art. 30; Governance, supra note 5.

[16] WHO Constitution art. 35.

[17] Id. art. 34.

[18] Regional Offices, WHO, http://www.who.int/about/structure/en/ (last visited Oct. 30, 2014).

[19] WHO Constitution arts. 45–47.

[20] Health Security (HSE), WHO, http://www.who.int/about/structure/organigram/hse/en/ (last visited Nov. 5, 2014).

[21] Id.

[22] HIV/AIDS, TB, Malaria and Neglected Tropical Diseases (HTM), WHO, http://www.who.int/about/structure/ organigram/htm/en/ (last visited Nov. 5, 2014).

[23] Id.

[24] WHO Headquarters Structure, WHO, http://www.who.int/about/structure/organigram/en/ (last updated Sept. 25, 2014).

[25] Essential Medicines and Health Products: African Regulators’ Meeting Looking to Expedite Approval of Vaccines and Therapies for Ebola,WHO, http://www.who.int/medicines/news/AFR_reg_meet/en/ (last visited Nov. 5, 2014).

[26] Id.

[27] Polio and Emergencies (PEC), WHO, http://www.who.int/about/structure/organigram/pec/en/ (last visited Nov. 5, 2014).

[28] Id.

[29] Id.

[30] Id.

[31] Id.

[32] Leadership Priorities, WHO(undated), http://www.who.int/about/resources_planning/WHO_GPW12_ leadership_priorities.pdf?ua=1 (last visited Oct. 29, 2014); Danielle Renwick & Toni Johnson, The World Health Organization (WHO), Council on Foreign Relations, http://www.cfr.org/public-health-threats-and-pandemics/world-health-organization-/p20003 (last updated Oct. 7, 2014). 

[33] WHO, International Health Regulations of 1969, amended in 1973 and 1981, http://whqlibdoc.who.int/ publications/1983/9241580070.pdf?ua=1; WHO, International Health Regulations (2d ed. 2005) (in force on June 15, 2007), http://www.who.int/ihr/publications/9789241596664/en/; see also Alert, Response, and Capacity Building Under the International Health Regulations (IHR), WHO, http://www.who.int/ csr/ihr/current/en/ (last visited Oct. 15, 2014).

[34] WHO, Foreword to International Health Regulations (2005), supra note 33, at 1; see also WHO Constitution arts. 21(a) & 22.

[35] International Health Regulations (2d ed. 2005), supra note 33.

[36] Id.

[37] Id.

[38] Global Influenza Surveillance and Response System (GISRS), WHO, http://www.who.int/influenza/ gisrs_laboratory/en/ (last visited Oct. 29, 2014); The Global Information Surveillance Network, WHO (undated), available at http://www.paho.org/hq/images/stories/AD/HSD/CD/INFLUENZA/gisn.pdf (last visited Oct. 29, 2014).

[39] National Influenza Centres, WHO, http://www.who.int/influenza/gisrs_laboratory/national_ influenza_centres/en/ (last visited Oct. 29, 2014).

[40] Global Influenza Surveillance and Response System (GISRS), supra note 38.

[41] Thomas W. Grein et al., Rumors of Disease in the Global Village: Outbreak Verification 6:2 Emerging Infectious Diseases 97, 97 (Mar. –Apr. 2000), http://wwwnc.cdc.gov/eid/article/6/2/pdfs/00-0201.pdf

[42] Stephen S. Morse, Global Infectious Disease Surveillance and Early Warning Systems: ProMED and ProMED-mail, in Global Infectious Disease Surveillance and Detection: Assessing the Challenges—Finding Solutions, Workshop Summary (Stanley M. Lemon et al. eds., 2007), available at http://www.ncbi.nlm.nih.gov/ books/NBK52873/#ch2.s2 (scroll down page to view).

[43] Id.

[44] Event Verification, WHO, http://www.who.int/csr/alertresponse/verification/en/ (last visited Oct. 28, 2014).  The criteria listed on the webpage are unknown disease, potential for spread beyond national borders, serious health impact or unexpectedly high rates of illness or death, potential for interference with international travel or trade, strength of national capacity to contain the outbreak, and suspected accidental or deliberate release.

[45] Id.

[46] Id.

[47] Id.

[48] Pandemic and Epidemic Diseases, WHO, http://www.who.int/csr/disease/en/ (last visited Oct. 28, 2014).  

[49] WHO Global Conference on Severe Acute Respiratory Syndrome (SARS): Where Do We Go from Here?, Kuala Lumpur, Malaysia, 17–18 June 2003, http://www.who.int/csr/sars/conference/june_2003/materials/report/en/.

[50] Clinical Guidance on the Identification and Evaluation of Possible SARS-CoV Disease among Persons Presenting with Community-Acquired Illness (Version 2) (last updated July 7, 2012), http://www.cdc.gov/sars/clinical/ guidance.html; see also James McIntosh, What Is SARS? What Are the Symptoms of SARS?, Medical News Today (last updated Sept. 10, 2014), http://www.medicalnewstoday.com/articles/ 7543.php.  For further information on SARS, see Severe Acute Respiratory Syndrome (SARS), WHO, http://www.who.int/topics/sars/en/ (last visited Oct. 28, 2014).

[51] The current version of this plan is published in WHO, Pandemic Influenza Preparedness and Response: A WHO Guidance Document (Apr. 2009), http://whqlibdoc.who.int/publications/2009/9789241547680_ eng.pdf?ua=1

[52] Id. For the role of the U.S. government in developing the pandemic phases, see J. Montero, Why is Pandemic Influenza Different?, 48 New Hampshire Bar Journal 54 (2007), available at http://www.lexis.com (by subscription).

[53] Pandemic Influenza Preparedness and Response: A WHO Guidance Document, supra note 51, at 29. 

[54] E. Eduardo Castillo, As Swine Flu Spreads, Who Should Get Tamiflu?, Associated Press (May 12, 2009), available at http://www.utsandiego.com/news/2009/may/12/med-swine-flu-051209/.

[55] WHO, Pandemic Influenza Preparedness Framework for the Sharing of Influenza Viruses and Access to Vaccines and Other Benefits (May 24, 2011), http://whqlibdoc.who.int/publications/2011/ 9789241503082_eng.pdf?ua=1.

[56] Id. at 6.

[57] Id. at 7.

[58] Pandemic Influenza Risk Management: WHO Interim Guidance (June 10, 2013), http://www.who.int/ influenza/preparedness/pandemic/influenza_risk_management/en/.

[59] Id.

[60] Id. at 2.

[61] Id. at 7.

[62] Id. at 2.

[63] Id. at 7.

[64] Id.

[65] Id.

[66] Id. at 3.  A PHEIC is defined under the IHR as “an extraordinary event which is determined, as provided in these Regulations: (i) to constitute a public health risk to other States through the international spread of disease and (ii) to potentially require a coordinated international response.”  IHR art. 1(1).  Article 12 of the IHR pertains to determining PHEICs.

[67] Strengthening National Health Emergency and Disaster Management Capacities and Resilience of Health Systems, WHA64.10 (May 24, 2011), at 2–3, http://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_R10-en.pdf.

[68] WHO, Background and Summary of Human Infection with Avian Influenza A(H7N9) Virus – as of 31 January 2014, at 1, http://www.who.int/influenza/human_animal_interface/20140131_background_and_summary_ H7N9_v1.pdf?ua=1

[69] Id.

[70] Press Release, WHO, Statement on the 3rd Meeting of the IHR Emergency Committee Regarding the 2014 Ebola Outbreak in West Africa (Oct. 23, 2014), http://www.who.int/mediacentre/news/statements/2014/ebola-3rd-ihr-meeting/en/.

[71] Id.

[72] Id.

[73] Id.

[74] Press Release, WHO, WHO Convenes Industry Leaders and Key Partners to Discuss Trials and Production of Ebola Vaccine (Oct. 24, 2014), http://www.who.int/mediacentre/news/releases/2014/ebola-vaccines-production/en/.

[75] Id.

[76] Id.

[77] Sheri Fink, Cuts at WHO Hurt Response to Ebola Crisis, NY Times (Sept. 3, 2014), http://www.nytimes.com/ 2014/09/04/world/africa/cuts-at-who-hurt-response-to-ebola-crisis.html?_r=1.

[78] Id.

[79] Id.

[80] Id.

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Last Updated: 06/09/2015