The Emperor's New Clothes: the amendments to the World Health Organization's International Health Regulations

The World Health Organization’s (WHO) International Health Regulations (IHR) are the pre-eminent international legal instrument concerning cross-border outbreak preparedness and response, with over 170 years of history and development behind them. In May 2024, the membership of the WHO agreed on a series of targeted amendments to these Regulations. These are intended to redress many of the failures in the IHR witnessed during COVID-19, notably around equity and compliance. This paper argues that despite the fanfare surrounding the 2024 amendments, many of the amendments reflect existing practices and priorities and will likely be invisible come the next global public health emergency unless significant changes are brought forward to the financing of preparedness and response activities. While there are some significant innovations within the amended text such as the development of a State Parties Implementation Committee, overall, the amendments are nothing like the wholesale changes to pandemic preparedness and response activities required to ensure a better prepared, more equitable response to future health emergencies. We conclude that the amendments are, as the title of our article suggests, a case of the ‘emperor’s new clothes’.