Sovereignty Versus Solidarity Divides US and WHO Over Health Regulations

With one day remaining before the 2024 amendments to the World Health Organization International Health Regulations (IHR) would become binding, the U.S. Department of Health and Human Services and the U.S. Department of State delivered a formal notice refusing to accept the revisions. Health and Human Services Secretary Robert F. Kennedy Jr. and Secretary of State Marco Rubio argued that the amendments risked sweeping new powers for the WHO—including authority to recommend global lockdowns and border restrictions based on loosely defined “potential public-health risks.” (HHS.gov)

What the amended IHR sought to change

Adopted by the World Health Assembly on June 1, 2024, the IHR package introduced a “pandemic emergency” category, stronger reporting timelines, and provisions to ensure equitable distribution of vaccines and therapeutics during future crises. WHO officials framed the revisions as lessons learned from COVID-19 and a hedge against fragmented responses in the next outbreak. (World Health Organization) Supporters contended that clearer escalation tiers and mandatory information-sharing would shorten detection-to-response intervals and save lives. Opponents countered that the text used ambiguous language on “misinformation” and “solidarity,” leaving room for political pressure on national measures such as school closures, masking rules, or movement restrictions.

Domestic legal and financial stakes

Federal agencies estimate that complying fully with the amended IHR could require $1 billion in additional preparedness investments over five years, spanning laboratory capacity, data-exchange platforms, and stockpile expansion. That projection, included in an HHS memorandum obtained through a 2023 Freedom of Information Act request, underscores the budgetary trade-offs now avoided. (HHS.gov) Yet costs alone did not drive the decision. Administration officials cited constitutional concerns over ceding decision-making authority to an international body whose directives, while technically non-binding, carry strong normative weight in global health governance.

Potential impact on public-health coordination

Health-security scholars warn that opting out could complicate cross-border outbreak management. Without a commitment to the new rapid-notification timelines, U.S. surveillance data may appear as “blind spots” in WHO dashboards, slowing the global community’s situational awareness. A recent analysis in The Lancet found that even short reporting delays correlate with measurably higher case counts in neighboring countries during influenza waves. (PubMed) The rebuttal from congressional allies of the administration emphasizes that bilateral and regional channels—such as the North American Plan for Animal and Pandemic Influenza—remain intact and can address transnational threats without surrendering sovereignty.

International and industry reaction

Reuters reported that several G-20 partners expressed disappointment, noting that U.S. disengagement from multilateral health rules could hamper efforts to secure equitable vaccine access in low-income regions. (Reuters). Hospital associations and life-sciences firms, meanwhile, focused on supply-chain stability. A patchwork of divergent emergency standards may create uncertainty over export licenses, liability waivers, and mutual-recognition agreements that facilitate rapid scale-up of critical supplies.

What happens next

Under Article 59 of the existing 2005 IHR, a country’s rejection applies only to the amendments, not to the underlying treaty. The United States therefore remains bound by the original framework but will not implement the 2024 changes when they enter into force on September 19, 2025. According to an issue brief from KFF, Washington could still adopt individual provisions piecemeal through domestic regulation or negotiate side agreements to preserve interoperability where interests align. (KFF) Congress is likely to seek further clarity on how federal agencies will coordinate with states, tribal nations, and private-sector partners if global guidance diverges from national policy. The Government Accountability Office has already launched a review into whether HHS possesses adequate statutory authority to manage cross-border data flows absent the amended reporting standards.

A narrowing window for common ground

Global health governance has long relied on a mix of legal obligations and reputational incentives. The U.S. decision signals a shift toward unilateral readiness over multilateral solidarity at a moment when antimicrobial resistance, climate-driven vector diseases, and persistent outbreaks demand expansive data-sharing. Whether alternative mechanisms can deliver comparable speed and transparency will determine if the sovereignty-first doctrine advances national safety, or leaves all parties more exposed when the next pathogen emerges.