Last week, the Trump administration rejected the 2024 amendments to the International Health Regulations (IHR) — a global treaty that the United States has been a part of since 2007. The rejection cited concerns about sovereignty, scientific freedom, and World Health Organization overreach.
Many of the concerns raised by the Trump administration — such as protecting U.S. sovereignty and ensuring rapid, science-based responses — were also priorities for the Biden administration. Thanks in large part to U.S. leadership during the negotiations, the final IHR amendments address those concerns and would enhance American safety. At a time when the risk of a catastrophic biological event is increasing, this decision undermines one of the best tools we have to track and stop those threats at their source before they reach our shores. That’s why the Trump administration must reconsider this decision.
The International Health Regulations are not new. Their roots go back nearly 200 years, to the 19th-century international response to cholera and yellow fever outbreaks. As diseases crossed borders, countries realized they couldn’t respond effectively on their own. In 1951, shortly after the creation of the WHO, the first formal International Sanitary Regulations were issued. They were updated and renamed the International Health Regulations in 1969, and then significantly revised in 2005, in response to the 2003 SARS outbreak.
The 2005 revision marked a turning point. It expanded the scope of the regulations beyond a few specific diseases to include any public health emergency of international concern — biological, chemical, radiological, or nuclear in origin. It also created binding obligations for countries to build basic disease detection and response systems, and to report serious outbreaks quickly to WHO and other countries. These reforms were driven by the understanding that information is critical to security. The faster countries know about a threat, the faster they can act — and the more likely they are to keep it from spreading.
The United States already meets and exceeds the surveillance and reporting rules established through the IHRs. For example, our National Notifiable Diseases Surveillance System (NNDSS) ensures that health threats are reported from state and local public health departments to the Centers for Disease Control and Prevention. We maintain one of the world’s most robust public health infrastructures, and we routinely share information with WHO and other countries to help contain global threats, in accordance with U.S. obligations under the IHRs.
But many countries don’t have such surveillance and reporting systems. In some places, disease surveillance is fragmented or nonexistent. International rules like the IHRs are how we press other countries to do their part.
Even with the IHRs in place, the Covid-19 pandemic exposed weaknesses in the global system. The WHO was too slow to declare a global emergency. It failed to endorse effective measures like masking and travel protocols early enough. And it was hampered by political influence, particularly from China, which delayed information sharing and blocked investigators. These are real problems. But they are exactly the problems the 2024 IHR amendments aim to fix.
That’s why the United States, under the Biden administration, led a multiyear negotiation to update the IHRs to make them stronger, faster, and more accountable. The final amendments reflect U.S. priorities and protect national sovereignty. They create a clear system for identifying true global emergencies, strengthen transparency and reporting obligations, and encourage pandemic preparedness without forcing high-income countries to provide funding.
So why reject a deal the U.S. helped shape — one that strengthens global preparedness and protects American interests?
The Trump administration’s objections — co-signed by secretaries Robert F. Kennedy Jr. and Marco Rubio — include vague concerns about digital health documents, limits on speech and privacy, a prioritization of “solidarity” over national interest, and perceived threats to national sovereignty.
But none of these concerns are grounded in the actual text. The amendments allow, but do not require, digital health documents. They do not restrict speech or limit civil liberties. And while they promote equity and solidarity as guiding principles, they do not impose new financial or legal obligations on the U.S.
Importantly, the IHR amendments do not give WHO authority over domestic health policy decisions, in the U.S. or elsewhere. They reaffirm the IHR’s original language on this issue: that each country retains “the sovereign right to legislate and to implement legislation in pursuance of their health policies.” The WHO cannot compel any country to follow its recommendations. It cannot override domestic law. It can only share information and offer guidance, which the signatories are free to accept or reject.
In fact, one of the global health community’s main criticisms of the amendments is that they don’t go far enough in pushing wealthy countries to do more. That’s because the U.S. insisted on language that protects our discretion and preserves our independence.
To be sure, the International Health Regulations, and the latest amendments, will continue without participation from the United States, but U.S. leadership is important to their success. Undermining the IHRs gives other countries an excuse to stop sharing data about outbreaks or to move more slowly to respond when outbreaks occur.
And it removes the WHO’s leverage to push countries to share information about threats quickly. Delays in reporting can allow threats to spread and cross borders, with more serious health and economic impacts.
Beyond protecting the U.S. from naturally emerging and accidental threats, the IHRs also put pressure on adversaries who may be considering bringing harm to the United States. When we walk away from the rules, it gives other countries an excuse to walk away as well. And while the system can always be strengthened, as of now the Trump administration does not seem to have a plan to put anything in its place.
Unfortunately, this rejection of the IHR amendments is part of a broader retreat from global health leadership: pulling out of the WHO, stepping away from the pandemic agreement negotiations, cutting the Centers for Disease Control and Prevention’s Global Health Center, defunding Gavi, and destroying USAID’s health security work. These moves dismantle the systems designed to protect Americans from biothreats — and offer no alternatives.
Pandemics are a transnational threat. We can and should invest in vaccines, therapeutics, and stockpiles at home. But no amount of domestic readiness will help if we don’t know what threats are emerging abroad. Information is our first line of defense — and the IHRs is how we get it.
These amendments are about protecting Americans through smart, science-based cooperation in a dangerous world. Walking away from them won’t make us safer. It will make us vulnerable, isolated, and ignorant of the next threat.
Stephanie Psaki was the U.S. coordinator for global health security at the Biden White House. She is currently a distinguished senior fellow in global health security at the Brown University School of Public Health.
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