How does the WHO declare a global health emergency (PHEIC), and who decides?
The WHO's highest alarm is decided by a committee created for each crisis, and its director-general can overrule a split vote.
The WHO's formal global alarm is called a public health emergency of international concern, or PHEIC, and the of the WHO decides it, after advice from a committee of outside experts. It is defined as an extraordinary event that is determined to constitute a public health risk to other states through the international spread of disease and that potentially requires a coordinated international response. Once declared, states have a legal duty under the 2005 (IHR) to respond promptly.
The process starts with countries: WHO member states have 24 hours to report potential PHEIC events. A decision tool asks four questions, whether the impact is serious, whether the event is unusual or unexpected, whether there is a significant risk of international spread, and whether there is a significant risk of travel or trade restrictions, and the WHO should be notified if any two are answered yes. Then the convenes an Emergency Committee, which is created rather than standing, and weighs its advice. The recommendations that follow are temporary and are reviewed every three months.
Step 1: Report
States have 24 hours to report potential events
Step 2: Four questions
Notify if any two are answered yes
Step 3: Emergency Committee
Created to advise the
Step 4: Declaration
The decides
Step 5: Review
Recommendations reviewed every three months
The committee advises; it does not decide. In July 2022 the committee was divided over mpox, with six members in favor of a PHEIC and nine against, and the declared one two days later. The first PHEIC was declared on 26 April 2009 for H1N1 swine flu, when it had occurred in only three countries; there have been nine since 2005, the latest in May 2026 for an Ebola epidemic in Uganda and the Democratic Republic of the Congo. Since September 2025, amended regulations also allow a higher alert above a PHEIC, a "pandemic emergency".
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Recap
Countries report, an ad hoc expert committee advises, and the WHO director-general decides whether to declare a PHEIC, which is reviewed every three months.
💡 A trick to remember it · Report, advise, decide: countries pull the cord, the committee gives advice, and one person presses the alarm.
Surprising fact · The WHO declared mpox a PHEIC in July 2022 after its committee voted six in favor and nine against.
Connects to
- 🚰 How can testing sewage reveal an outbreak before hospitals do?
- 🦠 What is mpox, and why did WHO declare it a global emergency twice?
- 💉 How did the world wipe out smallpox, and why only smallpox?
- 📈 What does it mean when an epidemic's R number is above one?
- 🦠 Why is the 1918 flu called 'Spanish' if it didn't start in Spain?
Sources (2)
No source, no claim. Every fact in this lesson (20 claims) cites at least one of these.