International Sanitary Conferences

Modern-day international cooperation for the control of infectious disease began in 1851 with the first International Sanitary Conference (ISC). In these meetings, ten European (city) states and Turkey gathered to map out coordinated guidelines to minimize the effects of disease along trade routes, spurred on by a series of cholera outbreaks in the 18th and 19th centuries, which had devastated port cities. Importantly, their mandate was to establish mechanisms to reduce disease spread, and to do so with minimal interference with international trade – a balancing act that remains at the very heart of the current IHR. Conferences continued for almost a century, expanding membership of participating states, and topics covered. While the ISCs were progressive in respect to recognizing the need for international cooperation, they were hampered by the inability to agree to terms, and indeed differences in opinion about understanding disease transmission. This limited efforts to create common processes for outbreak response; a tension that continues to blight cooperation for health security 170 years later. Despite these setbacks, ISCs did identify key tools for international infectious disease control: the standardization of quarantine at points of entry; the reporting of outbreaks internationally; and public health capacities to respond to an epidemic. By the early 20th century, international health cooperation led to the development of intergovernmental organizations for health: the Office International d’Hygiène Publique (OHIP), the Health Organization of the League of Nations and the International Sanitary Bureau, the precursor to the Pan American Health Organization (PAHO).

Such international cooperation greatly expanded in the wake of the Second World War with the creation of the WHO, a key pillar of the post-war multilateral system. As part of this mandate, the World Health Assembly (WHA) (the legislative arm of the WHO) was granted the authority to adopt regulations concerning sanitary and quarantine requirements to prevent the international spread of disease. Such activity is structurally aligned to the Constitutional Functions of the Organization, which state that the WHO will ‘establish and maintain administrative and technical services as may be required including epidemiological and statistical services … and to stimulate work to eradicate epidemic, endemic and other diseases’.