The PHEIC mechanism has been fraught with tension since it was first introduced in 2005, with the revisions to the IHR. As this book has shown, the declaration process and decision making underpinning a declaration are the source of many of the inconsistencies regarding the PHEIC.

In the wake of COVID-19, and the widespread failures of the global health architecture to manage disease transmission, many elements of the system will come under review, and likely reform. While it is too early to know the outcomes of such processes, it is likely that the IHR will be revised in some format in the coming years, or be replaced by, or replicate, a similar mechanism through the proposed ‘pandemic treaty’. We write this book to inform such discussions and demonstrate the need to ensure that any power bestowed upon the DG is exercised in a reasonable and proportional manner. In doing so we highlight the following arguments.

First, the PHEIC criteria, as laid out in the IHR, have been inconsistently applied by the DG and the EC throughout the history of PHEIC declarations and non-declarations. To this end, there have been PHEICs declared that do not appear to meet the objective criteria found at Article 1 (and nor did the EC describe these as such). Equally, there have been other events whereby the criteria appear to have been met, but no EC was convened by the DG, or an EC was called, and a PHEIC was not declared. Notably, while the convening of an EC remains the decision of the DG, the decision about declaring a PHEIC or not appears to be in practice at the discretion of the EC, rather than the DG simply taking advice from the EC. The role of the EC has thus grown in prominence, and through increased technocratization, the EC has been able to bolster its role within the IHR and governance of health emergencies, affording itself the option to consider social, economic and political interferences in the strict criteria for the PHEIC process.Indeed, as the PHEIC process has developed over successive outbreaks, it appears that there has been greater consideration of factors beyond the treaty criteria and, through continual use of such justifications for the PHEIC declaration the EC has been further empowered to depart from the three criteria for which it is allowed to advise the DG to declare a PHEIC: