To date there have been six PHEIC declarations, as well as several other health emergencies that have been considered as potential PHEICs. These non-PHEIC events fall into two distinct categories: those considered by an EC, but not declared a PHEIC; and those for which an EC was never convened, but which objectively met the criteria for declaration. In this chapter we examine each of the health emergencies declared a PHEIC in turn, followed by the non-PHEIC events. In doing so we explore how the criteria to declare a PHEIC have been understood and applied by the DG and the EC, as well as the wider considerations that each of these actors might have taken into consideration when fulfilling their functions in respect of a PHEIC under the IHR. In doing so, we demonstrate the overarching findings of this book: that the criteria to declare a PHEIC have been subject to broad interpretation by the EC beyond the legal text, which have been subsequently improperly validated by the DG in accepting the advice of EC. We structure each section first with a background to the context of the health emergency, second with detailed analysis of the apparent PHEIC decision making, third with consideration of the TRs recommended, and finally with analysis of the additional lessons learned about the broader PHEIC, IHR process and global health security. In the analysis we centre on the initial declaration of the PHEIC, and only consider later EC meetings for each disease outbreak if they are a noteworthy change in advice provided or justification.

2009-H1N1

The United States (US) first reported cases of 2009-H1N1, a novel influenza virus with human pandemic potential, on 18 April 2009. By the end of April 2009, more than 1,300 suspect cases and approximately 84 deaths were attributed to the outbreak. Under Annex 2 of the IHR, notification by states to the WHO must occur if there is a positive response to two of four criteria, or if a health emergency is caused by poliomyelitis, smallpox, human influenza caused by a new subtype or SARS. In response to this notification, on 25 April the DG convened an EC, which recommended 2009-H1N1 to be declared the first PHEIC under the revised IHR.