Global health and national sovereignty: an inevitable conflict?

Barely five years after the greatest global health crisis of the 21st century, the world is once again facing a troubling dilemma: while the memory of COVID-19 remains fresh and international organizations are working on reforms to ensure a similar emergency never catches us off guard again, some countries—led by the United States—are beginning to distance themselves from the consensus.

In mid-July, the US government officially announced its rejection of the reforms to the International Health Regulations (IHR), approved by the World Health Assembly in 2024. These amendments, long negotiated in the wake of the pandemic, sought to strengthen preparedness, response, and cooperation mechanisms among states in the face of cross-border health threats. Their content includes the creation of new emergency categories, more agile notification and response systems, and a commitment to share resources and data in critical situations.

US officials believe the new IHR provisions could "compromise the country's ability to make sovereign decisions."

For many public health and health diplomacy experts, this step back constitutes a major risk to the global health governance architecture. For others, it represents a reaffirmation of national sovereignty in a particularly sensitive area: decisions about health, security, and fundamental rights within the borders of each state.

What's at stake?

The IHR is not a new treaty. It dates back to 1969 and was amended in 2005 after the outbreak of Severe Acute Respiratory Syndrome (SARS). Its purpose is to define a common framework for detecting, reporting, and responding to cross-border public health threats, with the World Health Organization (WHO) as the coordinating body. It is not legally binding, but it does establish legal obligations for Member States, including the immediate reporting of certain health events and measures to avoid unjustifiably impeding trade or travel.

After COVID-19, it became clear that this instrument, while useful, was insufficient. Late notification, lack of cooperation between countries, competition for vaccines, and opacity regarding key data highlighted the limits of a voluntarist model in an interconnected world.

The reforms agreed upon in 2024 sought to correct these weaknesses. They include, among other aspects:

• The creation of a new "immediate health emergency" to act before a crisis reaches global proportions.
• The establishment of more operational national focal points with direct communication with the WHO.
• Mandatory cooperation mechanisms for the distribution of essential products (antivirals, vaccines, protective equipment).
• More stringent requirements regarding data transparency, access to biological samples, and genomic surveillance.

In short, a more robust version of the IHR, which points toward more preventive, equitable, and also binding health governance.

The argument of sovereignty and its limits

Why has the US rejected these reforms? The main argument is a hybrid of legal and political: US authorities believe the new IHR provisions could "compromise the country's ability to make sovereign decisions" regarding public health, national security, and individual freedoms. Particularly concerned are aspects that could be interpreted as a cession of control in emergency situations, as well as the possibility of the WHO declaring a crisis that would require a domestic response.

If a situation like that of 2020 is repeated in the future, and the most powerful countries decide to act outside of multilateral mechanisms, the response will be slower.

But this seemingly reasonable argument leaves unanswered a fundamental question: can a country face alone a health threat that recognizes no borders?

If the pandemic has made one thing clear, it's that global health cannot depend exclusively on the decisions of individual countries. Early detection of outbreaks, real-time sharing of epidemiological information, coordination of supply chains, and the distribution of vaccines or antivirals are processes that require more than goodwill: they demand common rules, institutional trust, and verifiable commitments.

From this perspective, appealing to sovereignty—although legitimate—becomes an obstacle if it paralyzes efforts to build global response mechanisms that ultimately also protect each individual country.

The risk of fragmentation and its consequences

The US rejection is not merely symbolic. It has practical and even strategic consequences . As the WHO's largest single funder, its decision could influence other countries hesitant to ratify the reforms. Furthermore, it could weaken the political legitimacy of the new rules, which must have broad support to be effective.

From a health perspective, the risks are tangible. If a situation like that of 2020 is repeated in the future, and the most powerful countries decide to act outside of multilateral mechanisms, the response will be slower, more unequal, and less effective. We already saw this with the race for vaccines, where the logic of "every man for himself" prevailed over the principles of equity.

Furthermore, the lack of international coordination in health generates indirect costs of economic, social, and political magnitude. Citizen trust in institutions is eroded when the response is chaotic. Inequalities worsen when essential resources do not reach everyone, and conspiracy theories find fertile ground when there are no clear institutional narratives or visible cooperation between states.

And Europe?

From Brussels, the position is more nuanced. The European Union has actively supported reforms to the IHR and the future pandemic treaty. However, some Member States have expressed reservations on issues of privacy, data protection, or compliance mechanisms. The US's rejection could encourage these more reluctant countries or sectors and slow down the implementation process.

Spain, for its part, has defended the need for a coordinated global response based on scientific evidence and solidarity. The Ministry of Health actively participated in the preliminary negotiations and has underscored the importance of moving toward more robust and equitable global health.

An opportunity we must not miss

The COVID-19 pandemic was a global tragedy, but also a historic opportunity to rethink international health cooperation. The IHR reforms were, and continue to be, a step in that direction. They require adjustments, probably. They require safeguards, surely too. But above all, they require political will, foresight, and long-term vision.

Rejecting them in the name of short-term and restrictive sovereignty is, at its core, a way of refusing to learn from experience. And in public health, refusing to learn is a luxury the world can no longer afford.