As one of the 194 states party to the legally binding 2005 International Health Regulations, China has a duty to rapidly gather information about and contribute to a common understanding of what may constitute a public health emergency with potential international implications. The legally binding International Health Regulations were adopted by the World Health Assembly in 1969, to control six infectious diseases: cholera, plague, yellow fever, smallpox, relapsing fever, and typhus. The 2005 revision added smallpox, poliomyelitis due to wild-type poliovirus, SARS, and cases of human influenza caused by a new subtype, set forth in the second annex.

Article 6 of the International Health Regulations requires states to provide expedited, timely, accurate, and sufficiently detailed information to WHO about the potential public health emergencies identified in the second annex in order to galvanize efforts to prevent pandemics. WHO also has a mandate in Article 10 to seek verification from states with respect to unofficial reports of pathogenic microorganisms. States are required to provide timely and transparent information as requested within 24 hours, and to participate in collaborative assessments of the risks presented. Yet China rejected repeated offers of epidemic investigation assistance from WHO in late January (and the U.S. Centers for Disease Control and Prevention in early February), without explanation. The Washington Post concluded in a story on Feb. 26 that China “was not sending details that WHO officials and other experts expect and need.” While WHO later commended China for its efforts, Mara Pillinger of Georgetown’s O’Neill Institute for National and Global Health Law concluded that Beijing’s partial collaboration “makes it politically tricky for WHO to publicly contradict” China while still getting at least some useful data from China.