Understanding non-compliance with the International Health Regulations (2005): Recommended strategies to inform and strengthen global coordination of the COVID‑19 outbreak response
Outbreaks such as the novel coronavirus (COVID-19) can result in inappropriate, excessive and counterproductive measures that hinder global coordination of outbreak response. Moreover, they compound loss of life and illness by contributing to unnecessary social and economic disruption, and can discourage countries from open reporting for fear of retaliation. For these reasons, the World Health Organization (WHO) declaration of the COVID‑19 outbreak as a public health emergency of international concern (PHEIC) included recommended, evidence-based measures for detection, containment and control based on available data. These measures adhere to International Health Regulations (IHR) principles concerning human rights, proportionality, and unnecessary interference with trade and travel. Yet preliminary analysis suggests a higher number and range of non-compliant measures are being adopted than previous PHEICs. The goal of this project is to strengthen global coordination of the COVID‑19 outbreak response through a fuller understanding of crossborder measures adopted, their likely positive/negative impacts, reason(s) for adoption, and strategies to increase compliance. This project applies a mixed-methods approach to achieve 4 objectives: a) define, categorize and track crossborder measures adopted during the COVID‑19 and previous outbreaks; b) systematically review existing evidence of their public health and wider impacts; c) understand decisions to adopt compliant or non-compliant measures in 4 case study settings (Australia, Canada, Hong Kong and US); and d) identify strategies to encourage increased compliance. Working closely with key knowledge users, including WHO, we will collect and analyze new data, and combine it with our existing datasets to conduct real time quantitative cross-outbreak analysis. The key outcome of this project is to mitigate the rapid spread of COVID‑19 through practical, evidence-informed strategies that strengthen global coordination.