Designing an international policy and legal framework for the control of emerging infectious diseases: first steps.

As the pace of emergence and reemergence of infectious diseases quickens, the International Health Regulations, which have served as the legal and policy framework of epidemic control for 45 years, are being revised by the World Health Organization (WHO). In this article, we review the recent history, legal construction, and application of these regulations and related international treaty-based sanitary measures, especially the General Agreement on Tariffs and Trade and the Agreement on the Application of Sanitary and Phytosanitary Measures, and the history of applying the regulations in the maritime and aviation industries. This review indicates that revision efforts should address 1) the limited scope of disease syndromes (and reporters of these syndromes) now in the regulations and 2) the mismatch between multisectoral factors causing disease emergence and the single agency (WHO) administering the regulations. The revised regulations should expand the scope of reporting and simultaneously broaden international agency coordination.