International Law and Antimicrobial Resistance: Learning from Fifteen Years Implementing the International Health Regulations

Although few international laws govern global health, there has been widespread discussion of the need for a global legal instrument to mitigate the ‘One Health’ threat posed by antimicrobial resistance (AMR). This chapter presents lessons learnt from the implementation of the International Health Regulations (2005) (IHRs) to inform debates about the potentials and pitfalls of international legal instruments for governing the global antimicrobial commons. Concretely, the chapter analyses the experiences of the World Health Organization (WHO) in IHR implementation through analysis of reports from the WHO archives, covering the years 2006-2021. Special attention is paid to the extent to which the IHRs incentivize action, institutionalize accountability, and activate interest groups. The analysis shows that IHR implementation suffers from lack of sustained action by WHO member states, lack of enforcement mechanisms, combined with an imbalance with respect to which interest groups are activated. The chapter concludes that the IHR is not suitable as an international legal framework for dealing with AMR. It argues that dispute resolution procedures with clear measures for enforcement and responsibilities need to be built into the global AMR governance regime and suggest that international trade regulation might have some relevant building blocks to draw from.