Cholera, plague and yellow fever caused severe epidemics worldwide  in the mid-nineteenth century, causing major disruptions in society and the economy. Especially in Europe, cholera epidemics caused high mortality between 1830-1847. During the first International Sanitary Conference, Paris 1851, participating countries agreed on a regime that consisted of two basic parts; obligations on States Parties to

  1. notify each other about outbreaks of specified infectious diseases in their territories;
  2. limit disease-prevention measures that restricted international trade and travel to those based on scientific evidence and public health principles.

Basically, this classic regime was upheld for the next 100 years, even though the legislation was modernised several times:

  • International Sanitary Convention, 1893
  • International Sanitary Convention, Paris 1926
  • International Sanitary Regulations, 1951
  • International Health Regulations 1969 (1973, 1981)

It is interesting to observe that from the first conference in 1851 in Paris, until the update of the IHR in 1981, the same 3 diseases played the key role in the regulations: cholera, yellow fever and plague, even though some other diseases were added and removed from the list. Often, modifications in the regulations focussed on modifications of the measures that were proposed. Society changed a lot, especially trade and people travelling. So though the pathogens stayed rather the same, their effect in the population changed with the development of society.

This is well illustrated by the text in the pre-abule of the 1893 ISC, where State Parties “decided to establish common measures for protecting public health during cholera epidemics without uselessly obstructing commercial transactions and passenger traffic”.

In the last decades of the 20th Century, it became more clear that the restricted, disease specific way of the Regulations would not address the need for threat management in the modern society. The new IHR focus more on the public health capacity that has to be present in a country in order to respond effectively to public health events of international concern.




David P. Fidler. From International Sanitary Conventions to Global Health Security: The New International Health Regulations.  Chinese Journal of International Law (2005), Vol. 4, No. 2, 325–392.