A public health emergency of international concern (PHEIC) is a formal declaration by the World Health Organization (WHO) of "an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response", formulated when a situation arises that is "serious, sudden, unusual, or unexpected", which "carries implications for public health beyond the affected state's national border" and "may require immediate international action". Under the 2005 International Health Regulations (IHR), states have a legal duty to respond promptly to a PHEIC. The declaration is publicized by an IHR Emergency Committee (EC) of international experts, which was developed following the 2002–2004 SARS outbreak. Between 2009 and 2022, there were seven PHEIC declarations: the 2009 H1N1 (or swine flu) pandemic, the 2014 polio declaration, the 2013–2016 outbreak of Ebola in Western Africa, the 2015–2016 Zika virus epidemic, the 2018–2020 Kivu Ebola epidemic, the ongoing COVID-19 pandemic, and the ongoing 2022–2023 monkeypox outbreak. The recommendations are temporary and require reviews every three months. Automatically, SARS, smallpox, wild type poliomyelitis, and any new subtype of human influenza are considered as PHEICs and thus do not require an IHR decision to declare them as such. A PHEIC is not only confined to infectious diseases, and may cover an emergency caused by exposure to a chemical agent or radioactive material. It can be seen as an "alarm system", a "call to action", and "last resort" measure. Background Multiple surveillance and response systems exist worldwide for the early detection and effective response to contain the spread of disease. Time delays occur for two main reasons. The first is the delay between the first case and the confirmation of the outbreak by the healthcare system, allayed by good surveillance via data collection, evaluation, and organisation. The second is when there is a delay between the detection of the outbreak and widespread recognition and declaration of it as an international concern. The declaration is promulgated by an emergency committee (EC) made up of international experts operating under the IHR (2005), which was developed following the SARS outbreak of 2002–2003. Between 2009 and 2016, there were four PHEIC declarations. The fifth was the 2018–20 Kivu Ebola epidemic that was announced on 17 July 2019. The sixth was the 2019–20 COVID-19 pandemic. The seventh is the 2022 monkeypox outbreak. Under the 2005 International Health Regulations (IHR),