| Summary: | In the aftermath of severe acute respiratory syndrome (SARS) (Figure 1) and in anticipation of avian flu, the international health community has recognized that pandemic planning and response is an inherently multigovernmental concern. The ability of pathogens to cross borders and rapidly spread around the globe requires highly coordinated public health responses that involve the cooperation of local, regional, national, and supranational governments (Figure 2). The understanding of this reality has informed the current International Health Regulations (IHR) revision process. Approved in May 2005, the revised IHR have increased the disease surveillance requirements of “states parties ” in an effort to better inform the pandemic response process and to protect the health of the global community [1]. Furthermore, the revisions have also outlined recommendations that the World Health Organization (WHO) could issue if an outbreak originating in one country is perceived to be a threat to other countries. The revision of the IHR is both long overdue and eminently necessary to face the challenges of an increasingly globalized world [2]. The practical implementation of these proposals, however, may encounter obstacles. This is particularly true for those WHO member nations that have federal systems of government (federations), and could ultimately threaten their ongoing support of the new regulations. Federalism and Public Health Response Federalism is a type of political system in which the advantages of shared rule are combined with those of regional The Policy Forum allows health policy makers around the world to discuss challenges and opportunities for improving health care in their societies.
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