Italy aligns with the US: WHO guidelines on global pandemic preparedness have been rejected.

In a letter dated July 18 to WHO Director-General Tedros Ghebreyesus , Health Minister Orazio Schillaci communicated Italy's rejection of the 2024 amendments to the International Health Regulations, adopted at the 77th World Health Assembly.

Italy thus aligns itself with the US position. The amendments move towards a legally binding framework for responding to public health emergencies . "Pursuant to Article 61 of the International Health Regulations (2005), I hereby notify you of Italy's rejection of all the amendments adopted," it reads.

The United States government announced its rejection of the regulations, arguing that they violate US sovereignty . The 2024 amendments to the International Health Regulations introduced the concept of "pandemic emergency" and called for "greater solidarity and equity" within the WHO.

Recall that in January 2025, one of the first executive orders signed by Donald Trump was to withdraw from the WHO. However, the United States has not yet formally left the WHO; the withdrawal process is ongoing. The procedure under the WHO Constitution (Article 7) stipulates that a country's withdrawal becomes effective only one year after official notification.

Meanwhile, the United States has suspended its participation and financial contribution, also recalling staff and ending its presence at major WHO assemblies through 2025 .

The exit process has begun and will only become effective in January 2026, unless there is a political change of course in the coming months.

Last May, the World Health Assembly, the legislative body of the World Health Organization (WHO), formally adopted the first Global Pandemic Agreement , designed to strengthen collective preparedness and response to future pandemics. The agreement came after three years of intense negotiations, initiated following the gaps that emerged during the COVID-19 pandemic.

In the vote in the commission that preceded the formal adoption, 124 countries expressed themselves in favor, none voted against, while 11 countries abstained : among these are, in addition to Italy, which reiterated the centrality of national sovereignty in decisions on public health, Poland, Slovakia, Iran, Israel and Russia .

This is the second binding agreement negotiated under Article 19 of the WHO Constitution, following the 2003 Framework Convention on Tobacco Control. Once ratified by at least 60 countries, the Pandemic Agreement will officially enter into force.

Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, in Davos for the 2024 World Health Organization Summit . (Hollie Adams/Bloomberg via Getty Images)

January 17, 2024

"I am writing to you," reads the letter sent by Minister Schillaci to the Director-General of the World Health Organization, "with reference to your communication of 19 September 2024 on the amendments to the International Health Regulations (2025) adopted by the 77th World Health Assembly with resolution no. WHA77.17. As indicated by paragraph 3 of Article 55 and paragraph 2 of Article 59 of the International Health Regulations (2005), these amendments will enter into force 12 months after the aforementioned communication, i.e. on 19 September 2025, except for those Parties that have notified the Director-General of the World Health Organization of their decision to reject or make reservations with respect to the aforementioned amendments."

Therefore, it reads, "pursuant to Article 61 of the International Health Regulations (2005), I hereby notify you of Italy's rejection of all the amendments adopted by the 77th World Health Assembly with resolution WHA77.17".

At the 77th World Health Assembly, held from May 27 to June 1, 2024, in Geneva, member countries adopted amendments to the International Health Regulations, a legally binding framework for responding to public health emergencies, to introduce the concept of "pandemic emergency" and "greater solidarity and equity." The Trump administration rejected the amendments, stressing that the changes risked "unjustifiably" interfering with national sovereign rights to develop health policies.