Timeline of health crisis responses

This is a timeline of health crisis responses.

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Year	Event type	Crisis type	Details	Location
1377 (July 27)	Quarantine or containment	Pandemic	After the Black Death first strikes in 1348 and keeps returning for three decades, lawmakers in the Adriatic merchant republic of Ragusa (present-day Dubrovnik) order that anyone arriving from a plague-stricken place must spend 30 days in isolation, on the island of Mrkan or in the town of Cavtat, before entering the city. Ships must anchor offshore, and residents may not visit them. The isolation period would later be extended to 40 days, the origin of the word quarantine, from the Italian quaranta. Ragusa depends on grain arriving by sea, so it cannot simply close its harbor. Instead, the city would add a health office, patrol boats and officials who trace the sick and their contacts. By detaining people who look healthy, the decree implies that disease can incubate unseen, roughly five centuries before germ theory could explain why. Encyclopaedia Britannica describes it as the first quarantine in the world.	Croatia (Dubrovnik)
1665 (September)–1666 (October)	Quarantine or containment	Pandemic	Plague reaches Eyam, a village in Derbyshire, England, killing 257 people over 14 months, about 37% of a population of roughly 700. Under rector William Mompesson and his predecessor Thomas Stanley, villagers accept a cordon sanitaire, staying inside the parish to keep the disease from spreading, and plague does not reach neighboring parishes. The quarantine would long be celebrated as an act of collective self-sacrifice, especially because similar measures elsewhere were unpopular and often disobeyed. Later historians would complicate the story. Some suggest that the quarantine prolonged the epidemic and raised the death toll inside the village, while others argue that the Earl of Devonshire's promise of supplies may have been tied to closing it. The cordon is not absolute: Mompesson sends his own children to safety in Yorkshire, and wealthier families may have fled. Poorer villagers are far more likely to die. A 2016 statistical study of parish records by Lilith Whittles and Xavier Didelot would estimate that about three-quarters of infections spread between people, and that sharing a household multiplies the risk many times over.	United Kingdom (Eyam)
1721 (May)	Medical countermeasure	Epidemic	When smallpox breaks out in Boston, Puritan minister Cotton Mather urges the town's physicians to inoculate everyone vulnerable to the disease, a practice he has learned about from Onesimus, a man he enslaves. Of the town's physicians, only Zabdiel Boylston agrees, igniting a bitter and sometimes violent dispute. Puritan ministers support inoculation, while a new secular class of medical professionals insists on its own authority in medical matters, and early newspapers profit from the fear and controversy. Despite the risk to himself and his family, Boylston inoculates 282 people, of whom six die (2.1%), while 844 of the 5,759 townspeople who catch smallpox naturally die (14.7%). It is America's first effort at preventive medicine and its first immunization controversy. Surgeon and historian Don K. Nakayama would argue that Boylston's results help win acceptance for inoculation in England, and later for Edward Jenner's vaccination technique, introduced in 1796.	United States (Boston)
1793 (September)	Relief operation	Epidemic	During a yellow fever epidemic in Philadelphia, then the temporary United States capital, nearly a third of the city flees, and physician Benjamin Rush asks ministers Richard Allen and Absalom Jones to organize the free Black community to help. Rush, a well-known antislavery figure, writes on September 2 that the fever "passes by persons of your color", repeating a belief from medical treatises that Black people are resistant. Nobody yet knows that mosquitoes carry the disease. Allen and Jones, founders of the mutual aid Free African Society, mobilize their community to nurse the sick and bury the dead. One white resident writes shortly before his own death that the Black residents are "the principal nurses". The belief proves false: Allen himself nearly dies, and Black deaths are under-recorded. Roughly 5,000 people die in a city of about 51,200. Publisher Mathew Carey then accuses Black residents of extortion and theft in a popular pamphlet. Jones and Allen reply with their Narrative, one of the only primary sources on Black experience of the crisis. Historian Rana Hogarth would credit their leadership with holding the city together.	United States (Philadelphia)
1848 (August 31)	Legislation	Epidemic	With a new wave of cholera sweeping west across Europe, the British Parliament passes the Public Health Act for England and Wales. Historians Elizabeth Fee and Theodore M. Brown would call it one of the great milestones in public health history. It follows the cholera epidemic of 1831–1832 and social reformer Edwin Chadwick's 1842 report linking working-class disease to filthy conditions in industrial cities. For the first time, the act makes the state the guarantor of health and environmental standards. It creates a General Board of Health for a provisional five years, which can set up local boards when a tenth of taxpayers petition, or compulsorily where mortality exceeds 23 per 1,000 over seven years. Local boards can manage water supplies, sewerage, food quality, paving and garbage removal, and appoint a medical officer of health. Opposed in the name of property rights and freedom, the board would not be renewed after its first five years, and Chadwick would be forced into retirement. Later historians would attribute the resistance less to vested interests than to genuine confusion over who should plan and pay for sanitary improvements.	United Kingdom (England and Wales)
1851 (July 23)	Conference	Multiple	The first International Sanitary Conference opens in Paris after cholera has twice struck Europe within 20 years and conflicting quarantines have burdened shipping with delays and spoiled cargo. France convenes 11 other governments to regulate quarantines and lazarettos in the Mediterranean uniformly, with each sending a physician and a diplomat. Its mandate is to limit disease while interfering as little as possible with trade, a tension that would remain central to the International Health Regulations. Delegates vote individually and disagree over whether quarantine works against cholera; they finally apply it by 15 votes to 4, with 4 abstentions. After six months they produce a draft convention and 137 articles of regulations, but only Sardinia would exchange ratifications with France, and these would later be denounced. The published minutes carry a cover date of July 27, although the opening session is dated July 23. Though practically fruitless, the conference establishes health as a proper subject for international consultation.	France (Paris)
1854 (September)	Quarantine or containment	Epidemic	Physician John Snow, who doubts the prevailing miasma theory that cholera spreads through foul air, investigates an outbreak around Broad Street in the poor Soho district of London, which he reports as causing more than 500 fatal attacks in 10 days. Most deaths occur near the Broad Street pump, while the nearby Poland Street workhouse, which has its own well, loses only five of 535 inmates, and more than 70 brewery workers who do not drink the water escape. Snow persuades the doubtful Board of Guardians of St. James parish to remove the pump handle, which happens the following day. The epidemic is already subsiding, partly because more than three-quarters of residents have fled the worst streets, so the removal is not proof that it stops the outbreak. Snow's later comparison of two water companies supports his case: 315 cholera deaths per 10,000 houses for one supplied from a sewage-polluted part of the Thames, against 37 for one drawing cleaner water. An official committee would still hedge between air and water, but the episode would help establish modern outbreak investigation.	United Kingdom (London)
1859 (April 9–August 30)	Conference	Multiple	The second International Sanitary Conference opens in Paris with only diplomatic delegates, as France hopes to salvage a simpler version of the failed 1851 draft. Austria's delegate withdraws on April 30 when war breaks out with France, returning only in August. Neither the 1854 microscopic work of Filippo Pacini on the cholera vibrio nor the water-supply studies of John Snow is mentioned. Britain argues that railways make maritime quarantine against cholera illusory. A final motion to exclude cholera from the grounds for detaining ships ties 5 to 5, and the chairman's casting vote defeats it. Eight countries sign the draft convention, while Greece and Turkey abstain, but no participant would ratify it.	France (Paris)
1866 (February 13–September 26)	Conference	Epidemic	The third International Sanitary Conference meets in Constantinople after cholera invades Europe in 1865, carried across the Mediterranean from Egypt for the first time in recorded history. France proposes the meeting, and the Ottoman government invites 16 other governments, all of which accept except the United States. Lasting seven months, it is the longest of the conferences and the first devoted solely to cholera. Delegates agree that the disease originates in India, that it is transmissible, and that people spread it, with sea travel the main route over long distances. However, they conclude that air is its main vehicle. Bavarian hygienist Max von Pettenkofer's soil theory dominates the debate, the water-borne evidence of physician John Snow gets only passing mention, and Florentine scientist Filippo Pacini's microscopic findings on the cholera organism are ignored. The conference produces no treaty, and its recommendations bind no participant.	Turkey (Constantinople)
1866 (March 1)	Quarantine or containment	Epidemic	At the International Sanitary Conference in Constantinople, delegates vote 17 to 8, with one abstention, for a French proposal to ban all sea traffic between Arabian ports and Egypt if cholera breaks out among Mecca pilgrims. Britain, Persia, Russia and the Ottoman Empire, which Russian delegate Lenz identifies as the main sources of pilgrims, vote against. British delegate Stuart says his task is to oppose any measure that interferes with trade unless its necessity is proven. Persian delegate Mirza Malkom Khan warns that a European-backed restriction on the pilgrimage would provoke hatred across the Muslim world. Other opponents warn that stranded pilgrims could lack food and transport, and Ottoman medical delegate Bartoletti argues that steam navigation has made the old camel routes unworkable. The vote has little practical effect, because no participant is bound by the conference's decisions.	Turkey (Constantinople)
1874 (July 1–August 1)	Conference	Epidemic	The fourth International Sanitary Conference opens in Vienna, reportedly at the initiative of Russia, which wants relief from quarantine requirements on its shipping through the Bosphorus. Twenty-one countries attend. It is the first of the conferences to adopt written rules of procedure, with one vote per country or health administration. Delegates reject land quarantine as unworkable by 13 votes to 4. On maritime quarantine, Mediterranean countries that favor it clash with northern countries that prefer medical inspection, until German epidemiologist August Hirsch proposes accepting both systems. The resulting regulations provide for both abolishing and keeping quarantine. The conference also votes to create a Permanent International Sanitary Commission in Vienna to study epidemic diseases, but it would never materialize. Writing in 1974, former WHO official N. Howard-Jones would conclude that the final act leaves countries free to do whatever they would have done anyway.	Austria (Vienna)
1881 (January 5–March 1)	Conference	Epidemic	The fifth International Sanitary Conference meets in Washington, the only one held in the Western Hemisphere. The United States convenes it to win foreign acceptance of an 1879 law that requires ships bound for American ports to carry sanitary certificates from United States consuls, a response to yellow fever outbreaks. Delegates reject consular inspection in foreign home ports. A proposed notification agency, with branches in Vienna and Havana, would never materialize. The meeting's lasting importance is unplanned: on February 18, Cuban physician Carlos Finlay, attending as a Spanish delegate, publicly proposes that yellow fever requires an independent third agent for its transmission. Nobody comments, and he would name the mosquito only months later. Proof would come almost 20 years later from a United States Army commission.	United States (Washington, D.C.)
1885 (May 20–June 13)	Conference	Epidemic	The sixth International Sanitary Conference opens in Rome after a cholera outbreak in Egypt in 1883, and a year after German bacteriologist Robert Koch returns from Calcutta claiming that a comma-shaped bacillus causes the disease. Although Koch is a delegate, the bacillus is never mentioned in the proceedings, as British and British Indian delegates block any discussion of cholera's cause. The real dispute is over the Suez Canal, used mainly by British ships. A British motion for uninspected passage fails, with 18 countries against, only Britain and India in favor, and Japan and Russia abstaining. The conference adjourns until November, but it would never resume. Britain's preference for inspecting arrivals rather than holding entire ships would later match modern practice.	Italy (Rome)
1892 (January 5–31)	Treaty or regulation	Epidemic	The seventh International Sanitary Conference, held in Venice, produces the first International Sanitary Convention after 41 years of failed attempts. Its scope is narrow, covering cholera controls on westbound ships using the Suez Canal. A compromise between Britain and France classifies ships as clean, suspect or infected and sets measures accordingly. It also reorganizes the Sanitary Council of Egypt. After further negotiations in Paris between Britain, Austria-Hungary and France, all participants would ratify an amended text. All signatories accept a statement that the cholera germ is found in patients' digestive tracts and spreads mainly through their discharges. Howard-Jones notes that the feared route never materialized: in more than a century, cholera never reached Europe by sea through the canal.	Italy (Venice)
1893 (March 11–April 15)	Treaty or regulation	Epidemic	The eighth International Sanitary Conference meets in Dresden, after a cholera epidemic reaches Europe by land in 1892 and kills 8,605 people in Hamburg alone, according to Koch's figures. Germany complains of the damage done to its trade by foreign restrictions. Nineteen European countries attend. The resulting convention requires governments to notify one another urgently of cholera outbreaks, ends land quarantine, frees letters, newspapers and books from restrictions, and limits detention of rail travelers to those with cholera or cholera-like symptoms. British delegate Richard Thorne Thorne declares that his country's health service agrees with scientific opinion that cholera passes between people, the first explicit official British acceptance of contagion. Ten countries sign, while others refer the text to their governments.	Germany (Dresden)
1894 (February 7–April 3)	Treaty or regulation	Epidemic	The ninth International Sanitary Conference meets in Paris to address the Mecca pilgrimage, after the 1893 cholera epidemic kills an estimated 30,336 of 200,500 pilgrims according to Mecca's medical officer. The resulting convention sets rules for pilgrims' departure ports, the Red Sea and the Persian Gulf. Thirteen of 16 countries sign. Britain, which says 98% of Persian Gulf shipping is British, rejects the annex on Gulf shipping, and other signatories reserve the same exemptions, turning those provisions into a dead letter. French delegate Henri Monod uses official statistics to accuse British India of being the source of cholera, showing recorded deaths there rising from 318,228 in 1878 to 721,938 in 1892.	France (Paris)
1897 (February 16–March 19)	Treaty or regulation	Epidemic	The tenth International Sanitary Conference opens in Venice, the first devoted entirely to plague, as an epidemic in Bombay raises fears that returning Mecca pilgrims could carry it to Europe. Delegates accept the bacillus isolated in Hong Kong in 1894 by Alexandre Yersin as the cause, and they recognize the susceptibility of rats, but the role of fleas is not yet understood. France, Britain and Russia ban or restrict the pilgrimage for their subjects. Several countries send medical missions to Bombay, and Britain would establish a plague commission whose work later proves how fleas transmit the disease. All participants except Denmark, Sweden/Norway and the United States sign the plague convention.	Italy (Venice)
1900 (May 28)	Court ruling	Epidemic	In Wong Wai v. Williamson, a federal court in San Francisco blocks the city's board of health and federal quarantine officer Joseph J. Kinyoun from forcing Chinese residents to receive the Haffkine plague vaccine against their will before leaving the city. The measures follow plague deaths in the Chinese district, which is placed under a cordon after 11 deaths between March 7 and June 2. The court rules that a quarantine restriction imposed on one class of people, such as Chinese or Japanese residents, and not on others in the same situation, is an arbitrary interference with personal liberty that violates the Fourteenth Amendment to the United States Constitution. It also finds that Kinyoun has no power under an 1890 federal law to restrict travel within the state. On June 15, the federal court dissolves the quarantine of the Chinese district. Kinyoun then orders carriers to refuse passage out of California to anyone without a health certificate. On July 3, the court declines to hold him in contempt, finding no proof that he went on discriminating against Chinese people after the injunction.	United States (San Francisco)
1903 (October 10–December 3)	Treaty or regulation	Multiple	The eleventh International Sanitary Conference, held in Paris, consolidates the conventions of 1892, 1893, 1894 and 1897 into one 184-article treaty. It is the first international convention to provide for killing rats on ships as a protection against plague. Delegates remain undecided about fleas, and yellow fever receives a single article, despite the antimosquito work presented by American delegate William C. Gorgas. Article 181 asks France to propose an international health office in Paris when the moment is right. French delegate Adrien Proust, a leading promoter of the idea and father of novelist Marcel Proust, dies a week before the conference closes.	France (Paris)
1904 (November 10)	Failure or controversy	Epidemic	The Vaccine Revolt breaks out in Rio de Janeiro, Brazil's capital, nine days after regulations are issued for a law making smallpox vaccination compulsory. A severe epidemic has killed some 3,500 people in the city that year. Vaccination has been mandatory in Brazil since the 19th century but never enforced, so public health director Oswaldo Cruz proposes a national law with broad powers, including requiring vaccination certificates to enroll in school, join the public service, marry or travel. Critics call it the "Torture Code", and opponents from army officers and workers to students, monarchists and some physicians form the League against the Mandatory Vaccine. They see compulsory injection as a violation of individual freedom, many believe the vaccine spreads the disease, and some object to women baring their arms and thighs for vaccinators. Congress passes the law on October 31. For a week, thousands protest, businesses and transport shut down, and a military uprising tries to depose President Rodrigues Alves. A state of siege restores order, but 30 people are killed and 945 arrested, many sent to forced labor in Acre. Alves keeps Cruz but ends compulsory vaccination. Smallpox deaths would fall to nine in 1906, then a new epidemic in 1908 would kill more than 6,500.	Brazil (Rio de Janeiro)
1907	Quarantine or containment	Epidemic	New York City health officials isolate Mary Mallon, an Irish immigrant cook and the first healthy carrier of typhoid fever they identify, on North Brother Island in the East River. The New York American would label her "Typhoid Mary" in June 1909. Health Commissioner Ernst J. Lederle releases her in 1910 and helps her find laundry work, but it pays less, and the department provides no lasting employment or retraining. She returns to cooking, and in 1915 she is sent back to the island permanently, where she would still be living more than 15 years later. Public opinion turns against her: the New York Tribune says that she has deliberately thrown away her freedom, and a historian in 1994 would liken her conduct to assault. Medical historian Judith Walzer Leavitt would argue that the blame should be shared, since officials leave many other uncooperative carriers free and choose to make an example of Mallon. Leavitt would also argue that carriers cooperate more readily when their economic security is protected and they are treated fairly, which points to the lasting conflict between civil liberties and public health.	United States (New York City)
1907 (December 3)	Institution	Multiple	Delegates of 12 countries meet in Rome to create the Office International d'Hygiène Publique, a permanent health office based in Paris that collects and shares public health information, particularly on cholera, plague and yellow fever. Austria-Hungary, Germany and the Scandinavian countries are absent. France secures the first two senior posts, with a diplomat, Jacques de Cazotte, as Director. Its committee first meets in November 1908 with nine countries represented, and later almost 60 would join. The office follows the International Sanitary Bureau, founded by American governments in Washington in 1902. Its European focus mirrors the bureau's concern with yellow fever.	Italy (Rome)
1910 (October)–1911 (April)	Quarantine or containment	Epidemic	A pneumonic plague epidemic, believed to come from tarbagan marmots hunted for their fur, breaks out in northeastern China, where China, Russia and Japan each control part of the railway network. Spread by droplets among crowded migrant hunters, and along the railways as workers travel home for the New Year, the almost always fatal disease kills more than 60,000 people. The three powers cooperate in the response. They quarantine suspected cases and contacts in train carriages, give "plague passports" and sealed wristbands to those released without symptoms, isolate households and burn contaminated property, and close ports and railways. Cambridge-educated physician Wu Lien-teh obtains imperial permission to cremate the dead, confirms through autopsies that the plague is pneumonic rather than bubonic, and urges everyone to wear face masks. The last case is recorded on March 1, and the epidemic is declared over by the end of April. The closures would devastate the fur and soybean trades, but closing the port of Dalian would be credited with keeping the disease out of Japan, Korea and Hong Kong.	China (Manchuria)
1911 (April 4)	Conference	Epidemic	The International Plague Conference opens in Mukden (now Shenyang), the first international scientific congress held in China, with Wu Lien-teh presiding. Thirty-three official representatives attend from eleven countries: the United States, Great Britain, Germany, France, Italy, Mexico, the Netherlands, Austria-Hungary, Russia, Japan and China. Bacteriologist Shibasaburo Kitasato, who had isolated the plague bacterium in Hong Kong in 1894, chairs part of the conference. Other delegates include Richard Strong of the United States, Daniil Zabolotny of Russia and Reginald Farrar of Britain. Topics include modes of contagion, asymptomatic carriers and super-spreaders. Held decades before the World Health Organization, when outbreak response is left largely to individual nations, the conference reflects a growing recognition that outbreaks need a multinational response. It would lead to the creation of the North Manchurian Plague Prevention Service in 1912, an early sign of the new Chinese republic adopting Western public health methods.	China (Shenyang)
1911 (November 7)–1912 (January 17)	Treaty or regulation	Multiple	The twelfth International Sanitary Conference meets in Paris with 41 countries, including 16 from the Americas. Its main problem is the healthy carrier: people who show no symptoms but excrete cholera vibrios, which undermines quarantine periods based on how long illness takes to appear. Screening results are mixed, with very few carriers found among travelers but up to half of contacts in some epidemic settings. Delegates agree on a definition of carriers but not on routine stool testing, and the final 160-article convention leaves testing to national authorities. Howard-Jones notes that modern experts would rediscover the importance of carriers during the cholera pandemic of the 1960s.	France (Paris)
1921 (June 22)	Institution	Multiple	The Council of the League of Nations decides to appoint a Provisional Health Committee, after plans to absorb the Office International d'Hygiène Publique into the League collapse. The United States belongs to the office but not to the League, and it refuses to let the office be combined with it. A compromise gives the office an advisory role. Two autonomous international health bodies would therefore coexist in Europe, alongside the American bureau in Washington. Howard-Jones regards the League's health organization, with its work on malaria, nutrition and biological standards, as the true precursor of the World Health Organization.	Switzerland (Geneva)
1926 (May 10–June 21)	Treaty or regulation	Multiple	The thirteenth International Sanitary Conference meets in Paris with delegates from more than 50 states and revises the 1912 convention. It adds notification of smallpox and typhus epidemics, while influenza stays out because international quarantine against it is impractical. The conference also records two later-discredited positions: it calls cholera vaccination of proven efficacy, and it accepts Japanese bacteriologist Hideyo Noguchi's claim that a leptospira causes yellow fever. Noguchi would later recognize his error before dying of yellow fever in Accra in 1928. Surgeon General Hugh S. Cumming of the United States asks for English to be recognized alongside French, but the request goes nowhere.	France (Paris)
1937	Failure or controversy	Food or drug safety	Shortly after the introduction of sulfanilamide, the first sulfa antimicrobial drug, a liquid version called Elixir Sulfanilamide is sold using diethylene glycol, a toxic solvent, to dissolve it. One hundred and five patients die from taking it as medicine, in what physician and toxicologist Paul M. Wax would call one of the most consequential mass poisonings of the 20th century. Under existing United States drug rules, manufacturers do not have to test new drugs for toxicity before selling them. In response, Congress would pass the Federal Food, Drug, and Cosmetic Act of 1938, requiring proof of safety before a new drug could be released. The law would change the Food and Drug Administration from a policing agency mainly concerned with seizing adulterated drugs into a regulator increasingly involved in evaluating new ones. Diethylene glycol would be behind other mass poisonings in later decades.	United States
1938 (October 28–31)	Conference	Multiple	The fourteenth and last International Sanitary Conference meets in Paris for four days with almost 50 countries. Called at Egypt's instigation, its only agenda item is the future of the international sanitary, maritime and quarantine council in Egypt, which the conference unanimously agrees to dissolve. The series that began in 1851 thus ends with a single administrative decision, 88 years later. Its goals would pass to the World Health Organization, which would absorb the earlier international health bodies.	France (Paris)
1945 (May)	Inquiry	Famine	The Famine Inquiry Commission, chaired by Sir John Woodhead, publishes its report on the Bengal famine of 1943, in which it says a million and a half people have died. It finds that rice supplies fell short after a poor crop in late 1942 and the loss of imports from Burma, but only by about three weeks' requirements, while prices rose to five or six times their early-1942 level. It concludes that resolute action to distribute supplies fairly could have prevented the famine as it occurred. The Bengal government abandoned controls in March 1943, delayed relief, failed to introduce rationing and never declared famine, and a "No Shortage" policy backed by the Government of India ran from April to June. The Government of India was also slow to plan grain movements between provinces. The commission blames profiteering and corruption too, and credits Viceroy Lord Wavell with improving distribution from late October. It states that cutting famine relief for lack of funds is never justified. The report exonerates the government in London. Some would denounce it as a whitewash, and the debate over responsibility would continue.	India, Bangladesh (Bengal)
1947 (April)	Medical countermeasure	Epidemic	New York City launches one of the fastest mass vaccination campaigns on record after smallpox is imported by an American businessman who arrives by bus from Mexico City in early March. He dies in a hospital within days, with the cause listed as bronchitis, and 11 days later two more patients at the same hospital develop the disease. Tests confirm smallpox in all three. Hospital staff and anyone in contact with the patients are vaccinated, and the health commissioner urges every New Yorker not vaccinated since early childhood to get the shot, with vaccine supplied free to clinics and private doctors. After a second death on April 13, the mayor asks all 7.8 million residents to be vaccinated, and police, fire and health departments join the effort under the slogan "Be sure, be safe, get vaccinated!" An estimated five to six million people are immunized by the end of April. Officials say little about side effects, assuring the public that vaccination is painless. Virologist Vincent Racaniello would credit ring vaccination of contacts with halting the outbreak, and present the campaign as a model for public health mobilization.	United States (New York City)
1951 (May 25)	Treaty or regulation	Multiple	The Fourth World Health Assembly, meeting in Geneva, adopts the International Sanitary Regulations (WHO Regulations No. 2), replacing the patchwork of earlier sanitary conventions and agreements with a single text administered by the World Health Organization. Their stated aim is "the maximum security against the international spread of disease with the minimum interference with world traffic". The regulations cover six quarantinable diseases: plague, cholera, yellow fever, smallpox, typhus and relapsing fever. Governments must notify WHO by telegram within 24 hours when a local area becomes infected, and the permitted sanitary measures are set as the maximum a state may require of international traffic. The text reflects the air age, with rules for airports and aircraft, while a separate annex still regulates the Mecca pilgrimage. Bills of health are abolished, and travelers may no longer be required to undergo rectal swabbing. The regulations bind member states unless they reject them or enter reservations accepted by the Assembly. They would enter into force on October 1, 1952, with seven countries holding accepted reservations.	Switzerland (Geneva)
1955 (April)	Failure or controversy	Food or drug safety	After a field trial with 1.8 million American children, paid for by the March of Dimes, finds Jonas Salk's polio vaccine highly effective and safe, the vaccine is licensed the next day under political pressure. At the time, the United States has 59,000 polio cases a year. Within two weeks, five companies distribute about five million doses. Thirteen days after the first doses, polio cases appear in vaccinated children, all at first traced to vaccine from Cutter Laboratories that contains live virus. At least 220,000 people would be infected, including 100,000 contacts of vaccinated children; 70,000 would develop muscle weakness, 164 would be severely paralysed and 10 would die. The causes would include a highly virulent strain, flawed inactivation and inadequate safety tests, although Cutter had met every licensing requirement. In the first of 60 lawsuits, a jury would find Cutter not negligent but liable for breaching an implied warranty of safety, establishing liability without fault. According to vaccine scientist Paul Offit, the litigation that followed would drive manufacturers away from vaccines and lead to the 1986 National Vaccine Injury Compensation Program.	United States
1956	Legislation	Environmental	The United Kingdom passes the Clean Air Act 1956, its main response to the Great Smog, which smothers London for five days in December 1952, collapsing visibility, disrupting transport and killing thousands. The 1954 report of a committee chaired by Hugh Beaver argues that air pollution is not inevitable but a social and economic problem that can be solved. Passage is contested: industrial interests fear the cost of cleaner technology, and housing minister Harold Macmillan is among the senior figures who stress economic concerns and play down the risks of smoke and sulfur pollution. Pressure from public health advocates, local politicians and media campaigns helps shift policy. The law introduces smoke-control areas, phases out dirtier fuels and regulates emissions, and air quality would improve dramatically over time. Environmental scientist Ian Williams would describe it as a model for evidence-led regulation in countries such as the United States, Japan, Germany and Australia, while arguing that the episode shows that science alone does not drive policy.	United Kingdom (London)
1961 (November)	Failure or controversy	Food or drug safety	German company Grünenthal withdraws the sedative thalidomide from the West German market, and from other markets shortly afterward, after physicians in West Germany and Australia link it to a sharp rise in a previously rare set of birth defects, including the absence of normal limbs. Grünenthal has marketed the drug, sold in West Germany as Contergan, as safe even for pregnant women, despite mixed trial results and complaints about side effects. Hamburg pediatrician Widukind Lenz pushes for the public investigation that forces the withdrawal. Distribution has been so wide and so poorly monitored that no one can be certain who has taken it. More than 5,000 children are affected in West Germany and several hundred each in Britain, Australia, Canada and Japan, while flawed reporting elsewhere leaves totals unknown. Responses would differ by country: West Germany would provide state compensation when licensing or monitoring fails, while Britain would change its drug testing and monitoring. A British court's censorship of newspaper reporting on victims' lawsuits would be ruled an unacceptable limit on free speech by the European Court of Human Rights.	Germany
1962 (October 10)	Legislation	Food or drug safety	United States President John F. Kennedy signs the Kefauver-Harris Amendment to the Food, Drug, and Cosmetic Act of 1938, requiring manufacturers to demonstrate that new drugs are both safe and effective before approval. Senator Estes Kefauver has pursued drug reform since 1959 against strong opposition from colleagues close to the industry, with little prospect of a stringent law. That changes on July 15, 1962, when newspapers report the global thalidomide disaster and how Food and Drug Administration (FDA) medical officer Frances Kelsey has questioned Richardson-Merrell's application to sell the drug in the United States. Although the company has distributed samples through more than 1,200 physicians to over 20,000 patients, few American births are affected, and the public sees a narrow escape. The law requires animal testing and well-monitored human trials, widens FDA inspection powers and its ability to withdraw hazardous drugs, and requires fuller information on side effects. It does not provide for tracking drugs after approval, a gap that Britain and the World Health Organization would address.	United States
1966	Eradication campaign	Epidemic	The Nineteenth World Health Assembly commits the World Health Organization to the global eradication of smallpox, with a special regular-budget allocation of about US$2.4 million a year. The resulting Intensified Smallpox Eradication Programme begins in 1967, with Donald Henderson leading a Geneva unit of only about 10 people. WHO Director-General Marcolino Candau is skeptical, fearing another failure while malaria eradication is in difficulty, as well as a diversion from basic health services. The strategy combines mass vaccination, aiming for at least 80% coverage, with surveillance to find cases and contain outbreaks. WHO has only moral suasion to secure cooperation, yet the programme would extend to more than 50 countries and at times involve 150,000 workers. Significant donations would take more than seven years to arrive, and civil wars in Ethiopia, Nigeria, Pakistan and Uganda would disrupt operations. The official history, written partly by the programme's leaders, rejects the later image of a well-funded, military-style campaign.	International
1976 (March 24)	Medical countermeasure	Pandemic	United States President Gerald Ford announces the National Swine Flu Immunization Program, after several soldiers at Fort Dix, New Jersey, fall ill with an H1N1 influenza strain and one dies, raising fears that it could be closely related to the strain behind the 1918 pandemic. Urged by the Centers for Disease Control and Prevention and well-known scientists, Ford asks Congress for $135 million to produce vaccine for the entire population, saying that "we cannot afford to take a chance with the health of our Nation", while admitting that no one knows how serious the threat could be. Vaccine manufacturers demand government liability protection for adverse reactions, which delays the program until a law signed on August 12 provides it. Distribution begins in October, and more than 40 million people are vaccinated in under three months. After a small number develop Guillain–Barré syndrome, a serious side effect, the program is suspended on December 16. Large-scale immunization would never resume, and the program would officially end in March 1977. Richard Neustadt and Harvey Fineberg would later call the effort unprecedented in timing and scope among American immunization campaigns.	United States
1976 (July 10)	Evacuation	Chemical	A reactor at the ICMESA chemical plant in Meda, near Milan, owned through Givaudan by Hoffmann-La Roche, ruptures its bursting disc six and a half hours after being shut down in violation of procedures for the weekend, in what becomes known as the Seveso disaster. A cloud containing dioxin contaminates about 1,800 hectares in four municipalities. The response is slow: a manager inspects the area and sees nothing unusual, the local health officer cannot be reached, and the company warns the mayors only the next afternoon. A danger zone is designated on July 15. Experts from firms with past dioxin accidents recommend evacuation, which begins on July 26 with 208 people from 37 houses, 16 days after the release. In all, 736 people are evacuated from Zone A, while 4,700 in Zone B stay. Many lessons on emergency planning and communication would enter the European Seveso Directive of 1982, later strengthened after the 1984 disaster in Bhopal. Zone A would be decontaminated by 1984 and become a park.	Italy (Meda, Seveso)
1976 (August–November)	Quarantine or containment	Epidemic	A previously unknown hemorrhagic fever appears at the rural Yambuku Mission Hospital in northern Zaire, where five glass syringes are reused without sterilization, and dozens of patients given injections fall ill and die within about a week. Congolese doctors raise the alarm, and on October 4–9 a team advises closing the hospital and quarantining Bumba Zone, which has 275,000 people, stopping commercial flights, village travel and river traffic. Thirteen of the hospital's 17 staff fall ill, and 11 die. Laboratories in Antwerp, Porton Down and Atlanta culture the virus, and the US Centers for Disease Control and Prevention identifies it as new. Scientific director Karl Johnson names it Ebola, after a nearby river, so that Yambuku will not be stigmatized. An International Commission convenes on October 18. With patient isolation, rapid burials that the community accepts and a three-week restriction on staff at a Kinshasa hospital, the outbreak ends within 11 weeks, after 280 deaths among 318 cases. Members of the commission would later contrast this with West Africa in 2014, where alert took more than three months and communities were often uncooperative.	Democratic Republic of the Congo (Yambuku)
1980 (May 8)	Eradication campaign	Epidemic	The 33rd World Health Assembly adopts resolution WHA33.3, the declaration of global eradication of smallpox, accepting the final report of the Global Commission for the Certification of Smallpox Eradication and declaring "solemnly that the world and all its peoples have won freedom from smallpox". The commission had submitted its report at the end of 1979, two years after the last endemic case in Africa, in Somalia in October 1977. Its recommendations include ending smallpox vaccination and vaccination certificates, creating a global vaccine reserve held by the World Health Organization, and sharply reducing the number of laboratories keeping variola virus. According to the organization's own magazine, the campaign it led from 1967 cost an estimated US$300 million through 1977, against estimated worldwide vaccination costs of about US$1 billion a year.	International
1981 (June)	Failure or controversy	Pandemic	The Centers for Disease Control and Prevention (CDC) publishes the first official United States report on the disease that would become known as AIDS. It spreads rapidly through urban gay communities, and the hundreds of cases diagnosed that year are only a fraction of existing infections. No proactive federal response follows. President Ronald Reagan has cut budgets at the National Institutes of Health (NIH) and the CDC, and social conservatives who helped elect him recoil from a disease associated with gay men. Over the next several years, the administration blocks congressional AIDS appropriations and impedes CDC prevention campaigns, though NIH research is less affected. Hard-hit communities fill the gap: groups such as New York's Gay Men's Health Crisis provide care and frank prevention programs that reduce infection rates among gay men within three years, while hemophilia organizations press to protect the blood supply. According to sociologist Tasleem Padamsee, federal neglect persists through 1985, when Reagan finally acknowledges AIDS publicly even as his administration proposes further spending cuts.	United States
1982 (November 4)	Treaty or regulation	Food or drug safety	About five weeks after seven people in the Chicago metropolitan area die from taking poisoned Extra-Strength Tylenol capsules, beginning on September 29, in what would become known as the Chicago Tylenol murders, the Food and Drug Administration issues rules requiring all nonprescription drugs sold in the United States to be packaged in tamper-resistant containers. The regulation affects 200,000 to 300,000 separate products, which must be made with tamper-resistant packaging within 90 or 180 days unless granted a special exemption. The killings would remain unsolved, and the requirement would make foil and other seals a standard feature of medicine bottles.	United States
1984	Failure or controversy	Chemical	A toxic gas cloud escapes from a pesticide factory owned by the American company Union Carbide in the Indian city of Bhopal, killing thousands of people, in what would become known as the Bhopal disaster. Four decades later, the German public broadcaster Deutsche Welle would describe it as an unending chemical disaster, reporting that the effects of the cloud are still causing birth defects in newborns.	India (Bhopal)
1984 (October 23)	Relief operation	Famine	BBC journalist Michael Buerk broadcasts a report from northern Ethiopia on a famine that has been building for about two years. More than 400 stations transmit it, and the American network NBC airs it on its main bulletin. Diplomats, aid agencies and journalists have been trying to draw attention to the crisis since 1982, with little success: in the summer of 1984, the British Foreign Office judges other places more important than the embassy's requests for ministerial visits. The British government acts only after the story breaks, with the Foreign Secretary making a statement to Parliament the next day and agreeing to airlifts. The report inspires a new style of celebrity fundraising and helps lead to Live Aid in 1985. According to journalism scholar Suzanne Franks, it is partly a matter of chance, as a rival reporter who arrives first has footage that goes unedited because of a strike. She argues that coverage presenting the famine as a drought obscures its man-made causes, a framing that also suits the government of Mengistu Haile Mariam.	Ethiopia
1985	Failure or controversy	Famine	About 90% of international aid for the Ethiopian famine goes to the government and to agencies working on its side, although the government can reach only a minority of the famine-stricken population in the north. Human Rights Watch, in a 1991 report by its Africa Watch division, would estimate that the famine of 1983 to 1985 kills at least 400,000 people, and that something over half of these deaths can be attributed to human rights abuses. It would also say that forced resettlement kills at least 50,000 more, and that the army attacks relief convoys and feeding centers and tries to stop clandestine supplies from Sudan reaching rebel-held Tigray. It would conclude that aid almost certainly prolongs the war and the Mengistu Haile Mariam government's life, and would criticize the UN and most aid agencies for avoiding these dilemmas. Aid to rebels would also prove controversial: in 2010 the BBC would apologize for suggesting that Band Aid or Live Aid money was spent on weapons, while standing by evidence that the Tigray People's Liberation Front diverted some famine relief funds.	Ethiopia
1986	Treaty or regulation	Radiological	As fallout from Chernobyl spreads across Europe, governments respond with widely differing measures, from extra monitoring to compulsory limits on food sales. The European Communities ban imports containing more than 370 Bq/kg of radiocesium in milk products and 600 Bq/kg in other food, applying the same limit to rarely eaten spices as to vegetables. Some countries compete to set the strictest standards, and slightly contaminated food is destroyed to avoid trivial doses. Advice can also backfire: when people are told to wash leafy vegetables, many stop buying them, costing producers far more than any health benefit. In Ukraine, 15,000 cows are slaughtered regardless of contamination, although clean fodder could have limited the problem. Agreement on guideline values for food in international trade would come only in 1989, through the Codex Alimentarius, and restrictions on some sheep in Britain and on reindeer in Nordic countries would persist for years.	Europe
1986 (April 26)	Evacuation	Radiological	Explosions destroy Unit 4 of the Chernobyl nuclear power station in Soviet Ukraine, and a graphite fire spreads radioactive material for about 10 days. National authorities have no plan for an accident on this scale. Firefighters and plant staff bear the worst exposure: 31 people die in the accident or soon after, and helicopters drop about 5,000 tonnes of material onto the reactor. Pripyat, with 49,000 residents, is evacuated on April 27, and more than 100,000 people would eventually leave the surrounding zone. Iodine tablets arrive about a week late and reach only part of the population, while contaminated milk delivers high thyroid doses to children. A large rise in childhood thyroid cancer would emerge from about 1990, much earlier than experts expect. Within seven months, the ruined reactor is enclosed in a concrete "sarcophagus". The OECD Nuclear Energy Agency would judge short-term Soviet measures reasonably timely and effective, but long-term resettlement criteria confused.	Ukraine (Chernobyl, Pripyat)
1986 (October)	Inquiry	Pandemic	The Institute of Medicine and United States Surgeon General C. Everett Koop, a Reagan appointee, separately publish reports on AIDS, following public alarm over the 1985 death of actor Rock Hudson. The Institute warns of extreme financial strain on hospitals in hard-hit cities and calls for a strong, coordinated response. Both reports reject coercive and punitive measures advocated by conservatives, and instead recommend mass public education, wider confidential testing and a long-term research program. Together with growing public concern, they make the administration's inaction harder to sustain, and Koop's findings would later be mailed to every American household. Even so, the United States lags Margaret Thatcher's Conservative government in Britain, which has already taken proactive leadership on the disease.	United States
1986	Institution	Pandemic	After Uganda's health minister tells the World Health Assembly in May that his country has AIDS and asks for help, the World Health Organization sets up a Control Programme on AIDS, funded by donors rather than WHO's core budget. Its director is Jonathan Mann, previously head of Projet Sida in Zaire. WHO Director-General Halfdan Mahler warns in August that "we stand nakedly in front of a pandemic as mortal as any pandemic there has ever been". In 1987 the UN General Assembly designates WHO as lead agency on AIDS, and Mann publishes a Global AIDS Strategy. The programme becomes the Global Programme on AIDS in January 1988. It makes human rights central to its work, opposing the anti-AIDS immigration laws that some 81 countries adopt. It becomes the largest and wealthiest programme in WHO's history, with donor commitments rising from just over US$30 million in 1987 to US$90 million in 1990. Mann would resign in March 1990 after Director-General Hiroshi Nakajima tried to scale the programme back.	International
1987	Treaty or regulation	Radiological	Two international agreements take effect in response to Chernobyl, after radioactivity from the accident is first detected abroad at a nuclear power station in Sweden, where staff initially suspect a Swedish reactor. The Convention on Early Notification of a Nuclear Accident and the Convention on Assistance in the Case of a Nuclear Accident or Radiological Emergency rest on the lesson that a major nuclear accident inevitably crosses borders. On this basis, the International Atomic Energy Agency sets up systems for information exchange and for assistance on request. By 2002, 83 states would be party to the first convention and 79 to the second. Related measures include a European radiological alert system, the International Nuclear Event Scale for communicating severity to the public, and international emergency exercises.	International
1988	Failure or controversy	Pandemic	The United States Congress bans federal funding of needle exchange programs despite expert testimony supporting them, as social conservatives argue that the approach legitimizes drug use. The same year, the United Kingdom permanently authorizes nationally funded programs, after a Scottish committee backs them and pilots show that they can reduce HIV transmission. The two countries face similar epidemics, evidence and moral objections, but reach opposite decisions. The American ban would prove durable: in 1998 the Secretary of Health and Human Services would declare the programs effective yet keep the ban in place, and it would be lifted in 2009, reinstated in 2012 and loosened again in 2015 amid the opioid epidemic. HIV infection among people who inject drugs would later stand below 3% in the United Kingdom and above 15% in the United States, though Padamsee cautions that a definitive causal link is hard to demonstrate.	United States, United Kingdom
1989	Activism	Pandemic	As President George H. W. Bush takes office, the activist group ACT UP confronts officials at the Food and Drug Administration and the National Institutes of Health directly. It wins regulatory changes that widen access to experimental treatments and speed drug approvals by two years or more. Activists also persuade federal agencies to include patient representatives and lay experts in decision-making, and they begin pressing the CDC to recognize how AIDS appears in women and people who inject drugs. The CDC would expand its definition of AIDS in 1993, despite the higher federal costs of more diagnoses. The episode makes patients active participants in shaping the response to an epidemic.	United States
1990	Legislation	Pandemic	The United States Congress passes the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, which President George H. W. Bush signs into law. It funds localities to provide health care, prescription drugs and support services to people with HIV who lack adequate coverage. Passage follows a fiscal crisis: uninsured AIDS patients are pushing urban hospitals toward bankruptcy, turning treatment financing into a general concern. Supporters also build backing by invoking "innocent victims" and distancing the bill from gay men and drug users; its namesake, Ryan White, is an Indiana teenager who contracts HIV during hemophilia treatment and dies in 1990. Padamsee describes the law as both a sign of slow response, coming three years after comparable British action, and a rare safety net in a system where income largely determines access to care. As a discretionary program, it would remain chronically underfunded.	United States
1991 (January 31)	Medical countermeasure	Epidemic	The first cases of cholera appear in Chancay and Chimbote on Peru's coast, beginning an epidemic that spreads through Lima and across the Andes into the Amazon. Peru declares a national health emergency for 120 days and requests about US$3.9 million in international aid, mainly drugs, rehydration fluids and laboratory supplies. The Pan American Health Organization coordinates the international response. More than 3.3 million packets of oral rehydration salts are distributed by late February. By April 23, the government reports 146,877 probable cases and 1,045 deaths, a low death rate that UN reports credit to rapid treatment and public education campaigns. Those campaigns urge people to drink only boiled water, but poverty, poor sanitation and water shortages limit their effect. WHO advises that costly mobile water purification plants are not appropriate, and Peru says it needs supplies rather than foreign doctors. WHO Director-General Hiroshi Nakajima estimates the epidemic's total cost at US$1 billion. With UNICEF support, the health ministry launches a basic sanitation plan for 200,000 families through women's grassroots organizations, while neighboring health ministers warn that cholera could spread across South America and remain endemic.	Peru (Chancay, Chimbote, Lima)
1991	Failure or controversy	Radiological	Ukraine introduces a compensation law for people affected by Chernobyl, with post-accident management reaching some three million Ukrainians and consuming about one-sixth of the national budget. Intended to ease the psychological impact, it may instead deepen it by labeling recipients as victims, increasing their separation from host communities and encouraging withdrawal and despair. Locally, the payment is nicknamed a "coffin subsidy". According to the OECD Nuclear Energy Agency, about 800 mostly elderly people who return to their contaminated homes, and so receive no compensation, appear less anxious than those relocated, despite worse living conditions. The dismissive label of "radiophobia" used by some officials further alienates the public. Researchers would conclude that the accident's lasting psychological harm cannot be directly linked to ionizing radiation, and the episode shows that support measures can themselves shape a disaster's health effects.	Ukraine
1994 (July)	Relief operation	Epidemic	After the Rwandan genocide, in which between 500,000 and 800,000 Tutsis are murdered in about 100 days, the Rwandan Patriotic Front takes power and more than two million people, mostly Hutus and including perpetrators of the killings, flee to neighboring countries. Some 850,000 cross into Goma in Zaire, where a contingency plan exists for about 50,000. Volcanic rock makes it hard to drill wells or install sanitation, and cholera and dysentery kill about 50,000 people, between 6% and 10% of the refugees, in the first month. Driven by media coverage, a huge response follows, with more than 250 organizations working across the region, including many inexperienced NGOs and military contingents. Armed militias control the camps, staff must leave cholera centers every night, and perpetrators use the aid to consolidate power in exile. Médecins Sans Frontières France would withdraw, denouncing the diversion of aid, a decision disputed within the organization. The crisis would sharpen a lasting debate over humanitarian neutrality.	Democratic Republic of the Congo (Goma)
1994 (September)	Quarantine or containment	Epidemic	An outbreak reported as pneumonic plague strikes Surat, a city of 2.2 million in western India, nearly 30 years after India's last urban plague outbreak. After reports of seven rapid deaths and a preliminary diagnosis on September 21, a quarter of residents flee within four days, spreading fear across India. On September 25, the government sends police to stem the exodus and stop patients from abandoning hospitals. Quick treatment follows, with about half a million tetracycline capsules distributed in Surat, and deaths fall from about 10 a day to none after September 28. The outbreak kills 56 people nationwide, and no case is confirmed in Bombay. Many countries nonetheless stop air and ship traffic to India, and the economy loses more than $600 million, including $420 million in exports. The World Health Organization plans a Disease Intelligence Unit and asks the International Civil Aviation Organization to tighten airport health controls, while India upgrades plague research and surveillance. The authors of World Resources 1996-97 would argue that the name of the disease, more than its toll, explains the panic.	India (Surat)
1995 (March 20)	Relief operation	Chemical	Members of the cult Aum Shinrikyo release sarin, an odorless, colorless nerve agent, in a coordinated attack on the Tokyo subway, in what would become known as the Tokyo subway sarin attack. Victims of the then-unknown chemical begin arriving in large numbers at the emergency department of St. Luke's International Hospital, which receives more than 500 people within the first few hours. More than 5,500 people would seek medical evaluation after the attack, and twelve would die. According to Kenichiro Taneda, the hospital's chief resident on duty that morning, most of those who came were not physically harmed but were acute psychological casualties, the "worried well" who feared they had been exposed. He would argue that planning for mass-casualty events must account for such psychosocial effects as well as for the victims of the agent itself.	Japan (Tokyo)
1996 (January 1)	Institution	Pandemic	UNAIDS, the Joint United Nations Programme on HIV/AIDS, begins operating, with 91 staff at its Geneva secretariat and 10 in the regions. It brings together six cosponsoring UN agencies, and is headed by scientist Peter Piot, who had joined the Global Programme on AIDS in 1992. The UN Economic and Social Council had endorsed the joint programme on July 26, 1994, in Resolution 1994/24, which calls for "co-ownership, collaborative planning and execution, and an equitable sharing of responsibility". Its aims include global leadership, consensus on policy, monitoring the epidemic and mobilizing political commitment and resources. The new body replaces WHO's Global Programme on AIDS, after donors grew critical of its spending and some argued it was too medical and imposed a one-size-fits-all model on national AIDS plans, a charge GPA director Michael Merson would dispute. UNAIDS is not a funding agency, which would cause friction with countries, and for years the division of roles between the secretariat and the cosponsors would remain unclear.	Switzerland (Geneva)
1996	Inquiry	Multiple	The Joint Evaluation of Emergency Assistance to Rwanda, an unprecedented multinational review launched in late 1994, publishes its findings. A study led by John Borton identifies the lack of early warning, underinvestment in preparedness because donors avoid funding emergencies that might not occur, weak coordination among up to 300 organizations and more than 20 donors, and poor performance and accountability among many NGOs. It stresses that humanitarian funding has served as a substitute for the political and military action that could have stopped the genocide. Proposals for a humanitarian ombudsman, a single UN humanitarian agency and international NGO accreditation would be rejected, and later reviews would find little progress on preventing genocide. However, the evaluation would catalyze major changes in standards, accountability and professionalization across the humanitarian system.	International
1996	Failure or controversy	Epidemic	During a meningococcal meningitis epidemic in Kano, Nigeria, the American drug company Pfizer runs an open-label trial of its new antibiotic trovafloxacin (Trovan) in 200 children, half of whom receive the standard drug, ceftriaxone. Five children given trovafloxacin die, along with six given ceftriaxone. The Washington Post would allege that at least one child was not switched to the standard drug despite failing to improve. A Nigerian federal panel's report, leaked in 2006, would allege an "illegal trial of an unregistered drug", while Pfizer would maintain that no one in the study was put at risk. Thirty Nigerian families would sue in New York in 2001, alleging that consent was never obtained, and a judge would rule in 2005 that the case belongs in Nigeria. The trial would deepen distrust of Western health programs in Kano, feeding the polio vaccine boycott of 2003 and 2004.	Nigeria (Kano)
1997 (December 29)	Quarantine or containment	Epidemic	Hong Kong begins three days of slaughter that kill 1.5 million birds, mainly chickens but also ducks and geese, to stop H5N1 avian influenza. Until this outbreak, scientists believe that avian flu cannot infect humans directly. A three-year-old boy dies in May, and visiting experts judge his case a fluke, but more cases appear from November, with 18 people infected and six dead in all. Testing finds 20% of chickens in the markets infected. Microbiologist Kennedy Shortridge of the University of Hong Kong fears that the virus could mix with human flu as the season starts. Having earlier reassured the public that she eats chicken every day, Director of Health Margaret Chan decides to kill all chickens, infected or not. The operation is widely criticized, but no further cases follow. Shortridge would argue that the cull averted a pandemic, while admitting that there is no definite way to prove it. Monthly market rest days and further culls would follow as H5N1 returns in 2001 and 2002.	China (Hong Kong)
1998	Institution	Multiple	The Sphere Project publishes the pilot version of its handbook, setting out a humanitarian charter and minimum standards for disaster response. Conceived in 1995 by Peter Walker of the International Federation of Red Cross and Red Crescent Societies and Nicholas Stockton of Oxfam, it asks what organizations must guarantee to people affected by a crisis. It builds on a 1994 Code of Conduct for disaster relief, and it is partly a self-regulation effort to head off external regulation after the Rwanda crisis. Several mostly French organizations object that technical standards may become a rigid recipe, and may shift political responsibility from governments to agencies. The same period brings ALNAP in 1997, a learning network, and in 1998 the UN Office for the Coordination of Humanitarian Affairs, which replaces a department whose limits Rwanda has exposed. Later editions would make Sphere a common reference for the sector.	International
2000 (October)	Inquiry	Food or drug safety	The United Kingdom publishes the 16-volume BSE Inquiry, chaired by Lord Phillips, on the government's handling of bovine spongiform encephalopathy (BSE), or mad cow disease, and its human form, variant Creutzfeldt-Jakob disease, which has killed or is killing more than 80 people. The epidemic spreads through animal protein recycled into cattle feed, and more than 170,000 cattle are slaughtered. The inquiry finds that measures were sensible but often late or inadequate, that scientific committees were slow, and that bureaucracy caused unacceptable delays. It concludes that the government did not lie, but that its campaign of reassurance was a mistake, since people were told beef was safe without being told why, creating the false impression that BSE posed no risk to humans. Former chief medical officers Donald Acheson and Kenneth Calman are criticized for playing down the risk. The BMJ describes a report reluctant to assign blame. Its lasting message is that reassurance without sufficient evidence is unwise, and that openness and admitting ignorance are better. Compensation and care packages for patients follow.	United Kingdom
2000–2005	Failure or controversy	Pandemic	South African President Thabo Mbeki, in office from 1999, publicly challenges the scientific consensus that HIV causes AIDS and delays a national antiretroviral drug program, calling the drugs toxic and a Western effort to weaken his country. His government withdraws support from clinics using AZT to prevent mother-to-child transmission and restricts the use of a donated supply of nevirapine. Health minister Manto Tshabalala-Msimang promotes beetroot, garlic and lemon as alternatives. Under pressure from the Treatment Action Campaign, an activist group, the government launches a program against mother-to-child transmission in 2003 and a national treatment program in 2004, but by 2005 only 23% of AIDS patients receive the drugs, against more than 70% in Botswana and Namibia. A 2008 study by Harvard researcher Pride Chigwedere and colleagues, comparing South Africa with its neighbors, would estimate that more than 330,000 people die prematurely and at least 35,000 babies are born with preventable HIV infections as a result. After Mbeki's resignation in 2008, his successor's health minister, Barbara Hogan, would say she is "ashamed", and the Treatment Action Campaign's leader would call for Mbeki and Tshabalala-Msimang to face a judicial board.	South Africa
2001 (October–November)	Surveillance	Bioterrorism	After the September 11 attacks, envelopes containing anthrax spores are mailed from around Trenton, New Jersey, to news media companies and to senators Tom Daschle and Patrick Leahy, in what would become known as the 2001 anthrax attacks. Once a Florida media worker is diagnosed with the first inhalational anthrax case in the United States since 1976, the Centers for Disease Control and Prevention coordinates a national investigation through its Emergency Operations Center. It works with state and local health departments, the Federal Bureau of Investigation and the United States Postal Service, and searches for cases in all 50 states. Twenty-two cases are found, 11 inhalational and 11 cutaneous, and five people die. Twenty of the patients handled contaminated mail or worked where it was processed or received. Investigators had not expected that sealed envelopes passing through high-speed postal sorters could infect workers, and the earlier prevention guidelines prove inadequate. About 32,000 people begin antibiotic prophylaxis, and no further cases appear among them. The investigators would conclude that prophylaxis almost certainly prevented illness among Senate staff.	United States
2003 (February 10)	Failure or controversy	Epidemic	The WHO office in Beijing receives an email describing a "strange contagious disease" that has killed more than 100 people in Guangdong in a week, and Hong Kong's health officials learn of the outbreak from local newspapers. The first cases of what would be called SARS emerge in Foshan in mid-November 2002, but no announcement follows. Under Chinese law, infectious disease outbreaks are treated as state secrets until officially announced, so doctors and journalists who disclose them risk prosecution. Guangdong newspapers carry denials such as "Epidemic is only a rumor", and in late January a "top secret" warning lies unread for three days because no one with clearance is present. Residents clear pharmacy shelves, and reports spread by text message. On February 11, officials announce 305 cases and five deaths, saying that the situation is under control. Hong Kong's own attempts to reach Guangdong officials fail, and two University of Hong Kong scientists travel to Guangzhou to investigate. The secrecy leaves neighboring health systems unprepared for the outbreak that would soon reach them.	China (Guangdong)
2003	Quarantine or containment	Epidemic	Severe acute respiratory syndrome (SARS), a respiratory disease caused by a novel coronavirus, spreads to 29 countries, territories and areas, causing 8,096 cases and 774 deaths in about six months. Many health workers are infected, and economic losses are estimated at US$60 billion. The WHO Regional Director for the Western Pacific would judge that it causes "more fear and social disruption than any other outbreak of our time". Screening and isolation can contain it because patients do not transmit the virus until several days after symptoms appear, but experts understand that a pathogen spreading without symptoms would be far more dangerous. Affected East and Southeast Asian countries build whole-of-government command structures and centralized health agencies, which would help several of them respond quickly to COVID-19.	International
2003 (October)–2004 (July)	Failure or controversy	Epidemic	Political and religious leaders in Kano, Zamfara and Kaduna, three states in northern Nigeria, halt a polio vaccination campaign by urging parents to refuse it, alleging that the vaccine contains anti-fertility agents, HIV and cancer-causing substances. Nigeria accounts for 45% of polio cases worldwide. The boycott draws on low use of modern health care in the north, rumors linking vaccination to population control, suspicion of free door-to-door campaigns where basic care is scarce, tensions between the northern opposition and the southern-led federal government, anger over the war in Iraq, and the 1996 Pfizer drug trial in Kano. Because states control primary care, Kano can block the federal program. The Supreme Council for Sharia in Nigeria rejects federal safety tests, and the impasse ends only after delegates observe the vaccine being tested in Indonesia, South Africa and India. Kano resumes vaccination in July 2004, using an Indonesian supplier. By then the virus has spread from Nigeria to previously polio-free countries in west and central Africa, and would later reach Yemen, Saudi Arabia and Indonesia. Researcher Ayodele Samuel Jegede would urge involving traditional and community leaders in immunization campaigns.	Nigeria (Kano, Zamfara, Kaduna)
2004 (October 15)	Failure or controversy	Chemical	The Supreme Court of Japan upholds a ruling that the national government and Kumamoto Prefecture failed to use their regulatory powers to prevent Minamata disease, a form of mercury poisoning caused by wastewater that the Chisso chemical factory releases into Minamata Bay until 1968. The mercury concentrates in fish, and people who eat them suffer seizures, numbness, paralysis and, in extreme cases, death. A doctor at the factory reports rising cases of nervous system damage in 1956. The Court finds that by November 1959, three years after that discovery, the authorities have still not stopped residents from consuming contaminated seafood. Victims sue Chisso in 1969 and win compensation after a trial of almost four years, and the government introduces a certification process as victims multiply. A former company president and a factory supervisor are sentenced in 1979. In 1995 the government offers uncertified sufferers a settlement in exchange for dropping litigation, but the Minamata Disease Kansai Patients Association refuses, leading to this ruling. Disputes would continue, with compensation for uncertified sufferers approved in 2010 and further court rulings in 2014 and 2023.	Japan (Minamata)
2005	Treaty or regulation	Multiple	After SARS pushes decade-long negotiations to a rapid conclusion, the revised International Health Regulations are adopted, entering into force in 2007. They set legally binding duties for states and WHO on notification and information-sharing, prohibit unnecessary interference with travel and trade, and require cooperation to contain disease. They also add requirements that must be met before the WHO Director-General can act on an emergency, instead of allowing immediate independent action. Weak implementation would persist: a World Bank, African Development Bank and European Union report would find early warning systems inadequate in the countries hit by Ebola in 2014, and self-reported core capacities would average 64 out of 100 before COVID-19.	International
2005 (September 11–October 29)	Relief operation	Environmental	After Hurricane Katrina strikes the Gulf Coast on August 29, causing deaths, flooding and massive damage, the state of Louisiana and the city of New Orleans invite the Centers for Disease Control and Prevention to help rebuild the city's public health system. The National Institute for Occupational Safety and Health sends three teams in turn to protect cleanup and recovery workers. The first assesses hazards, the second samples exposures, and the third distributes safety information, including to Hispanic and Vietnamese workers, at one point through inserts in meals delivered to Hispanic cleanup crews. Apart from some noise and carbon monoxide readings, the teams find exposures to asbestos, metals, dust and other substances within occupational limits. Contractors, however, vary widely in their ability to recognize and control hazards, and in their rush to work quickly appear to overload trucks and haul debris uncovered. A day after a team visits one debris site, a flagman is killed under a bulldozer there. The response marks the first use of the Worker Safety and Health Annex of the federal National Response Plan, which sets out the Occupational Safety and Health Administration's responsibilities for protecting responders.	United States (New Orleans)
2009 (April 25)	Emergency declaration	Pandemic	The Director-General of the World Health Organization declares the novel H1N1 influenza outbreak in North America a public health emergency of international concern. It is the first use of the revised International Health Regulations of 2005 to address a global health emergency. Swift international notification allows countries to activate their pandemic preparedness plans, while Mexico voluntarily adopts stringent social distancing. Researchers Rebecca Katz and Julie Fischer would argue that these factors probably delay sustained human-to-human transmission outside the Americas. The response shows unprecedented efficiency in international communication and cooperation, but it also exposes weaknesses at every level of government, including uneven national capacities and limited means of responding to states that go beyond evidence-based health, trade and travel recommendations. The episode raises the question of how far the regulations can govern a pandemic response without encroaching on national sovereignty.	International
2011 (March)	Evacuation	Radiological	After the Great East Japan Earthquake of March 11, the Fukushima Daiichi nuclear power plant suffers meltdowns and explosions and releases radioactive material. The Japanese government orders everyone within 20 km to evacuate, and advises people 20 to 30 km away to shelter indoors or leave voluntarily. Hospital patients and nursing home residents are also moved, in haste and often without their medical records. About 50 patients moved from one hospital to a high school gymnasium die during the transfer or soon after arrival. Of 86 frail, mostly elderly patients followed up after transfer to Aizu Chuo Hospital, about 100 km from the plant, 41 (48%) die by the end of 2011, although none dies during the transfer itself and none is exposed to radiation above the limit. Patients who cannot eat by mouth and men are at particular risk. The authors of a 2018 study argue that evacuation orders must be weighed against radiation risks, citing research that the loss of life expectancy from rapid evacuation far exceeds that from radiation. They urge careful planning for vulnerable patients.	Japan (Fukushima)
2009 (June 11)	Emergency declaration	Pandemic	WHO Director-General Margaret Chan announces that the scientific criteria for an influenza pandemic have been met. She declares the 2009 H1N1 pandemic after consulting an Emergency Committee set up under the International Health Regulations. The declaration caps ten years of pandemic preparedness planning that WHO began in 1999, spurred by the 1997 Hong Kong bird flu outbreak. It triggers pre-arranged pandemic vaccine contracts around the world, and governments following WHO's 2004 guidance have already stockpiled the antivirals oseltamivir (Tamiflu) and zanamivir (Relenza). In early May, WHO had removed the phrase "enormous numbers of deaths and illness", a measure of severity, from its definition of a pandemic. The pandemic would prove far milder than WHO's predictions.	International
2010 (June 3)	Failure or controversy	Pandemic	A joint investigation by The BMJ and the Bureau of Investigative Journalism reports that key scientists who advised the World Health Organization on pandemic planning had done paid work for drug companies that stood to gain from their guidance, interests WHO never publicly disclosed. WHO's 2004 guidance recommending antiviral stockpiles was written by an expert then being paid by Roche, maker of oseltamivir. The identities of the 16-member Emergency Committee that advised on declaring the pandemic also remain secret. In the same week, a Council of Europe Parliamentary Assembly report by British MP Paul Flynn criticizes the lack of transparency, citing distorted health priorities, wasted public money and unjustified fear. Governments are unwinding vaccine contracts while billions of dollars' worth of antivirals lie unused. WHO says numerous safeguards manage conflicts of interest and that the committee's secrecy protects members from industry influence. Chan had earlier rejected accusations of a "fake pandemic". The investigators acknowledge that the pandemic could have been far worse.	International
2008 (September 11)	Failure or controversy	Food or drug safety	The Chinese government announces a recall of infant milk powder from the Sanlu dairy company tainted with melamine, a nitrogen-rich chemical used in plastics that is added illegally to watered-down milk to raise its apparent protein content, starting the 2008 Chinese milk scandal. Infants develop kidney stones that can cause renal failure and death. More than 290,000 people, most of them infants, are poisoned, and at least six babies die. Virtually all Chinese-made dairy products prove to contain melamine, and countries around the world ban imports. News reports indicate that company officials knew of the problem for months, possibly since December 2007. Economists Changbai Xiu and K. K. Klein would attribute the crisis to rapid, heavily invested growth, with modern processors buying from millions of small farmers, and a government that stresses growth over inspection and safety. Penalties include life sentences and executions. A new food safety law takes effect on June 1, 2009, along with mandatory inspections of all food businesses and new tolerances for melamine in dairy products.	China (Shijiazhuang)
2014	Failure or controversy	Epidemic	During the Ebola epidemic in West Africa, early public messages and burial rules backfire. Warnings such as "Ebola kills" and "Ebola is incurable" push people away from treatment centers and toward family care or traditional healers. Responders in protective suits remove sick relatives who are never seen again, deepening fear and resistance, and the rules for safe burial clash with rites that protect families. Black body bags, associated in Sierra Leone with an undignified death, are replaced with white ones only after teams learn this. In September, eight members of a community outreach team are killed in a remote area of Guinea. Community-led approaches would show better results, as in Pujehun, the first Ebola-free district in Sierra Leone, and in Lofa County, Liberia. Researchers at the Humanitarian Policy Group would argue that aid agencies repeat lessons already documented in earlier outbreaks, treating communities as a problem to overcome rather than as a resource.	Guinea, Liberia, Sierra Leone
2014 (March 23)	Failure or controversy	Epidemic	The World Health Organization officially declares an Ebola outbreak in Guinea, about three months after the first known death, of a two-year-old boy. Guinea lacks laboratory capacity, so samples are sent to France. On March 31, Médecins Sans Frontières (MSF) calls the spread "unprecedented", and the next day a WHO spokesman describes it as "relatively small". Budget cuts have reduced WHO's outbreak expertise, and donors earmark an estimated 77% of its funding. WHO's own expert in West Africa warns of "the tip of an iceberg", but a June 10 memo cautions that declaring an emergency could be seen as a "hostile act" by affected countries, whose governments in Guinea and Sierra Leone are downplaying the crisis. MSF warns on June 23 that the outbreak is out of control, while WHO would deny that politics influenced its timing. A senior aid executive would call the response "criminally late".	Guinea
2014 (April)	Failure or controversy	Chemical	Flint, Michigan, under a state-appointed emergency manager, begins treating Flint River water at its own plant and distributing it to customers without the corrosion control required by federal rules, starting the Flint water crisis. The more corrosive water destroys the protective scale on pipes, and lead enters drinking water. Residents complain about odor, color and taste, and General Motors stops using the supply in October, but state regulators insist that the water is safe. An outbreak of Legionnaires' disease in the county goes unlinked to the switch, with 45 cases and five deaths by March 2015. Outsiders force the issue in 2015: Virginia Tech professor Marc Edwards reports high lead levels in August, and pediatrician Mona Hanna-Attisha shows in September that more children have elevated blood lead since the switch. The state first disputes her findings, then confirms them on October 1. Flint switches back to Detroit water on October 16. A task force commissioned by Governor Rick Snyder would call the crisis a clear case of environmental injustice, with the causes lying primarily with the state.	United States (Flint, Michigan)
2014 (May 5)	Emergency declaration	Epidemic	The WHO Director-General declares the international spread of polio a public health emergency of international concern, issues temporary recommendations to reduce it, and asks the Emergency Committee to reassess the situation every three months. The recommendations ask countries with local transmission to vaccinate residents and long-term visitors before international travel and to restrict the departure of residents who lack proof of vaccination, making polio one of the few diseases for which travel can depend on a vaccination certificate. Unlike most such emergencies, it does not end. At its 45th meeting in May 2026, the committee unanimously finds that the emergency continues, while also concluding that it is not a "pandemic emergency", a category added to the International Health Regulations in 2024. Wild poliovirus type 1 still circulates in Afghanistan and Pakistan, with the south of Afghanistan the area of greatest concern. Outbreaks of vaccine-derived poliovirus, which can arise where too few children are immunized, continue in more than 24 countries, particularly in the Lake Chad Basin and the Horn of Africa. The committee blames insecurity, vaccine hesitancy, population movement and weak routine immunization.	International
2014 (August)	Quarantine or containment	Epidemic	Liberia attempts to quarantine the West Point neighborhood of Monrovia, leading to violence and the death of a teenager and raising fears of government collapse. The three affected countries have declared states of emergency, and Sierra Leone adds roadblocks, lockdowns and curfews, along with criminal penalties for Ebola denial, breaking movement limits and unsafe burials. After the violence, Liberia shifts toward community engagement, dividing Greater Monrovia into smaller zones based on historical community ties. Human Rights Watch would argue in September that the quarantines fail legal standards and call for social mobilization instead. Sierra Leone's later national "stay at home" days pass without major incident, despite opposition from many donors and aid groups. The episode shows the tension between what helps an individual patient and the demands of protecting the wider public.	Liberia (Monrovia)
2014 (August 8)	Emergency declaration	Epidemic	The Director-General of the World Health Organization declares the Ebola epidemic a public health emergency of international concern, more than four months after the outbreak is announced. By early September, there is still no coordinated international response. Because the crisis is framed as a health emergency rather than a humanitarian one, the surge staff, emergency funding and coordination clusters of a large-scale disaster response are not triggered across all three countries. This leaves national authorities in the lead, but many non-health organizations are unsure how to help, and wider effects on education, livelihoods and stability are downplayed. Care for other illnesses also suffers: in Guinea, primary consultations fall by 58%, and one study estimates that 74,000 malaria cases go without care at public health facilities.	International
2014 (September 19)	Institution	Epidemic	The United Nations Mission for Ebola Emergency Response is created, the first UN health mission, following United Nations Security Council Resolution 2177. The United States and Britain announce deployments of about 3,000 and 750 troops, working mainly in logistics and construction instead of the medical teams MSF requested. By the end of the year, over $2.89 billion is pledged and $1 billion paid. The mission's strategy aims for 70% of patients isolated and 70% of burials made safe within 60 days, targets that are met on time in Guinea and Liberia and later in Sierra Leone. However, affected countries are absent from its initial strategy talks, and many implementing organizations would remain unclear about its role. Treatment capacity also arrives late: beds peak at 2,044 in February 2015, when weekly new cases have fallen to 128. The mission would close on July 31, 2015.	International
2015 (May–July)	Failure or controversy	Epidemic	An outbreak of Middle East respiratory syndrome (MERS) begins at a hospital in Pyeongtaek, South Korea, after it fails to screen the first infected patient, and the virus spreads to patients, visitors and health workers through poor ventilation and ineffective disinfection. Similar transmission follows in neighboring hospitals, and 186 people are infected and 36 die, the largest loss of life from the disease outside the Middle East. At first, the Korea Centers for Disease Control and Prevention withholds from the public which hospitals are affected, and the Samsung Medical Center in Seoul also refuses to share information. Some patients' relatives keep visiting and sharing food in hospitals, as is customary, and rumors spread online. Many schools cancel classes, against WHO advice, and fear empties shopping malls and drives away tourists, cutting the country's growth forecast to about 2%. Researcher Kyoo-Man Ha would argue that Korea treats the outbreak as a hospital infection-control problem, and that it should instead be handled as an emergency involving government, businesses, the media and the public in a coordinated response.	South Korea (Pyeongtaek, Seoul)
2015 (May 23)	Institution	Epidemic	The 68th World Health Assembly approves emergency reforms that the World Health Organization had proposed at a special Executive Board session on Ebola in January. By then, the organization's leadership had admitted that its "initial response was slow and insufficient" to the West African Ebola epidemic. The reforms give WHO a clear mandate as global leader in responses to public health emergencies, restructure it to support emergency operations alongside its technical role, create standing and surge response capacity, and set up an emergency contingency fund of about US$100 million that it could draw on promptly. Member states had rejected similar proposals, including a US$100 million crisis budget, after the 2009 swine flu pandemic. Political scientist Colin McInnes would call the contingency fund a crucial step toward operational independence from member states. He would name two tests of whether the change would last: sustained funding, when less than a quarter of WHO's budget is under its own control, and stronger International Health Regulations, whose surveillance and reporting targets 70 per cent of signatories had not met.	Switzerland (Geneva)
2015 (June)	Inquiry	Epidemic	With the West African Ebola epidemic at an estimated 27,181 cases and 11,162 deaths, mostly in Guinea, Liberia and Sierra Leone, the Ebola Interim Assessment Panel led by Barbara Stocking reports on the World Health Organization's handling of the crisis. The WHO Executive Board had requested the panel in January. It concludes that the crisis "exposed organizational failings in the functioning of WHO", which "does not have a culture of rapid decision-making" and tends to react to emergencies rather than anticipate them. Critics had faulted the organization for waiting until August 8, 2014 to declare a Public Health Emergency of International Concern, and leaked documents reported by the Associated Press suggested that political and economic concerns about the affected countries delayed the declaration. The panel notes that budget cuts had left WHO's African regional office with fewer than ten core staff for the whole region. McInnes would argue that the crisis shifts WHO's authority from technical advice toward the capacity to act. He would also note that the panel's members are independent, but their appointment by WHO raises questions about that independence.	International
2016 (February 1)	Emergency declaration	Epidemic	WHO Director-General Margaret Chan declares the spread of Zika virus and its associated complications a public health emergency of international concern. The mosquito-borne virus, identified in Africa in the 1940s, causes large outbreaks in the Pacific from 2007 and is confirmed in northeastern Brazil in 2015. Its arrival in the Americas coincides with steep rises in babies born with abnormally small heads, or microcephaly, and in cases of Guillain–Barré syndrome. The declaration rests largely on uncertainty over whether Zika causes these conditions. WHO launches a strategic response plan on February 14, focused on surveillance, response and research, and its Contingency Fund for Emergencies releases money within 24 hours. The first donor contributions arrive only six weeks after the declaration, and it takes about nine months for funds to cover the first response plan. By late 2016, 69 countries and territories report mosquito-borne transmission and 29 report congenital syndrome. With evidence that Zika can cause a congenital syndrome, the Emergency Committee would recommend ending the emergency later that year, and WHO would shift to a long-term program.	International
2016 (December 1)	Failure or controversy	Epidemic	United Nations Secretary-General Ban Ki-moon apologizes to the people of Haiti before the United Nations General Assembly for the world body's role in a cholera outbreak that has killed more than 9,300 people and sickened 800,000. Haiti has been free of cholera until 2010, when the epidemic is blamed on Nepalese troops in a UN peacekeeping force, whose sewage reportedly contaminates a river. Cholera is endemic in Nepal. An independent panel appointed by Ban does not determine conclusively in 2011 how the disease arrived, but its members conclude in a 2013 article that personnel associated with the mission are "the most likely source". Ban says that the UN "simply did not do enough" and is "profoundly sorry", but he does not say that UN personnel brought the disease, and the UN accepts no legal responsibility. A United States federal appeals court has upheld UN immunity in August, a ruling that the deputy secretary-general says allows the apology. The UN hopes to raise $200 million for the worst-affected families and communities, which some victims say is not enough. A UN adviser has already called raising it through donations "highly unlikely".	Haiti
2017 (April)	Failure or controversy	Epidemic	A cholera outbreak begins in Yemen, already in what the United Nations calls the world's worst humanitarian crisis, and becomes the largest and fastest-spreading since WHO began recording outbreaks in 1949. Since 2015, bombing by the Saudi Arabian-led intervention in Yemen has destroyed water and sanitation systems, hospitals and supply routes, and the main port is blockaded. By October 2018, WHO counts more than 1.2 million suspected cases and 2,556 deaths, 58% of them children. Aid agencies treat cases effectively, keeping the death rate at 0.21%, but do little to prevent spread. In July 2017, 500,000 oral cholera vaccine doses due in Sana'a are redirected after the request is canceled, as some agencies judge a campaign futile because of insecurity and the outbreak's scale. Vaccines finally reach 540,000 people in August 2018, nearly 16 months in. A cholera appeal for US$250 million raises only $47 million. Researchers Frederik Federspiel and Mohammad Ali would call the outbreak a historic failure to control cholera with available tools, while stressing that its cause, and its solution, are political.	Yemen
2017 (October 26)	Emergency declaration	Food or drug safety	President of the United States Donald Trump designates the opioid epidemic a public health emergency. At his request, Eric Hargan, acting Secretary of the United States Department of Health and Human Services, issues a declaration giving the department and other federal and state health agencies more flexibility in responding to the crisis. According to the Centers for Disease Control and Prevention, 64,000 people in the United States had died of drug overdoses in the 12 months ending in January 2017, more than 45,000 of them involving opioids, making overdose the country's leading cause of unintentional death.	United States
2018 (August)–2020 (June 25)	Medical countermeasure	Epidemic	An Ebola outbreak in North Kivu and Ituri provinces of the Democratic Republic of the Congo, the second largest on record, unfolds in an active conflict zone. The response is led by the country's government and Ministry of Health with support from the World Health Organization and partners. It registers 250,000 contacts, tests 220,000 samples, gives patients access to advanced therapeutics and offers care to all survivors after recovery. It also vaccinates more than 303,000 people with the rVSV-ZEBOV-GP vaccine, which WHO calls highly effective. More than 16,000 local frontline responders work alongside more than 1,500 people deployed by WHO. By the time the outbreak is declared over on June 25, 2020, it has caused 3,481 cases and 2,299 deaths, with 1,162 survivors. WHO would credit the engagement of affected communities, and preparedness work in neighbouring countries, with keeping the outbreak from spreading internationally.	Democratic Republic of the Congo (North Kivu, Ituri)
2019 (December 31)	Surveillance	Pandemic	WHO learns of an outbreak of pneumonia of unknown origin in Wuhan through three routes: health authorities in Taiwan, who contact it after media reports; the ProMED website, whose alert is picked up by its surveillance system; and its China office, which sees a public bulletin describing 27 cases. Doctors have already sent samples for sequencing and raised concerns, and on December 30 the Wuhan Municipal Health Commission issues urgent notices to hospitals. WHO alerts all governments on January 5, and the virus's genetic sequence is made public on January 11. Human-to-human transmission is confirmed publicly in China only on January 20. The Independent Panel would describe two worlds moving at different speeds: near-instant open data and the slower step-by-step verification under the International Health Regulations.	China (Wuhan)
2020 (January 23)	Quarantine or containment	Pandemic	Wuhan imposes a drastic population lockdown, with 830 cases and 25 deaths reported. A joint WHO-China mission in February would consider China's measures successful in rapidly reducing transmission. National strategies would then diverge into aggressive containment, suppression and mitigation, while some countries have no consistent strategy. Countries pursuing aggressive containment, such as New Zealand, South Korea, Singapore, Thailand and Vietnam, would combine testing, tracing, isolation and social and economic support. The Independent Panel would conclude that stay-at-home orders work only where households can afford them, workers can work remotely and people trust their government, and that countries doing worst devalue science, deny the threat and delay action.	China (Wuhan)
2020 (January 30)	Emergency declaration	Pandemic	The WHO Director-General declares COVID-19 a public health emergency of international concern, with 98 cases in 18 countries outside China. The Emergency Committee had split on the question a week earlier, and the Independent Panel would judge that the outbreak probably already met the criteria on January 22. The declaration does not produce an urgent global response, and the Panel would call February a "lost month", as many governments wait and see. WHO characterizes the outbreak as a pandemic on March 11, with 118,000 reported cases in 114 countries, although the International Health Regulations do not use the term. The Panel would argue that WHO should have told countries to assume human-to-human transmission from the start.	International
2020 (April)	Failure or controversy	Pandemic	By this month, 75 countries have imposed export controls on medical supplies and medicines, as the COVID-19 pandemic exposes the lack of any international system of sufficient stockpiles. In February, WHO had warned of delays of four to six months for masks and protective suits, and by March manufacturing shortfalls reach an estimated 40%. Stockpiles built after the 2009 H1N1 pandemic have run down, hoarding, price gouging and fraud appear, and supply chains depend on a few producers. The shortages contribute to a high death toll among health workers, at least 17,000 of whom would die in the pandemic's first year. Responses include the UN COVID-19 Supply Chain System and an African Union purchasing platform, while oxygen remains a critical gap without a lead agency.	International
2020 (April 24)	Medical countermeasure	Pandemic	WHO and partners launch the Access to COVID-19 Tools Accelerator, with COVAX as its vaccine pillar, intended to secure equitable access. Vaccine development moves fast, building on HIV, Ebola and cancer research and on the Coalition for Epidemic Preparedness Innovations, which sponsors early candidates by January 20, when there are fewer than 600 cases worldwide. Distribution proves far less equal. By April 2021, high-income countries would secure doses covering over 200% of their populations, while fewer than 1% of people in the poorest countries would have received a first dose. WHO's technology-sharing pool would receive no contributions, and a push by South Africa and India for an intellectual property waiver at the World Trade Organization would run into opposition.	International
2021 (May)	Inquiry	Pandemic	The Independent Panel for Pandemic Preparedness and Response, co-chaired by former New Zealand Prime Minister Helen Clark and former Liberian President Ellen Johnson Sirleaf, reports to the World Health Assembly on COVID-19, calling it the 21st century's "Chernobyl moment". It finds that at least 11 high-level panels and commissions have made recommendations since 2009 that mostly went unimplemented. It proposes a Global Health Threats Council, a pandemic framework convention, a more independent and better-funded WHO with authority to publish outbreak information without government approval, and a financing facility able to release US$50 to US$100 billion at short notice. The World Health Assembly requested the review in May 2020.	International
2021 (September 28)	Inquiry	Epidemic	An Independent Commission set up by WHO Director-General Tedros Adhanom Ghebreyesus publishes its report on sexual exploitation and abuse during the 2018–2020 Ebola response in North Kivu and Ituri. Press reports had prompted the inquiry, after more than 50 women accused officials of WHO, other UN agencies and aid groups. Based on 210 interviews, including 75 with alleged victims, the commission identifies 83 alleged perpetrators, 21 of them confirmed WHO employees during the response. Most are Congolese staff hired on a temporary basis who use their apparent authority to obtain sex. Alleged victims, mostly women and including girls, describe being promised jobs in exchange for sex. They report nine rapes and 29 pregnancies. The commission finds "clear structural failures and unpreparedness" at WHO. It had only nine part-time prevention focal points for 2,800 deployed staff, and its first prevention training came in November 2019, reaching only 371 people. It also routinely dismissed reports that were not made in writing. The commission additionally identifies individual negligence by managers that may amount to professional misconduct.	Democratic Republic of the Congo (North Kivu, Ituri)
2022 (July 23)	Emergency declaration	Epidemic	WHO Director-General Tedros Adhanom Ghebreyesus declares the multi-country mpox outbreak, then called monkeypox, a public health emergency of international concern, even though the Emergency Committee has failed to reach consensus, with nine members against and six in favor. By July 20, WHO has received reports of 14,533 cases and five deaths in 72 countries, up from 3,040 cases in 47 countries in early May. Supporters argue that the outbreak meets all the criteria and needs a coordinated response, including equitable access to vaccines and antivirals. Opponents argue that severity is low, that targeted measures are possible, and that a declaration could fuel stigma, as most cases in Europe and the Americas are among gay, bisexual and other men who have sex with men. The temporary recommendations call for wider production and affordable availability of diagnostics, vaccines and treatments. The emergency would end in May 2023. A second, separate declaration would follow in August 2024.	International
2024 (August 14)	Emergency declaration	Epidemic	The WHO Director-General declares an upsurge of mpox in Africa a public health emergency of international concern, the second such declaration for the disease in two years. This time the Emergency Committee is unanimous. The Democratic Republic of the Congo has reported more than 15,000 clinically compatible cases and over 500 deaths in the first half of the year, already above its 2023 count. A newly identified strain, clade Ib, is spreading between people mainly in the eastern part of the country, and linked cases have appeared in Burundi, Kenya, Rwanda and Uganda, none of which had previously reported mpox. The committee cites severe illness in children and immunocompromised people, along with surveillance gaps. The day before, the Africa Centres for Disease Control and Prevention declares its own Public Health Emergency of Continental Security. WHO's recommendations call for targeted vaccination, better surveillance and diagnostics, and action against stigma, and they advise against general travel and trade restrictions.	Democratic Republic of the Congo
2025 (May 20)	Treaty or regulation	Pandemic	The World Health Assembly adopts the WHO Pandemic Agreement after more than three years of negotiations, launched in 2021 in response to the shortcomings exposed by COVID-19. Member states approve it in committee the previous day with 124 votes in favor, none against and 11 abstentions, including Italy, Poland, Russia and Iran. The United States, which is withdrawing from WHO, does not take part. The treaty aims to correct the inequities in access to vaccines and other products seen during COVID-19: it promotes technology transfer as mutually agreed, establishes a Global Supply Chain and Logistics Network, and requires participating manufacturers to give WHO rapid access to a target of 20% of their real-time production during a pandemic emergency, with at least 10% donated. It also creates a Pathogen Access and Benefit-Sharing (PABS) System, but leaves its terms to a later annex. Addressing fears about sovereignty, the text states that it gives WHO no authority to order countries to ban travelers, mandate vaccination or impose lockdowns. It would enter into force 30 days after the 60th ratification.	Switzerland (Geneva)
2026 (May 19)	Failure or controversy	Pandemic	The Seventy-ninth World Health Assembly extends negotiations on the PABS annex, missing the target set in 2025 of submitting it to this Assembly. Under the WHO Pandemic Agreement, the treaty cannot open for signature until the annex is adopted, so the main lesson-learning instrument of the COVID-19 era remains out of reach more than six years after that pandemic began. The new deadline is a special session in 2026 or the Assembly of May 2027. Talks would continue through a ninth working group meeting opening on November 2, when WHO Director-General Tedros Adhanom Ghebreyesus would call the annex "the last remaining piece". According to the Third World Network, a group that follows the talks from the perspective of developing countries, disputes include which pathogens are covered, whether countries must notify WHO within 24 hours, and how benefits apply in emergencies short of a pandemic. The deadlock revives the old conflict between rapid disease reporting and what affected countries receive in return.	Switzerland (Geneva)

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