This post addresses two questions:
How does a nation reject amendments to the IHR?
How does a nation withdraw from the WHO?

1. How does a nation reject amendments to the IHR?

The WHO Constitution states that:

  • It has the authority to create new regulations (Article 21)
  • The proposed amendments to the IHR are considered new regulations
  • Members may reject such regulations or amendments within a given time period
  • Notification shall be given to the Director-General of the WHO
  • The time period for rejection is given in the notice of the new regulation or amendment
  • In the case of the IHR, we must look to IHR(2005) to find the time period

Article 22

Regulations adopted pursuant to Article 21 shall come into force for all Members after due notice has been given of their adoption by the Health Assembly except for such Members as may notify the Director-General of rejection or reservations within the period stated in the notice.

WHO Constitution, https://apps.who.int/gb/bd/pdf_files/BD_49th-en.pdf

In the International Health Regulations (2005), we find Article 59, which refers to Article 22 of the WHO Constitution:

Article 59 Entry into force; period for rejection or reservations

  1. The period provided in execution of Article 22 of the Constitution of WHO for rejection of, or reservation to, these Regulations or an amendment thereto, shall be 18 months from the date of the notification by the Director-General of the adoption of these Regulations or of an amendment to these Regulations by the Health Assembly. Any rejection or reservation received by the Director-General after the expiry of that period shall have no effect.
  2. These Regulations shall enter into force 24 months after the date of notification referred to in paragraph 1 of this Article…
IHR 2005 https://iris.who.int/bitstream/handle/10665/246107/9789241580496-eng.pdf?sequence=1&isAllowed=y

In May of 2022, amendments to the IHR(2005) were adopted which reduce the period of time for rejection from 18 months to 10 months. See the chart below to see the new timelines for rejecting amendments.

Thus, for Members to reject amendments, the head of state must submit a letter providing notice of rejection of the amendments to the WHO Director-General, Dr Tedros Adhanom Ghebreyesus.

WHO lists contact information as:

WHO Headquarters in Geneva

Avenue Appia 20
1211 Geneva
Switzerland

Telephone: +41 22 791 21 11

2. How does a nation withdraw from the WHO?

The WHO Constitution doesn’t contain an option for withdrawal of Member States. This is true for international organizations created after the Second World War, in order to prevent destabilization, such as when Japan, Germany and Italy withdrew from the League of Nations in 1933 and 1934.

The UN Charter doesn’t allow for withdrawals either. One country, Indonesia, sent a withdrawal letter in 1965 to the UN Secretary General, but about a year later reversed its decision. Indonesia’s effort was minimized by the UN to avoid attempts to characterize it as a real withdrawal and reinstatement.

Despite this, in theory, it is possible to suspend or withdraw from any organization based on a customary international law principle codified by the 1969 Vienna Convention on the Law of Treaties. The principle “rebus sic stantibus” (things thus standing) was construed by articles 61 and 62 of the Vienna Convention as below.

Article 61.2 essentially requires invoking a fault from the other party that makes it impossible for the remaining party to continue to execute the treaty. To base withdrawal on this, a State may, for example, claim that WHO has not respected its own Constitution…

Article 62 requires a fundamental change in circumstances not initially foreseen. This is also used in contract law and trade law. A State may use it if it doesn’t agree with where the WHO is going or plans to go.


In 1948, the USA added a reservation to its treaty with the newly formed WHO which allowed it to leave the organization with one year’s notice and payment of all outstanding dues. Possibly some other countries made similar reservations.

In July of 2020, Trump began the process of withdrawing the United States from the WHO. Because of this step, there are several research articles which describe the process. The WHO constitution does not describe a withdrawal process.

When Biden became President in 2021, he canceled the process of withdrawing from the WHO, which would be a one year process for the USA.

In the United States, both the WHO Constitution and the International Health Regulations (2005) are active treaties, enacted through international agreement, as opposed to Senate ratification. The two documents are listed on page 532 of Treaties in Force, the 2020 document hosted by the State Department.

Read More:

Cambridge University Press: Trump Administration Submits Notice of U.S. Withdrawal from the World Health Organization Amid COVID-19 Pandemic October 20th, 2020

Congressional Research Service: US Withdrawal from the World Health Organization: Process and Implications October 21st, 2020

On July 6th, 2020, Trump sent a letter to the UN secretary-general, the depository for the WHO Constitution notifying him that the US was withdrawing from the WHO. We have not found a copy of this letter.

On July 14th, 2020, the Secretary General of the United Nations, acting as depository for the WHO Constitution, issued the notification of United States withdrawal, which would become active within one year (July 6th, 2021.)

Important Notes:

  • The WHO Constitution does not have a withdrawal provision
  • The WHO Constitution Depository is the UN Secretary General
  • The United States joined the WHO in 1948, but created an additional provision for withdrawal
  • Other countries will need to research if they have a withdrawal provision or reservation recorded
  • Barring that, members may review Articles 61 or 62 of the Vienna Convention for applicability


The US withdrawal provision from 1948 reads:

In adopting this joint resolution the Congress does so with the understanding that, in the absence of any provision in the World Health Organization Constitution for withdrawal from the Organization, the United States reserves its right to withdraw from the Organization on a one-year notice: Provided, however, That the financial obligations of the United States to the Organization shall be met in full for the Organization’s current fiscal year.

https://uscode.house.gov/statviewer.htm?volume=62&page=441#