• Guilherme Queiroz, Joana Maia, Filipa Gomes, José Chen-Xu, Joana China, Sofia Carmezim Pereira, Patrícia Pita Ferreira, José Ramalho, Joana Roque, José Pedro Teixeira, Constança Carvalho, Luís Oliveira, Diogo Simões, João Gomes, Carla Lopes, and Tiago Correia.
• National School of Public Health. Universidade NOVA de Lisboa. Lisboa; Agrupamento de Centros de Saúde do Baixo Vouga. Administração Regional de Saúde do Centro. Coimbra. Portugal.
• Acta Medica Port. 2023 Dec 4; 36 (12): 819825819-825.

IntroductionThe International Health Regulations (IHR) were developed to prepare countries to deal with public health emergencies. The spread of SARS-CoV-2 underlined the need for international coordination, although few attempts were made to evaluate the integrated implementation of the IHR's core capacities in response to the COVID-19 pandemic. The aim of this study was to evaluate whether IHR shortcomings stem from non-compliance or regulatory issues, using Portugal as a European case study due to its size, organization, and previous discrepancies between self-reporting and peer assessment of the IHR's core capacities.MethodsFifteen public health medical residents involved in contact tracing in mainland Portugal interpreted the effectiveness of the IHR's core capabilities by reviewing the publicly available evidence and reflecting on their own field experience, then grading each core capability according to the IHR Monitoring Framework. The assessment of IHR enforcement considered efforts made before and after the onset of the pandemic, covering the period up to July 2021.ResultsFour out of nine core IHR capacities (surveillance; response; risk communication; and human resource capacity) were classified as level 1, the lowest. Only two were graded level 3 (preparedness; and laboratory), the highest. The remaining three) (national legislation, policy & financing; coordination and national focal point communication; and points of entry) were classified as level 2.ConclusionPortugal exemplifies the extent to which implementation of the IHR was not fully achieved, which has resulted in the underperformance of several core capacities. There is a need to improve preparedness and international cooperation in order to harmonize and strengthen the global response to public health emergencies, with better political, institutional, and financial support.

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