The 2009 H1N1 influenza outbreak tested the revised International Health Regulations [IHR (2005)] robustly for the first time. The IHR (2005) contributed to swift international notification, allowing nations to implement their pandemic preparedness plans while Mexico voluntarily adopted stringent social distancing measures to limit further disease spread – factors that probably delayed sustained human-to-human transmission outside the Americas. While the outbreak revealed unprecedented efficiency in international communications and cooperation, it alsos revealed weaknesses at every level of government. The response raises questions regarding the extent to which the IHR (2005) can serve as a framework for global pandemic response and the balance between global governance of disease control measures and national sovereignty.

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