Background and Objective:
The International Health Regulations (IHR) govern how 196 countries and the World Health Organization (WHO) collectively address the global spread of disease while avoiding unnecessary tampering with international travel and commercial trade. A total of four public health emergencies of international concern have been declared since its last amendment, with the COVID-19 pandemic demanding a special degree of health diplomacy. The purpose of this scoping review was to identify and compile literature reporting the main challenges associated with implementing the regulations, outlining key areas for revision.

Methods:
A scoping review was conducted following the methodological framework developed by Arksey and OMalley. PubMed was the only database used, plus backwards citation chaining. Data selection and analysis were performed by all five researchers using pretest forms. To complement the descriptive analysis of each publication, the researchers performed a qualitative thematic analysis of the identified challenges.

Results:
From 128 articles screened, 52 met the inclusion criteria, and 135 challenges were identified. The thematic analysis revealed ten categories of challenges, listed in decreasing order of frequency: (i) requirement of financial and technical resources, (ii) lack of enforcement and accountability mechanisms, (iii) need for rules clarification, (iv) deterrents to reporting, (v) inadequate governance, (vi) insufficient cooperation between countries, (vii) sovereignty issues, (viii) scarcity of guidance and technical support from WHO, (ix) lack of inclusion of roles for relevant non-state actors, and (x) conflicts and emergencies.

Conclusion:
The debate over updating the IHR is already ongoing, and it is expected to continue as countries continue to submit their proposals to the Working Group on Amendments to the International Health Regulations (2005). Studies like this scoping review provide the necessary evidence and framework for this discussion, confirming that a revision of the IHR is highly necessary to safeguard global health.