In 2025 and 2026, Italy’s position towards the World Health Organization (WHO) and global health governance more in general was marked by a significant ambivalence. On the one hand, the Government repeatedly reaffirmed the need for international cooperation in the field of public health, acknowledging that global health emergencies cannot be addressed through unilateral action. On the other, Italy’s diplomatic and parliamentary practice showed a growing insistence on the preservation of the State’s margin of discretion in the implementation of international health standards.
During the 158th session of the WHO Executive Board in 2026, for instance, Italy affirmed that WHO is most effective when focused on its core functions and comparative advantages, and that its action should be “underpinned by national ownership”, since Member States retain “primary responsibility and prerogatives for health policies and health systems”.[1] The same attitude emerged in other contexts: Italy’s explanation of vote on the United Nations General Assembly resolution on Global Health and Foreign Policy, the domestic debate on a possible withdrawal from the WHO, the rejection of all the 2024 amendments to the 2005 International Health Regulations (IHR), and Italy’s abstention on the WHO Pandemic Agreement.
Policy Autonomy in Global Health and Foreign Policy
In its explanation of vote on the resolution on Global Health and Foreign Policy, adopted by the United Nations General Assembly in 2025,[2] Italy aligned itself with the statement delivered by the European Union[3] and reiterated that health and food security are essential to the implementation of the 2030 Agenda and the Sustainable Development Goals.[4] It also confirmed its commitment to the negotiations on the modalities of the United Nations High-Level Meeting on Pandemic Prevention, Preparedness and Response, which Italy co-facilitated together with Vietnam.[5]
At the same time, however, Italy expressed “serious concern” and dissociated itself from the language used in preambular paragraph 35 of the resolution, concerning fiscal and regulatory measures aimed at addressing unhealthy diets. In Italy’s view, such language remained inconsistent with previously agreed formulations, in particular those contained in the 2018 Political declaration on non-communicable diseases.[6] Italy further stated that the effectiveness of taxation and marketing restrictions in improving health outcomes was “highly debated”, while alternative strategies, such as product reformulation through public-private partnerships, food education, and consumer information, had proved effective.
The most relevant aspect of the explanation of vote lies in Italy’s insistence on national policy autonomy. While supporting the resolution, Italy declared that measures such as taxation and marketing restrictions “fall within national jurisdiction” and that General Assembly language should reflect “the importance of policy autonomy at the national level and context-specific approaches”.
The Debate on Italy’s Withdrawal from the WHO
The same tension between cooperation and sovereignty emerged in the domestic debate concerning Italy’s possible withdrawal from the WHO. The debate followed the decision of the United States (US), announced by President Donald Trump on 20 January 2025, to withdraw from the Organization. The US justified that decision by referring, inter alia, to the WHO’s alleged mishandling of the COVID-19 pandemic and to the need to reform the Organization’s governance and funding structure.[7] Shortly thereafter, on 23 January 2025, members of a political party – belonging to the governing coalition – led by the Vice-President of the Council of Ministers, Mr. Matteo Salvini, announced the presentation of a legislative proposal aimed at terminating Italy’s participation in the WHO.[8]
On 29 January 2025, the Government’s position on this matter was expressed by the Minister of Health, Mr. Orazio Schillaci, during the question time before the Chamber (419th Meeting, XIX Legislature, answer to Question no. 3-01691). He first clarified that the issue concerned the foreign policy of the State and therefore involved the Government as a whole and Parliament. He recalled that Italy participates in the WHO through an annual assessed contribution, which in 2024 amounted to approximately 18 million US dollars, and that, in the same year, Italy had also paid voluntary contributions amounting to approximately 7.8 million US dollars.
Most importantly, Minister Schillaci stated that withdrawal from the WHO was not part of the Government’s programme, but at the same time he considered it “legitimate and constructive” to open a debate on the role of the Organization, especially regarding its governance and the allocation and use of resources. According to the Minister, it was the Government’s duty to ensure that “every euro invested in global health is used in the most effective way possible”.
The Minister’s statement is particularly relevant because it expressly connected sovereignty and cooperation. He stated that “claiming one’s sovereignty in the field of health is legitimate” but immediately added that this should translate into “a more incisive and conscious presence within international fora”. The experience of the pandemic, he continued, had shown that “only through effective and coordinated international cooperation can we address health emergencies of a global scale”, since “viruses have no citizenship, nor do they respect national borders”. The Minister also emphasized that even leaders who had expressed critical positions towards the WHO, such as President Trump, had mainly questioned the allocation of resources and the Organization’s operational methods, rather than the fundamental need for global health governance.
In his statement, Minister Schillaci stressed that the Ministry of Health cooperates with the WHO in crucial areas, including surveillance, prevention, preparedness and response to health emergencies, prevention of chronic-degenerative diseases, epidemiological monitoring, standardization of data, control of risks connected with healthcare, and the fight against antimicrobial resistance. He concluded that Italy should strengthen its role within international fora, since “isolating oneself does not represent a viable path for addressing the complex global health challenges of our time”.
This statement is important because it shows that, at the beginning of 2025, the Government sought to distinguish itself from more radical positions – coming from sectors within the same majority that supports the executive – advocating withdrawal from the WHO. Nevertheless, the same statement already contained the main elements of the position that would later emerge in relation to the IHR amendments and the Pandemic Agreement: cooperation was accepted, but only within a framework capable of ensuring respect for national sovereignty.
Italy’s Rejection of the 2024 Amendments to the International Health Regulations
The most significant manifestation of Italy’s cautious attitude towards WHO legal instruments was its rejection of all the amendments to the IHR adopted by the World Health Assembly in 2024.[9] The IHR are the main legally binding instrument governing the prevention, detection, notification and response to public health events with potential international relevance.[10] The 2024 amendments were negotiated after the COVID-19 pandemic within the Working Group on Amendments to the International Health Regulations and were adopted by consensus by the World Health Assembly.
The amendments introduced, inter alia, the notion of a “pandemic emergency” as a particularly serious form of public health emergency of international concern, strengthened national implementation structures through the designation of National IHR Authorities, and reinforced provisions on international cooperation, equity, access to health products, and financing.[11] The amendments do not give the Organization the power to impose domestic health measures on States. Temporary recommendations issued in the event of a public health emergency of international concern are not legally binding,[12] and the Organization has “no ability to impose any health measure, including lockdowns or other restrictions”.[13]
Under Article 59 of the IHR, as amended in 2022, amendments adopted by the World Health Assembly enter into force for all States Parties twelve months after notification by the Director-General, except for those States that notify a rejection or reservation within the relevant period. Italy made use of this opt-out mechanism. On 18 July 2025, the Minister of Health notified the WHO Director-General of Italy’s rejection of all the amendments adopted in Resolution WHA77.17. The letter, reproduced in the consolidated version of the IHR, does not provide reasons. It states: “[i]n accordance with Article 61 of the International Health Regulations (2005), I hereby notify Your Excellency of Italy’s rejection of all the amendments adopted by the Seventy Seventh World Health Assembly with Resolution WHA77.17 (2024)”.[14]
On 22 July 2025, a parliamentary question was presented before the Chamber of Deputies (515th Meeting, Question no. 5-04278), asking the Minister of Health to clarify the reasons for the rejection. The question referred to press reports according to which the Government had justified its decision by arguing that the amendments would reduce national sovereignty in the field of health policy, including by allowing the WHO to exercise control over health information. It also stressed that the refusal had been decided without prior parliamentary debate and that it appeared difficult to reconcile with the position expressed by Minister Schillaci on 29 January 2025, when he had rejected isolation and emphasized the need for stronger Italian participation in the WHO. At the time of writing, no ministerial answer appears to have been published. However, the issue resurfaced in a subsequent question presented before the Chamber on 28 May 2026 (667th Meeting, Question no. 5-05446). Reference was again made to Italy’s rejection of the 2024 IHR amendments, which was linked to the subsequent abstention on the Pandemic Agreement. The Minister was asked to clarify the reasons for the abstention and for Italy’s alleged failure to take part in an international WHO exercise aimed at testing pandemic preparedness.
The rejection of the IHR amendments is therefore highly significant as it showed Italy’s unwillingness to accept the strengthening of a binding legal framework designed to govern international health emergencies. By rejecting all amendments, Italy preserved its freedom from the new obligations introduced in 2024 and signalled distrust towards mechanisms of automatic incorporation of WHO rules into the domestic legal order, even when those rules had been adopted by consensus by the World Health Assembly.
Italy’s Abstention on the WHO Pandemic Agreement
Italy’s sovereignty-centred approach also emerged during the adoption of the WHO Pandemic Agreement.[15] The negotiations on the Agreement were launched in the aftermath of the COVID-19 pandemic with the aim of strengthening international prevention, preparedness and response to future pandemics.[16] The text adopted by the World Health Assembly in May 2025 was the result of more than three years of negotiations and sought to create a more coordinated international framework, including provisions on surveillance, prevention, One Health, health-system strengthening, technology transfer, and equitable access to pandemic-related health products.
The Agreement itself addresses concerns over sovereignty. It recognizes that States have the sovereign right to legislate and implement legislation in pursuance of their health policies, and it does not confer on WHO the power to direct national laws or policies.[17] Moreover, the Agreement was not immediately opened for signature, since further negotiations were required on the Pathogen Access and Benefit-Sharing system, an annex considered essential for the functioning of the future regime.[18]
Italy abstained from the vote. In its explanation of vote, the Italian representative stated that the abstention reiterated “the need to reaffirm States’ sovereignty in addressing public health matters”.[19] Italy welcomed the inclusion of that principle in the text of the Agreement and, in particular, the clarification that the Pandemic Agreement did not entitle the WHO “to direct, order, alter or prescribe national laws or policies”, nor to mandate States to take specific actions, such as banning or accepting travellers, imposing vaccinations, therapeutic or diagnostic measures, or implementing lockdowns.[20]
Italy also stressed that the Agreement should be implemented in full respect of proportionality and fundamental rights, including the protection of personal data and individual freedoms. At the same time, it expressed its readiness to continue working with other WHO Member States to resolve the remaining pending issues.[21]
The explanation of vote confirms that Italy’s abstention was not based on opposition to the objective of pandemic preparedness. Rather, the Government sought to emphasize that any future international legal framework on pandemics must remain compatible with State sovereignty and individual freedoms. In this respect, the abstention on the Pandemic Agreement is consistent with the rejection of the IHR amendments: in both cases, Italy refused or withheld support from legal instruments that, in the Government’s narrative, might reduce its sovereign margin of discretion in the management of future health emergencies.
Assessment
Italy’s diplomatic and parliamentary practice in 2025 and 2026 reveals a cautious, and at times sceptical, approach towards the WHO and global health law. This is particularly striking if one considers that Italy was among the countries most severely affected during the first phase of the COVID-19 pandemic and has consistently acknowledged that health threats do not respect national borders.
The Government did not embrace the option of withdrawing from the WHO. On the contrary, Minister Schillaci expressly stated that isolation was not a viable path and that Italy should strengthen its presence within international health fora. Italy also continued to cooperate with the WHO in several technical areas and to support global health initiatives. Yet this formal commitment to cooperation was accompanied by a clear determination to preserve national autonomy. Italy dissociated itself from General Assembly language perceived as endorsing domestic fiscal and regulatory measures in the field of nutrition and public health. It rejected all the 2024 amendments to the IHR, thereby excluding itself from a strengthened legal framework. It abstained on the WHO Pandemic Agreement, despite welcoming the inclusion of safeguards on sovereignty and the WHO’s lack of authority to prescribe domestic measures. The resulting position can therefore be described as sovereignty-centred.[22] Italy continues to accept the need for international cooperation in global health but resists any development of WHO-related legal instruments that could be perceived as limiting domestic political discretion.
Marco Pertile
A quotable version of this post will be published in the Italian Yearbook of International Law: Marco Pertile, “To Cooperate, but on Its Own Terms: Italy, the WHO, and the Defence of Health Sovereignty”, IYIL XXXV (2025), 2026.
[1] Italy, Statement at the 158th session of the Executive Board of the World Health Organization, Item 2, General Debate, Geneva, February 2026.
[2] UNGA Resolution 79/287, “Global health and foreign policy: rethinking health promotion as a transformative path towards improved and more sustainable well-being for all”, UN Doc. A/RES/79/287, 29 April 2025.
[3] Delegation of the European Union to the United Nations in New York, “EU Explanation of Vote – UN General Assembly: Draft Resolution on Global Health and Foreign Policy”, 29 April 2025.
[4] Permanent Mission of Italy to the United Nations in New York, “Explanation of Vote. Resolution Global Health and Foreign Policy”, 29 April 2025.
[5] Ibid.
[6] UNGA Resolution 73/2, “Political declaration of the third high-level meeting of the General Assembly on the prevention and control of non-communicable diseases”, UN Doc. A/RES/73/2, 10 October 2018.
[7] Executive Order 14155 of 20 January 2025, “Withdrawing the United States From the World Health Organization”, 90 Fed. Reg. 8361, 29 January 2025, s. 1.
[8] “Ddl della Lega per uscire dall’Oms: ‘Gli alleati condividano’”, ANSA, 23 January 2025.
[9] WHA Resolution WHA77.17, “Strengthening preparedness for and response to public health emergencies through targeted amendments to the International Health Regulations (2005)”, 1 June 2024.
[10] WHA Resolution WHA58, International Health Regulations (2005), 23 May 2005.
[11] WHA Resolution WHA77.17, cit. supra note 9, Annex, Arts. 1, 4, 13, 44 and 44bis.
[12] Ibid., Art. 1, defining a “temporary recommendation” as “non-binding advice issued by WHO pursuant to Article 15”.
[13] WHO, “International Health Regulations: amendments – Questions and answers”, 1 October 2024.
[14] WHO, International Health Regulations (2005), as amended in 2014, 2022 and 2024, Appendix 4, Letter of the Minister of Health of Italy, received on 18 July 2025.
[15] Seventy-eighth World Health Assembly, Summary Records of Committees, Geneva, 19-27 May 2025, WHA78/2025/REC/3, pp. 39-40.
[16] WHA Dec. SSA2(5), “The World Together: Establishment of an intergovernmental negotiating body to strengthen pandemic prevention, preparedness and response”, 1 December 2021, para. 1(1).
[17] WHA Resolution WHA78.1, WHO Pandemic Agreement, 20 May 2025, Annex, Arts. 3(1) and 22(2), recognizing “the sovereign right of States […] to legislate and to implement legislation” and providing that nothing in the Agreement gives the WHO Secretariat or Director-General “any authority to direct, order, alter or otherwise prescribe” national or domestic law or policies.
[18] Ibid., Arts. 12 and 31(2).
[19] “WHA 78 – Item 16.2: INB negotiations: Italy’s explanation of vote”, Seventy-eighth World Health Assembly, Geneva, 19 May 2025.
[20] Ibid.
[21] Ibid.
[22] A similar approach by the Government and the governing coalition is evident in different fields: regarding the Government’s migration policy, see the note by Bortolato here (and also published on this site) (to be published); regarding environmental law, see the opinions adopted by the Chamber in relation to the proposal for a directive implementing certain provisions of the Biodiversity Beyond National Jurisdiction (BBNJ) Agreement and to the proposal amending Regulation (EU) 2021/1119 establishing the framework for achieving climate neutrality. The governing coalition took the view that both proposals were incompatible with the principles of attribution and subsidiarity: Chamber of Deputies, Doc. XVIII-bis, no. 60, on the proposal concerning the implementation of the BBNJ Agreement (COM(2025) 173 final), approved by the XIV Committee on 8 July 2025, 511st Meeting, 15 July 2025; Chamber of Deputies, Doc. XVIII-bis, no. 68, on the proposal amending Regulation (EU) 2021/1119 on climate neutrality (COM(2025) 524 final), approved by the XIV Committee on 18 September 2025, 539th Meeting, 30 September 2025.
