How can U.S. states legally participate in international public health networks without federal approval?
Executive summary
States can and already do engage with foreign partners, multilateral networks, and technical forums on public health without explicit federal sign‑off by acting through state agencies, academic institutions, subnational agreements, and nongovernmental organizations, while remaining constrained by federal control over treaty implementation, international reporting like the IHR, and foreign affairs prerogatives [1] [2] [3] [4]. The practical route is pragmatic: technical cooperation, data‑sharing agreements, participation by state universities and public health labs in global networks, and membership in non‑UN international initiatives — all while the federal government retains lead responsibility for formal treaty obligations and some international data flows [5] [6] [2].
1. Legal landscape: state police powers versus federal foreign‑affairs and treaty prerogatives
Public health regulation is traditionally a state function under state police powers, giving states authority to conduct surveillance, manage outbreaks, and enter many cross‑border technical partnerships, but the federal government plays a dominant coordinating role in international health matters and in implementing treaties like the IHR — the Department of Health and Human Services and CDC are assigned lead responsibilities for IHR reporting and response coordination [1] [2] [4]. Congress and federal agencies control funding and many formal international obligations, and there is legal uncertainty about whether the President can alter U.S. treaty commitments without Congress [4] [3].
2. Practical routes states use: data sharing, scientific collaboration, and networks
States routinely participate in global disease surveillance and research through state public health labs, state health departments, and academic centers that join WHO technical networks, Global Health Security Agenda activities, or consortia without a need for federal treaty approval, because many channels are scientific or programmatic rather than diplomatic treaty acts [6] [5]. Individual U.S. scientists and institutions can remain active in WHO committees and technical working groups even if formal U.S. membership changes, and several reporting outlets note that scientists told reporters they retained capacity to engage as individuals [5].
3. Subnational agreements, memoranda, and MOUs as tools
States can sign memoranda of understanding (MOUs) or cooperative agreements with foreign subnational governments, universities, and NGOs to exchange surveillance data, laboratory samples, training, and technical assistance; these arrangements are widely used in global health and fall into the routine exercise of state public‑health functions rather than foreign‑policy treaty making [1] [6]. Such partnerships can sustain vaccine strain sharing or lab capacities when federal ties shift, although they lack the reach and leverage of coordinated federal programs [5] [7].
4. Limits and risks: data flows, sample access, and international legal instruments
There are clear limits: treaties and regulations adopted by international bodies can create obligations that the federal government is expected to implement nationally (IHR amendments enter into force for States Parties unless rejected), and federal law designates HHS/CDC as the conduit for IHR notifications and reporting, which constrains the ability of states to unilaterally bind the U.S. or represent it in formal treaty processes [3] [2] [4]. Moreover, withdrawing federal membership or funding from WHO reduces centralized access to some WHO databases and formal decision forums, which may force states into ad hoc data deals but can degrade national coordination [8] [7] [5].
5. Political and operational tradeoffs: scale, influence, and financing
State‑level engagement can preserve technical collaboration but lacks federal diplomatic weight, guaranteed funding streams, and unified national policy — the U.S. government historically marshaled extensive resources through State, USAID, CDC, and other agencies for global health, and most international program financing and formal diplomacy flows through federal channels [6] [9]. States acting alone can build important bilateral and multilateral public‑health ties, but they may hit practical walls if federal policy blocks data sharing, sample transfer, or participation in treaty organs [6] [3].
6. Bottom line and reporting limits
Bottom line: states can legally participate in international public health networks via scientific collaboration, MOUs, academic partnerships, and non‑treaty international initiatives, but they cannot unilaterally alter U.S. treaty commitments or fully substitute for federal roles in formal international reporting and diplomacy; the sources document the federal lead on IHR duties and the practical ability of scientists and subnational actors to engage, but do not provide a full map of litigation risk or detailed state statutes that might further constrain particular actions [2] [3] [5].