The International Health Regulations (2005; IHR) require States Parties to designate a National IHR Focal Point (NFP; i.e. a national centre) to ensure timely communications with the World Health Organization (WHO) about all events that may constitute a public health emergency of international concern and, following recent amendments, to designate a National IHR Authority to coordinate IHR (2005) implementation within the Parties. Since 2008, the WHO Regional Office for the Western Pacific has been running an annual simulation exercise, known as the IHR Exercise Crystal, to test and strengthen NFP functionality. This study analyses NFP performance during the IHR Exercise Crystal over a 16-year period (2008–2024, excluding 2009) to inform Member States’ planning for NFP capacity-strengthening in the context of the recent IHR (2005) amendments. Data collected about NFP performance during these exercises were analysed using descriptive statistics across six key NFP performance indicators. Key findings show that the proportion of NFPs that are accessible via email is consistently high (mean: 99%), but there is suboptimal NFP accessibility via telephone (mean: 64%). The proportion of NFPs participating in tele- and videoconferencing during the exercise improved over time (mean: 73%), as did the proportions of NFPs notifying WHO of simulated events (mean: 80%) and contributing information to the Event Information Site for NFPs (mean: 77%). The proportion engaging in multisectoral communication remained variable, with no clear trend (mean: 73%). These results demonstrate that significant progress has been made in strengthening NFP functionality, but there are opportunities for further improvement, particularly in the areas of telephone accessibility and multisectoral coordination. It is critical that States Parties continue strengthening and testing NFP functionality through simulation exercises and other capacity-building activities to ensure effective IHR (2005) implementation. Furthermore, States Parties should develop, test and maintain up-to-date standard operating procedures to support the clear demarcation of roles and responsibilities between the NFP and the National IHR Authority.

The International Health Regulations (2005; IHR) are a legally binding instrument for the 196 States Parties, including the 194 Member States of the World Health Organization (WHO), requiring them to build and maintain capacities across critical domains to prevent, detect and respond to public health threats. In an analysis of 15 IHR (2005) core capacity scores reported by States Parties in WHO’s Western Pacific Region from 2021 to 2023, average regional scores increased from 68% in 2021 to 72% in 2022, then declined to 66% in 2023. Seven States Parties maintained consistently strong scores (>=85%), whereas nine exhibited fluctuations of at least 10 percentage points. Categorizing States Parties into three groups based on geographical and economic characteristics highlighted that core capacities such as financing, food safety and the control of zoonotic diseases were areas requiring additional capacity-building, particularly among Pacific Island States Parties. Low- and middle-income States Parties also reported notable gaps in financing and infection prevention and control. These findings underscore the need to strengthen national coordination and accountability mechanisms. The strategic establishment or designation of a National IHR Authority – a key amendment introduced in the 2024 revision of the IHR – has the potential to enhance implementation by ensuring institutional leadership, fostering multisectoral collaboration and facilitating resource mobilization. However, national efforts alone may not be sufficient. Regional coordination will enhance political commitment and promote coordinated action, thereby strengthening preparedness and response capacities across diverse contexts and supporting more effective implementation of the IHR (2005).