Global health collaboration has evolved through three historical regime periods:

the mid 19th century to the early 20th century, the early 20th century through the

1980s, and the 1990s to the present. The first period witnessed arduous negotiations

to conclude a treaty to control the international spread of epidemic diseases. It led to

the acceptance of the International Sanitary Regulations of 1903. During the second

period, for the most part, states tended to ignore the International Health Regulations

(IHR), as the 1903 regulations came to be called. They thus had a very limited impact.

The decade and a half since 1990 has seen quite a dramatic expansion in multilateral