The International Health Regulations (ihr) have been severely tested by the covid-19 pandemic. Recent reviews have identified a number of gaps and challenges and proposed improvement, but the Regulations should be analysed in their context as a constitutional instrument deeply embedded in who’s governance to better understand their systemic strengths and weaknesses. The ihr embody a managerial model of health governance that aims at depoliticizing international response to health emergencies and coordinating it on the basis of expertise and persuasion. The political crisis accompanying the covid-19 pandemic, however, reveals the need for a different and more political approach that injects states in the governance of the ihr following models tested by other international agreements. It also highlights the need for a more effective framework of cooperation and coordination that builds upon who’s practice of inter-institutional cooperation but complements it through institutional consultation structures involving directly states parties.