What makes a requirement binding here
None of its own, and that is the first thing to understand about it. The International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use has been a non-profit legal entity under Swiss law, headquartered in Geneva, since October 2015 — before that it was the International Conference on Harmonisation, a tripartite initiative rather than an organisation. Its legal personality lets it hold members and run a secretariat. It does not let it make law anywhere, and the guidelines it publishes bind nobody until a regulator adopts them.
By regional adoption, one authority at a time, and the adopted instrument is what a practitioner is actually held to. Regulatory members are expected to implement the guidelines in their own systems: FDA issues them as guidance for industry, the European Union brings them in through CHMP and the Commission, Japan by MHLW notification. The consequence is that “ICH Q9(R1) requires” is a shorthand rather than a citation — the requirement, and its exact version and effective date, belongs to whichever authority adopted it in the market being addressed.