International Regimes in Global Health Governance

Jiyong Jin

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000353907
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

By analysing the roles and problems faced by international regimes as major players in global health governance, this book looks into the root causes of the often insufficient supply of global public goods for health and of thedeficiencies in current global health governance.

Combining several different methods of analysis and methodologies, this book sketches out the landscape of international public health governance involving a range of international actors. These include the World Health Organization, the World Trade Organization, the Biological Weapons Convention and international human rights regimes. Through a novel theoretical framework that synthesises the theory of securitisation, public goods and international regimes, the author then focuses on factors that have resulted in observed deficiencies in global health governance. Based on these examinations, the book also tries to explore feasible approaches for institutional refinement and innovations for greater effectiveness in global health governance.

The book will appeal to academics and policy makers interested in global health, international relations and international law.

1
Introduction

1.1 Practical and theoretical implications of research

Human history is a history of combatting diseases. From time immemorial, pandemic crises have plagued human society. The first-ever recorded plague in human history virtually destroyed Athens. The flu that swept the globe in 1918 killed an estimated 20–50 million people in just a few months. As of 2017, an estimated 70 million people had been infected with HIV, and 35 million had died of AIDS, making the disease the “primary killer” in Africa and the world. The September 11 terrorist attacks in the United States, as well as the subsequent anthrax virus outbreak, left the international community deeply haunted by the spectre of bio-terrorism. The rapid spread of SARS in 2003 demonstrated starkly the vulnerability of human beings in an increasingly interdependent world to deadly diseases. In 2014, the raging Ebola outbreak in West Africa caused a death toll of more than 11,000 people, underscoring the serious challenges to maintaining global health security and promoting global health development. The unprecedented global health, humanitarian and socioeconomic crisis triggered by the COVID-19 pandemic has significantly reflected the vulnerability of the international community to infectious diseases. Simply put, “the state of global health is in a state of crisis” (Bradford, 2007, p. 77).

However, such astonishing public health problems have long been regarded as technical issues delegated to the biological and medical domains or to the specialised territory of epidemiologists. Public health issues within a country are also considered problems within its sovereignty with which no other nation or international organisations may interfere. In other words, public health governance in the traditional sense has always been subject to what German philosopher Ulrich Beck (2007) called rules of “methodological nationalism” (p. 286). However, as globalisation deepens, public health governance—once an issue of domestic governance—has become global. At the same time, public health crises have also risen above their status as mere medical problems and brought forth important societal, economic, and political implications. Viruses travel around the world passport-free. Many emerging and recurrent infectious diseases have made countries around the world more vulnerable and interdependent. Today, it has become a serious challenge to manage global health issues confronting the international community.

Global health issues are major global problems “with potential ramifications as great as any war; yet hardly any political scientist shows scientific interest in it!” (Lanegran & Hyden, 1993, p. 247). Not even in the realm of issues regarded as “low politics” can we find discussions of these problems. As Rudolph Virchow, a German politician and doctor and revered as the “father of modern pathology” observes, “Medicine is a social science, and politics nothing but medicine at a larger scale” (1848). Indeed, public health issues are not only medical issues but also political issues. “Health is deeply political. We need to tackle the political determinants of health” (Kickbusch, 2005, p. 246). Given that transnationally transmissible diseases and potential bioterrorism pose a threat to security at individual, national, international and global levels, global health issues have been increasingly securitised in recent years. Scholars in China and elsewhere have extended some discussions about such securitisation, ¹ all agreeing that global health threats have risen to the status of security issues. As Su (2000) put it,

International Relations Studies, or the Studies of the International Society, should and in many ways has already become a discipline both aiming to explore and realize global public interest and designed to probe the meaning of ‘publicness’. Only in this sense can International Relations Studies justifiably maintain its status as a unique discipline.

(p. 284)

Doubtless, the “publicness” of global health issues has made global health governance a central concern for scholars in the field. It is thus not only practical but also necessary to analyse global health issues from the perspective of international relations.

The emergence of global public issues calls for global governance. The efficiency of global governance, in turn, depends on the availability of global public goods. The proper response to global health crises lies in how to effectively achieve global health governance. The approach relies on providing more global public goods for health when it comes to global health (Kaul et al., 2003; Smith et al., 2003). As main actors in global health governance, international regimes are the most important providers of global public goods for health, spanning security, trade, development, human rights and many other policy areas. Therefore, an analysis of the roles and deficiencies of global regimes in addressing global health governance, including those of the World Health Organization (WHO), the World Trade Organization (WTO), the Biological Weapons Convention (BWC) and international human rights regimes, can help identify the root causes of the insufficient supply of global public goods for health. It will also help us achieve greater effectiveness of global health governance through further regime design and innovation.

By identifying the shortcomings of these international regimes in global health governance, this book seeks to map out the deep-seated causes leading to these deficiencies. It is therefore of both theoretical and practical significance to approach the issue of global health governance from the perspective of international regimes.

1.2 Literature review

Research on global health issues is inextricably linked to the globalisation of public health issues. Since the 1990s, three major development trends have been identified in the area of public health: 1) AIDS continues to spread globally and is wielding increasing political, economic and social impact in developing countries; 2) people are increasingly concerned about the proliferation of biological weapons, especially such proliferation in terrorist groups and 3) people are increasingly aware of the vulnerability and interdependence in both rich and poor countries arising from the global spread of pathogens, products and pollutants. “In the global context, the transnational menace of infectious and non-communicable diseases in a globalizing world has immersed all of the humanity in a single microbial sea” (Aginam, 2007, p. 147). Such interdependence in global health security has been driving this line of academic research. Although international regimes play an important role in global health governance, most public health scientists choose not to view international regimes as effective tools but rather analyse global health issues from a narrowly defined medical science perspective. Scholars of international relations have thus remained quite passive in the fields of global health issues. As Lee and Dodgson (2003) point out, “Although health is a classic trans-border issue, it continues to receive limited attention in international relations” (p. 214). Scholars interested in this issue have mostly adopted a “segmented” approach and have analysed the impact of these factors on public health from the aspect of international trade and international human rights regimes separately. In general, a holistic and interdisciplinary research approach is wanting for such scholarship.

Due to the impact of emerging and recurrent infectious diseases, particularly AIDS, and threats from bioterrorism, research on global health issues from the angle of international relations has garnered increasing attention. Prominent among international relations scholars is David P. Fidler, of Indiana University, USA, who has made important contributions to interdisciplinary research in international relations and public health. One of his most representative works is SARS, Governance, and Globalization of Diseases (2003). Taking the SARS epidemic as an example, he analyses, in the context of globalisation, the impact brought by the public health crisis to international politics under the Westphalian system. He argues that the globalisation of public health issues requires taking a “post-Westphalian” system of public health governance—that is, a global health governance approach—and identifies the deficiencies of the International Health Regulations (IHR) as an international regime in addressing issues in global health governance. He even coined a new term, “microbialpolitik”, to describe the interaction between international relations and health problems posed by pathogens (Fidler, 1998, pp. 1–11). He has placed global health issues under the framework formed by the international treaties, analysed the impact arising from the threat of viral microbes on the formation of a global health regime, and traced the history to a series of international public health conferences and public health diplomacies in the 19th century.

In 2008, Fidler and Lawrence O. Gostin co-published their book Biosecurity in the Global Age: Biological Weapons, Public Health, and the Rule of Law. The two authors believe that since biosecurity threats mainly come from biological weapons and natural outbreaks, security and public health—two previously independent areas—need to be integrated and coordinated, in particular through the coordination of two international regimes, the BWC and the WHO. This approach exemplifies the securitisation of public health issues. In the book, they also emphasise the importance and difficulties of this integration strategy and maintain that the integration between safety issues and public health issues requires a change of perspective and practice to cope with, through sustainable governance, the threat from microbial pathogens. They hold that it is important to use legal channels to provide an effective global governance framework for biosafety, in particular by strengthening the legal functions of the WHO and the Biological Weapons Convention, to enhance the role of the two international regimes in global biosafety governance.

In 2001, Andrew T. Price-Smith, Professor of International Politics at Colorado College, USA, published Plagues and Politics: Infectious Disease and International Policy. He based his discussion on theories of international relations and analysed the impact of public health crises on global security. He argued that global health crises would pose direct and serious long-term threats to global governance and prosperity. In 2005, Obijiofor Aginam, of Carleton University, Canada, published Global Health Governance: International Law and Public Health in a Divided World. Through the lens of globalisation, Aginam examined the shared vulnerabilities the international community faced in the field of public health security. He also traced the history of diplomatic efforts on infectious diseases in the 19th century and the origin of public health multilateralism during the European colonial period. Through investigating contemporaneous international law, Aginam critically examined the significance and limitations of the IHR and of the right to health in global health governance. He concluded that, despite the international community’s interdependence in public health security, the widening capability gap between developed and developing countries at the time meant international law could only play a limited role in global health governance.

In 2007, Andrew F. Cooper et al. co-published Governing Global Health: Challenges, Responses, and Innovations. The book highlighted the significance and challenges of global health governance in the 21st century and examined the evolution of global health cooperation since the 1990s. Using WHO as an example, the authors listed a number of public health challenges that had emerged in the era of globalisation and discussed the influence WTO had on public health in its quest to meet the United Nations’ (UN) Millennium Development Goals (MDGs). The authors believed global health governance required innovations, particularly innovations of multilateral international regimes. These innovations involved relinquishing sovereignty to collective action, setting up accountability mechanisms and establishing effective monitoring and implementation mechanisms.

In the same year, Wolfgang Hein, in collaboration with his fellow researchers from the German Institute of Global and Area Studies (GIGA), published Global Health Governance and the Fight Against HIV/AIDS (2007). The authors gave a convincing explanation on the role global health governance has in curbing HIV/AIDS. The authors started with a serious attempt to define the concept of global health governance, followed by an evaluation of the functions of international intergovernmental organisations and non-governmental organisations in global health governance. The book ended by endorsing the view that global health governance requires a “post-Westphalian” framework in which global health governance is not restricted to countries, and non-state actors can play an increasingly important role in global health governance.

In 2008, Mark Zacher and Tania Keefe, Professors of International Relations at the University of British Columbia in Canada, co-published their monograph The Politics of Global Health Governance. They traced the development of global health governance regimes in the 20th century and described the clashes between international patent law and the accessibility to essential medicines. They contended that global health governance requires cooperation in global politics. In addition, some Western scholars have also taken a historical approach to study how global public issues have emerged as global issues (Goodman, 1977; Hayes, 1998; Howard-Jones, 1975; McNeill, 1976; Porter, 1999; Zinsser, 1963).

At the same time, there is also research from the field of public health focusing on the mutual interactions between public health and international relations. For example, World Health and World Politics (1995), written by J...