Effect on International Health Governance

Before the emergence of SARS, international health regimes (as governed by the International Health Regulations) were badly dated, for two reasons. First, since their inception in 1951, the IHR had not been revised adequately in the face of other emerging novel pathogens. The member states of the WHO had last formally revised the IHR in 1969. Yet since 1970 humanity has witnessed the emergence of more than 30 previously unknown pathogens, and none of those were covered by the IHR in 2003, when they only required member states to report the incidence of smallpox, cholera, plague, and yellow fever. Further, under the provisions of the IHR the reporting of pathogen-induced morbidity and mortality remained the exclusive domain of sovereign member states. Countries have long sought to suppress the flow of information regarding endogenous epidemics, because the emergence of contagion typically generates significant negative effects on the economy and society of infected polities.46 Thus, states have had significant material incentives to refrain from issuing timely and accurate reports on domestic epidemics to the global community. Beijing's early attempts to suppress the flow of information to the WHO and the insistence by Canadian officials that the WHO's travel advisories were erroneous both reflect this historical pattern of tension between sovereign member states and the WHO.

Nonetheless, some positive changes have taken place in the international health governance regime since the 1970s as a result of technological advances, the rise of new and reemerging infectious diseases, and the increasing involvement of non-state actors in addressing global microbial threats.

The WHO was instrumental in building the Global Outbreak Alert and Response Network, which was effectively mobilized to deal with the SARS contagion. Developed in 1997 and formalized in 2000, the GOARN is a network of approximately 120 partner networks engaged in pathogen detection, surveillance, and response. "During the response to SARS," the physician David Heynmann observed, "GOARN electronically linked some of the world's best laboratory scientists, clinicians, and epidemiologists in virtual networks that rapidly created and disseminated knowledge about the causative agent, mode of transmission, and other epidemiological features of SARS."47

During the World Health Assembly meetings of May 2003, member states of the World Health Organization stipulated that the organization should redouble its efforts to garner and analyze data from non-state actors. Specifically, the WHA requested that the Director-General of the WHO "take into account reports from sources other than official notification."48 The new ability of non-state actors to communicate data directly to the WHO would seem to have broken the sovereign state's historical monopoly regarding the reporting of public health information, but this is only possible in those societies with sufficient telecommunications infrastructure.

In 1995, the WHO sought to revise the IHR so that the WHO could be allowed to use information from non-governmental organizations for epidemiological surveillance of infectious disease outbreaks.49 Revisions to the IRH were finally completed in 2005, and member states must now immediately report the following pathogens to WHO: SARS coronavi-rus, novel strains of human influenza, smallpox, and polio. Adopted by the World Health Assembly in May 2005, the revised regime entered into force globally on June 15, 2007. The new regulations clarify the WHO's authority to recommend strategies of containment to member states, including various restrictions (such as quarantine) at ports, airports, and terrestrial borders and on means of international transportation.50 This successful revision of the IHR, directly induced by the SARS scare, put an end to a decade of dithering by member states. Thus, SARS changed the calculus of the material interests of member states to reflect the threat that disease posed to their material interests, resulting in rapid innovation and change of the existing regime.

However, Fidler's arguments that we are now witness to a transformative or "post-Westphalian order that effectively limits the sovereign state's ability to compromise processes of global health governance under the auspices of international organizations (e.g., the WHO) are rather overstated. While the SARS epidemic appeared to have increased the power and authority of the WHO, the shift in power from sovereign states to the international organization was largely ephemeral. The sovereign state remains very capable of obfuscation through the non-reporting of disease data, and through other means of thwarting international efforts to address the spread of contagion. One need only look at the history of obfuscation and denial by political leaders in sub-Saharan Africa (Thabo Mbeki of South Africa and Robert Mugabe of Zimbabwe in particular) in the context of the HIV/AIDS pandemic to observe such obstruction.51

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