Lessons from SARS: Why the WHO Must Provide Greater Economic Incentives for Countries to Comply with International Health Regulations

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TABLE OF CONTENTS

  I. INTRODUCTION
 II. BACKGROUND: THE SCOPE OF THE THREAT FROM INFECTIOUS
     DISEASE, SARS, AND THE WHO
     A. The Scope of the International Threat from Infectious
        Disease
     B. SARS: An International Wakeup Call
        1. Characteristics of SARS
        2. The Chinese Government Did Not Have
           Sufficient Incentives to Disclose the Disease
     C. The WHO's International Law-Making Powers
III. THE WHO'S ANSWER TO THE THREAT: REVISING THE
     INTERNATIONAL HEALTH REGULATIONS
     A. The Previous Regulations and the Legal Obligations of
        Member States
     B. Problems with the Previous IHR
     C. The WHO's Limited Answer: Revise the IHR
        1. Reporting of Public Health Emergencies
        2. Reports from Non-State Actors
 IV. INEFFICIENCES IN INTERNATIONAL DISEASE CONTROL: THE WHO
     Is INHERENTLY DISADVANTAGED
  V. How MEDICAL ECONOMICS RELATES TO THE FIGHT AGAINST
     DISEASE
     A. Public Health as a Public Good
     B. All Nations Have an Interest in Joining the Fight Against
        Infectious Disease
 VI. SUGGESTIONS FOR IMPROVEMENT
     A. The WHO Must Attract Funding through Efficiency of
        Operation
        1. The WHO Must Give Wealthy Nations and
           Organizations a Reason to Provide Funding
        2. The WHO Needs to Spend Money in a More
           Cost-Efficient Manner
        3. The WHO Should Avoid Politicization by Sticking
           to its Technical Mandate
     B. The WHO Must Provide Further Incentives for States to
        Comply with the Regulations
     C. International Health Should Not Be Bound by International
        Politics
VII. CONCLUSION

I. INTRODUCTION

In 1969 the United States Surgeon General announced that humans had effectively won the battle against infectious diseases. (1) As a result, health care professionals around the globe turned their focus from infectious diseases to chronic illnesses. (2) This "premature triumphalism" (3) caused government and public health officials to become complacent concerning infectious diseases, increasing the morbidity and mortality caused by infectious diseases internationally. (4) Since that time a record number of new diseases have emerged throughout the world, including HIV/AIDS, Lyme disease, Hepatitis C, Ebola, Dengue hemorrhagic fever, and SARS. (5) Billions of dollars have been spent and millions of lives lost as a result of these and other diseases. In fact, in 1996, infectious diseases claimed 17,312,000 lives, comprising 33% of all deaths worldwide. (6) In the United States alone, even the common flu kills over 36,000 people a year. (7) Put simply, the spread of infectious disease is one of the most important global problems facing international leaders today.

Currently the World Health Organization (WHO or Organization) is the only multilateral organization charged with combating infectious diseases internationally. For decades the WHO has worked--with varying degrees of success--to fulfill this role. Currently, the WHO believes that the best way to help nations combat the international spread of infectious disease is to strengthen the International Health Regulations (IHR or Regulations). The IHR are the only existing international laws dealing with infectious diseases. They describe the surveillance and reporting requirements of member states concerning infectious outbreaks. Unfortunately, the IHR have proven largely unsuccessful, and member states treat them more like recommendations than international law. In the hope that strengthening the IHR would improve compliance with the Regulations, the WHO spent the past decade working to modify the IHR. This work culminated a few months ago when WHO member states voted to accept a new version of the Regulations.

Changing the IHR is a welcome development that is long overdue. After all, even with the advent of HIV/AIDS, the previous Regulations were not changed for twenty-three years. …