Academic journal article Vanderbilt Journal of Transnational Law

Making International Health Regulations Work: Lessons from the 2014 Ebola Outbreak

Academic journal article Vanderbilt Journal of Transnational Law

Making International Health Regulations Work: Lessons from the 2014 Ebola Outbreak

Article excerpt

ABSTRACT

Many legal scholars believe that the lack of enforcement mechanisms provided by the International Health Regulations (IHR) in part explains the slow containment of the deadly Ebola virus disease outbreak in West Africa in 2014. In contrast, some global health practitioners deem funding for global health emergencies as a key remedy to the ineffective international infectious disease control regime. Such belief underpinned the creation of the Pandemic Emergency Facility (PEF), the World Bank's new financing initiative, aiming to finance global disaster response. Some commentators hope that the establishment of the PEF will resuscitate international interest in global health security and cooperation. Although current discussion touches upon how to integrate the PEF with the existing international infectious disease control regime, much remains unclear about how the PEF will relate to the IHR operationally and normatively. Relatedly, legal scholars and global health practitioners continue to talk about IHR enforcement and global health emergency funding as two different things, without exploring how the latter can incentivize the former.

Starting from the IHR as a pillar of global health security, this Article focuses on strengthening the IHR enforcement mechanism--thus far overlooked in the current discussion--vis-a-vis the PEF. It also argues that such linkage is important in ensuring consistent, rapid global health emergency responses. Drawing on lessons from the 2014 Ebola outbreak, the Article demonstrates that the proposal is normatively desirable and politically feasible. The Article makes a timely intervention, as the PEF has tremendous potential in shaping the international infectious disease regime, creating new opportunities and anxiety simultaneously.

TABLE OF CONTENTS

  I.  INTRODUCTION
      A. Definitional Matters
         1. Global Governance for Health
         2. Failed or Failing State
         3. Compliance
      B. Background: The 2014 Ebola Crisis in
         West Africa
 II. THE WORLD HEALTH ORGANIZATION
     A. The WHO's Normative Visions
     B. The WHO's Constitutional Functions
     C. The International Health Regulations
III. INTERNATIONAL FINANCIAL INSTITUTIONS AND THE
     GLOBAL GOVERNANCE OF HEALTH
 IV. THE PANDEMIC EMERGENCY FACILITY AND THE LINKAGE WITH THE IHR
     A. The Pandemic Emergency Facility
     B. The Proposal: Informal IHR-PEF Linkage
     C. International Infectious Disease Control and Risk Governance
     D. Potential Challenges to the IHR-PEF Linkage
  V. CONCLUSIONS: ADVANCING GLOBAL HEALTH SECURITY

I. INTRODUCTION

Many legal scholars believe international law is a pillar of the maintenance of global health security and cooperation. This belief is reflected in the extensive law-making power granted to the World Health Organization (WHO), (1) a global public health agency. Yet, in the past decades, and most recently during the Ebola virus disease (sometimes abbreviated "EVD," but referred to here more colloquially as "Ebola") outbreak of 2014 in West Africa, the consistently poor performance of the WHO in the global policy realm of infectious disease control shattered that expectation markedly. Indeed, at the most recent opening of the annual World Health Assembly (WHA), German Chancellor Angela Merkel made clear that the WHO's response to the 2014 Ebola epidemic was nothing less than catastrophic. (2) Chancellor Merkel's sharp criticism reflects a widely held sentiment within the international community because the delayed WHO response to the epidemic had resulted in 11,300 deaths and 28,601 confirmed cases, as of December 1, 2015. (3) Many infectious disease experts believe that, had the WHO responded promptly, such human devastation could have been averted. (4) Likewise, many commentators noted that the International Health Regulations (IHR), (5) which provide the international legal architecture for global health security, have contributed little to enhancing international cooperation. …

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