MANAGING GLOBAL HEALTH SECURITY
The World Health Organization and Disease Outbreak Control
** Winner of 2016 International Studies Association Global Health Book Prize **
Drawing on insights from international organization and securitization theory, the author investigates the World Health Organization and how its approach to global health security has changed and adapted since its creation in 1948. He also examines the organization's prospects for managing global health security now and into the future.
International Norms and Global Health Security
(co-authored with Sara Davies and Simon Rushton)
Drawing on Martha Finnemore and Kathryn Sikkink’s "norm life cycle" framework and based on extensive documentary analysis and key informant interviews, Disease Diplomacy traces the emergence of the new norms of global health security, the extent to which they have been internalized by states, and the political and technical constraints governments confront in attempting to comply with their new international obligations. The authors also examine in detail the background, drafting, adoption, and implementation of the IHR while arguing that the very existence of these regulations reveals an important new understanding: that infectious disease outbreaks and their management are critical to national and international security.
THE TRANSFORMATION OF GLOBAL HEALTH GOVERNANCE
(co-authored with Colin McInnes, Kelley Lee, Anne Roemer-Mahler, Simon Rushton & Owain Williams)
The authors examine how health governance is being transformed amid globalization, characterized by the emergence of new actors and institutions, and the interplay of competing ideas about global health. They explore how this has affected the governance of specific health issues and how it relates to global governance more broadly.
'ON THE VALUE OF VIEWING AMR AS A THREAT TO INTERNATIONAL SECURITY' (2017) AMR CONTROL, 29-32.
(co-authored with Dale Dominey-Howes and Maurizio Labbate)
In recent years, antimicrobial resistance (AMR) has been increasingly described as a threat to national and global health security. However the utilization of security terminology in reference to health issues has generally been regarded as a negative development, one that should be avoided. We consider the benefits and drawbacks of utilizing this descriptor, concluding that, on balance it can serve as an important tool in assisting leaders and decision-makers address the complex challenge that AMR presents.
'SAME, SAME BUT DIFFERENT: REFORMING THE WORLD HEALTH ORGANIZATION IN AN AGE OF PUBLIC SCRUTINY AND GLOBAL COMPLEXITY' (2017) GLOBAL HEALTH GOVERNANCE, XI(I): 4-6.
(co-authored with Tine Hanrieder)
Introduction to special issue on Reform of the World Health Organization
'CIVIL-MILITARY COOPERATION IN EBOLA AND BEYOND' (2016) THE LANCET, 387(10014): 104-105.
(co-authored with Sophie Harman, Clare Wenham and Frank Smith III)
The 2014 Ebola outbreak in west Africa blurred the lines between a public health emergency and humanitarian crisis. In so doing, it highlighted serious problems with coordinating disaster responses. Civilian agencies were overwhelmed; several non-government organisations closed down their operations and exited the affected countries; and, although the health sector in Liberia stepped up, Sierra Leone and Guinea remained in disarray. Since then WHO declared Sierra Leone to be Ebola free on Nov 7, 2015,1 and declared the end of human-to-human transmission of Ebola virus in Guinea on Dec 29, 2015.
'FIGHTING FLU: SECURITIZATION AND THE MILITARY ROLE IN COMBATING INFLUENZA' (2016) ARMED FORCES & SOCIETY, 42(1): 145-168.
(co-authored with Christopher Watterson)
The growing trend toward the securitization of infectious disease has legitimated a role for national militaries in responding to public health crises. This apparent “militarization” of health has met with resistance from the health and security sectors alike, who argue that it risks politicizing health outcomes while also draining limited military resources. This article attempts to place such concerns within the broader historical context of military involvement in public health. With specific reference to pandemic influenza—a disease of great historical import and a current policy priority in the context of securitized global public health—this article details the pedigree of military involvement in fighting the disease and draws on the established record to demonstrate the role that militaries can play in improving public health outcomes. The article argues for an ongoing military role in the global fight against pandemic influenza, both in augmenting civil influenza programs and in improving their own preparation and response mechanisms for future pandemics.
'NAVIGATING THE ROLE OF THE PRIVATE SECTOR IN HEALTH EMERGENCIES' (2016) MEDICINE, CONFLICT & SURVIVAL, 32(3): 171-174.
(editorial - special section)
It is now a common refrain in contemporary international relations that the modern state is in retreat. Views vary on the extent of that retreat, ranging from marginal to a full rout (Bauman and Bordoni 2014; Schneider and Hage 2008; Strange 1996); and of course, as the academy is prone to do, there are those who problematize such claims to argue the reverse (Grygiel 2016; Helm 2013; Levy 2016). Conceivably the only common ground is that the international system has become far more complex, in large part due to the proliferation of actors. The second feature that may also enjoy some consensus is that the structures, systems, institutions and processes created in the first half of the twentieth century are no longer fit-for-purpose in the first half of the twenty-first....
'WHO'S TO BLAME? THE WORLD HEALTH ORGANIZATION AND THE 2014 EBOLA OUTBREAK IN WEST AFRICA' (2016) THIRD WORLD QUARTERLY, 37(3): 401-418.
Since 2001 the World Health Organization (WHO) has been actively promoting its credentials for managing ‘global health security’. However, the organisation’s initial response to the 2014 Ebola outbreak in West Africa has attracted significant criticism, even prompting calls for its dissolution and the creation of a new global health agency. Drawing on principal–agent theory and insights from previous disease outbreaks, this article examines what went wrong, the extent to which the organisation can be held to account, and what this means for the WHO’s global health security mandate.
'WHO MUST REMAIN A STRONG GLOBAL HEALTH LEADER POST EBOLA' (2016) THE LANCET, 385(9963): 111.
(co-authored with Sophie Harman, Joao Nunes, Anne Roemer-Mahler and Clare Wenham)
The 2014 Ebola outbreak in west Africa has demonstrated again the urgent need for strong leadership and coordination in responding to global health challenges. As members of the global health scholarly community, we call upon all WHO Member States to recommit themselves to strengthening global outbreak alert and response by sustainably investing in the WHO, its departments, and personnel.
'ANTIPODAL BIOSECURITY? OVERSIGHT OF DUAL USE RESEARCH IN THE UNITED STATES AND AUSTRALIA' (2014) FRONTIERS IN PUBLIC HEALTH, 2: 1-3.
(co-authored with Frank Smith III)
The creation of a virulent mousepox virus in Australia and publication of this experiment in 2001 are often argued to mark a dangerous turn in dual use research (1). After this experiment and – far more consequential – September 11 and the anthrax letters, the oversight of dual use research in the life sciences received considerable attention in the United States. We argue that the American experience provides valuable lessons for Australia, three of which are highlighted here...
'THE MULTIPLE MEANINGS OF GLOBAL HEALTH GOVERNANCE: A CALL FOR CONCEPTUAL CLARITY' (2014) GLOBALIZATION AND HEALTH, 10(28): 1-10.
(co-authored with Kelley Lee)
The term global health governance (GHG) is now widely used, with over one thousand works published in the scholarly literature, almost all since 2002. Amid this rapid growth there is considerable variation in how the term is defined and applied, generating confusion as to the boundaries of the subject, the perceived problems in practice, and the goals to be achieved through institutional reform...
'THE POLITICS OF MEDICINE AND THE GLOBAL GOVERNANCE OF PANDEMIC INFLUENZA.' (2013) INTERNATIONAL JOURNAL OF HEALTH SERVICES, 43(1): 105-121.
While still significant, the 2009 H1N1 (A) influenza pandemic was generally viewed as comparatively mild in contrast to past influenza pandemics. Even so, the conventional response of many governments to protect their populations against the threat from the H1N1 virus was to ensure adequate vaccine production and/or access to supplies of vaccines and antiviral medications. In this article, I examine the influence of biomedical knowledge (and the professionals that wield it) in determining the acceptable and rational limits of influenza public policy from 1918 to today. Particular attention is given to the role that medical practitioners have played in shaping post-World War II influenza policy and governance structures, together with the development, deployment, and political effect of more recent biomedical techniques—such as evidence-based medicine—in reinforcing the importance attached to influenza vaccines and antivirals. The article concludes by discussing how the intense focus on pharmaceutical-based solutions reflects a particular view of biomedicine that has had serious political implications in distorting global health governance arrangements, and I argue that only by unpacking these structures and revealing the political authority in play can alternative policy responses more appropriate to a wider proportion of humanity be considered.
'ASIAN CONTRIBUTIONS TO THREE INSTRUMENTS OF GLOBAL HEALTH GOVERNANCE' (2012) GLOBAL POLICY, 3(3): 348-361.
(co-authored with Kelley Lee, Sungwon Yoon and Jingying Xu)
It is widely recognised that the adverse impacts that transnational forces are having on health determinants and outcomes require more effective collective action. The Asian region has been among the most acutely affected by the health impacts of globalisation, while many health issues in the region have potentially far reaching consequences. The rapidly rising economic status of many Asian countries, coupled with their vulnerability to global health, points to the need to better understand their contributions to Global Health Governance (GHG). This article analyses Asian contributions to three key instruments underpinning GHG – the International Health Regulations (IHR), Pandemic Influenza Preparedness Framework (PIPF), and Framework Convention on Tobacco Control (FCTC). It finds that, if Asian countries are to move, from rule takers to rule makers, there is a need to address weak capacity in the region, to go beyond traditional notions of sovereignty, and to build trust and policy processes across the region.
'CHANGING PERCEPTIONS OF PANDEMIC INFLUENZA AND PUBLIC HEALTH RESPONSES' (2012) AMERICAN JOURNAL OF PUBLIC HEALTH, 102(1): 90-98.
According to the latest World Bank estimates, over the past decade some US $4.3 billion has been pledged by governments to combat the threat of pandemic influenza. Presidents, prime ministers, and even dictators the world over have been keen to demonstrate their commitment to tackling this disease, but this has not always been the case. Indeed, government-led intervention in responding to the threat of pandemic influenza is a relatively recent phenomenon. I explore how human understandings of influenza have altered over the past 500 years and how public policy responses have shifted accordingly. I trace the progress in human understanding of causation from meteorological conditions to the microscopic, and how this has prompted changes in public policy to mitigate the disease's impact. I also examine the latest trend of viewing pandemic influenza as a security threat and how this has changed contemporary governance structures and power dynamics.
'EVIDENCE-BASED MEDICINE AND THE GOVERNANCE OF PANDEMIC INFLUENZA' (2012) GLOBAL PUBLIC HEALTH, 7(2): S111-S126.
The conventional response of governments to protect their populations against the threat of influenza has been to ensure adequate vaccine production and/or access to supplies of vaccines and antiviral medications. This focus has, in turn, shaped the global governance structures around pandemic influenza, with collective efforts centred on facilitating virus sharing, maintaining and increasing vaccine production, and ensuring access to pharmaceuticals – responses that remain unattainable for many low- and middle-income countries (LMICs) in the short to medium term. This paper argues that this emphasis on pharmacological responses reflects a particular view of biomedicine that pays inadequate attention to the weak capacity of many health systems. In more recent years, this dynamic has been further exacerbated by the influence of evidence-based medicine (EBM) that preferences certain types of biomedical knowledge and practice. This paper explores the role that EBM has played in shaping the global governance of pandemic influenza, and how it has served to reinforce and reify the authority of particular groups of actors, including policy-makers, elected officials and the medical community. The paper concludes that only by unpacking these structures and revealing the political authority in play can alternative policy responses more appropriate to LMICs be considered.
'FRAMING GLOBAL HEALTH: THE GOVERNANCE CHALLENGE' (2012) GLOBAL PUBLIC HEALTH, 7(2): S83-S94.
(co-authored with Colin McInnes, Kelley Lee, David Reubi, Anne Roemer-Mahler, Simon Rushton, Owain Williams and Marie Woodling)
With the emergence of global health comes governance challenges which are equally global in nature. This article identifies some of the initial limitations in analyses of global health governance (GHG) before discussing the focus of this special supplement: the framing of global health issues and the manner in which this impacts upon GHG. Whilst not denying the importance of material factors (such as resources and institutional competencies), the article identifies how issues can be framed in different ways, thereby creating particular pathways of response which in turn affect the potential for and nature of GHG. It also identifies and discusses the key frames operating in global health: evidence-based medicine, human rights, security, economics and development.
'THE REVISED INTERNATIONAL HEALTH REGULATIONS: SOCIALIZATION, COMPLIANCE AND CHANGING NORMS OF GLOBAL HEALTH SECURITY' (2012) GLOBAL CHANGE, PEACE AND SECURITY, 24(1): 57-70.
(co-authored with Simon Rushton)
This paper takes a constructivist approach to examining one of the new norms embodied in the recently revised International Health Regulations (IHR). The paper focuses on the provisions that seek to restrain states from applying disproportionate international travel and trade restrictions in response to a disease outbreak occurring in another country. This new norm, which aims to limit unjustified ‘additional health measures’, has significant implications for state sovereignty. Using the example of the 2009 H1N1 ‘swine flu’ pandemic, the paper examines whether state behaviour and the discourse surrounding that outbreak supports a constructivist contention that a new norm has been created and that most states can be expected to comply with that norm most of the time. We conclude by discussing what the discourse over H1N1 suggests about the extent to which the new norm concerning additional health measures has been internalized by states.
'THE SECURITISATION OF PANDEMIC INFLUENZA: FRAMING, SECURITY AND PUBLIC POLICY' (2012) GLOBAL PUBLIC HEALTH, 7(2): S95-S110.
(co-authored with Colin McInnes)
This article examines how pandemic influenza has been framed as a security issue, threatening the functioning of both state and society, and the policy responses to this framing. Pandemic influenza has long been recognised as a threat to human health. Despite this, for much of the twentieth century it was not recognised as a security threat. In the decade surrounding the new millennium, however, the disease was successfully securitised with profound implications for public policy. This article addresses the construction of pandemic influenza as a threat. Drawing on the work of the Copenhagen School, it examines how it was successfully securitised at the turn of the millennium and with what consequences for public policy.
'THE 2011 PANDEMIC INFLUENZA PREPAREDNESS FRAMEWORK: GLOBAL HEALTH SECURED OR A MISSED OPPORTUNITY?' (2011) POLITICAL STUDIES, 59(4): 831-847.
(co-authored with Kelley Lee)
In early 2007 the Indonesian government announced that it would cease sharing H5N1 influenza virus samples with the World Health Organization's Global Influenza Surveillance Network. At the heart of the government's complaint was the fact that samples were being passed by the WHO to pharmaceutical companies which developed, and patented, influenza vaccines that the Indonesian authorities could not purchase. The decision gained widespread support among advocates of greater equity of access to medicines, and in response the WHO established an intergovernmental process to agree a framework for influenza virus sharing. The process officially concluded in April 2011 and a new Pandemic Influenza Preparedness Framework (PIPF) was agreed at the 64th World Health Assembly in May 2011. This article investigates the events that prompted the re-examination of a technical cooperation system that has provided effective global health security on influenza for 60 years, and evaluates the framework that has now been agreed. Drawing the distinction between functional and moral-political benefits, the article argues that PIPF more accurately represents a diplomatic stand-off – one that has now been effectively sidelined with the passage of the agreement – rather than genuine reform. In fact, the PIPF papers over fundamental disagreements regarding authority in global health governance, the relationship between the WHO and governments, and the role of private industry. The article concludes by examining an alternative mechanism that would arguably better address the inherent tensions between national and collective interests, and accomplish the functional and moral-political benefits that the negotiations set out to achieve.
'THE EVOLVING WHO: IMPLICATIONS FOR GLOBAL HEALTH SECURITY' (2011) GLOBAL PUBLIC HEALTH, 6(8): 801-813.
The World Health Organization (WHO) is central to the international community's efforts to control infectious disease outbreaks. In recent years, however, the Organization's powers have undergone substantial revision following a series of interconnected global events including the 2003 severe acute respiratory syndrome outbreak, the revised International Health Regulations, the emergence and spread of avian influenza, and more recently, the 2009 H1N1 Swine Flu pandemic. This paper explores how the WHO's role, authority and autonomy have been shaped and re-shaped, and examines what this may mean for the future of global health security.
'THE WHO SECRETARIAT, NORM ENTREPRENEURSHIP & GLOBAL COMMUNICABLE DISEASE CONTROL' (2010) JOURNAL OF INTERNATIONAL ORGANIZATION STUDIES, 1(1): 72-89.
In this article, I explore how a small group of committed individuals within the World Health Organization (WHO) Secretariat introduced a new norm in global communicable disease control. Drawing on Finnemore and Sikkink’s (1998) “norm life cycle” theory and Barnett and Finnemore’s (2004) work on international-organizations-as-bureaucracies, I examine how the new practice of using unofficial sources of information to verify disease outbreaks was progressively advanced under the guise of revising the International Health Regulations (IHR). By demonstrating the effectiveness of this new norm and through a favorable convergence of
events such as Gro Harlem Brundtland’s appointment as Director-General and the 2003 SARS outbreak, this small group of individuals successfully managed to embed this norm at the heart of contemporary global disease outbreak control.
'DISEASE OUTBREAKS AND HEALTH GOVERNANCE IN THE ASIA-PACIFIC: AUSTRALIA'S ROLE IN THE REGION' (2009) AUSTRALIAN JOURNAL OF INTERNATIONAL AFFAIRS, 63(4): 550-570.
The revised International Health Regulations (IHR) entered into force on 15 June 2007. In accordance with this new international treaty, every member state of the World Health Organization has been given five years in which to review their existing health systems and structures, and where necessary, improve their capacity for the detection, reporting, assessment of, and response to public health emergencies of international concern. Of course, for developed countries, it is unlikely that establishing and maintaining these core capabilities will be difficult. For many less developed countries, however, the revised IHR obligations pose a challenge on a number of fronts. This article explores some of the challenges that less developed countries face in meeting their new IHR obligations prior to discussing the role that the Australian government can play in assisting its Asia-Pacific neighbours achieve these measures.
'THE WORLD HEALTH ORGANIZATION, GLOBAL HEALTH SECURITY, AND INTERNATIONAL LAW'
In Legal Perspectives on Security Institutions, edited by Hitoshi Nasu and Kim Rubenstein. 2015. Cambridge: Cambridge University Press, pp. 225-247.
'HEALTH, SECURITY AND DIPLOMACY IN HISTORICAL PERSPECTIVE'
In Routledge Handbook of Global Health Security, edited by Simon Rushton and Jeremy Youde. 2015. Abingdon: Routledge, pp. 189-200.
'PREPARING FOR THE NEXT PANDEMIC'
In The Handbook of Global Health Policy, edited by Garrett W. Brown, Gavin Yamey and Sarah Wamala. 2014. West Sussex: Wiley-Blackwell Publishing, pp. 539-553.
'FUTURE PANDEMICS: TRANSNATIONAL HEALTH CHALLENGES IN EAST AND SOUTHEAST ASIA'
(co-authored with Hung-Lai Yu and Richard Coker)
In East and South-East Asia: International Relations and Security Perspectives, edited by Andrew Tan. 2013. London: Routledge, pp. 212-222.
'PROBLEMS AND PROSPECTS FOR HEALTH IN THE TWENTY-FIRST CENTURY'
In Governing the World Cases in global governance, edited by David Williams and Sophie Harman. 2013. Abingdon, UK: Routledge, pp. 128-141.
'THE GLOBAL HEALTH GOVERNANCE OF PANDEMIC INFLUENZA: A SNAPSHOT OF ASIA'S CONTRIBUTION'
(co-authored with Sungwon Yoon)
In Asia's Role in Governing Global Health, edited by Kelley Lee, Tikki Pang and Yeling Tan. 2013. Abingdon, UK: Routledge, pp. 99-113.
'THE INTERNATIONAL HEALTH REGULATIONS (2005): ASIA'S CONTRIBUTION TO A GLOBAL HEALTH GOVERNANCE FRAMEWORK'
(co-authored with Kelley Lee and Jingying Xu)
In Asia's Role in Governing Global Health, edited by Kelley Lee, Tikki Pang and Yeling Tan. 2013. Abingdon, UK: Routledge, pp. 83-98.
'THE SHIFTING LANDSCAPE OF PUBLIC HEALTH: FROM INTERNATIONAL TO GLOBAL HEALTH'
(co-authored with Chris Holden and Kelley Lee)
In Routledge Handbook of Global Public Health, edited by Richard Parker and Marni Sommer. 2011. United States of America and Canada: Taylor and Francis, pp. 31-37.
'THE WHO AND SARS: THE CHALLENGE OF INNOVATIVE RESPONSES TO GLOBAL HEALTH SECURITY'
In Innovation in Global Health Governance: Critical Cases, edited by Andrew F. Cooper and John Kirton. 2009. Farnham: Ashgate, pp. 63-79.
ACHIEVING GLOBAL HEALTH SECURITY: THE IMPLEMENTATION OF INTERNATIONAL HEALTH REGULATIONS.
2016. Geneva, Switzerland: Geneva Center for Security Policy.
SAVING LIVES: THE CIVIL-MILITARY RESPONSE TO THE 2014 EBOLA OUTBREAK IN WEST AFRICA.
(co-authored with Sophie Harman, Clare Wenham and Frank Smith III)
2015. Sydney, Australia: University of Sydney.