{"id":48746,"date":"2020-10-07T11:26:16","date_gmt":"2020-10-07T10:26:16","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=48746"},"modified":"2020-10-13T16:02:25","modified_gmt":"2020-10-13T15:02:25","slug":"if-the-uk-wants-to-lead-in-global-health-it-must-demonstrate-a-commitment-to-international-laws-which-underpin-global-governance","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/10\/07\/if-the-uk-wants-to-lead-in-global-health-it-must-demonstrate-a-commitment-to-international-laws-which-underpin-global-governance\/","title":{"rendered":"If the UK wants to lead in global health, it must demonstrate a commitment to international laws which underpin global governance"},"content":{"rendered":"<p><span style=\"font-weight: 400\">In Boris Johnson\u2019s <\/span><a href=\"https:\/\/www.gov.uk\/government\/speeches\/prime-ministers-speech-to-un-general-assembly-26-september-2020\"><span style=\"font-weight: 400\">speech<\/span><\/a><span style=\"font-weight: 400\"> to the United Nations General Assembly last week, the world welcomed the commitment for the UK to increase its spending to the World Health Organization (WHO) and in doing so become the <\/span><a href=\"https:\/\/www.theguardian.com\/world\/2020\/sep\/25\/uk-to-become-whos-largest-state-donor-with-30-funding-increase\"><span style=\"font-weight: 400\">largest donor to WHO<\/span><\/a><span style=\"font-weight: 400\"> if indeed the USA continues to withdraw from the organisation. The UK also increased commitments to <\/span><a href=\"https:\/\/www.gavi.org\/covax-facility\"><span style=\"font-weight: 400\">COVAX<\/span><\/a><span style=\"font-weight: 400\"> for equitable covid-19 vaccine distribution.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Yet, what has been less discussed is the commitment made for the UK government\u2019s leadership of G7, which will focus\u00a0on global health security. The UK committed to forge a network of research hubs on zoonotic disease to stop new viruses emerging; develop manufacturing capacity for vaccines and treatment; design a new pandemic early warning system, devise protocols for what governments must do in the event of an outbreak with global reach in future, and ensure tariff free supply chains for clinical resources such as personal protective equipment (PPE).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Sounds good? Well yes, but a lot of what he suggests exists already<\/span><span style=\"font-weight: 400\">\u2014<\/span><span style=\"font-weight: 400\">it exists in international law. The <\/span><a href=\"https:\/\/www.who.int\/publications\/i\/item\/9789241580496\"><span style=\"font-weight: 400\">International Health Regulations<\/span><\/a><span style=\"font-weight: 400\"> (2005) lay out clear protocols as to how governments must develop or strengthen core capacity to \u201cprevent, detect, and respond\u201d to epidemics through building surveillance and laboratory facilities. Governments must report emerging outbreaks to WHO in a timely manner. The regulations set out what governments should do at borders and within the transport industry to minimise spread, and what provision there is for WHO to make recommendations for trade or travel restrictions to minimise global disease transmission, doing so within efforts to reduce any potential impact on trade (that finely account for the balance between public health and the economy that is continuing to dominate policy decisions during covid-19).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">If this law exists, then you might ask why has covid-19 caused so much chaos, and why would any new protocols be any different? The problem is that this international law is hard to enforce, based on normative commitments to global collective action under the banner of \u201cdiseases know no borders,\u201d and considering a highly pathogenic risk in any country could pose a concern to all. For some <\/span><a href=\"https:\/\/link.springer.com\/article\/10.1057\/ip.2012.19\"><span style=\"font-weight: 400\">governments this is enough<\/span><\/a><span style=\"font-weight: 400\">, and they are willing to forego some sovereign power to WHO and other states to ensure this global public good of health security, and implement the IHR (2005) as much as possible within their state capacities.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Yet, the opposite it also true, and we have consistently seen <\/span><a href=\"https:\/\/link.springer.com\/article\/10.1007\/s11558-016-9260-1\"><span style=\"font-weight: 400\">governments flouting<\/span><\/a><span style=\"font-weight: 400\"> this international law, prioritising domestic <\/span><a href=\"http:\/\/www.ghgj.org\/Katz%20and%20Fischer_The%20Revised%20International%20Health%20Regulations.pdf\"><span style=\"font-weight: 400\">politics over the collective responsibility<\/span><\/a><span style=\"font-weight: 400\"> enshrined in the IHR (2005). Even during the early stages of covid-19 outbreak, many governments imposed travel bans, despite the WHO advising against them, which falls within WHO\u2019s mandate under the IHR (2005). We have also seen governments failing to report outbreaks to WHO in a timely manner, whether actively shirking such a responsibility, or simply not having the surveillance infrastructure to detect an outbreak in a timely manner. The only punishment governments face for non-compliance is being \u201cnamed and shamed,\u201d rather than deterrent sanctions, such as those implementable by the World Trade Organization (WTO).<\/span><\/p>\n<p><span style=\"font-weight: 400\">Given this, it is hard to imagine what the new protocols that the UK government is suggesting may cover, that isn\u2019t already included within the IHR? While the IHR (2005) are in need of some significant reforms in the wake of limitations during the Ebola outbreak and covid-19, the fundamental problem with these is not the legal content, inasmuch as their implementation and the failure of governments to comply. Why would this be any different for any new proposal that Johnson puts forward?<\/span><\/p>\n<p><span style=\"font-weight: 400\">The IHR (2005) were developed in consultation with multiple governments over many years towards the late nineties and early 2000s. Catalysed by the SARS outbreak, they were finally agreed upon, after significant deliberation, at the World Health Assembly in 2005 (the governing body of the WHO) and entered force in 2007. Points of contention in the negotiations centred on the proposed authority given to the WHO and the challenge to sovereign decision making and power during an outbreak. These issues still remain fundamental to designing new governance arrangements for global disease control<\/span><span style=\"font-weight: 400\">\u2014<\/span><span style=\"font-weight: 400\">and the question remains why would global governments collectively agree to have stricter protocols for pandemic preparedness and response, when they don\u2019t abide by the ones that they have in place already?\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">This is particularly tense for the UK government to suggest changes to international law to improve global health efforts, at the very time when the UK government itself has decided to contravene international law in \u201c<\/span><a href=\"https:\/\/www.bbc.co.uk\/news\/uk-politics-54073836\"><span style=\"font-weight: 400\">specific and limited ways<\/span><\/a><span style=\"font-weight: 400\">\u201d within the Internal Markets Bill. Given this, why would any government commit to proposed changes, when there is precedent for law to be breached by the very government who proposed it.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The success of the IHR (2005) is rooted in voluntary commitment to the normative goal of reducing the global risk of epidemics, and indeed many governments do just this. While I welcome the UK government\u2019s revitalised commitment to global health security, we must hold the government to task for the ramifications for global virus control by seemingly unrelated domestic politics within the UK. If the UK wants to be a leader in global health, then it must demonstrate a commitment to the norms and values of international law which underpin global governance.\u00a0<\/span><\/p>\n<p><b><i>Clare Wenham<\/i><\/b><i><span style=\"font-weight: 400\"> is Assistant Professor of Global Health Policy at London School of Economics. Twitter <\/span><\/i><a href=\"https:\/\/twitter.com\/clarewenham?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor\"><i><span style=\"font-weight: 400\">@clarewenham<\/span><\/i><\/a><\/p>\n<p><b><i>Competing interests<\/i><\/b><i><span style=\"font-weight: 400\">: None declared<\/span><\/i><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In Boris Johnson\u2019s speech to the United Nations General Assembly last week, the world welcomed the commitment for the UK to increase its spending to the World Health Organization (WHO) [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/10\/07\/if-the-uk-wants-to-lead-in-global-health-it-must-demonstrate-a-commitment-to-international-laws-which-underpin-global-governance\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":48747,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[263],"tags":[],"class_list":["post-48746","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-global-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - 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