PANDEMICS AS THREATS TO GLOBAL HEALTH GOVERNANCE AND SECURITY:

EXAMINING GLOBAL RESPONSE TO SARS

A research paper submitted to

DR. RUTH LUSTERIO-RICO

And the faculty of the Department of Political Science,

University of the Philippines, Diliman

In partial compliance with the requirements for

INTERNATIONAL STUDIES 267

By

AVEMAR T. TAN

MA International Studies Program, 2002-05696

1 April 2010
I. INTRODUCTION TO THE STUDY:

A. Health and Security:

Despite the fact that health has been recognized early on as a determinant in the success

of wars as evidenced by Thucydides’ account of the eventual fall of Athens which he attributed

to the onset of the plague, the degree of attention placed on health as a factor in maintaining

national security, has wavered over the years (Maclean, 2008).

Thus, although the foundation of a system for international cooperation on the prevention

of the spread of infectious diseases was laid down in 1851 through the International Sanitary

Conference, the effort did not succeed in maintaining the idea that health concerns were directly

related to maters of state-security (Leboeuf and Broughton, 2008).

Preoccupation with the successive World Wars and the arms race between the United

States and the Soviet Union that followed during the Cold War solidified the existing primacy of

“hard security” and the extant threats to it. With the end of the Cold War however, new

discourses on a multitude of other security issues emerged (Leboeuf and Broughton, 2008;

Glasgow, 2008). One of these was the discourse of health security.

According to John Kirton and Jenilee Guebert (2009), what finally transformed

“international” efforts at managing health issues into “global” efforts were, firstly, the WHO

campaign of “health for all” launched during the 1970’s that brought to light the idea of the

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social and economic determinants of health (Kirton and Guebert, 2009). This introduced the role

of the individual as an actor and not just the nation-state cooperating with other states in limited

ways as sovereigns in charge of managing their respective health situations. In addition to this,

Kirton and Guebert (2009) also highlight the role globalization played in shifting international

focus to human security and in involving other international organizations in the field of global

health governance.

In the last two decades, globalization, which has triggered increased trade and travel

across borders, has heightened the vulnerability of states to the spread of diseases (Labonte and

Schrecker, 2007; Davies, 2008; World Health Organization, 2003; Fischer 2008). This increased

movement of people between states and territories, as history would show, has contributed to the

higher rate of transfer of disease, widening its scope and the magnitude of its geographical

spread (Fischer, 2008; Glasgow, 2008; Leboeuf and Broughton, 2008). Two examples of

communicable diseases, which quickly became pandemics, are the Severe Acute Respiratory

Syndrome (SARS) and most recently, the Swine Flu (H1N1).

In the midst of these however, there remains an absence of a global government that

could effectively address health concerns of this magnitude. Coupled with the international norm

of the sovereignty of states, linking efforts towards a similar goal and inciting obedience among

states to follow certain measures have been quite a challenge (Mitrany, 1966; Brown, 2002). The

implications of states’ failing to cooperate in such instances may prove to be devastating. It is

thus necessary that an examination into the way by which the existing global health governance

regime responded to the threat of epidemics such as SARS be done to determine which specific

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international laws, principles and norms in place were instrumental in a controlling the spread of

the disease. More specifically, this study shall examine what measures were adopted, what

difference these moves made and what factors pushed the states to cooperate.

Recognizing the increasing importance of global health governance within the context of

an anarchical international state system, the ways in which international institutions such as the

World Health Organization responded to the threat of the global pandemics such as SARS are but

necessary.

This research thus aims to study the way by which the international community

collectively addressed the specific pandemic of Sever Acute Respiratory Syndrome or (SARS). It

shall attempt to point out areas for further improvement and opportunities for strengthening

global health governance in the present context.

B. Research Question: How did the current global health governance regime respond to the

SARS pandemic and what implications would these responses have for the future of global

health governance?

Guide Questions:

1. What constitutes the global health governance regime?

2. How did the regime respond to the threat of SARS?

3. What affect did these responses have on the containment, prevention and cure of these

two pandemics?

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 4. What are the areas for further improvement in responding to global health concerns

particularly in cases of communicable diseases?

C. Argument of the Study:

This study argues that the response of the global health governance regime, as

represented in particular by the World Health Organization, to the pandemic of SARS has

implications on the evolution and development of global health governance and state cooperation

in terms of issues on infectious diseases.

D. Research Objectives:

1. To inform the reader about the history and development of the existing global health

governance regime and the main actors present under the system

2. To analyze how the existing regime’s response to the threat of SARS affects global health

governance

3. To trigger further academic research into the possible ways by which the current global

health governance system may be improved to better-equip it in dealing with global

pandemic threats such as SARS

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 E. Theoretical Framework of Analysis:

David Mitrany’s seminal work “A Working Peace System” that contains a series of his

essays written some time between 1943 and 1955 serves as the theoretical ground on which this

paper rests. Written years after the dissolution of the League of Nations and the subsequent

Second World War, Mitrany’s essays confront a period where state cooperation has been severely

challenged in light of prevailing sentiments of state sovereignty. In his works, Mitrany posits the

idea that “the root of international problems and the real obstacle to international cooperation and

peace is the division of the world into sovereign states” (Siddiqi, 1995).

Relative to this observation, he proposes the idea of the functional alternative and of

functional actions in building an international society. In contrast to the traditional idea of ceding

state sovereignty in favor of international superstructures that shall govern state relations,

Mitrany suggests the development of cooperation in areas which most if not all states would

have a sufficient stake and benefit (Mitrany, 1966). He theorizes of a functional approach that

would require states to pool rather than surrender, part of their sovereignty and which would

marry power to specific functions (Mitrany, 1966; Siddiqi, 1995).

Mitrany identifies the area of health as one of those where functional cooperation may be

useful. He alludes to the International Sanitary Conference of 1851 to illustrate how states took it

upon themselves to collaborate and resolve the pressing issue of the cholera outbreak that was

then being transmitted via trading ships (Mitrany, 1966). While at the core of Mitrany’s theory is

the centrality of the “state” as an international actor, his theory remains timely and relevant even

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at the present where multiple actors have been known to exist. This is because the usual culprits

that prevent the successful application of international laws and conventions remain to be the

idea of sovereign states refusing to bend to the dictates of the consensus of the majority of

nations.

F. Organization, Scope and Limitation of the Study:

This paper examines the current global health governance regime’s response to SARS

and its implications on the reformation and development of global health governance. As such,

there is a need to clarify what constitutes the said regime. The first portion of the succeeding

section is devoted to a discussion on the evolution of health governance from its “international”

to its present “global” form. In passing, the conventions reached during the early International

Health Sanitary Conferences is considered, along with the existing, relevant international health

laws relating to the management of communicable and infectious diseases.

After establishing what constitutes the regime in question and who the notable actors in

the system are, the study goes on to present data on the emergence of the Severe Acute

Respiratory Syndrome pandemic which was formally recognized in early 2003. This particular

infectious disease has been chosen for this study since it has been considered as the “second

major event of the 21st century to change the perception of the infectious disease threat in the

eyes of politicians and the general public” (Heymann and Rodier, 2004a). In particular, with the

SARS pandemic came the realization that through globalization, infectious diseases have become

more potent threats to human health and safety (Heymann and Rodeir, 2004a). Basic facts on

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how the disease is transmitted, its symptoms, and the statistical data on its geographical spread

are also provided to illustrate its magnitude followed by the central discussion on the operational

response carried out by the regime to address the pandemic. The paper looks particularly at the

World Health Organization, the UN organization that took up the lead role in containing the

threat. Various efforts, including the actions taken by states such as China who were hit

particularly hard by the spread of the disease, is also recognized.

The fifth part of the paper focuses on the implications of the SARS pandemic on global

health governance, in particular, on how the operational responses and its results will affect the

role of the World Health Organization and the prevailing health governance regime. This is

followed by an analysis, which has at its core, David Mitrany’s (1966) theory of functional

cooperation after which the study’s conclusions are laid out and the recommendations for further

action and research are likewise detailed.

While an assessment of the World Health Organization’s operational response to

containing SARS is an equally interesting and important topic to address, this has not been

attempted due to the limited time, capacity, resources and space, which constrained the author. In

addition, such a study would warrant the development of sound and justifiable criteria to serve as

benchmarks for the evaluation, a task that would take significant amounts of further research,

which the writer cannot sufficiently undertake at this point to mount a credible and scholarly

assessment. Future attempts at developing such a criteria for examining WHO’s operational

response to SARS may however benefit from a rather similar work written by Javed Siddiqi

(1995) entitled “World Health and World Politics.”

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 II. WHO GOVERNS? GLOBAL HEALTH GOVERNANCE IN AN ANARCHICAL

WORLD

At no other time has the effect of globalization on health been more profoundly

highlighted as it was in early 2003 when the world was jolted by the news of a fast-spreading,

highly infectious and incurable disease, Severe Acute Respiratory Syndrome (SARS) (Heymann

and Rodier, 2004a; World Health Organization, 2003; Davies, 2008; Smith, 2009; Kirton and

Guebert, 2009; Fischer, 2008). Heightened globalization that has brought the world closer via

fast and accessible modes of travel have likewise permitted the faster transmission of

communicable diseases across borders where human vectors of disease can easily switch

locations, mingle with other members of the population and transmit the pathogen.

Yet despite the relatively recent advent of globalization and of SARS, which rode its

waves, the initial response to this event as well as the UN agency that led global efforts for the

disease’s containment has its roots in as far back as the 1851 International Sanitary Conference

(Siddiqi, 1995; Kirton and Guebert, 2009; Loughlin and Berridge, 2002).

Due to the Industrial Revolution of the 19th Century, which brought forth significant

developments in travel and trade, new diseases found its way across once unchartered borders

(Siddiqi, 1995; Loughlin and Berridge, 2002). In response, quarantine measures, which had

earlier been employed in the 15th century by Italian city-states were set in place at various ports

(Siddiqi, 1995; Fidler, 1999; Maclean, 2008). These quarantine measures were, however,

arbitrary in nature and the costs relating to such measures lay heavily on maritime nations such

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as Britain and France who eventually feared economic collapse more than the threat of new

disease (Siddiqi, 1995; Fidler, 1999; Maclean, 2008). Thus, there were those among these states

who opposed quarantine measures and sought to abandon them (Siddiqi, 1995). However, in

1830 and 1847 successive cholera outbreaks plagued Europe, pushing the affected nations to

collaborate in order to contain and prevent its further spread (Siddiqi, 1995; Maclean, 2008).

The first of what would be eleven International Sanitary Conferences that took place on

23 July 1851 in Paris actually accomplished little in terms of setting specific measures to contain

cholera (Siddiqi, 1995; Maclean, 2008; Leboeuf and Broughton, 2008). This was due in part to

the lack of correct information on the nature of the disease and the refusal of Britain to accept

proposals to adopt quarantine measures, arguing that the disease was not communicable (Siddiqi,

1995). In spite of the fact that the Conference contributed little in the development of strategies

to combat cholera, this first International Sanitary Conference has been identified as the earliest

example of international attempts at cooperation in the area of health. (Siddiqi, 1995).

Subsequent International Sanitary Conferences were held but again, there was meager

progress until the seventh conference, which gave way to the first International Sanitary

Convention that mandated sanitary measures for Westbound ships passing through the Suez

Canal (Siddiqi, 1995; Fidler, 1999; Loughlin and Berridge, 2002). Other Conventions dealing

with specific diseases such as the plague were eventually conceived and eventually, these were

codified and consolidated during the eleventh International Sanitary Conference (Siddiqi, 1995).

In addition to this, an agreement creating an international health office called the Office

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International d’Hygiene Publique (OIHP) was also reached (Siddiqi, 1995; Fidler, 1999). This

became the precursor of present-day World Health Organization (Siddiqi, 1995).

The central role played by this Office was eventually replaced when in the 1920’s the

League of Nations was established, and along with it, a League Health Organization (Siddiqi,

1995; Fidler, 1999; Loughlin and Berridge, 2002; Maclean, 2008). With the eventual dissolution

of the League and the rise of the United Nations came a new organization, the present-day World

Health Organization (WHO), whose objective is the “attainment by all peoples of the highest

possible level of health” (World Health Organization, 2006).

According to David Fidler, the WHO, through Article 21 of its Constitution promulgated

the International Health Regulations (IHR) as the “only international health agreement on

communicable diseases that is binding on [WHO] Member States” (Fidler, 2003; World Health

Organization, 1996).

The International Health Regulations represents the evolution of the consolidated treaties

on the control of infectious diseases that were produced between 1851 and 1945 as well as

subsequent international agreements on issues such as sanitary quarantine requirements (Fidler.

1999). The sheer amount of these treaties during the period after the war had weakened the

prevailing health governance regime since it contained inconsistencies, holes, or were otherwise

overlapping and confusing thus creating the need for its eventual consolidation and also, the

creation of a single specialized agency to promote international health cooperation (Fidler, 1999;

Siddiqi, 1995).

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 Working around the prevailing Westphalian state system, the IHR sought maximum

security with minimum interference (Fidler, 1999). This was done through the development of a

global surveillance system for the diseases mentioned in the IHR namely yellow fever, the

plague and cholera (Fidler, 1999).

By the time the global threat of SARS emerged however, the prevailing International

Health Regulations, which the World Health Organization had begun to reform in 1997, proved

to be outdated and technically inapplicable to the situation. However, the same basic principles

and action plans contained in the IHR were set in place during the SARS pandemic.

III. SEVERE ACUTE RESPIRATORY SYNDROME: PROFILE OF A KILLER

Severe Acute Respiratory Syndrome (SARS) first came to the attention of the WHO

sometime in late February 2003 through the late Dr. Carlo Urbani who alerted the Organization

on the news of an unidentified respiratory illness infecting hospital staff in Hong Kong and

Vietnam (World Health Organization, 2003; Gerberding, 2003). Dr. Urbani died of the disease

late the following month and became one of SARS’ early casualties (World Health Organization,

2003).

By 12 March of the same year, the WHO issued its first global alert on cases of “atypical

pneumonia” with the following symptoms: high fever (temperature greater than 100.4°F

[>38.0°C]), headache, overall feeling of discomfort, body aches and mild respiratory symptoms

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(WHO, 2003c; Center for Disease Control, 2004). Some patients developed diarrhea and most

developed pneumonia (Center for Disease Control, 2004). It was later determined that SARS was

caused by a new strain of coronavirus that is believed to have originated from domesticated

game animals (WHO, 2003c).

The virus began its attack in the Chinese province of Guangdong in as early as November

2002 where multiple independent cases of SARS were recorded in seven of its municipalities

(WHO, 2003c). While news of a deadly disease spread, it has been widely documented that

China had not reported the cases to the WHO and that even after the Organization had inquired

about the rumors of a “fatal flu” they downplayed the incident and claimed that it was under

control (Smith, 2009). Not long after these early cases, the number of patients suffering from the

symptoms mentioned had rapidly increased (WHO, 2003c). All in all, there were a total of 1,512

confirmed cases of SARS in the Guangdong outbreak (WHO, 2003c). Especially vulnerable

were the elderly and the health care workers in urban hospitals where patients were treated and

where the disease is believed to have amplified in terms of transmission (WHO, 2003c).

From China, the virus easily spread to Hong Kong, Vietnam, Singapore and Canada

through air travel after a doctor who treated patients in China (Mainland) with atypical

pneumonia reported suffering from the same symptoms when he spent a night in a hotel in Hong

Kong. Through contact tracing, it was determined that around 16 people who occupied rooms at

the same floor had been infected. In turn, these people had traveled by air to other countries

including Vietnam and Canada, bringing with them the deadly pathogen resulting into an

international outbreak (WHO, 2003c).

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 One hundred days into the outbreak in 18 June 2003, SARS was determined to have

claimed seven hundred seventy five (775) lives out of a cumulative total of eight thousand four

hundred three (8,403) probable cases spanning twenty nine (29) states (WHO, June 2003b).

Ninety-five percent (95%) of reported cases occurred in the Western Pacific Region (World

Health Organization Regional Committee, 2003). By the end of its run, the fatality ratio of SARS

was at 11% (WHO, 2003c).

What made SARS particularly worrisome during the early days of its detection was the

fact that it did not respond to any course of treatment known to address lung infections and most

patients had since then developed severe pneumonia from which none had yet recovered (WHO,

2003c). In addition to this, health workers comprised a considerable percentage of those infected,

threatening the very institutions meant to address the concern (WHO, 2003c).

IV. OPERATIONAL RESPONSE TO THE SARS PANDEMIC:

Health management and protection has traditionally been considered the sole

responsibility of the state to its population where the “state governments are assumed to have

ultimate authority over their own domestic affairs” (Smith, 2009; Fischer, 2008). The present

scenario characterized by heightened globalization has however challenged this notion especially

as the SARS case had shown, disease essentially “respects no borders” (Fischer, 2008). In

responding to the threat of SARS therefore, the WHO’s capacity and influence was tested, while

the norm of state sovereignty was also tried.

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 The global health governance regime governing the management of communicable

diseases is composed existing norms, principles and conventions on health as codified in the

1969 International Health Regulations (the revisions of which had yet to be finalized at the time

of the outbreak). To-date, it remains the only internationally binding agreement on the

management of communicable diseases (WHO, 1996; Fidler, 2004). Despite being archaic,

addressing a very limited number of diseases specifically yellow fever, the plague and cholera,

its core principles and strategies for action became the foundation on which the response of the

international community, as spearheaded by the WHO, were based. In particular, conventions on

quarantine measures and disease surveillance that had been 19th century innovations were the

same core ideas employed in the management of SARS years later (WHO, May 2003a;

Heymann and Rodier, 2004b).

For instance, even prior to the first known cases of SARS which have been determined to

have emerged around November of 2002, the WHO had already set in place a Global Outbreak

Alert and Response Network (GOARN) in the year 2000 and a Global Public Health Intelligence

Network (GPHIN), a “web-crawling computer application,” in 1997 (WHO, 2003d; Heymann

and Rodier, 2004b). These surveillance mechanisms proved to be vital in alerting global health

governance actors such as the World Health Organization on emerging infectious diseases which,

most often than not, depends on the state’s willingness to report considering the potential

negative consequences of a reported outbreak (Smith, 2009; WHO 2003d).

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 Through the GPHIN, the World Health Organization was able to pick-up reports of a flu-

like outbreak in Mainland China in as early as 27 November 2002 (Heymann and Rodier,

2004b). Acting on its suspicions, WHO requested for further information from the Chinese

Ministry of Health but were informed that the cases were normal and were occurring among

Beijing and Guangdong’s school-children (Heymann and Rodier, 2004b). By February 2010 the

GPHIN again picked up news on a “strange contagious disease” but although Chinese officials

confirmed the existence of an outbreak on the 19th of that month, they had declared that it was

under control (Heymann and Rodier, 2004b; WHO, 2003c).

The World Health Organization’s operational response to SARS, according to a document

relased on line last 16 April 2003, was through four fronts namely “(1) On the ground-and in the

air; (2) on the ground-international field support and logistics coordination; (3) epidemiological

networking and (4) clinical networking” (WHO, April 2003d).

“On the ground-and in the air” response aimed primarily at information dissemination.

The WHO issued various global alerts and travel advisories, often without the state’s prior

consent (WHO, April 2003d; WHO, March 2003; Smith, 2009; Fidler, 2004; Zacher 2007). After

its initial global alert on 12 March 2003 wherein the WHO advised that persons suffering from

atypical pneumonia be isolated and treated according to strict public health regulations, the

Organization continued to issue regular updates, reports, alerts and travel advisories keeping the

international community informed on the spread of the disease (WHO, 2003c; Heymann and

Rodier, 2004a).

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 By the second alert on 15 March 2003, which came in the form of an emergency travel

advisory, the WHO was able to provide a name and case definition for the disease, triggering the

beginning of coordinated global efforts (Heymann and Rodier, 2004b). WHO also undertook

proper information management which meant verifying which reports constituted new cases of

SARS and consequently, dispelling other baseless rumors about the disease (WHO, April 2003d).

Case identification, to ascertain if they are indeed SARS, was likewise performed by national

and international teams coordinated by the WHO.

The Organization, which took the central role in this particular case successfully

mobilized health and epidemiology experts from various states to assist in identifying the cause

of SARS and develop a possible cure (Smith, 2009). Just two days after the emergency travel

advisory was released, WHO was able to bring together, through virtual networks, groups of

health experts, epidemiologists and clinicians from various research laboratories, an

unprecedented feat and laudable attempt at identifying, among other things, SARS’ causative

agent (WHO, May 2003; Smith, 2009; Heymann and Rodier, 2004b).).

Through its on the ground-international field support and logistics coordination, around

60 health experts representing 20 organizations and 15 nationalities teamed up with the existing

GOARN to review progress, compare experiences and plan further action in containing SARS

(WHO, April 2003d).

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 The subsequent document published by the World Health Organization’s Regional Office

for the Western Pacific in August of 2003 lists the following activities undertaken by the

Organization in response to SARS:

(1) “Establishing a regional response and preparedness team at the regional office;
(2) Sending many experts to countries to support response and preparedness
activities;
(3) Sending emergency supplies to both affected and unaffected countries;
(4) Developing practical infection control and preparedness guidelines and training
materials;
(5) Coordinating with other international agencies and donors; and
(6) Collecting information on SARS and successful control strategies and
disseminating it to Member States and the international community” (WHO Regional
Office for the Western Pacific, August 2003).

In turn, Member States likewise responded through the following ways:

(1) “Infection control procedures were significantly strengthened in

health care settings;
(2) enhanced surveillance was conducted to detect any possible cases;
(3) potential cases were rapidly isolated in proper isolation facilities;
(4) aggressive contact tracing was carried out and close contacts were
quarantined;
(5) communities were mobilized to implement control measures;
(6) awareness campaigns were conducted among the general
population; and
(7) information was shared with other Member States and with WHO”
(WHO Regional Office for the Western Pacific, August 2003).

Due to these coordinated efforts, the spread of SARS was stopped less than a year from

the time it first emerged.

V. ANALYSIS: IMPLICATIONS OF THE RESPONSE TO SARS TO GLOBAL

HEALTH GOVERNANCE

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 The speed at which the SARS pandemic was addressed, contained and resolved has been

lauded in a number of works (such as Gerberding’s 2003 article in the New England Journal of

Medicine). However, much remains to be done in terms of strengthening and reforming the

current global health governance system.

The fact that during the time of the SARS outbreak, the International Health Regulations,

last amended in the 1981, covering only yellow fever, the plague and cholera, was the only

legally binding international agreement among WHO member states when it comes to

communicable diseases has had immense implications in the way states responded to the 2003

pandemic. In particular, China, who has been heavily criticized for failing to report the first few

cases of the disease after it was detected by local authorities in November 2002 cannot deemed

as violating any international convention considering that it was legally under no international

obligation to report the existence of the newly emergent disease. Such behavior, in light of an

already anarchical system would prove to be all the more uncontrollable and unpreventable in the

absence of any treaty, convention or international regulation requiring states to report newly

discovered infectious diseases.

In place of the outdated regulations, the WHO responded by creating the GOARN and the

GPHIN but again, in the absence of a backbone legal structure through which it could require or

press for compliance, the reports secured by the network, as the SARS experience shows,

requires the confirmation of the state involved.

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 In addition, even though requisite international laws on reporting the existence of

communicable disease were properly in place, the prevailing Westphalian state system prevents

any international organization from exacting punishment on erring states, and is constrained to

use naming and shaming tactics as what WHO did to pressure China into providing accurate

reporting on the disease.

Despite the plausibility of functional cooperation in areas such as disease control and

health as Mitrany upholds in his 1966 work, one cannot expect full disclosure on the part of

sovereign states when it comes to these matters considering, as the case of 19th century Britain

and France, control measures needed to contain pandemics would have negative effects on trade

and the state’s economic well-being. In the recent SARS outbreak the economies of nations in

the Asian region registered $11 billion to $ 18 billion in losses particularly from the hard-hit

airline and tourism industries.

Also, in the face of frequent allusions to the existence of a highly globalized international

system, states remain to be primary actors and decision-makers particularly in situations of this

magnitude. Fidler’s (2003) observation is worth noting: “the problem by-passes the state but the

solution has to rely on the state through the medium of international law.” Although globalization

has undermined state capacity in protecting itself from the entrance of outside threats of disease,

at the end of the day, the state remains to be the sole institution with the capacity and authority to

address the issue (Smith, 2009; Fidler, 2003). This is unless the state has an inadequate public

health system in place and it would willingly seek the intervention of international organizations

and other non-governmental institutions and even then, should the state require assistance, all

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efforts remain to be under their supervision. Consequently, the World Health Organization for its

part, does not possess the sufficient capacity and resources to go down at the national level to

address actual provision of healthcare to patients suffering from SARS (Smith, 2009).

Thus, while the World Health Organization can mount successful disease surveillance

operations, provide accurate and up-to-date information on the pandemic and coordinate research

on epidemiology and clinical management, the successful containment of the disease is still

dependent upon the quality and capacity of national health networks and institutions who shall be

directly handling the reported cases. Thus, while the cliché “disease knows no borders” may be

valid, it must be realized that the “the prevalence and severity of diseases do correspond to

borders reflecting real differences in state capacity” (Smith, 2009). It is in this sphere that global

health governance regimes and institutions exercise no authority.

It must also be pointed out that despite all references to “global” health governance which

exists in literature, the response to the SARS pandemic has been largely state-driven considering

that reporting was noticeably dependent on state mechanisms and actual disease management

remained in the hands of the affected states (Smith, 2009; Fidler, 2003). This is not to downplay

however, the equally valid observation that the response has achieved a new “global” scale in

that apart from inter-state cooperation, the response has been coordinated by non-state actors

such as the World Health Organization and to some extent regional organizations such as the

Association of Southeast Asian Nations.

VI. CONCLUSION AND RECOMMENDATION:

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 The brief and limited examination into the global health governance regime and its

response to the 2003 SARS pandemic leads to the following observations and conclusions:

• The global health governance regime is composed of a number of treaties,

regulations and international laws but only one, the International Health

Regulations, constitutes a legally binding international agreement governing

communicable diseases;

• International health governance has moved towards “global” health

governance where once solely inter-state cooperative mechanisms have given

way to the participation of non-state actors, such as the World Health

Organization which had taken the lead in addressing the recent pandemic;

• Despite the “global” nature of health governance, response to the outbreak

was still dependent upon or influenced by the state, its decisions, actions and

interests;

• The World Health Organization, the primary institution in global health

governance addressed the SARS pandemic through a combination of disease

surveillance, reporting, information dissemination through alerts and travel

advisories, coordination of health experts, the promotion of collaboration

among epidemiologists and clinicians from various research laboratories and

on the ground assistance to affected states;

• The existence of a global network composed of various non-state groups

and regional actors combined with the state-centric manner by which SARS

TAN, Avemar T. • Pandemics as threats to Global Health Governance and Security 22 | P a g e

 was addressed shows that there is a possibility in transcending current

Westphalian concepts of international relations and crisis management but that

the same lies in the independent realization of states of their role and the

implications of their decisions in a globalized world;

• Functional cooperation in the area of health is a desirable path but again,

its feasibility is dependent upon the consensus of states to pool their

sovereignty;

This study leans towards the recommendation that further development must be made on

the global health governance regime through the conduct of more participative conventions and

assemblies pertaining to matters of health, and in particular highly infectious and communicable

diseases that would include non-state actors such as non-governmental international

organizations. Such conventions must deal with the threat of future pandemics and how it may be

effectively managed. Reporting and standard quarantine guidelines for travelers must be set in

place. Commitment aimed at strengthening national health institutions must be secured as well.

In light of the recent publication of the revised International Health Regulations, progress

may have very well been made already and the lessons from the SARS outbreak applied

immediately. As such, other courses of action which may be taken at this point is to assess the

World Health Organization’s performance in addressing this and other pandemics such as the

Avian Flu (H5N1) and the Swine Flu (H1N1). Detailed and systematic comparisons of strategies

and action plans undertaken in each of these three pandemics must also be done so as to glean

the best and effective practices which must be replicated.

TAN, Avemar T. • Pandemics as threats to Global Health Governance and Security 23 | P a g e

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