. "4 Global Public Health Governance and the Revised International Health Regulations." Infectious Disease Movement in a Borderless World: Workshop Summary. Washington, DC: The National Academies Press, 2010.
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Infectious Disease Movement in a Borderless World: Workshop Summary
disease surveillance. In their contribution to this chapter, speaker May Chu and WHO colleagues Heymann and Guénaël Rodier discuss the obligation of signatories to the IHR 2005 to develop the capacity to detect, assess, and report a possible PHEIC, and they describe steps being taken by the WHO to support progress toward this ambitious and crucial goal by member nations. Chu et al. note that countries may take a variety of routes to build surveillance capacity, including collaboration and networking with other member nations and nongovernmental organizations (NGOs) not limited to the WHO. They also consider the crucial role of information networks, such as the Global Outbreak Alert and Response Network (GOARN), coordinated by the WHO, in broadcasting timely disease alerts to the worldwide health community.
The chapter’s third paper presents a view of the IHR 2005 from the perspective of the developing world. Workshop speaker Oyewale Tomori, of Redeemer’s University in Nigeria, notes that the successful implementation of the IHR 2005 depends on addressing the concerns of policy makers from resource-constrained countries. While some of these concerns are country- and region-specific, he states that “a large proportion of policy-makers in resource-constrained countries perceive that the emphasis of the IHR 2005 on the international spread of disease evinces little concern regarding the burden of infectious diseases on the nations in which they occur.”
Tomori examines significant obstacles to implementing IHR 2005 in Africa, which include multiple barriers to the establishment of surveillance systems; lack of political will and commitment to global public health; barriers to sharing public health information among countries; and constraints imposed by donor agencies on funded projects. He also describes steps that could be taken to correct misperceptions of the IHR 2005 in Africa (and elsewhere) and to enable implementation of these regulations in resource-constrained countries.
In his workshop presentation, David Fidler of Indiana University stated that the IHR 2005 represents a “radical departure from all previous uses of international law for public health purposes.” After examining the basis for this statement in his contribution to this chapter, Fidler explores a series of challenges that must be overcome if the IHR 2005 are to live up to their promise. His focus is Indonesia’s refusal to share H5N1 viral samples with the WHO’s H5N1 influenza surveillance team and the significance of this controversy to the implementation of IHR 2005 and to global public health governance in general.
In 2006, Indonesia claimed “viral sovereignty” over samples of H5N1 collected within its borders and announced that it would not share them until the WHO and developed countries established an equitable means of sharing the benefits (e.g., vaccine) that could derive from such viruses. Proposals to use IHR 2005 as a means to force Indonesia to share the samples for global surveillance purposes have failed; Fidler notes that this incident highlights the important, yet ambiguous, position of health as a foreign policy issue and its broad implications for global public health governance.