The revised International Health Regulations: socialization, compliance and changing norms of global health security

Abstract

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.

Keywords:

• global health security
• International Health Regulations
• norm compliance
• norm life cycle
• pandemic influenza

Acknowledgements

Work on this paper was funded by the European Research Council under the European Community's Seventh Framework Programme – Ideas Grant 230489 GHG. The authors would like to thank Sara Davies and Jeremy Youde for their contribution, and the three anonymous reviewers. All views expressed are those of the authors.

Notes

1 Stephen C. Neff, ‘A Short History of International Law’, in International Law, ed. Malcolm E. Evans (Oxford: Oxford University Press, 2003), 54.

2 World Health Organization, International Sanitary Regulations. World Health Organization Regulations No. 2. Technical Report Series No. 41 (Geneva: World Health Organization, 1951); and World Health Organization, International Health Regulations (1969). Third Annotated Edition (Geneva: World Health Organization, 1983).

3 Article 2 – World Health Organization, International Health Regulations (2005), 2nd ed. (Geneva: World Health Organization, 2008), 10.

4 David P. Fidler, ‘From International Sanitary Conventions to Global Health Security: The New International Health Regulations’, Chinese Journal of International Law 4, no. 2 (2005): 325–92; and Adam Kamradt-Scott, ‘The WHO Secretariat, Norm Entrepreneurship, and Global Disease Outbreak Control’, Journal of International Organizations Studies 1, no. 1 (2010): 72–89.

5 Richard A. Cash and Vasant Narasimhan, ‘Impediments to Global Surveillance of Infectious Diseases: Consequences of Open Reporting in a Global Economy’, Bulletin of the World Health Organisation 78, no. 11 (2000): 1358–67.

6 Barbara van Tigerstrom, ‘The Revised International Health Regulations and Restraint on National Health Measures’, Health Law Journal 13 (2006): 35–76.

7 Ibid., 53–4.

8 World Health Organization, International Health Regulations (2005), 17–18.

9 Ibid., 29.

10 Ibid., Article 43, paragraph 2.

11 Martha Finnemore, ‘Are Legal Norms Distinctive?’, International Law and Politics 32 (2000): 699–705.

12 Alexander Wendt, ‘Anarchy is What States Make of It: The Social Construction of Power Politics’, International Organization 46, no. 2 (1992): 391–425.

13 Friedrich Kratchowil and John G. Ruggie, ‘International Organization: A State of the Art on the Art of the State’. International Organization 40, no. 4 (1986): 767 (emphasis original).

14 These issues are addressed in greater depth than is possible here in Sara Davies, Adam Kamradt-Scott, and Simon Rushton, Disease Diplomacy: Politics, Pandemics and Global Health Security (Baltimore: Johns Hopkins University Press, forthcoming).

15 Stephen D. Krasner, Sovereignty: Organized Hypocrisy (Princeton, NJ: Princeton University Press, 1999).

16 Robert Keohane, After Hegemony: Cooperation and Discord in the World Political Economy (Princeton, NJ: Princeton University Press, 1984).

17 For a comparison of realist, neoliberal and ‘cognitivist’ approaches to international regimes see Andreas Hasenclever, Peter Mayer, and Volker Rittberger, Theories of International Regimes (Cambridge: Cambridge University Press, 1997), 1–7.

18 Peter M. Haas, ‘Choosing to Comply: Theorizing from International Relations and Comparative Politics’, in Commitment and Compliance: The Role of Non-binding Norms in the International Legal System, ed. Dinah Shelton (Oxford: Oxford University Press, 2000), 62.

19 Sheela V. Basrur, Barbara Yaffe, and Bonnie Henry, ‘SARS: A Local Public Health Perspective’, Canadian Journal of Public Health 95, no. 1 (2004): 22.

20 United Nations System Influenza Coordinator and World Bank, Animal and Pandemic Influenza: A Framework for Sustaining Momentum. Fifth Global Progress Report, July 2010 (Bangkok: UNSIC and World Bank, 2010), 31.

21 Jon Cohen, ‘Out of Mexico? Scientists Ponder Swine Flu's Origins’, Science 324, no. 5928 (2009): 700–702.

22 World Health Organization, ‘Influenza-like Illness in the United States and Mexico. Global Alert and Response (GAR), 24 April 2009’, http://www.who.int/csr/don/2009_04_24/en/index.html (accessed July 14, 2011).

23 World Health Organization, ‘Swine Influenza – Statement by WHO Director-General, Dr Margaret Chan. Media Centre, 27 April 2009’, http://www.who.int/mediacentre/news/statements/2009/h1n1_20090427/en/ (accessed July 14, 2011).

24 World Health Organization, ‘DG Statement Following the Meeting of the Emergency Committee. Global Alert and Response (GAR), 11 June 2009’, http://www.who.int/csr/disease/swineflu/4th_meeting_ihr/en/ (accessed July 14, 2011).

25 World Health Organization, ‘Pandemic Influenza Prevention and Mitigation in Low Resource Communities’, http://www.who.int/csr/resources/publications/swineflu/PI_summary_low_resource_02_05_2009.pdf (accessed July 15, 2011).

26 Rebecca Katz and Julie Fischer, ‘The Revised International Health Regulations: A Framework for Global Pandemic Response’, Global Health Governance 3, no. 2 (2010): 1–18; and James G. Hodge, Jr., ‘Global Legal Triage in Response to the 2009 H1N1 Outbreak’, Minnesota Journal of Law, Science and Technology 11, no. 2 (2010): 599–628.

27 World Health Organization, ‘Swine Flu Illness in the United States and Mexico – Update 2. Global Alert and Response (GAR)’, April 26, 2009, http://www.who.int/csr/don/2009_04_26/en/index.html (accessed July 15, 2011).

28 World Health Organization, ‘Swine Influenza – Update 3. Global Alert and Response (GAR)’, April 27, 2009, http://www.who.int/csr/don/2009_04_27/en/index.html (accessed July 13, 2011).

29 World Health Organization, ‘Joint FAO/WHO/OIE Statement on Influenza A(H1N1) and the Safety of Pork. WHO Media Centre – Statements’, May 7, 2009, http://www.who.int/mediacentre/news/statements/2009/h1n1_20090430/en/index.html (accessed July 14, 2011).

30 World Trade Organization, ‘Members Discuss Trade Responses to H1N1 Flu. World Trade Organization Sanitary and Phytosanitary Measures’, June 25, 2009, http://www.wto.org/english/news_e/news09_e/sps_25jun09_e.htm (accessed July 14, 2011).

31 Laura MacInnis, ‘Mexico Says Pork Import Bans Unjustified, Illegal’, Reuters, May 5, 2009, http://uk.reuters.com/article/2009/05/05/idUKL5956461 (accessed July 14, 2011).

32 David P. Fidler, ‘H1N1 After Action Review: Learning from the Unexpected, the Success and the Fear’, Future Microbiology 4, no. 7 (2009): 767–9.

33 World Trade Organization, ‘Members Discuss Trade Responses to H1N1 Flu’.

34 Phil Stewart, ‘UN Agency Slams Egypt Order to Cull All Pigs’, Reuters, April 29, 2009, http://www.reuters.com/article/2009/04/29/idUSLT11250 (accessed July 14, 2011).

35 Jomana Karadesh, ‘Wild Boars Killed in Iraq over Swine Flu Fears’, CNN.com/world, May 3, 2009, http://edition.cnn.com/2009/WORLD/meast/05/03/iraq.boars/ (accessed July 14, 2011).

36 Mohit Joshi, ‘Philippines Bans Pork Imports from Mexico, US’, TopNews.in, April 25, 2009, http://www.topnews.in/philippines-bans-pork-imports-mexico-us-2156861 (accessed September 14, 2011).

37 Maila Ager, ‘Import Ban on Pork Lifted, Except Canada’, Inquirer.net, May 4, 2009, http://newsinfo.inquirer.net/breakingnews/nation/view/20090504-203022/Import-ban-on-pork-lifted-except-Canada (accessed July 14, 2011).

38 BBC, ‘China Denies Flu Discrimination’, BBC World Service, May 4, 2009, http://news.bbc.co.uk/1/hi/world/asia-pacific/8032157.stm (accessed July 14, 2011).

39 Associated French Press, ‘China Apologises to Mexico for Tough H1N1 Flu Stand’, Channelnewsasia.com, July 4, 2009, http://www.channelnewsasia.com/stories/afp_asiapacific/view/440320/1/.html (accessed July 14, 2011).

40 World Trade Organization, ‘Members Discuss Trade Responses to H1N1 Flu’.

41 Aleksandras Budrys, ‘Russia Says Extend Pork Import Ban to Canada, Spain’, Reuters, May 4, 2009, http://www.reuters.com/article/2009/05/04/us-flu-russia-idUSTRE5431PB20090504 (accessed July 14, 2011).

42 Nadim Audi, ‘Culling Pigs in Flu Fight, Egypt Angers Herders and Dismays U.N.’, New York Times Online, April 30, 2009, http://www.nytimes.com/2009/05/01/health/01egypt.html (accessed July 14, 2011).

43 Kumanan Wilson et al., ‘Strategies for Implementing the New International Health Regulations in Federal Countries’, Bulletin of the World Health Organization 86, no. 3 (2008): 215–20.

44 World Health Organization, ‘WHO Reform. World Health Assembly Resolution WHA64.2’, May 20, 2011, http://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_R2-en.pdf (accessed July 15, 2011).

45 Andrea S. Fogarty et al., ‘Communicating Uncertainty – How Australian Television Reported H1N1 Risk in 2009: A Content Analysis’, BMC Public Health 11 (2011): 181, doi: 10.1186/1471-2458-11-181, http://www.biomedcentral.com/1471-2458/11/181.