Global health governance responds to COVID-19: Does the security/access divide persist?

ABSTRACT

This paper evaluates global health responses to the COVID-19 pandemic through the ‘two regimes of global health’ framework. This framework juxtaposes global health security, which contains the threat of emerging diseases to wealthy states, with humanitarian biomedicine, which emphasises neglected diseases and equitable access to treatments. To what extent did the security/access divide characterise the response to COVID-19? Did global health frames evolve during the pandemic?

Analysis focused on public statements from the World Health Organization (WHO), the humanitarian nonprofit Médecins Sans Frontières (MSF), and the American Centers for Disease Control and Prevention (CDC). Following a content analysis of 486 documents released in the first two years of the pandemic, the research yielded three findings. First, the CDC and MSF affirmed the framework; they exemplified the security/access divide, with the CDC containing threats to Americans and MSF addressing the plight of vulnerable populations. Second, surprisingly, despite its reputation as a central actor in global health security, the WHO articulated both regime priorities and, third, after the initial outbreak, it began to favour humanitarianism. For the WHO, security remained, but was reconfigured: instead of traditional security, global human health security was emphasised – collective wellbeing was rooted in access and equity.

KEYWORDS:

• COVID-19
• global health security
• humanitarianism
• World Health Organization
• global governance

Acknowledgements

This paper benefited from the research assistance of Eliza Caldwell and Kevin Hamilton and from the financial support of the Holy Cross J.D. Power Center Research Associates Program and a Committee on Faculty Scholarship Publication Grant. This paper was presented at the 2022 British International Studies Association conference in Newcastle upon Tyne, UK and at the 2022 International Studies Association-Northeast conference in Baltimore, MD.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Namely, MSF’s ‘voices from the field’ and ‘reports’ categories (20 documents, total) and the larger WHO ‘speeches’ category, discussed in fn4.

2 Normalisation creates consistency across records, here across document groups. For example, because the WHO had twice as many documents as the CDC, absolute numbers would be misleading. To facilitate comparison, ATLAS.ti increases the relative weight of the CDC’s documents.

3 The RAs were 91.3% in agreement – per Drisko and Maschi (2016, p. 47), 80%+ is a high level of agreement – and the Krippendorff’s alpha was .955.

4 Speeches were ultimately dropped from the content analysis for lack of parity. Specifically, the WHO published 465 speeches during the study period compared to 2 for MSF and 0 for the CDC. Commentaries were included.

5 ‘Vulnerable groups’ included those identified as such and specific named groups, e.g. ‘children,’ ‘refugees,’ and ‘the elderly.’

6 A partial exception is Kirk (2020), who analysed the Obama administration’s Ebola discourse.