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

Figures & data

Table 1. Two regimes of global health code list.

Global Health Security			Humanitarian Biomedicine
Themes	Categories	Codes	Themes	Categories	Codes
Type of threat Emerging infectious diseases that threaten wealthy countries	Emerging	Emerg(e/ed/ing/ence) (L'10, 59; L'17, 71; Y'11, 814; J/S'14, 996); unusual (Y'11, 2019); unknown (L'17, 78); unpredictable (L'17, 80; J/S'14, 1003); acute (R'11, 784; Y'11, 819); potential (L'10, 65); circulation (L'10, 72); spread(ing) (L'10, 67)	Type of threat Neglected diseases that afflict poor countries	Neglected	Neglected (diseases) (L'10, 60; J/S'14); existing (L'10; J/S'14, 998); forgotten (diseases) (L'10, 60); chronic (J/S'14, 997); tropical (J/S'14, 997); preventable (R'11, 785; J/S'14, 997); treatable (L'17, 73)
	Threaten	Threat(en/ened/ening); risk(y); (en)danger(ous); fear (L'10, 59; L'17, 71; R'11, 779; Y'11, 814; J/S'14; D'08, 302); weapon(ized); bioweapon; terror; attack (L'10, 59, 69; R'11, 780)		Affliction	Afflict(ion/ed/ing) (L'10, 60); affect(ing/ed); suffering; a need/needs (not ‘need to’) (L'10, 60); suffer(ing) (L'10, 60; L'17, 72; J/S'14, 998; C'12, 59)
	Wealthy countries	Global North (J/S'14, 1002); United States/US/USA; Americ(a/an); Canad(a/ian); Europe(an)/EU; Western; developed (states)*; high-income (H/W'18, 363); wealthy*		Poor countries	Poor (L'10, 60; L'17, 77; J/S'14, 997); tropics*; tropical* (regions) (J/S'14, 997); developing (countries/economies/ states); Global South*; colonial*; low-income (H/W'18, 363)
Source of pathogenicity Social and ecological transformations linked to globalisation	Globalization	Globaliz(ed/ation)’ (L'10, 60; R'11, 782); airport(s) (L'17, 143); trade; commerce; travel; markets (J/S'14, 999)	Source of pathogenicity Failure of development; lack of access to health care	Underdevelopment	Poverty (L'10, 60; L'17, 77; J/S'14, 997); impoverished; socio-economic (H/W'18, 368); infrastructure/capacity (insufficient/broken/crumbling) (L'10, 60; L'17, 72; H/W'18, 367); root causes* (J/S'14, 997); (under) development*((L'10, 64; R'11, 792; J/S'14, 1002); depriv(e/ed/ation) (C'12, 59); neglect (populations); vulnerable (J/S'14, 997), low’ (capacity) (L'17, 64)
	Transformations	Transform(ed/ation/ing) (L'10, 64); catastroph(y/ic) (L'10, 63; L'17, 73)		Lack of Access	(Lack of) access (to existing treatments/essential medicines) (L'10, 60; L'17, 72; J/S'14, 998; C'12, 58); lack; unavailable; inaccessible; scarc(e/ity)
Interventions Global disease surveillance; building response capacity; rapidly develop biomedical interventions to manage novel pathogens	Surveillance	Surveillance; monitor(ing) (L'10, 59; L'17, 72; R'11, 784; Y'11, 814; H/W'18, 368; J/S'14, 1003; D'08, 295); (early) warning; alert(ing/ed) (L'10, 59); (early) detect(ion/ed/ing) (L'10, 65); investigat(e/ed/ing/ion) (L'10, 69); identif(y/ying/ied/ication) (L'10, 69)	Interventions Provide access to essential medicines; drug and vaccine research and development for diseases of the poor	Provide Access	(Provide) access (to existing treatments/essential medicines) (L'10, 60; L'17, 72; J/S'14, 998; C'12, 58); provi(de/sion); relief; alleviat(e/ion/ing) (L'10, 60)
	Response capacity	Prepar(e/ing/ation) (L'10, 59); preparedness (L'17, 71); proactive (Y'11, 821); capacity; simulation(s); scenario(s) (L'17, 49); stockpile(s)* (L'17); readiness (L'17, 30)		Research	Research (neglected diseases) (L'10, 60; L'17, 72); intellectual property/IP/TRIPS (L'10, 74)
	Rapid management	Rapid(ly) (L'10, 64; R'11, 779); manag(ement/ing); coordinat(e/ed/ion) (H/W'18, 366)		Immediate	Urgen(cy/t/tly) (L'10, 66); emergency (C'12, 58); crisis (J/S'12, 998)
Target National public health infrastructures	National	Nation(al) (L'10, 59); sovereign(ty) (H/W'18, 365); national interest (H/W'18, 364)	Target Suffering individuals	Humanity	Individuals; huma(ns/nity)’ (L'10, 60; L'17, 72; H/W'18, 364); victims (L'10, 66); universal (H/W'18, 365; C'12, 60); collective(ly) (C'12, 60); global’; world’; international community; patient(s)’ (H/W'18, 370); solidarity (C'12, 56)
Ethic Self-protection	Protection	Protect(ing/ed/ion); contain(ed/ing/ment) (L'10, 59; R'11, 780; D'08, 295); (national) security (L'10, 62; R'11, 780; H/W'18, 364; J/S'14, 1002; D'08, 300); biodefense* (L'10, 69); risk assessment(s) (L'10, 60); border(s) (D'08, 309)	Ethic Common humanity	Principled	Equit(y/able) (L'10, 63; L'17, 71; J/S'14, 998); moral(ity); ethic(al); obligation(s); responsibilit(y/ies) (L'10, 60; L'17, 76; J/S'14, 998; C'12, 59); fair(ly/ness) (L'10, 63; J/S'14, 1004; C'12, 59); right(s) (L'10, 66; J/S'14, 997; C'12, 61); (in)justice (J/S'14, 998; C'12, 60)

Sources: L'10 (Lakoff, 2010), L'17 (Lakoff, 2017), Y'11 (Youde, 2011), J/S'14 (Jackson & Stephenson, 2014), R'11 (Rushton, 2011), H/W'18 (Harman & Wenham, 2018), D'08 (Davies, 2008), C'12 (Calain 2012).

*Codes skipped for lack of results; ‘Codes skipped for ambiguity.

Figure 1. Organisational articulations of global health security (GHS) and humanitarian biomedicine (HB).

Figure 2. Surveillance and access, relative emphasis.

Figure 3. Global health security, emphasis over time.

Figure 4. WHO, two regimes over time.

Lakoff, A. (2010). Two regimes of global health. Humanity: An international journal of human rights. Humanitarianism, and Development, 1(1), 59–79. https://doi.org/10.1353/hum.2010.0001

 Google Scholar

Lakoff, A. (2017). Unprepared: Global health in a time of emergency. University of California Press.

 Google Scholar

Youde, J. (2011). Mediating risk through the international health regulations and bio-political surveillance. Political Studies, 59(4), 813–830. https://doi.org/10.1111/j.1467-9248.2011.00918.x

 Web of Science ®Google Scholar

Jackson, Y., & Stephenson, N. (2014). Neglected tropical disease and emerging infectious disease: An analysis of the history, promise and constraints of two worldviews. Global Public Health, 9(9), 995–1007. https://doi.org/10.1080/17441692.2014.941297

 PubMed Web of Science ®Google Scholar

Rushton, S. (2011). Global health security: Security for whom? Security from what? Political Studies, 59(4), 779–796. https://doi.org/10.1111/j.1467-9248.2011.00919.x

 Web of Science ®Google Scholar

Harman, S., & Wenham, C. (2018). Governing Ebola: Between global health and medical humanitarianism. Globalizations, 15(3), 362–376. https://doi.org/10.1080/14747731.2017.1414410

 Web of Science ®Google Scholar

Davies, S. E. (2008). Securitizing infectious disease. International Affairs, 84(2), 295–313. https://doi.org/10.1111/j.1468-2346.2008.00704.x

 Web of Science ®Google Scholar

Calain, P. (2012). In search of the ‘new informal legitimacy’of Médecins Sans Frontières. Public Health Ethics, 5(1), 56–66. https://doi.org/10.1093/phe/phr036

 PubMed Web of Science ®Google Scholar