Research
You will find a complete range of our monographs, muti-authored and edited works including peer-reviewed, original scholarly research across the social sciences and aligned disciplines. We publish long and short form research and you can browse the complete Bristol University Press and Policy Press archive.
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Books: Research
To date there have been six PHEIC declarations, as well as several other health emergencies that have been considered as potential PHEICs. These non-PHEIC events fall into two distinct categories: those considered by an EC, but not declared a PHEIC; and those for which an EC was never convened, but which objectively met the criteria for declaration. In this chapter we examine each of the health emergencies declared a PHEIC in turn, followed by the non-PHEIC events. In doing so we explore how the criteria to declare a PHEIC have been understood and applied by the DG and the EC, as well as the wider considerations that each of these actors might have taken into consideration when fulfilling their functions in respect of a PHEIC under the IHR. In doing so, we demonstrate the overarching findings of this book: that the criteria to declare a PHEIC have been subject to broad interpretation by the EC beyond the legal text, which have been subsequently improperly validated by the DG in accepting the advice of EC. We structure each section first with a background to the context of the health emergency, second with detailed analysis of the apparent PHEIC decision making, third with consideration of the TRs recommended, and finally with analysis of the additional lessons learned about the broader PHEIC, IHR process and global health security. In the analysis we centre on the initial declaration of the PHEIC, and only consider later EC meetings for each disease outbreak if they are a noteworthy change in advice provided or justification.
The PHEIC mechanism has been fraught with tension since it was first introduced in 2005, with the revisions to the IHR. As this book has shown, the declaration process and decision making underpinning a declaration are the source of many of the inconsistencies regarding the PHEIC.
In the wake of COVID-19, and the widespread failures of the global health architecture to manage disease transmission, many elements of the system will come under review, and likely reform. While it is too early to know the outcomes of such processes, it is likely that the IHR will be revised in some format in the coming years, or be replaced by, or replicate, a similar mechanism through the proposed ‘pandemic treaty’. We write this book to inform such discussions and demonstrate the need to ensure that any power bestowed upon the DG is exercised in a reasonable and proportional manner. In doing so we highlight the following arguments.
First, the PHEIC criteria, as laid out in the IHR, have been inconsistently applied by the DG and the EC throughout the history of PHEIC declarations and non-declarations. To this end, there have been PHEICs declared that do not appear to meet the objective criteria found at Article 1 (and nor did the EC describe these as such). Equally, there have been other events whereby the criteria appear to have been met, but no EC was convened by the DG, or an EC was called, and a PHEIC was not declared.
Amid a global health crisis, the process for declaring a Public Health Emergency of International Concern (PHEIC) is at a crossroads.
As a formal declaration by the World Health Organization, a PHEIC is governed by clear legislation as to what is, and what is not, deemed a global health security threat. However, it has become increasingly politicized, and the legal criteria now appear to be secondary to the political motivation or outcome of the announcement. Addressing multiple empirical case studies, including COVID-19, this multidisciplinary book explores the relationship between international law and international relations to interrogate how a PHEIC is declared and its role in how we collectively respond to outbreaks.
Further to the case studies in the previous chapter, we also sought to understand whether the same inconsistencies were present in outbreaks that were not declared a PHEIC. Within this chapter we consider events for which the DG convened an EC, but which did not result in a PHEIC declaration and second, we also consider events the DG did not convene an EC for, despite the criteria appearing to be met. Considering these events enables us to have a clearer understanding of the use of executive discretion by the DG in regard to the PHEIC, particularly in respect of when an EC is convened, and the relationship between the DG and the EC. We find that multiple DGs failed to convene ECs to consider an event a potential PHEIC, despite the criteria to do so appearing to be met. We further show that the DG is unwilling to go against the advice provided by the EC, even when, as was the case with MERS-CoV, it was apparent that the criteria to declare a PHEIC had been met. This is unusual, given the advice of an EC is one of multiple considerations the DG needs to consider when determining whether a PHEIC declaration is warranted, and goes some way towards demonstrating the extent to which certain aspects of the DG role have been fettered away to the EC.
Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic virus, which is transferred to humans from camels.
Modern-day international cooperation for the control of infectious disease began in 1851 with the first International Sanitary Conference (ISC). In these meetings, ten European (city) states and Turkey gathered to map out coordinated guidelines to minimize the effects of disease along trade routes, spurred on by a series of cholera outbreaks in the 18th and 19th centuries, which had devastated port cities.1 Importantly, their mandate was to establish mechanisms to reduce disease spread, and to do so with minimal interference with international trade – a balancing act that remains at the very heart of the current IHR. Conferences continued for almost a century, expanding membership of participating states, and topics covered. While the ISCs were progressive in respect to recognizing the need for international cooperation, they were hampered by the inability to agree to terms, and indeed differences in opinion about understanding disease transmission.2 This limited efforts to create common processes for outbreak response; a tension that continues to blight cooperation for health security 170 years later. Despite these setbacks, ISCs did identify key tools for international infectious disease control: the standardization of quarantine at points of entry; the reporting of outbreaks internationally; and public health capacities to respond to an epidemic.3 By the early 20th century, international health cooperation led to the development of intergovernmental organizations for health: the Office International d’Hygiène Publique (OHIP), the Health Organization of the League of Nations4 and the International Sanitary Bureau, the precursor to the Pan American Health Organization (PAHO).5
We have witnessed the emergence of a previously unknown pathogen, which has escalated into an unprecedented outbreak and which has been met by an unprecedented response…. We do not know what sort of damage this virus could do if it were to spread in a country with a weaker health system. We must act now to help countries prepare for that possibility.1
I am declaring a PHEIC over the global outbreak of novel coronavirus. The main reason for this declaration is not because of what is happening in China, but because of what is happening in other countries. Our greatest concern is the potential for the virus to spread to countries with weaker health systems and which are ill prepared to deal with it. Let me be clear, this declaration is not a vote of no confidence in China.2
This statement helpfully highlights the key tensions within the PHEIC mechanism: is the PHEIC a tool of international law to be enacted whenever the objective criteria are met, or a political, normative device within the securitization of health to get governments to pay attention to a health emergency, or does the PHEIC fall ambiguously between the two?
The PHEIC mechanism is a tool designed to alert the globe to a new or spreading health emergency that may pose a concern to international travel and trade, and for which an internationally coordinated response may be required. In this chapter, we describe the roles of actors and process for declaring a PHEIC, providing clear and separate roles for state parties, the WHO DG, and the EC. In doing so, we lay out two of the central claims of this book. First, that the criteria to declare a PHEIC have been subject to broad interpretation by the EC beyond the legal text and mandate. Second, and linked to the first claim, that the EC is taking into account political considerations in decision making, a prerogative reserved for the DG, and in turn the DG has allowed this to occur. In the concluding section of this chapter, we outline the implications these two claims have on the good governance and legitimacy of the IHR and WHO.
State obligations in respect of the PHEIC declaration are made up of two interlocking components: first, strengthening the national health system to be able to detect and assess emerging health threats rapidly; and second, making timely notifications to the WHO regarding potential PHEIC events. Under the IHR, state capacity becomes an issue of legitimate international concern, outlined at Articles 51 and 13,2 as well as Annex 1,3 and must correspondingly ‘generate accountability and responsibility akin to those arising from erga omnes obligations’.
This chapter looks at targeting as an essential and insightful step in the policy solution formulation process. By studying how people are classified and categorized as target groups in Dutch immigrant integration policies, the chapter illustrates how the formulation of policy solutions is constrained by the taboos on the political and public agenda. By avoiding group-based policies for immigrants and applying indirect or generic policies instead, policy makers anticipate public and political approval in the pre-decision stage of policy solution definition. The analysis of targeting as part of the policy solution process contributes to this book’s aim of a constructivist understanding of the policy formulation stage. In support of the editors’ claim that, like the policy stage of problem definition, the construction of policy solutions is also marked by conflict, critique, and opposition (see Chapter 1), this chapter illustrates how policy makers cope with the ‘conflictual nature’ of solution definition through different discursive strategies for targeting. These interchanging strategies help policy makers to navigate contestation and policy taboos, within both the administration as well as the broader public and political debate. Policy makers anticipate the public approval of their policy solutions in the selection of target groups and policy instruments. Although policy formulation largely takes place in the ‘hidden’ pre-decision stage, the public is present in the stage of policy solution formulation. By anticipating public and political approval, policy makers see themselves forced to restrict the possible policy solutions to those that are considered politically opportune.
Given the contested nature of migration policies and their key focus on identity, an analysis of targeting strategies in this field provides an insightful look into the dynamics of policy solution formulation.
In the domain of agriculture in the United States (US), a ‘window of opportunity’ for policy debate and change opens up approximately every four to five years. The Farm Bill expires after that period, unless it is extended or reauthorized by Congress, usually resulting in a ‘new’ Farm Bill. Failure to do so would result in many farm programmes ceasing to operate, while other programmes would revert to the provisions from the permanent law from the 1938 and 1949 Farm Bills, which would force the government to apply outdated price support levels for some commodities, for example. The need to authorize a Farm Bill to secure funding for existing programmes, combined with the negative repercussions of this ‘sunset clause’, secures that farm legislation is a regular topic on the political agenda.
Despite being periodically up for debate, agricultural policy is an area par excellence where policy change tends to be difficult and incremental rather than far-reaching. This policy stickiness is often attributed to a policy network favouring powerful farm interest groups who prefer state intervention, while retrenchment is periodically enabled by incentives emanating from budgetary problems and trade conflicts (Moyer and Josling 2002; Josling and Tangermann 2015). While these material and institutional factors are certainly important in explaining developments in agricultural policy, they have difficulty explaining why, at specific points in time, certain policy instruments rather than other alternatives were successfully constructed as appropriate and feasible policy solutions, became part of the dominant discourse, and were eventually turned into the selected policy outcome. Moreover, sometimes these new policy solutions became the object of much contestation almost as soon as they were implemented, resulting in vigorous political debate and a fluctuation in policy instrument mixes through the discontinuation of policies and the reintroduction of ‘new’ alternative policies – or old policy instruments in new guises – over time.
Why do some solutions become serious policy contenders while others simply fade away? Utilizing the Multiple Streams Framework (MSF), in this chapter I unpack the concept of ‘value acceptability’ and explore the politics of what Kingdon (1995) calls the ‘process of alternative specification’. I focus on and reconceptualize value acceptability – defined as congruence around principles or qualities of collective action with intrinsic importance – as building discursive coalitions (Hajer 1993). Each solution is supported by a coalition of actors built around a relative convergence of preferences, values, and frames. Policy values are differentiated from political values (Stewart 2009, p 14). The latter underpin the design of governments and change slowly, if any, for example freedom or equality, while the former permeate specific governance measures and may change frequently, such as zero-tolerance policy as a form of being tough on crime. Frames are highlighted selections of aspects of perceived experience to create meaning and structure social reality (Entman 1993). Hence, the crafting of solutions not only creates meaning ‘in action’ but also brings together disparate actors in a single ‘package’ replete with interpretations of the past, expediencies of the present, and estimates of the future. I examine how that process works and argue that four factors make solutions likely contenders for serious consideration and final adoption: side payments, institutional rule manipulation, short time horizons, and advocacy/framing. Political coalitions are forged around each solution by policy entrepreneurs, who mainly (but not exclusively) take part in the process through argumentation, partly the result of political conflict and partly the consequence of discursive meaning contestation.
The argument informs MSA by adding a dynamic element to the process of generating policy solutions (ideas or alternatives; I use the terms interchangeably), but it also goes beyond it by adding elements of pragmatic constructivism.
