Four: Events That Were Not Declared a PHEIC

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.

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.

MERS-CoV

Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic virus, which is transferred to humans from camels. It was first reported to the WHO in 2012, and since then has been detected in 27 countries, and has led to at least 858 deaths and 2,494 reported cases, with an estimated 35% mortality rate.1 The majority of these have occurred in Saudi Arabia, although there was a notable outbreak in South Korea.

A considerable issue with the initial global response to MERS was the lack of clear and transparent information. For example, a case was detected in the UK in a passenger recently arriving from Saudi Arabia, after the initial analysis by Public Health England MERS was confirmed, the UK was obligated to report this case to the WHO under Article 6 of the IHR. However, the UK failed to give prompt notification, and instead chose to delay notification by a few days, recognizing that the implicit assumption would be that Saudi Arabia had not complied with its duties under the IHR.2 Information sharing was mired with further delays, including the silencing of those who shared information about the pathogen without approval within Saudi Arabia.3

An EC has met ten times since the pathogen was first detected in 2012. The first two EC meetings were scant on information, with the associated report simply stating that the EC was called for an independent expert view – and it considered that additional information was required before a decision could be made as to whether to recommend the outbreak be declared a PHEIC.4 Once such data emerged, the EC reconvened to review whether the criteria to declare a PHEIC were now met, concluding at the third and fourth EC meetings that ‘it saw no reason to change its advice to the DG’5 and that it had used a ‘risk assessment approach’6 to make the unanimous decision not to declare a PHEIC.7 It is not clear what this ‘risk assessment approach’ is, what factors this takes into consideration, how they are weighted, or even how they are related to the actual criteria for declaring a PHEIC. As is well established in this book, the decision making for the declaration of a PHEIC is based on the three factors of an unusual or extraordinary outbreak, with a risk to other countries through international spread and potentially requiring a coordinated response.

Nevertheless, despite not declaring a PHEIC, and thus the DG not having the legal powers to issue TRs, the EC issued ‘advice’ for countries and the WHO including: targeted surveillance for countries with pilgrims participating in Umrah and Hajj; risk communication; increased diagnostic capacities; and sharing data on the pathogen when available. Interestingly, despite some of these recommendations clearly being targeted at Saudi Arabia, the country was never expressly addressed in the recommendations, a notable shift considering how Pakistan was highlighted in the case of polio. This suggests that the decision to include countries in the guidance produced is a nuanced decision affected by geopolitics.

By the fourth EC, there were two notable points of analysis. First, this was the first time that ‘expert advisors’ were listed as present in the EC, although there is now one advisor listed for H1N1, but as the membership was not public at the time, this was not disclosed. What is not clear is what the difference is between expert advisors and EC members, given that the members were also selected based on their expertise. It was later clarified that the expert advisors did not participate in the ‘formulation of advice to the Director-General’.8 Second, cases had already emerged beyond Saudi Arabia and there was growing concern about the potential for further international transmission; clearly, the criterion for international spread was met. Indeed, the number of different member state participants contributing to the EC had increased up to 13 by the fifth meeting. Despite this, the EC justified not recommending a PHEIC on the basis of ‘no evidence of human-to-human transmission’, while simultaneously noting that ‘the seriousness of the situation had increased in terms of public health impact’.9 Importantly, human-to-human transmission is not a requirement for a PHEIC to be declared, and this, coupled with the lack of transparency surrounding the EC, means that we are not able to fully understand why this was seen as a quasi-threshold for declaring a PHEIC. Moreover, we have not seen this emphasis placed on human-to-human transmission in other ECs – for example for Zika, which relies on a mosquito vector for transmission to occur. A comparison between MERS and Zika also raises the question of why the mass gatherings associated with Umrah and Hajj were not seen as a risk that needed to be mitigated, in the same way that the Olympic Games in Rio de Janeiro were considered a key determinant in the declaration of a PHEIC for Zika. In the seventh, eighth and ninth ECs, additional reasoning was introduced to justify the lack of a declaration. This included: that there was no sustained human-to-human transmission; that the current response activities appeared to be sufficient; and that this might become a seasonal infection. Notably at this time, the ECs included key language for the PHEIC – ‘the possibility of international spread … remains a concern’ – despite this not being included in earlier ECs when international spread had already occurred.

By the time the outbreak had emerged in South Korea, there was greater concern amid the international community, with the assumption that human-to-human transmission must be occurring, given the lack of camels in Korea. The EC noted that there was a lack of awareness among healthcare workers and suboptimal infection control in hospitals where cases appeared to be spreading.10 It even stated: ‘The recent outbreak in the Republic of Korea demonstrated that when the MERS virus appears in a new setting, there is great potential for widespread transmission and severe disruption to the health system and to society.’11 Such a statement in many ways describes the exact sort of conditions for a PHEIC to be declared, and the wider raison d’être 2005 revisions to the IHR, yet in this case it was seen as a mere warning, rather than a rationale for declaring a PHEIC.

The final EC had a clear intention to de-escalate the emergency. While the members (again) agreed that the event did not constitute a PHEIC, they began to use much more long-term language than in previous meetings, recognizing that the outbreak had been unfolding for three years. The EC offered ‘recommendations’ or advice to states, outside of the legal framework of the IHR, taking a long-term perspective on MERS, including: training in healthcare facilities to minimize transmission; addressing the systemic issues that impede the control of MERS in animals and humans; fostering greater data sharing and collaboration; and encouraging national leadership and a whole-of-government response.12 In spite of these recommendations occurring outside of the framework of the IHR, this informal guidance represents some of the most political advice given by an EC across any outbreaks. The EC called on politics and political systems to engage in the response, but also recognized that the fundamentals of outbreak response are based in the structures of societies and health systems and that tackling these are key to reducing the threat of pathogens.13 It is therefore disappointing to see this sort of important engagement with the political dimensions of outbreak response occur in an informal, ad-hoc manner by the EC, rather than through the formalized process created in the IHR and delegated to the DG. This is yet again another example of the mission creep of the EC, which we have identified at multiple points in this text, but once again, this has been endorsed by a DG allowing an EC to step beyond its defined treaty mandate and take into consideration factors reserved explicitly for the DG. This is not an arbitrary distinction between the role of the EC and that of the DG; political considerations, where they are taken into account in the PHEIC declaration process, must be done by the DG in line with Article 12 of the IHR. The DG is a political position, accountable to the WHA and Executive Board for their decision making, and the decision to declare a PHEIC is one that comes with political consequences for the states concerned, as well as the WHO. A situation whereby a technical committee adopts the discretionary power of the DG to consider such political consequences is beyond its legal mandate, leaving the DG with little more than a rubber-stamping role; it is expertocratic decision making and at odds with constitutional legitimacy.14

Yellow fever

In 2016, concurrently to the Zika outbreak, an outbreak of yellow fever spread from Angola to the DRC, and subsequently to China and Kenya. This resulted in approximately 8,000 cases, and 400 deaths globally (although the numbers are likely under-reported).15 Urban yellow fever is of particular concern because of the ease of transmission, combined with a high mortality rate, and the risk of spread to other urban areas through transport hubs and networks.16 This, in part, contributed to the decision to call an EC, compounded at this time by the dwindling yellow fever vaccine stockpile, which had been impacted by mass vaccination efforts across affected regions in the past decades. It is important to remember the historical context of yellow fever control:17 it is a pathogen that has afflicted trade routes for centuries, and indeed was one of the three pathogens listed in the 1969 IHR. In recent years, yellow fever has been less of a concern globally, largely due to the scaling up of efforts by the Yellow Fever Initiative (YFI), a global vaccination programme led by the WHO, UNICEF and GAVI, which has sought to vaccinate those deemed high-risk.18

Yellow fever is referenced in the decision instrument at Annex 2 of the IHR as an event that ‘shall always lead to utilization of the algorithm, because they [such diseases] have demonstrated the ability to cause serious public health impact and to spread rapidly internationally’. To this end, in May 2016, four months after the first notification under the IHR from Angola, DG Chan convened an EC. This was subsequently followed by a second (and final meeting) in August of that year.19

The report of the first EC noted that the impact of the YFI, along with updates on the global stockpile of a vaccine, were part of the briefing the EC received. It appears that these updates, along with the fact that there was a safe and efficacious vaccine as the primary medical countermeasure to mitigate against the outbreak, have gone some way to assuaging fears of the virus.20 Yet the vaccine issue became a point of contention. On the one hand, the cheap availability of a well-established vaccine (less than $1 a dose) and a considerable vaccine rollout through the YFI in recent years, coupled with the immediate rollout in areas of elevated risk and among travellers, would do a lot to minimize the potential spread of the disease. Yet, on the other, simultaneous concerns prevailed about the lack of a substantial stockpile for the vaccine and how demand could soon outstrip supply. As part of this, the EC also considered the suitability of a dose-sparing strategy – where individuals are not given as many doses within the regimen as clinically indicated – in response to the outbreak.21 While the EC stopped short of expressly recommending moving to this strategy (perhaps in recognition of its limited, and specific, role under the IHR), it recommended that this should be ‘given due consideration by the relevant experts within the WHO infrastructure to understand if this could be a way to ensure greater coverage of the finite resource’.22 Moreover, the EC gave further consideration as to how manufacturers could increase production to supply the outbreak regions in need of the vaccine. Interestingly, while it was made explicit that vaccine scarcity was not part of the criteria used for the decision making about the PHEIC, the EC nevertheless highlighted a need for international cooperation to consider approaches to fractional dosing (that is, international coordinated response efforts).

The language used in the statement from the first meeting of the EC was nuanced in the use of language required for a PHEIC declaration. Urban outbreaks were considered a serious public health event warranting intensified national action and enhanced international support (in contrast to the PHEIC requirement of ‘potentially require coordinated international response’). At this stage there was clearly a public health risk to other states, as there had already been international spread by the time of the first EC meeting. Indeed, this was part of the justification used as to why the EC was convened in the first place.23 At the second EC meeting, the Republic of Congo also attended the meeting, despite no cases having been identified there at that time. Nevertheless, ‘there was concern that intense population movements between the DRC and the Republic of the Congo pose a risk of expansion of the outbreak’.24 On this basis alone, there was a clearly identified risk of international spread, which satisfied at least one of the PHEIC criteria. To this end, the second EC recognized that yellow fever posed a public health risk to other states, and potentially required a coordinated international response to bring it under control. However, the it was not convinced that this was an ‘extraordinary’ outbreak, within the meaning of the PHEIC criteria; urban outbreaks such as those seen in Kinshasa are not unprecedented within the meaning of Article 1 of the IHR.25 At the accompanying press conference, additional insights into PHEIC discussions were provided, including the EC’s fears of the ‘potentially explosive nature of this disease and the risk internationally’.26 In contrast, it was noted that although yellow fever was a ‘public health threat’, and had crossed international borders, this did not constitute a risk of significant international spread as ‘it had been associated with migrant workers’.27 It is unclear if spread associated with migrant workers fails to be ‘significant’ in the eyes of this particular EC.

At the same time as not declaring the yellow fever epidemic a PHEIC, the EC did issue a series of ‘immediate actions’ for the WHO and member states, similar to TRs, although lacking the legal and normative weight of the IHR. These ‘immediate actions’ included: increased surveillance; vaccination; risk communication; community mobilization; vector control; vaccination certificates for travellers from infected countries; and consideration of rapid management for new importations, given the limited global supply of vaccines. The second EC was equally long-termist in its approach, making it comparable to that of the final EC for MERS – with a focus on how best to manage this endemic disease, with a focus on long-term strategies such as continued surveillance and vaccination strategies at the population level.28 This provides an interesting perspective on what happens at the end of the PHEIC, or end of an EC process. In almost all cases the PHEIC is declared over before the virus has been eradicated or supressed, and thus there needs to be greater consideration as to what happens in the wake of an outbreak, once the fanfare of the PHEIC is over. This can take two different trajectories. In one scenario, such as Ebola, the outbreak is eliminated, and preparedness efforts are increased to mitigate against future development of the spread of the disease. The second scenario is one where the outbreak is not over, such as Zika, whereby the disease becomes endemic, but at low levels, and different policy tools are introduced to ensure longer-term support for the health system and public awareness.

What is also interesting in the non-declaration of yellow fever is the discussion about the fragile health systems, which appears several times in the EC’s press conferences, and the impact that impending rainy seasons increasing transmission of vector-borne disease could have on such health systems. The EC states that there are structural challenges in resource-poor settings to deploy vaccines – the key weapon in the fight against the disease – which impedes good population coverage. The emergency on top of routine health concerns means that it is equally hard to get robust data about the effectiveness of the programme. This focus on weak health systems, while undeniably important, was used as part of the justification for the polio PHEIC declaration, but in the case of yellow fever it is seen as supplementary, rather than being part of the issue and justification of the EC. Thus, the inclusion of considerations of health system capacity seems to be non-systematic, suggesting that they are instrumentalized when useful (such as in the case of polio) but not in and of itself a justification amid EC or DG deliberations, noting indeed the lack of formal criteria for assessment within the PHEIC process.

Events for which no IHR EC was convened

Until now our argument has centred around how the EC and DG have interpreted and applied the IHR once an EC has been convened. In doing so, we have argued that the IHR are poorly designed, and inconsistently applied, due to political factors not embedded within the IHR, and reflect broader geopolitical and multilateral relations. However, in this section we will consider some events that appear to constitute a PHEIC, but for which an EC was never convened (this list is non-exhaustive).

Cholera in Zimbabwe

Cholera has long been an established part of the regulation of infectious diseases in international law from the International Sanitary Convention (1892) and being a notifiable disease under previous iterations of the IHR.29 Moreover, cholera has due prominence in Annex 2.30

The 2008 cholera outbreak began in Zimbabwe in August 2008, it quickly overwhelmed the country, and spread to South Africa, Malawi, Botswana, Mozambique and Zambia. Nearly 100,000 cases were reported, and more than 4,000 deaths over the course of the outbreak (an unusually high fatality rate for cholera).31 It is clear therefore that cholera in Zimbabwe met the criteria to be declared, or at the very least considered, a PHEIC: it was an unusual or unexpected event, at least in respect of the scale and magnitude of the outbreak, if not the source; there was a clear risk of international spread, as international spread was already occurring, and neighbouring states were proactively planning for further spread; and finally, the event required a coordinated international response. Indeed, that international response had been directly requested by the Zimbabwean government,32 and the WHO was directly involved in said response, along with other UN agencies, and international aid.33 And yet, the DG never convened an EC. Despite this, it did not stop the WHO issuing recommendations in respect of trade and travel as regards Zimbabwe – something which typically requires a PHEIC and the issuing of TRs. Nevertheless, the WHO bypassed this system and guidance as part of its DONs system (Disease Outbreak News), in which it stated that the ‘WHO does not recommend any special restrictions to travel or trade to or from affected areas. However, neighbouring countries are encouraged to strengthen their active surveillance and preparedness systems’.34 These recommendations mirror the language of TRs pursuant to Article 15 of the IHR, but as we previously argued, issued outside of the structure and formalism of Article 15, and the IHR, such recommendations lose legal, normative and accountability weight.

Cholera in Haiti

Cholera was introduced to Haiti in 2010, when, due to improper sanitation practices, infected faeces from the base occupied by the United Nations Stabilisation Mission in Haiti (MINUSTAH) entered the Artibonite river system, a river system relied on by tens of thousands of Haitians for farming, bathing and drinking.35 This resulted in the most serious cholera epidemic in recent history, infecting nearly 800,000 people and killing more than 9,000 of the cholera-naïve population.36 It has been argued that these official figures undercount both the sick and the dead from this outbreak.37 This was clearly an extraordinary event, both in scale and magnitude of harm. Cholera was introduced to the Haitian population by United Nations peacekeepers who negligently introduced the previously unknown disease into the country.38 Latterly, the UN was insulated from any accountability for this introduction, which remains even more extraordinary given that emergence hunting has proven so pivotal in other outbreaks.39 The outbreak spread rapidly throughout the country, as well as to the Dominican Republic in little over a month.40 It subsequently spread into Cuba and Mexico, demonstrating international spread.41 Moreover, a coordinated international response was desperately required to bring the outbreak under control.42 And yet, no EC was convened.

To reiterate, a PHEIC can only be declared after an EC has made an advisory determination, and an EC can only meet if the DG instructs it to do so.43 As previously stated, the process of a PHEIC starts and ends with the discretionary powers of the DG; they convene an EC, and they make the final determination to declare a PHEIC. Moreover, the PHEIC process was designed to limit and control the use of executive discretion by the DG during a health emergency.44 Given this, it is concerning to us that so much power remains vested in the DG, particularly given the involvement of the WHO within the broader UN system, as well as the lack of clarity on what triggers the DG to call an EC. It is alarming that this outbreak, given the scale if nothing else, was not considered for a fully transparent EC deliberation.

Cholera is listed as one of the few diseases whereby its detection ‘shall always lead to utilization of the PHEIC algorithm, because they [these diseases] have demonstrated the ability to cause serious public health impact and to spread rapidly internationally’.45 The implication of this is clear: it is likely that an outbreak of cholera would constitute a PHEIC, and yet, when we are concerned with two of the biggest outbreaks of cholera in the past century, there was silence from the DG. One thing that unites the outbreaks of cholera in Zimbabwe and Haiti is mismanagement of the outbreaks by the UN. In both instances the UN appears to have downplayed the severity of the outbreaks for politically expedient reasons.46 It is unclear if, or to what extent, these highly political considerations within the UN family influenced the DG in their decision to not convene an EC. This also speaks more broadly to the securitized notions of which issues get prioritized in global health security, and by default who/what does not get prioritized.47 Cholera is one of the three notifiable diseases under the 1969 IHR and, indeed, the reason for convening the International Sanitary Conferences in the 19th century. However, as infection control has improved in the global north, and noting the localized nature of cholera transmission, this pathogen is no longer perceived as posing a threat to Western economies, and thus it does not get considered for EC discussions, despite almost annual emergence globally.

Beyond naturally occurring events

While the IHR may have their origins in the control of naturally occurring disease outbreaks, the all-hazards approach embedded within the IHR (2005) is responding to the reality of the 21st century, which can include deliberate events, or a chemical or radionuclear event.48 To this end, both the use of chemical weapons in Syria, and the Fukushima nuclear disaster in Japan, could constitute PHEICs.

Use of chemical weapons in Syria began in 2013,49 with almost all the incidents being attributable to the Syrian government50 – a state party to the IHR. The WHO was notified of the events and ran situation reports in response to the conflict and use of chemical weapons.51 The most recent analysis shows that between March 2013 and February 2018, 85 reported uses of chemical weapons in Syria occurred, causing a total of 1,385 deaths and 6,568 injuries in the short term.52 There was considerable data regarding the public health impact the use of chemical weapons was having on the Syrian population, not just from the direct use of the incendiaries, but also from disruption of the healthcare system and a reduction in both the quality and quantity of food and water supplies,53 as well as from the mass displacement and international refugee crisis caused by people fleeing the violence.54

In 2011, the Fukushima Daiichi power plant in Japan was irreparably damaged by the 2011 Tōhoku earthquake and tsunami causing a reactor core and spent fuel rod meltdown, which led to large-scale radiation dispersion in contaminated water.55 While the earthquake and tsunami killed more than 18,000 people, it is thought that only one person died as a result of the meltdown, although many hospital inpatients died being moved from facilities deemed to be at risk from radiation, and 150,000 people remain unable to return to their homes more than ten years later due to radioactivity concerns. These individuals have faced further health concerns, mainly related to migration – access to health services, quality of housing, access to resources and mental health concerns – and these still remain a factor today.56 There are also still considerable clean-up efforts that remain, as the government must decide what to do with the reactors and site, worrying that moving any material, or allowing it into the sea, would have a significant effect on animal and human health.

The nature or source in and of itself is not a barrier to these events coming under the remit of a PHEIC declaration.57 Moreover, the fact that both events were geographically contained within their territory is also not a barrier to considering these events as potential PHEICs, as we have been keen to stress throughout this book that we are concerned with potential risk to other states through the international spread of disease, rather than simply actual spread – and both of these events were recognized as having the potential to spread internationally; neither source event recognizes or respects international borders. However, despite the extraordinary nature, and the fact that they did potentially pose a risk to other states through the spread of disease, and required a coordinated international response, no EC was convened for either of the events.

It has been hinted that the DG might not have convened EC for some of the events described in this book if the state in question had not given official notification to the WHO of the potential PHEIC under Article 6 of the IHR.58 Yet, Article 12 sets out that the DG shall determine whether an event ‘constitutes a public health emergency of international concern in accordance with the criteria and the procedure set out in these Regulations’.59 In order to do so, the DG shall consider:

(a) information provided by the State Party; (b) the decision instrument contained in Annex 2; (c) the advice of the Emergency Committee; (d) scientific principles as well as the available scientific evidence and other relevant information; and (e) an assessment of the risk to human health, of the risk of international spread of disease and of the risk of interference with international traffic.60

Information provided by the state party (pursuant to Article 6) is one of a range of factors the DG make take into consideration when declaring a PHEIC, or even convening an EC to consider the PHEIC question. However, Articles 9 and 10 allow the WHO to rely on notification and reports from sources other than the state party concerned, so even if official notification had not come from the state party in question, that does not prevent the convening of an EC, or declaring a PHEIC.

1

Mazin Barry, Maha Al Amri and Ziad A Memish, ‘COVID-19 in the Shadows of MERS-CoV in the Kingdom of Saudi Arabia’ (2020) 10 Journal of Epidemiology and Global Health 1.

2

Clare Wenham, ‘Examining sovereignty in global disease governance: surveillance practices in United Kingdom, Thailand and Lao People’s Democratic Republic’ (doctoral dissertation, Aberystwyth University) (2015).

3

Jeremy Youde, ‘MERS and Global Health Governance’ (2014) 70 International Journal 119; Declan Butler, ‘Tensions Linger over Discovery of Coronavirus’ (2013) Nature.

4

WHO, ‘Middle East Respiratory Syndrome Coronavirus (MERS-CoV)’ (9 July 2013) https://www.who.int/news/item/09-07-2013-middle-east-respiratory-syndrome-coronavirus-(mers-cov).

5

WHO, ‘Statement on the 4th Meeting of the IHR Emergency Committee Concerning MERS-CoV’ https://www.who.int/mediacentre/news/statements/2013/mers_cov_20131204/en/.

6

It is unclear what this actually means; it is a language inconsistent with previous meetings of the MERS EC, and meetings of ECs for other events. It is not language that is found in the terms of reference for the EC in the IHR, nor is it in the criteria that guides the EC found at Article 1.

7

WHO, ‘Statement on the 4th Meeting of the IHR Emergency Committee Concerning MERS-CoV’.

8

WHO, ‘Statement on the 5th Meeting of the IHR Emergency Committee Concerning MERS-CoV’ https://www.who.int/mediacentre/news/statements/2014/mers-20140514/en/.

9

WHO, ‘Statement on the 5th Meeting of the IHR Emergency Committee Concerning MERS-CoV’.

10

WHO, ‘Statement on the 9th Meeting of the IHR Emergency Committee Regarding MERS-CoV’ https://www.who.int/mediacentre/news/statements/2015/ihr-ec-mers/en/.

11

WHO, ‘Statement on the 10th Meeting of the IHR Emergency Committee Regarding MERS’ (3 September 2015) https://www.who.int/mediacentre/news/statements/2015/ihr-emergency-committee-mers/en/.

12

WHO, ‘Statement on the 10th Meeting of the IHR Emergency Committee Regarding MERS’.

13

WHO, ‘Statement on the 10th Meeting of the IHR Emergency Committee Regarding MERS’.

14

Christoph Möllers, ‘Constitutional Foundations of Global Administration’ in Sabino Cassese (ed) Research Handbook on Global Administrative Law (Edward Elgar Publishing 2016) 112.

15

Moritz UG Kraemer and others, ‘Spread of Yellow Fever Virus Outbreak in Angola and the Democratic Republic of the Congo 2015–16: A Modelling Study’ (2017) 17 The Lancet Infectious Diseases 330.

16

WHO, ‘Press Conference for the Meeting of the Yellow Fever IHR Emergency Committee’ (19 May 2016) https://www.who.int/mediacentre/news/statements/2016/YF-EC-19-May-2016.pdf.

17

J Erin Staples, ‘Yellow Fever: 100 Years of Discovery’ (2008) 300 JAMA 960, 100.

18

Amanda Makha Bifani, Eugenia Z Ong and Ruklanthi de Alwis, ‘Vaccination and Therapeutics: Responding to the Changing Epidemiology of Yellow Fever’ (2020) 12 Current Treatment Options in Infectious Diseases 349.

19

WHO, ‘Statement on the 1st Meeting of the International Health Regulations (2005) Emergency Committee for Yellow Fever’ https://www.who.int/mediacentre/news/statements/2016/ec-yellow-fever/en/.

20

WHO, ‘Statement on the 1st Meeting of the International Health Regulations (2005) Emergency Committee for Yellow Fever’.

21

WHO, ‘Press Conference for the Meeting of the Yellow Fever IHR Emergency Committee’.

22

WHO, ‘Press Conference for the Meeting of the Yellow Fever IHR Emergency Committee’.

23

WHO, ‘Statement on the 1st Meeting of the International Health Regulations (2005) Emergency Committee for Yellow Fever’.

24

WHO, ‘Statement on the 2nd Meeting of the International Health Regulations (2005) Emergency Committee for Yellow Fever’ https://www.who.int/en/news-room/detail/31-08-2016-second-meeting-of-the-emergency-committee-under-the-international-health-regulations-(2005)-concerning-yellow-fever.

25

WHO, ‘Press Conference for the Meeting of the Yellow Fever IHR Emergency Committee’.

26

WHO, ‘Press Conference for the Meeting of the Yellow Fever IHR Emergency Committee’.

27

WHO, ‘Press Conference for the Meeting of the Yellow Fever IHR Emergency Committee’.

28

WHO, ‘Statement on the 2nd Meeting of the International Health Regulations (2005) Emergency Committee for Yellow Fever’.

29

Adam Rainis Houston, ‘Applying Lessons from the Past in Haiti: Cholera, Scientific Knowledge, and the Longest- Standing Principle of International Health Law’ in Mark Eccleston-Turner and Iain Brassington (eds) Infectious Diseases in the New Millennium: Legal and Ethical Challenges (Springer 2020).

30

Annex 2, International Health Regulations (2005) UNTS 2509.

31

Z Mukandavire and others, ‘Estimating the Reproductive Numbers for the 2008-2009 Cholera Outbreaks in Zimbabwe’ (2011) 108 Proceedings of the National Academy of Sciences 8767.

32

Angela Balakrishnan, ‘Zimbabwe Declares State of Emergency over Cholera Epidemic’ The Guardian (London, 4 December 2008) https://www.theguardian.com/world/2008/dec/04/zimbabwe-health.

33

Balakrishnan, ‘Zimbabwe Declares State of Emergency over Cholera Epidemic’.

34

WHO, ‘Cholera in Zimbabwe’ Disease Outbreak News (2 December 2008) https://www.who.int/csr/don/2008_12_02/en/.

35

Rainis Houston, ‘Applying Lessons from the Past in Haiti: Cholera, Scientific Knowledge, and the Longest-Standing Principle of International Health Law’.

36

Pan American Health Organization, ‘Epidemiological Update – Cholera’ (24 February 2017) http://reliefweb.int/sites/reliefweb.int/files/resources/2017-feb-23-phe-epi-update-cholera.pdf.

37

Francisco J Luquero and others, ‘Mortality Rates during Cholera Epidemic, Haiti, 2010-2011’ (2016) 22 Emerging Infectious Diseases 410.

38

Rainis Houston, ‘Applying Lessons from the Past in Haiti: Cholera, Scientific Knowledge, and the Longest-Standing Principle of International Health Law’.

39

Mara Pillinger, Ian Hurd and Michael N Barnett, ‘How to Get Away with Cholera: The UN, Haiti, and International Law’ (2016) 14 Perspectives on Politics 70.

40

‘Haiti Cholera Reaches Dominican Republic’ BBC (London, 17 November 2010) http://www.bbc.com/news/world-latin-america-11771109.

41

WHO, ‘Cholera in Mexico’ (19 October 2013) http://www.who.int/csr/don/2013_10_19_cholera/en/.

42

Rainis Houston, ‘Applying Lessons from the Past in Haiti: Cholera, Scientific Knowledge, and the Longest-Standing Principle of International Health Law’.

43

Article 48, International Health Regulations (2005) UNTS 2509.

44

Christian Kreuder-Sonnen, ‘China vs the WHO: A Behavioural Norm Conflict in the SARS Crisis’ (2019) 95 International Affairs 535.

45

Annex 2, International Health Regulations (2005) UNTS 2509.

46

C Nicholas Cuneo, Richard Sollom and Chris Beyrer, ‘The Cholera Epidemic in Zimbabwe, 2008-2009: A Review and Critique of the Evidence’ (2017) 19 Health and Human Rights 249; Rainis Houston, ‘Applying Lessons from the Past in Haiti: Cholera, Scientific Knowledge, and the Longest-Standing Principle of International Health Law’.

47

Simon Rushton, ‘Global Health Security: Security for Whom? Security from What?’ (2011) 59 Political Studies 799.

48

International Health Regulations (2005) UNTS 2509 p 3.

49

The incidents have been investigated by the Organization for the Prohibition of Chemical Weapons − United Nations Joint Investigative Mechanism, the United Nations Commission of Inquiry, the OPCW Fact-Finding Mission in Syria, the United Nations Mission to Investigate Allegations of the Use of Chemical Weapons in Syria and Amnesty International; Ingrid Elliott, ‘“A Meaningful Step towards Accountability”?’ (2017) 15 Journal of International Criminal Justice 239.

50

Gregory D Koblentz, ‘Chemical-Weapon Use in Syria: Atrocities, Attribution, and Accountability’ (2019) 26 The Nonproliferation Review 575.

51

Debarati Guha-Sapir and others, ‘Civilian Deaths from Weapons Used in the Syrian Conflict’ (2015) BMJ h4736.

52

Guha-Sapir and others, ‘Civilian Deaths from Weapons Used in the Syrian Conflict’.

53

Jose M Rodriguez-Llanes and others, ‘Epidemiological Findings of Major Chemical Attacks in the Syrian War Are Consistent with Civilian Targeting: A Short Report’ (2018) 12 Conflict and Health 16.

54

Sarah Deardorff Miller, Political and Humanitarian Responses to Syrian Displacement (Routledge, Taylor & Francis Group 2017).

55

Justin McCurry, ‘Japan: The Aftermath’ (2011) 377 The Lancet 1061.

56

A Hasegawa and others, ‘Emergency Responses and Health Consequences after the Fukushima Accident; Evacuation and Relocation’ (2016) 28 Clinical Oncology 4.

57

David P Fidler and Lawrence O Gostin, ‘The New International Health Regulations: An Historic Development for International Law and Public Health’ (2006) 34 The Journal of Law, Medicine & Ethics 85.

58

Lawrence O Gostin and Rebecca Katz, ‘The International Health Regulations: The Governing Framework for Global Health Security’ (2016) 94 The Milbank Quarterly 264.

59

Article 12(1), International Health Regulations (2005) UNTS 2509; The decision instrument contained in Annex 2 referenced at (b) is the ‘Decision instrument for the assessment and notification of events that may constitute a Public Health Emergency of International Concern’. ‘Is the public health impact of the event serious? Is the event unusual or unexpected? Is there a significant risk of international spread? Is there a significant risk of international restrictions to travel and trade?’, which is typically used by states parties to determine if a public health event within their territory ought to be notified to WHO under Article 6 of the International Health Regulations, as a potential PHEIC.

60

Article 12(4), International Health Regulations (2005) UNTS 2509.

  • Abbott KW, Keohane RO Moravcsik A, Slaughter AM and Snidal D ‘The Concept of Legalization’ (2000) 54 International Organization 3

  • Aginam O, Global Health Governance: International Law and Public Health in a Divided World (University of Toronto Press 2005) https://www.degruyter.com/view/title/519380

  • Asian Development Bank, The Economic Impact of the COVID-19 Outbreak of Developing Asia (Asian Development Bank 2020), https://www.adb.org/sites/default/files/publication/571536/adb-brief-128-economic-impact-covid19-developing-asia.pdf

  • Aylward B and Tangermann R, ‘The Global Polio Eradication Initiative: Lessons Learned and Prospects for Success’ (2011) 29 Vaccine D80

  • Balakrishnan A, ‘Zimbabwe Declares State of Emergency over Cholera Epidemic’ The Guardian (4 December 2008) https://www.theguardian.com/world/2008/dec/04/zimbabwe-health

  • Barnett M and Finnemore M, ‘The Politics, Power, and Pathologies of International Organizations’ (1999) 53 International Organization 4

  • Barry M, Al Amri M and Memish ZA, ‘COVID-19 in the Shadows of MERS-CoV in the Kingdom of Saudi Arabia’ (2020) 10 Journal of Epidemiology and Global Health 1

  • Barua D, ‘History of Cholera’ in D Barua and WB Greenough (eds) Cholera (Springer US 1992)

  • Benton A and Dionne KY, ‘International Political Economy and the 2014 West African Ebola Outbreak’ (2015) 58 African Studies Review 223

  • Bifani AM, Ong EZ and de Alwis R, ‘Vaccination and Therapeutics: Responding to the Changing Epidemiology of Yellow Fever’ (2020) 12 Current Treatment Options in Infectious Diseases 349

  • Brown TM and Ladwig S, ‘COVID-19, China, the World Health Organization, and the Limits of International Health Diplomacy’ (2020) 110 American Journal of Public Health 1149

  • Brunnée J, ‘International Legal Accountability through the Lens of the Law of State Responsibility’ (2005) 36 Netherlands Yearbook of International Law 21

  • Brunnée and Toope SJ, Legitimacy and Legality in International Law: An Interactional Account (Cambridge University Press 2010)

  • Burci GL, ‘Shifting Norms in International Health Law’ (2004) 16 Proceedings of the American Society of International Law 18

  • Burci GL and Eccleston-Turner M, ‘Preparing for the Next Pandemic: The International Health Regulations and World Health Organization during COVID-19’ (2020) 2 Yearbook of International Disaster Law

  • Butler D, ‘Tensions Linger over Discovery of Coronavirus’ (2013) Nature News

  • Chan K, Zheng JP, Mok YW, Li YM, Liu YN, Chu CM and IP MS, ‘SARS: Prognosis, Outcome and Sequelae’ (2003) 8 Respirology S36

  • Cheng M, ‘Emails: UN Health Agency Resisted Declaring Ebola Emergency’ Associated Press (20 March 2015) https://apnews.com/article/2489c78bff86463589b41f3faaea5ab2

  • Chinazzi M and others, ‘The Effect of Travel Restrictions on the Spread of the 2019 Novel Coronavirus (COVID-19) Outbreak’ (2020) 368 Science 395

  • Chorev N, ‘The World Health Organization between the United States and China’ (2020) 20 Global Social Policy 378

  • Cohen NJ and others, ‘Travel and Border Health Measures to Prevent the International Spread of Ebola’ (2016) 65 MMWR Supplements 57

  • Cueto M, Brown TM and Fee E, The World Health Organization: A History (Cambridge University Press 2019)

  • Cumming HS, ‘The International Sanitary Conference’ (1926) 16 American Journal of Public Health 975

  • Cuneo CN, Sollom R and Beyrer C, ‘The Cholera Epidemic in Zimbabwe, 2008–2009: A Review and Critique of the Evidence’ (2017) 19 Health and Human Rights 249

  • Davies SE, Global Politics of Health (Polity 2010)

  • Davies SE, ‘The International Politics of Disease Reporting: Towards Post-Westphalianism?’ (2012) 49 International Politics 591

  • Davies SE, Kamradt-Scott A and Rushton S, Disease Diplomacy: International Norms and Global Health Security (Johns Hopkins University Press 2015)

  • Davies SE and Rushton S, ‘Public Health Emergencies: A New Peacekeeping Mission? Insights from UNMIL’s Role in the Liberia Ebola Outbreak’ (2016) 37 Third World Quarterly 3

  • Davies SE and Wenham C, ‘Why the COVID-19 Response Needs International Relations’ (2020) 96 International Affairs 1227

  • Davies SE and Youde J, ‘The IHR (2005), Disease Surveillance, and the Individual in Global Health Politics’ (2013) 17 The International Journal of Human Rights 133

  • Deardorff Miller S, Political and Humanitarian Responses to Syrian Displacement (Routledge, Taylor & Francis Group 2017)

  • Eccleston-Turner M and Kamradt-Scott A, ‘Transparency in IHR Emergency Committee Decision Making: The Case for Reform’ (2019) 4 BMJ Global Health e001618

  • Eccleston-Turner M and McArdle S, ‘Accountability, International Law, and the World Health Organization: A Need for Reform?’ (2017) XI Global Health Governance 27

  • Eccleston-Turner M and McArdle S, ‘The Law of Responsibility and the World Health Organization: A Case Study on the West African Ebola Outbreak’ in M Eccleston-Turner and I Brassington (eds) Infectious Diseases in the New Millennium: Legal and Ethical Challenges (Springer 2020)

  • Elbe S, Pandemics, Pills, and Politics: Governing Global Health Security (Johns Hopkins University Press 2018)

  • Elliott I, ‘“A Meaningful Step towards Accountability”?’ (2017) 15 Journal of International Criminal Justice 239

  • Fidler DP, ‘International Law and Global Public Health’ (1999) 48 Kansas Law Review 2

  • Fidler DP, ‘SARS: Political Pathology of the First Post-Westphalian Pathogen’ (2003) 31 The Journal of Law, Medicine & Ethics 485

  • Fidler DP, SARS: Governance and the Globalization of Disease (Palgrave Macmillan 2004)

  • Fidler DP, ‘From International Sanitary Conventions to Global Health Security: The New International Health Regulations’ (2005) 4 Chinese Journal of International Law 325

  • Fidler DP, ‘To Declare Or Not to Declare: The Controversy over Declaring a Public Health Emergency of International Concern for the Ebola Outbreak in the Democratic Republic of the Congo’ (2019) 14 Asian Journal of WTO and International Health Law and Policy 287

  • Fidler DP and Gostin LO, ‘The New International Health Regulations: An Historic Development for International Law and Public Health’ (2006) 34 The Journal of Law, Medicine & Ethics 85

  • Forsyth CF and Wade W, Administrative Law (11th edn, Oxford University Press 2014)

  • Fourie P, ‘The Relationship between the AIDS Pandemic and State Fragility’ (2007) 19 Global Change, Peace & Security 281

  • Franck TM, The Power of Legitimacy among Nations (Oxford University Press 1990)

  • Garrett L, Betrayal of Trust: The Collapse of Global Public Health (1st edn, Hyperion 2000)

  • Goodman NM, International Health Organizations and Their Work (2nd edn, Churchill Livingstone 1971)

  • Gostin L, ‘The Future of the World Health Organization: Lessons Learned From Ebola’ (2015) 93 Milbank Quarterly 475

  • Gostin L, ‘Ebola in the Democratic Republic of the Congo: Time to Sound a Global Alert?’ (2019) 393 The Lancet 617

  • Gostin L and Friedman E, ‘Ebola: A Crisis in Global Health Leadership’ (2014) 384 The Lancet

  • Gostin LO, ‘New Ebola Outbreak in Africa Is a Major Test for the WHO’ (2018) 320 JAMA 125

  • Gostin LO and Friedman EA, ‘A Retrospective and Prospective Analysis of the West African Ebola Virus Disease Epidemic: Robust National Health Systems at the Foundation and an Empowered WHO at the Apex’ (2015) 385 The Lancet 1902

  • Gostin LO and Katz R, ‘The International Health Regulations: The Governing Framework for Global Health Security’ (2016) 94 The Milbank Quarterly 264

  • Governments of France and Germany, ‘Non-Paper on Strengthening WHO’s Leading and Coordinating Role in Global Health’ (2020) http://g2h2.org/wp-content/uploads/2020/08/Non-paper-1.pdf

  • Griffith DC, Kelly-Hope LA and Miller MA, ‘Review of Reported Cholera Outbreaks Worldwide, 1995–2005’ (2006) 75 The American Journal of Tropical Medicine and Hygiene 973

  • Grigorescu A, ‘Transparency of Intergovernmental Organizations: The Roles of Member States, International Bureaucracies and Nongovernmental Organizations’ (2007) 51 International Studies Quarterly 625

  • Guha-Sapir D and others, ‘Civilian Deaths from Weapons Used in the Syrian Conflict’ (2015) BMJ h4736

  • Hale TN, ‘Transparency, Accountability, and Global Governance’ (2008) 14 Global Governance: A Review of Multilateralism and International Organizations 73

  • Hardiman M and Wilder-Smith A, ‘The Revised International Health Regulations and Their Relevance to Travel Medicine’ (2007) 14 Journal of Travel Medicine 141

  • Harmann S, ‘Norms Won’t Save You: Ebola and the Norm of Global Health Security’ (2017) 11 Global Health Governance

  • Harmann S and Wenham C, ‘Governing Ebola: Between Global Health and Medical Humanitarianism’ (2018) 15 Globalizations 362

  • Harrison M, ‘Disease, Diplomacy and International Commerce: The Origins of International Sanitary Regulation in the Nineteenth Century’ (2006) 1 Journal of Global History 197

  • Hasegawa, A, Ohira T, Maeda M, Yasumura S and Tanigawa K, ‘Emergency Responses and Health Consequences after the Fukushima Accident; Evacuation and Relocation’ (2016) 28 Clinical Oncology 4

  • Heymann DL and others, ‘Zika Virus and Microcephaly: Why Is This Situation a PHEIC?’ (2016) 387 The Lancet 719

  • Heymann DL and Roider G, ‘SARS: A Global Response to an International Threat’ (2004) 10 The Brown Journal of World Affairs 185

  • Hovell D, ‘The Deliberative Deficit: Transparency, Access to Information and UN Sanctions’ in JM Farrell and K Rubenstein (eds) Sanctions, Accountability and Governance in a Globalised World (Cambridge University Press 1999)

  • Huber V, ‘The Unification of the Globe by Disease? The International Sanitary Conferences on Cholera, 1851–1894’ (2006) 49 The Historical Journal 453

  • Ilunga Kalenga O and others, ‘The Ongoing Ebola Epidemic in the Democratic Republic of Congo, 2018–2019’ (2019) 381 New England Journal of Medicine 373

  • International Law Association, Final Report of the ILA Committee on the Accountability of International Organizations (ILA 2004)

  • Jee Y, ‘WHO International Health Regulations Emergency Committee for the COVID-19 Outbreak’ (2020) 42 Epidemiology and Health e2020013

  • Kamradt-Scott A, ‘The WHO Secretariat, Norm Entrepreneurship, and Global Disease Outbreak Control’ (2010) 1 Journal of International Organizations Studies 72

  • Kamradt-Scott A, ‘The Evolving WHO: Implications for Global Health Security’ (2010) 6 Global Public Health 8

  • Kamradt-Scott A, Managing Global Health Security: The World Health Organization and Disease Outbreak Control.(Palgrave Macmillan 2015)

  • Kamradt-Scott A, Managing Global Health Security: The World Health Organization and Disease Outbreak Control (Springer 2015)

  • Kamradt-Scott A, ‘What Went Wrong? The World Health Organization from Swine Flu to Ebola’ in A Kruck, K Oppermann and A Spencer (eds) Political Mistakes and Policy Failures in International Relations (Springer International Publishing 2018)

  • Kamradt-Scott A and Rushton S, ‘The Revised International Health Regulations: Socialization, Compliance and Changing Norms of Global Health Security’ (2012) 24 Global Change, Peace & Security 57

  • Katz R, ‘Pandemic Policy Can Learn from Arms Control’ (2019) 575 Nature

  • Katz R and Fischer J, ‘The Revised International Health Regulations: A Framework for Global Pandemic Response’ (2010) III Global Health Governance 1

  • Kekulé A, ‘Learning from Ebola Virus: How to Prevent Future Epidemics’ (2015) 7 Viruses 3789

  • Kingsbury B, Krisc, N Stewart R, ‘The Emergence of Global Administrative Law’ (2005) 68 Law and Contemporary Problems 3

  • Klabbers J, ‘The Paradox of International Institutional Law’ (2008) 5 International Organizations Law Review 151

  • Koblentz GD, ‘Chemical-Weapon Use in Syria: Atrocities, Attribution, and Accountability’ (2019) 26 The Nonproliferation Review 575

  • Koskenniemi M, ‘The Politics of International Law’ (1990) 1 European Journal of International Law 4

  • Kraemer MUG and others, ‘Spread of Yellow Fever Virus Outbreak in Angola and the Democratic Republic of the Congo 2015–16: A Modelling Study’ (2017) 17 The Lancet Infectious Diseases 330

  • Kreuder-Sonnen C, ‘China vs the WHO: A Behavioural Norm Conflict in the SARS Crisis’ (2019) 95 International Affairs 535

  • Krieger N, Epidemiology and the People’s Health: Theory and Context (Oxford University Press 2011)

  • Krisch N, ‘The Pluralism of Global Administrative Law’ (2006) 17 European Journal of International Law 247

  • Lauterpacht H, The Function of Law in the International Community (1st paperback edn, Oxford University Press 2011)

  • Lloyd BJ, ‘The Pan American Sanitary Bureau’ (1930) 20 American Journal of Public Health and the Nation’s Health 925

  • Loughlin M, Sword and Scales: An Examination of the Relationship between Law and Politics (Hart 2000)

  • Mack E, ‘The World Health Organisation’s New International Health Regulations: Incursion on State Sovereignty and Ill-Fated Response to Global Health Issues’ (2006) 7 Chicago Journal of International Law 365

  • McCarthy DR and Fluck M, ‘The Concept of Transparency in International Relations: Towards a Critical Approach’ (2017) 23 European Journal of International Relations 416

  • McCloskey B and Endericks T, ‘The Rise of Zika Infection and Microcephaly: What Can We Learn from a Public Health Emergency?’ (2017) 150 Public Health 87

  • McCurry J, ‘Japan: The Aftermath’ (2011) 377 The Lancet 1061

  • McInnes C and Lee K, ‘Health, Security and Foreign Policy’ (2006) 32 Review of International Studies 5

  • Möllers C, ‘Constitutional Foundations of Global Administration’ in S Cassese (ed) Research Handbook on Global Administrative Law (Edward Elgar Publishing 2016)

  • Mukandavire Z and others, ‘Estimating the Reproductive Numbers for the 2008–2009 Cholera Outbreaks in Zimbabwe’ (2011) 108 Proceedings of the National Academy of Sciences 8767

  • Mullen L and others, ‘An Analysis of International Health Regulations Emergency Committees and Public Health Emergency of International Concern Designations’ (2020) 5 BMJ Global Health e002502

  • Muyembe-Tamfum JJ and others, ‘Ebola Outbreak in Kikwit, Democratic Republic of the Congo: Discovery and Control Measures’ (1999) 179 The Journal of Infectious Diseases S259

  • Ofori-Adjei D and Koram K, ‘Of Cholera and Ebola Virus Disease in Ghana’ (2014) 48 Ghana Medical Journal 120

  • Olson KB, ‘Aum Shinrikyo: Once and Future Threat?’ (1999) 5 Emerging Infectious Diseases 413

  • Paddeu F and Waibel W, ‘The Final Act: Exploring the End of Pandemics’ (2020) 114 American Journal of International Law 698

  • Pantzerhielm L, Holzscheiter A and Bahr T, ‘Power in Relations of International Organisations: The Productive Effects of “Good” Governance Norms in Global Health’ (2020) 46 Review of International Studies 3

  • Pillinger M, Hurd I and Barnett MN, ‘How to Get Away with Cholera: The UN, Haiti, and International Law’ (2016) 14 Perspectives on Politics 70

  • Piot P, ‘Ebola’s Perfect Storm’ (2014) Nature: 1221

  • Previsani N and others, ‘World Health Organization Guidelines for Containment of Poliovirus Following Type-Specific Polio Eradication — Worldwide, 2015’ (2015) 64 MMWR. Morbidity and Mortality Weekly Report 913

  • Price-Smith AT, The Health of Nations: Infectious Disease, Environmental Change, and their Effects on National Security and Development (MIT Press 2001)

  • Rainis Houston A, ‘Applying Lessons from the Past in Haiti: Cholera, Scientific Knowledge, and the Longest-Standing Principle of International Health Law’ in M Eccleston-Turner and I Brassington (eds) Infectious Diseases in the New Millennium: Legal and Ethical Challenges (Springer 2020)

  • Rasmussen SA and others, ‘Zika Virus and Birth Defects — Reviewing the Evidence for Causality’ (2016) 374 New England Journal of Medicine 1981

  • ‘Revision of the International Health Regulations. Progress Report, February 2001’ (2001) 76 Releve Epidemiologique Hebdomadaire 61

  • Rodier G and others, ‘Global Public Health Security’ (2007) 13 Emerging Infectious Diseases 1447

  • Rodriguez-Llanes JM and others, ‘Epidemiological Findings of Major Chemical Attacks in the Syrian War Are Consistent with Civilian Targeting: A Short Report’ (2018) 12 Conflict and Health 16

  • Rushton S, ‘Global Health Security: Security for Whom? Security from What?’ (2011) 59 Political Studies 799

  • Siedner MJ, ‘Strengthening the Detection of and Early Response to Public Health Emergencies: Lessons from the West African Ebola Epidemic’ 12 PLOS Medicine (2015)

  • Sprinz D and Wolinsky-Nahmias Y (eds),Models, Numbers, and Cases: Methods for Studying International Relations (University of Michigan Press 2004)

  • Staples JE, ‘Yellow Fever: 100 Years of Discovery’ (2008) 300 JAMA 960

  • Sturtevant JL, Anema A and Brownstein JS, ‘The New International Health Regulations: Considerations for Global Public Health Surveillance’ (2007) 1 Disaster Medicine and Public Health Preparedness 117

  • Tajaldin B and others, ‘Defining Polio: Closing the Gap in Global Surveillance’ (2015) 81 Annals of Global Health 386

  • Tejpar A and Hoffman SJ, ‘Canada’s Violation of International Law during the 2014–2016 Ebola Outbreak: Notes and Comments’ (2016) 54 Canadian Yearbook of International Law 366

  • ‘The WHO Ebola Response Team, “Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections” 371’ [2014] New England Journal of Medicine 1481

  • The World Health Organization, The First Ten Years of the World Health Organization (1st edn, World Health Organization 1958)

  • Thompson KM and Kalkowska DA, ‘An Updated Economic Analysis of the Global Polio Eradication Initiative’ (2021) 41 Risk Analysis 393

  • Tsai F-J and Katz R, ‘Measuring Global Health Security: Comparison of Self- and External Evaluations for IHR Core Capacity’ (2018) 16 Health Security 304

  • UK Government, ‘Prime Minister’s Speech to United Nations General Assembly’ 26 September 2020 https://www.gov.uk/government/speeches/prime-ministers-speech-to-un-general-assembly-26-september-2020

  • United States Government, ‘Reviewing COVID-19 Response and Strengthening the WHO’s Global Emergency Preparedness and Response WHO ROADMAP’, 9 September 2020 https://www.hhs.gov/about/agencies/oga/about-oga/what-we-do/international-relations-division/multilateral-relations/who-roadmap-2020.html

  • Velimirovic B, ‘Do We Still Need International Health Regulations?’ (1976) 133 Journal of Infectious Diseases 478

  • Vogel C, Mathys G, Verweijen J, Benton A, Sweet R and Marijen E, ‘Clichés can Kill in Congo’ (2019) 30 Foreign Policy

  • Von Bernstorff J, ‘Procedures of Decision-Making and the Role of Law in International Organizations’ (2008) 9 German Law Journal 1939

  • Weir L and Mykhalovskiy E, Global Public Health Vigilance: Creating a World on Alert (Routledge 2012)

  • Weiss TG, ‘Governance, Good Governance and Global Governance: Conceptual and Actual Challenges’ (2000) 21 Third World Quarterly 795

  • Wenham C, ‘What We Have Learnt about the World Health Organization from the Ebola Outbreak’ (2017) 372 Philosophical Transactions of the Royal Society B: Biological Sciences 20160307

  • Wenham C, ‘The Oversecuritization of Global Health: Changing the Terms of Debate’ (2019) 95 International Affairs 1093

  • Wenham C, Feminist Global Health Security (Oxford University Press 2021)

  • Wenham C and Farias DB, ‘Securitizing Zika: The Case of Brazil’ (2019) 50 Security Dialogue 398

  • Wenham C, Kavanagh M, Phelan A, Rushton S, Voss M, Halabi S, Eccleston-Turner M and Pillinger M, ‘Problems with Traffic Light Approaches to Public Health Emergencies of International Concern’ (2021) 397 The Lancet 10287

  • Weyer J, Grobbelaar A and Blumberg L, ‘Ebola Virus Disease: History, Epidemiology and Outbreaks’ (2015) 17 Current Infectious Disease Reports 21

  • White ND, ‘Accountability and Democracy Within the United Nations: A Legal Perspective’ (1997) 13 International Relations 1

  • WHO (World Health Organization) ‘Ad Hoc Scientific Teleconference on the Current Influenza A(H1N1) Situation’, WHO, Geneva, 29 April 2009 http://www.who.int/csr/resources/publications/swineflu/TCReport2009_05_04.pdf

  • WHO, Global Crises, Global Solutions: Managing Public Health Emergencies of International Concern through the Revised International Health Regulations (2002) WHO/CDS/CSR/GAR/2002/4/ENP

  • WHO, ‘Implementation of the International Health Regulations (2005) – Report of the Review Committee on the Functioning of the International Health Regulations (2005) in Relation to Pandemic (H1N1) 2009’ (2011) A64/10

  • WHO, ‘Intergovernmental Working Group on the Revision of the International Health Regulations’ (12 January 2004) IGWG/IHR/working paper/12.2003

  • WHO, ‘Intergovernmental Working Group on the Revision of the International Health Regulations, Review and Approval of Proposed Amendments to the International Health Regulations: Explanatory Notes’ (7 October 2004) A/IHRIGWG/4

  • WHO, ‘Interim Report on WHO’s Response to COVID-19 January-April 2020 Geneva: World Health Organization’ (28 April 2020) https://www.who.int/publications/m/item/interim-report-on-who-s-response-to-covid---january---april-2020

  • WHO, ‘Response to Global Change – Progress Report by the Director-General’ EB95/12, Ninety-Fifth Session (31 October 1994)

  • WHO, ‘Revision of the International Health Regulations: Progress Report’ (10 March 1998) A51/8

  • WHO, ‘Review and Approval of Proposed Amendments to the International Health Regulations: Explanatory Notes. Intergovernmental Working Group on the Revision of the International Health Regulations, Provisional Agenda Item 3’ (7 October 2004) A/IHR/IGWG/4

  • WHO, ‘Statement on the Meeting of the International Health Regulations (2005) Emergency Committee for Swine Influenza on 25th April 2009’ (25 April 2009) https://www.who.int/mediacentre/news/statements/2009/h1n1_20090425/en/

  • WHO, ‘Statement on the 4th Meeting of the IHR Emergency Committee Concerning MERS-CoV’ (2013) https://www.who.int/mediacentre/news/statements/2013/mers_cov_20131204/en/

  • WHO, ‘Middle East Respiratory Syndrome Coronavirus (MERS-CoV)’ (9 July 2013) https://www.who.int/news/item/09-07-2013-middle-east-respiratory-syndrome-coronavirus-(mers-cov)

  • WHO, ‘Statement on the 3rd Meeting of the International Health Regulations Emergency Committee Regarding the International Spread of Wild Poliovirus’ (2014) https://www.who.int/mediacentre/news/statements/2014/polio-20141114/en/

  • WHO, ‘Statement on the 4th IHR Emergency Committee Meeting Regarding the International Spread of Wild Poliovirus’ (27 February 2015) https://www.who.int/news-room/detail/27-02-2015-statement-on-the-4th-ihr-emergency-committee-meeting-regarding-the-international-spread-of-wild-poliovirus

  • WHO, ‘Statement on the 6th IHR Emergency Committee Meeting Regarding the International Spread of Wild Poliovirus’ (17 August 2015) https://www.who.int/mediacentre/news/statements/2015/ihr-polio-17-august-2015/en/

  • WHO, ‘Statement on the 10th Meeting of the IHR Emergency Committee Regarding MERS’ (3 September 2015) https://www.who.int/mediacentre/news/statements/2015/ihr-emergency-committee-mers/en

  • WHO, ‘Statement on the 1st Meeting of the International Health Regulations (2005) Emergency Committee for Yellow Fever’ (2016) https://www.who.int/mediacentre/news/statements/2016/ec-yellow-fever/en/

  • WHO, ‘Statement on the 8th IHR Emergency Committee Meeting Regarding the International Spread of Poliovirus’ (1 March 2016) https://www.who.int/news-room/detail/01-03-2016-statement-on-the-8th-ihr-emergency-committee-meeting-regarding-the-international-spread-of-poliovirus

  • WHO, ‘Statement on the 1st Meeting of the International Health Regulations (2005) (IHR 2005) Emergency Committee on Zika Virus and Observed Increase in Neurological Disorders and Neonatal Malformations’ (1 February 2016) https://www.who.int/en/news-room/detail/01-02-2016-who-statement-on-the-first-meeting-of-the-international-health-regulations-(2005)-(ihr-2005)-emergency-committee-on-zika-virus-and-observed-increase-in-neurological-disorders-and-neonatal-malformations

  • WHO, ‘Statement on the 5th Meeting of the IHR Emergency Committee Concerning MERS-CoV’ (2014) https://www.who.int/mediacentre/news/statements/2014/mers-20140514/en/

  • WHO, ‘Statement on the 6th Meeting of the IHR Emergency Committee Concerning MERS-CoV’ (2014) https://www.who.int/mediacentre/news/statements/2014/ihr-emergency-committee-merscov/en/

  • WHO, ‘Summary of States Parties 2012 report on IHR core capacity implementation’ (2014) WHO/HSE/GCR/2014

  • WHO, ‘Summary of States Parties 2013 report on IHR core capacity implementation’ (2014) WHO/HSE/GCR/2014

  • WHO, ‘Statement on the 7th IHR Emergency Committee Meeting Regarding the International Spread of Poliovirus’ (2015) http://www.who.int/mediacentre/news/statements/2015/ihr-ec-poliovirus/en/

  • WHO, ‘Statement on the 9th Meeting of the IHR Emergency Committee Regarding MERS-CoV’ (2015) https://www.who.int/mediacentre/news/statements/2015/ihr-ec-mers/en/

  • WHO, ‘Press Conference for the Meeting of the Yellow Fever IHR Emergency Committee’ (19 May 2016) https://www.who.int/mediacentre/news/statements/2016/YF-EC-19-May-2016.pdf

  • WHO, ‘Statement on the 3rd Meeting of IHR Emergency Committee on Zika Virus and Observed Increase in Neurological Disorders and Neonatal Malformations’ (12 June 2016) https://www.who.int/en/news-room/detail/12-06-2016-who-convenes-3rd-meeting-of-emergency-committee-on-zika-and-observed-increase-in-neurological-disorders-and-neonatal-malformations

  • WHO, ‘Statement on the 2nd Meeting of the International Health Regulations (2005) Emergency Committee for Yellow Fever’ (31 August 2016) https://www.who.int/en/news-room/detail/31-08-2016-second-meeting-of-the-emergency-committee-under-the-international-health-regulations-(2005)-concerning-yellow-fever

  • WHO, ‘Statement on the 4th Meeting of IHR Emergency Committee on Zika Virus and Observed Increase in Neurological Disorders and Neonatal Malformations’ (2 September 2016) https://www.who.int/news-room/detail/02-09-2016-fourth-meeting-of-the-emergency-committee-under-the-international-health-regulations-(2005)-regarding-microcephaly-other-neurological-disorders-and-zika-virus

  • WHO, ‘Statement of the 13th IHR Emergency Committee Regarding the International Spread of Poliovirus’ (2 May 2017) https://www.who.int/news-room/detail/02-05-2017-statement-of-the-13th-ihr-emergency-committee-regarding-the-international-spread-of-poliovirus

  • WHO, ‘Statement on the 1st Meeting of the IHR Emergency Committee Regarding the Ebola Outbreak in 2018’ (18 May 2018) https://www.who.int/news/item/18-05-2018-statement-on-the-1st-meeting-of-the-ihr-emergency-committee-regarding-the-ebola-outbreak-in-2018

  • WHO, ‘Statement of the 18th IHR Emergency Committee Regarding the International Spread of Poliovirus’ (15 August 2018) https://www.who.int/news-room/detail/15-08-2018-statement-of-the-eighteenth-ihr-emergency-committee-regarding-the-international-spread-of-poliovirus

  • WHO, ‘Statement of the 17th IHR Emergency Committee Regarding the International Spread of Poliovirus’ (5 October 2018) https://www.who.int/news-room/detail/10-05-2018-statement-of-the-seventeenth-ihr-emergency-committee-regarding-the-international-spread-of-poliovirus

  • WHO, ‘Statement of the 19th IHR Emergency Committee Regarding the International Spread of Poliovirus’ (30 November 2018) https://www.who.int/news-room/detail/30-11-2018-statement-of-the-nineteenth-ihr-emergency-committee-regarding-the-international-spread-of-poliovirus

  • WHO, ‘Statement on the Meeting of the International Health Regulations (2005) Emergency Committee for Ebola Virus Disease in the Democratic Republic of the Congo on 12th April 2019’ (12 April 2019) https://www.who.int/news-room/detail/12-04-2019-statement-on-the-meeting-of-the-international-health-regulations-(2005)-emergency-committee-for-ebola-virus-disease-in-the-democratic-republic-of-the-congo-on-12th-april-2019

  • WHO, ‘Statement of the 21st IHR Emergency Committee Regarding the International Spread of Poliovirus’ (29 May 2019) https://www.who.int/news-room/detail/29-05-2019-statement-of-the-twenty-first-ihr-emergency-committee

  • WHO, ‘Statement on the Meeting of the International Health Regulations (2005) Emergency Committee for Ebola Virus Disease in the Democratic Republic of the Congo on 14 June 2019’ (14 June 2019) https://www.who.int/news-room/detail/14-06-2019-statement-on-the-meeting-of-the-international-health-regulations-(2005)-emergency-committee-for-ebola-virus-disease-in-the-democratic-republic-of-the-congo

  • WHO, ‘Statement on the Meeting of the International Health Regulations (2005) Emergency Committee for Ebola Virus Disease in the Democratic Republic of the Congo on 17 July 2019’ (17 July 2019) https://www.who.int/ihr/procedures/statement-emergency-committee-ebola-drc-july-2019.pdf

  • WHO, ‘Statement of the 22nd IHR Emergency Committee Regarding the International Spread of Poliovirus’ (3 October 2019) https://www.who.int/news-room/detail/03-10-2019-statement-of-the-twenty-second-ihr-emergency-committee-regarding-the-international-spread-of-poliovirus

  • WHO, ‘Statement on the Meeting of the International Health Regulations (2005) Emergency Committee for Ebola Virus Disease in the Democratic Republic of the Congo on 18 October 2019’ (18 October 2019) https://www.who.int/news-room/detail/18-10-2019-statement-on-the-meeting-of-the-international-health-regulations-(2005)-emergency-committee-for-ebola-virus-disease-in-the-democratic-republic-of-the-congo

  • WHO, ‘Statement on the 1st Meeting of the IHR Emergency Committee Regarding the Outbreak of Novel Coronavirus (2019-NCoV)’ (23 January 2020) https://www.who.int/news/item/23-01-2020-statement-on-the-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)

  • WHO, ‘Statement on the 2nd Meeting of the International Health Regulations (2005) Emergency Committee Regarding the Outbreak of Novel Coronavirus (2019-NCoV)’ (30 January 2020) https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)

  • WHO, ‘Statement on the 24th IHR Emergency Committee Meeting Regarding the International Spread of Poliovirus’ (8 April 2020) https://www.who.int/news/item/08-04-2020-statement-of-the-twenty-fourth-ihr-emergency-committee

  • WHO, ‘Statement of the 25th IHR Emergency Committee Regarding the International Spread of Poliovirus’ (8 April 2020) https://www.who.int/news/item/08-04-2020-statement-of-the-twenty-fifth-ihr-emergency-committee

  • WHO, ‘Statement on the 3rd Meeting of the IHR Emergency Committee Regarding the Outbreak of Coronavirus Disease (Covid-19)’ (1 May 2020) https://www.who.int/news/item/01-05-2020-statement-on-the-third-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-coronavirus-disease-(covid-19)

  • WHO, ‘Statement on the 26th IHR Emergency Committee Meeting Regarding the International Spread of Poliovirus’ (22 October 2020) https://www.who.int/news/item/22-10-2020-statement-of-the-twenty-sixth-polio-ihr-emergency-committee

  • WHO, ‘Statement on the 5th Meeting of the IHR Emergency Committee Regarding the Coronavirus Disease (Covid-2019)’ (30 October 2020) https://www.who.int/news/item/30-10-2020-statement-on-the-fifth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic

  • WHO, ‘Report of the Third Open Meeting of the Review Committee on the Functioning of the International Health Regulations (2005) During the COVID-19 Response’ (3 November 2020) https://www.who.int/publications/m/item/third-meeting-of-the-review-committee-on-the-functioning-of-the-international-health-regulations-(2005)-during-the-covid-19-response

  • World Health Assembly, ‘Communicable Disease Prevention and Control: New, Emerging and Re-Emerging Infectious Diseases’ WHO Doc. WHA 18.13 (12 May 1995)

  • World Health Assembly, ‘Revision and Updating of the International Health Regulations’ WHO Doc. WHA 48.7 (12 May 1995)

  • World Trade Organization, World Organisation for Animal Health, World Health Organization and Food and Agriculture Organization of the United Nations, ‘Joint WTO/OIE/WHO/FAO Statement on A/H1N1 Influenza’ (2 May 2009) https://www.oie.int/en/for-the-media/press-releases/detail/article/joint-wtooiewhofao-statement-on-ah1n1-influenza/

  • Yamin AE and Habibi R, ‘Human Rights and Coronavirus: What’s at Stake for Truth, Trust, and Democracy?’ (2020) Health and Human Rights Journal https://www.hhrjournal.org/2020/03/human-rights-and-coronavirus-whats-at-stake-for-truth-trust-and-democracy/

  • Youde J, ‘Enter the Fourth Horseman: Health Security and International Relations Theory’ (2005) 6 The Whitehead Journal of Diplomacy and International Relations 6

  • Youde J, Biopolitical Surveillance and Public Health in International Politics (1st edn, Palgrave Macmillan 2010)

  • Youde J, ‘Biosurveillance, Human Rights, and the Zombie Plague’ (2012) 24 Global Change, Peace & Security 83

  • Youde J, Global Health Governance (Polity Press 2012)

  • Youde J, ‘MERS and Global Health Governance’ (2014) 70 International Journal 119

  • Zacher MW and Keefe TJ, The Politics of Global Health Governance: United by Contagion (1st edn, Palgrave Macmillan 2008)

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