‘Because we all know that vaccines are an extremely effective public health tool’: path dependency, H1N1 and the World Health Organisation

Abstract

Infectious disease threats are surrounded by scientific uncertainty. As a result, institutional structures can heavily determine the way in which such risks are managed. This is illustrated by the World Health Organisation's (WHO) management of the 2009 H1N1 pandemic. Given this, theories of path dependency, derived from the ‘new institutionalism’, are useful in analysing such events. This article examines theories of institutional and discursive path dependency in respect to the case study of the WHO's management of H1N1. It argues that the WHO's emphasis on the use of vaccines as a protective measure constitutes a path dependent reaction, based on the organisation's historical achievements with vaccines and its discourse surrounding vaccine use. Furthermore, in contrast to accounts which understand historical and institutional path dependency as exclusive theoretical models, the article argues that institutional and discursive path dependencies were mutually interacting in forming the WHO's response to H1N1. Finally, the article explores the question of institutional change within theories of path dependency. Here, using the case of the WHO, it is shown that the interference of an outside actor, the Council of Europe, caused the WHO to internally evaluate its actions, leading to institutional change.