Abstract
BackgroundIn 2014, the World Health Organization (WHO) declared two "public health emergencies of international concern", in response to the worldwide polio situation and the Ebola epidemic in West Africa respectively. Both emergencies can be seen as testing moments, challenging the current model of epidemic governance, where two worldviews co-exist: global health security and humanitarian biomedicine.DiscussionThe resurgence of polio and the spread of Ebola in 2014 have not only exposed the weaknesses of national health systems, but also the shortcomings of the current global health regime in dealing with transnational epidemic threats. These shortcomings are of three sorts. Firstly, the global health regime is fragmented and dominated by the domestic security priorities of industrialised nations. Secondly, the WHO has been constrained by constitutional country allegiances, crippling reforms and the limited impact of the (2005) International Health Regulations (IHR) framework. Thirdly, the securitization of infectious diseases and the militarization of humanitarian aid undermine the establishment of credible public health surveillance networks and the capacity to control epidemic threats.SummaryThe securitization of communicable diseases has so far led foreign aid policies to sideline health systems. It has also been the source of ongoing misperceptions over the aims of global health initiatives. With its strict allegiance to Member States, the WHO mandate is problematic, particularly when it comes to controlling epidemic diseases. In this context, humanitarian medical organizations are expected to palliate the absence of public health services in the most destitute areas, particularly in conflict zones. The militarization of humanitarian aid itself threatens this fragile and imperfect equilibrium. None of the reforms announced by the WHO in the wake of the 68th World Health Assembly address these fundamental issues.Electronic supplementary materialThe online version of this article (doi:10.1186/s13031-015-0058-1) contains supplementary material, which is available to authorized users.
Highlights
DiscussionThe resurgence of polio and the spread of Ebola in 2014 have exposed the weaknesses of national health systems, and the shortcomings of the current global health regime in dealing with transnational epidemic threats
In 2014, the World Health Organization (WHO) declared two "public health emergencies of international concern", in response to the worldwide polio situation and the Ebola epidemic in West Africa respectively
With its strict allegiance to Member States, the WHO mandate is problematic, when it comes to controlling epidemic diseases
Summary
Smallpox and polio eradication: different political epochs The Global Polio Eradication Initiative launched in 1988 has been a remarkable endeavour prompted by the precedent of smallpox eradication. Health security can either be understood in terms of protection of health, protection of trade and economy or as a matter of non-proliferation of biological weapons and counter-terrorism This ambiguity has far reaching consequences, especially in the case of global public health surveillance. Article VII 39 in the final document of the 7th review conference of the Biological Weapons Convention (BWC) makes it clear that the IHR (2005) are instrumental to building surveillance and detection capacities pertaining to the BWC [25] In this example, where the WHO is expected to provide the technical capacity to investigate suspicious outbreaks, securitization is counterproductive to public health goals [26]. USA (Security agencies, academia) Development of event-based surveillance technology
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