Wenham Clare
Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, England.
Bull World Health Organ. 2024 Feb 1;102(2):123-129. doi: 10.2471/BLT.23.290480. Epub 2023 Oct 31.
Global health security is an increasingly complex regime. The failures of global governance and norms of cooperation during the coronavirus disease 2019 (COVID-19) pandemic and the re-entrenchment to nationalist policy-making have created impetus for new governance arrangements, institutions and policy development. These changes include amendments to the (IHR), development of a pandemic convention or accord, convening of the High-Level Meeting on Pandemic Preparedness and Response, establishment of the Pandemic fund, and development of the medical countermeasures platform, among others. These various developments claim to be in synergy with each other, but understanding of regime complexes and forum shifting from international relations reveal the power dynamics which underlie these processes. I use these concepts to demonstrate how states are transferring negotiations from one institutional location to another in search of more favourable outcomes, or are creating strategic uncertainty within negotiations to avoid future accountability. I further highlight three risks posed by these developments: (i) an increasingly complex landscape for global health security; (ii) erosion of the World Health Organization's authority in global health security; and (iii) dominance of high-income state positions within these negotiations.
全球卫生安全是一个日益复杂的体系。2019冠状病毒病(COVID-19)大流行期间全球治理和合作规范的失灵,以及向民族主义政策制定的倒退,为新的治理安排、机构和政策发展创造了动力。这些变化包括对《国际卫生条例》(IHR)的修订、大流行公约或协定的制定、召开大流行防范和应对高级别会议、设立大流行基金以及开发医疗对策平台等。这些不同的发展据称相互协同,但对国际关系中的体系复合体和论坛转移的理解揭示了这些进程背后的权力动态。我运用这些概念来展示各国如何将谈判从一个机构场所转移到另一个场所,以寻求更有利的结果,或者如何在谈判中制造战略不确定性以避免未来的问责制。我进一步强调了这些发展带来的三个风险:(i)全球卫生安全的格局日益复杂;(ii)世界卫生组织在全球卫生安全方面的权威受到侵蚀;(iii)高收入国家在这些谈判中占据主导地位。