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WHO has determined a public health emergency of international concern (PHEIC) seven times, and beyond this nomenclature declared COVID-19 to be a pandemic. Under the International Health Regulations (IHR), and through their operationalisation in the joint external evaluation (JEE), governments are urged to create suitable legislation to be able to enact a response to a public health emergency. Whether the pandemic declaration had a greater effect than a PHEIC in encouraging goverments to act, however, remains conjecture, as there is no systemic analysis of what each term means in practice and whether either has meaningful legal implications at the national level. We undertook a legal scoping review to assess the utilisation of PHEIC and pandemic language within national legislation in 28 WHO member states. Data were collected from national websites, JEE reviews, COVID Analysis and Mapping of Policies Tool, Natlex, and Oxford Compendium of National Legal Responses to COVID-19. We found that only 16% of countries have any reference to the PHEIC in national legislation and 37·5% of countries reference the term pandemic. This finding paints a weakened picture of the IHR and PHEIC mechanisms. Having such legalese enshrined in legislation might enhance the interaction between WHO determining a PHEIC or declaring a pandemic and resulting action to mitigate transnational spread of disease and enhance health security. Given the ongoing negotiations at WHO in relation to the amendments to the IHR and creation of the pandemic accord, both of which deal with this declaratory power of the PHEIC and pandemic language, negotiators should understand the possible implications of any changes to these proclamations at the national level and for global health security. [ABSTRACT FROM AUTHOR]

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 International health regulations (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 dyna mics 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. [ABSTRACT FROM AUTHOR]

Across multiple pandemics, global health governance institutions have struggled to secure the compliance of states with international legal and political commitments, ranging from data sharing to observing WHO guidance to sharing vaccines. In response, governments are negotiating a new pandemic treaty and revising the International Health Regulations. Achieving compliance remains challenging, but international relations and international law research in areas outside of health offers insights. This Health Policy analyses international relations research on the reasons why states comply with international law, even in the absence of sanctions. Drawing on human rights, trade, finance, tobacco, and environmental law, we categorise compliance mechanisms as police patrol, fire alarm, or community organiser models. We show that, to date, current and proposed global health law incorporates only a few of the mechanisms that have shown to be effective in other areas. We offer six specific, politically feasible mechanisms for new international agreements that, together, could create compliance pressures to shift state behaviour. [ABSTRACT FROM AUTHOR]

This article reviews the state of the literature on the politics of global health governance and associated political dynamics of actors involved in this issue space. We identify seven eras in the field, beginning with the period of empire and colonialism and ending with the COVID-19 outbreak. The field of global health has long had a focus on infectious disease, often rooted within a state-centered approach to transnational global health problems with recurrent debates about whether and how restrictions on trade and travel should be imposed in the wake of disease outbreaks. This statist focus is in tension with more cosmopolitan visions of global health, which require broader health system strengthening. In the mid-2000s, a golden age emerged with the influx of new financing and political attention to addressing HIV/AIDS and malaria, as well as reducing the risk posed by infectious disease outbreaks to economies of the Global North. Despite increased awareness of noncommunicable diseases and the importance of health systems, events of recent years (including but not limited to the COVID-19 outbreak) reinforced the centrality of states to global health efforts and the primacy of infectious diseases. [ABSTRACT FROM AUTHOR]

During health emergencies, neglect of gender experiences and needs can compromise the outbreak response. Ebola in West Africa and Zika in Latin America had gendered effects that were evident during the crises, yet governments and international organizations failed to prioritize a gender-inclusive response. There is the same risk that gender-inclusive responses and knowledge will continue to be neglected during the COVID-19 pandemic. In this article, we examine the drivers of gender exclusion in health emergency response. We ask: where can we locate institutional responsibility for taking gender seriously to inform and improve sustainable disease control? The article addresses this question by turning to feminist institutional theory to explain why gender inclusion in decision-making processes is vital for effective response and post-crisis recovery. We argue that the institutional responsibility to recognize gender within the global health emergency regime lies with the World Health Organization (WHO). WHO has neglected to mainstream gender in the policies and practices that it promotes for the prevention and detection of, and response to, infectious disease outbreaks. WHO is in a position to support gender-inclusive practices, but this requires the technical agency to recognize the value of having a gender-inclusive framework to inform outbreak response, financial models, and recovery. [ABSTRACT FROM AUTHOR]

In November 2021, the World Health Assembly (WHA) is hosting a special session to discuss the proposed plans for a pandemic treaty. Despite the fact that there are scant details concerning the treaty, the proposal has gained considerable support in both the academic community, and at the international level. While we agree that in the wake of the numerous governance failures during COVID-19, we need to develop appropriate global solutions to be able to prevent, detect, respond to, and recover from future global health crises—and that such mechanisms should be rooted in global equity—we disagree, however, that this pandemic treaty, currently, is the most appropriate way in which to achieve this. Indeed, notions of global community, solidarity, fairness are far removed from the reality that we have seen unfolding in the actions of states responding to the pandemic. This is the crux of the tension with the proposed treaty: the balance between the ideal cosmopolitan worldview held by those in power in global health, and the practice of national security decision-making witnessed in the last 18 months. Indeed, we do not believe that a pandemic treaty will deliver what is being extolled by its proponents, and it will not solve the multiple problems of global cooperation in global health that supporters believe it will. [ABSTRACT FROM AUTHOR]

Operative paragraph 7 of UN Security Council (UNSC) Resolution 2532 (2020) acknowledges 'the critical role that women are playing in the COVID-19 response efforts', the 'disproportionate negative impact the pandemic is having on women and girls', and 'calls for concrete actions to minimise this impact and ensure the full, equal and meaningful participation of women and youth in the development and implementation of an adequate and sustainable response to the pandemic'. This Resolution is clear in its language: states must recognise and respond to the gendered effects of the pandemic. The adoption of Resolution 2532 and subsequently 2565 (2021) is an important opportunity to further integrate health emergencies and UNSC's Women, Peace, and Security (WPS) agenda. The language is deliberate: it offers global health a set of mechanisms on how to integrate gender into complex crises and, in turn, offers WPS a chance to engage with health and pandemics as a security challenge for women and girls. However, as previous health emergencies and the WPS agenda show us, Resolutions are not a panacea: they are political compromises often riddled with contradictions and are dependent on states and the international community to implement them. [ABSTRACT FROM AUTHOR]

Combating threats of infectious diseases has been increasingly framed as a global shared responsibility for a multi-actor framework of states, international organisations and nongovernmental actors. However, the outbreak of Ebola Virus Disease (EVD) has shown that this governance framework has not been able to limit the spread of this virus, despite the normative and legislative changes to global disease control. By unbundling the concept of responsibility, this article will assess how global shared responsibility may have failed because accountability does not fall on any one state or stakeholder, highlighting an inherent weakness in the global disease governance regime. The paper concludes that a move towards multiple responsibilities may prove a more effective mechanism for ensuring global health security. [ABSTRACT FROM AUTHOR]

The article addresses the association of gender bias with the poor global health of women. Topics discussed include under-representation of women in leadership, decision making, and senior research roles; initiatives such as Women in Global Health for gender balance in workplaces; and feminist research agenda that can advance gender equality in global health.