The International Health Regulations After Ebola

by Sam Halabi — Thursday, Feb. 26, 2015

Although the sharp drop in the number of new Ebola infections has, worryingly, appeared to level off, the international community has made significant progress toward raising funds toward the response, developing and now undertaking widespread testing of vaccines, and implementing measures meant to control the worldwide spread of the disease. All of this leaves the global public health community with a number of questions about what pandemic threats might emerge in the future and, so far as the most important international agreement on pandemics goes, what international regulatory preparedness is in place?

The experience with the 2013-14 Ebola outbreak has taught at least two lessons about the International Health Regulations as they now operate. First, they do not effectively commit the international community to the core capacities the IHR contemplate to manage international public health emergencies. The Ebola experience has shown that outbreaks in low-resource settings can have cataclysmic multiplier effects. The IHR’s Annex 1 Core Capacities call for health systems infrastructure and medical personnel almost impossible to imagine without international assistance for the most afflicted countries: Guinea, Liberia, and Sierra Leone. Second, the IHR may have been dated even at their passage as to the role and influence of non-governmental organizations in global public health responses to public health emergencies of international concern. The great hero of the Ebola response will almost certainly be remembered as Medicins Sans Frontieres (MSF) which led the first-line response, mobilized the international community, including WHO, with evidence as to the seriousness of the emergency, and did so through a decentralized structure that emphasizes responses at once humanitarian and public health-promoting in nature like civilian casualties and refugees of war.

The takeaway for the IHR is that, if it remains a mirror of its backing organization – state-centered and slowly moving – it will at the very least need to commit real resources to the Annex 1 core capacities. Even better, its next revision may acknowledge and internalize the non-governmental networks making real gains by tackling disease at some of its resource and conflict roots.

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About Sam Halabi

Professor Halabi is a scholar of national and global health law with a specialization in health services, pharmaceutical and agrifood business organizations. He serves as a Scholar at the O'Neill Institute for National and Global Health Law at Georgetown University, where he has also served as a special advisor to the Lancet-Georgetown University Commission on Global Health and Law. His work is published in the American Journal of Law and Medicine, the Harvard International Law Journal, the Journal of Law, Medicine, and Ethics, the Lancet, and the Journal of the American Medical Association (JAMA). He has also published volumes on pharmaceutical regulation and global management of infectious disease with Oxford University Press and Elsevier Academic Press. Before earning his J.D. from Harvard Law School, Professor Halabi was awarded a British Marshall scholarship to study in the United Kingdom where he earned an M.Phil in International Relations from the University of Oxford (St. Antony’s College). During the 2003-04 academic year, he served as a Rotary International Ambassadorial Scholar at the American University of Beirut.

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