Global Health IV: Pandemic Surveillance and Problems of International Cooperation

Science of Viruses

*H1N1 influenza “Swine flu,” 2009

Influenza A viruses

Protein combinations: H1-H18+N1-N11

*1918 Spanish flu

500 million cases

50-100 million deaths

*Ebola, 2014

Zoonotic virus endemic in West Africa

fruit bats? Monkeys?

50% death rate

International Law of Disease Surveillance

*International Health Regulations (IHR), 2005

Requirements of member states

Establish surveillance system

42 in compliance, 2012

64 in compliance, 2014

Remainder given extensions

Report outbreaks

Smallpox, polio, SARS, new influenzas, and other new diseases with serious health and spread risks.

WHO Director-General’s requirements

Convene advisory Emergency Committee

*Public Health Emergency of International Concern (PHEIC)

Special Session of WHA, Nov. 29-Dec.1 2021

Agreement to negotiate a new treaty on pandemic response by May 2024!!

Youde, pp. 139-62; review previous readings on COVID-19; Searchinger, "Why Pandemic Agreement Negotiations Failed to Land" 

Compare the performance of the WHO and member states under the 2005 IHR in surveilling for new infectious diseases, declaring a PHEIC, and collaborating to prevent a local outbreak from growing into a pandemic. Consider these outbreaks:

H1N1 influenza in the U.S. and Mexico in 2009

Ebola in Guinea, Liberia and Sierra Leone, 2014

COVID-19 (Refer to “25 Days that Shook the World” & Gostin, "Global Health Institutions Reached Their Limits")

What are the goals of the pandemic treaty now being negotiated among member states of the World Health Assembly?

Why has it proven to be difficult to negotiate a final treaty so far?

How have divisions between the interests of high-income developed nations and low-income developing nations contributed to slowing negotiations?

How would you advise developed and developing nations involved in treaty negotiations to find compromises that will help finalize a treaty?

Surveillance and PHEIC

H1N1 influenza in the U.S. and Mexico in 2009

Time from notification to PHEIC: 26 days

Ebola in Guinea, Liberia and Sierra Leone, 2014

Time from notification to PHEIC: 8 months

Médicins Sans Frontières/Doctors Without Borders

COVID-19 in Wuhan China, 2019

Time from notification to PHEIC: 1 month

Visualizing World Distribution of Wealth, 2019

Health Care Spending Per Person, 2017 (World Bank Data)

Nation-State Amount in $ U.S.
Guinea $33.72
Liberia $56.60
Sierra Leone $66.40
China $440.83
Mexico $494.68
United States $10,246.14
World $1,061.15
European Union $3,261.43

Global Health Institutions

*COVAX Joint-venture

Gavi, the Vaccine Alliance

Coalition for Epidemic Preparedness Innovations (CEPI)

World Health Organization

UNICEF