Governing the global health security domain


The Ebola crisis has brought the issue of global health security back on the political and the technical agenda. There is much debate on how the governance of global health security should be reformed, especially in a context in which the shared global space of threat seems to expand and is not matched by a shared global space of responsibility. This has also become obvious in view of other global crises related to terrorism and the refugee crisis. None of these global risks have well-functioning mechanisms of global governance to ensure preparedness and response,or (as would be required) a preventative approach. This paper outlines the present global order for preventing and responding to global health risks, especially the role of the International Health Regulations (IHR), a unique, legally binding governance mechanism that aims to protect all countries; gives a brief analysis of the significant gaps that emerged in response to the Ebola crisis; and discusses how the Ebola crisis reopened the discussion on the framing of global health security. It further presents a range of governance proposals that have recently emerged to strengthen the global health security regime. The UHC agenda has also been revisited, reinforcing the need to build health systems in resource-poor countries and to apply an integrated approach that does not separate the health security from the health care agenda. The Ebola outbreak has underlined not only that viruses cross borders, but also that outbreaks can effect everybody; can weaken communities, destroy the social fabric and destabilise countries; can severely impact economies and trade; and can impact on the relationship between countries and peoples. It reinforced the position that no outbreak can be handled by the health sector alone. While first steps to implement the IHR should be a political priority, it has become clear that a larger shift in the global order for governing global health security will be required. Global health security will have to move out of the health space and be part of a larger global order.