Pandemics are for the most part disease outbreaks that become widespread as a result of the spread of human-to-human infection. (1) Beyond the debilitating, sometimes fatal, consequences for those directly affected, pandemics have a range of negative social, economic and political consequences. These tend to be greater where the pandemic is a novel pathogen, has a high mortality and/or hospitalization rate and is easily spread. According to Lee Jong-wook, former Director-General of the World Health Organization (WHO), pandemics do not respect international borders. (2) Therefore, they have the potential to weaken many societies, political systems and economies simultaneously.
The association of pandemics with national security threat grew to prominence in the 1990s. In 1995, the World Health Assembly (WHA) agreed to revise the International Health Regulations (IHR), the only international legal framework governing how WHO and its member States should respond to infectious disease outbreaks, on the grounds that revision was needed to take "effective account of the threat posed by the international spread of new and re-emerging diseases". (3) In 2005, the IHR revisions were adopted as WHA Resolution 58.3. (4) Article 2 announced that the scope and purpose of the instrument was "to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks". (5) Since its entry into force in 2007, signatory States have been working, individually and collectively, to meet their core capacity requirements under the new framework.
The focus of IHR is on the prevention and containment of public health emergencies of international concern. Member States committed themselves to building core capacities in the areas of national legislation, policy and financing, coordination and National Focal Point (NFP) communications, surveillance, response, preparedness, risk communication, and human resources and laboratories. It was widely presumed that not all member States would achieve these eight capacities by the 1 July 2012 deadline, but those that could not would identify areas in which they needed assistance in order to achieve these capacities.
The political logic behind the attachment of health to security within the IHR framework would underline their importance and help sustain the political will needed to achieve the core capacities. The global threat posed by pandemics required a global approach to security as the rapid transmission of disease in a globalized world means that capacity failures in any member State could place any other state or society in peril. By 2013, 110 member States out of 195 signatories requested an additional two-year extension to build the capacities. This unexpectedly large number could be interpreted in one of two ways. First, that member States are not taking their commitment seriously and that the use of security language in the health field is no more than rhetoric. Second, that most states face immense challenges when it comes to building core capacities, especially when domestic health systems are fragmented, inadequately funded and understaffed.
At this stage, indications point to the latter rather than former explanation. Multiple extensions were built into the IHR framework in recognition of the fact that the revised framework demanded much more of member States in terms of pandemic prevention and containment. The evident difficulties in these 110 States are largely rooted in more general health system deficiencies and do not reflect political objections to the R...