MERS and global health governance
| Date | 01 March 2015 |
| DOI | 10.1177/0020702014562594 |
| Published date | 01 March 2015 |
| Author | Jeremy Youde |
| Subject Matter | Teaching Tool |
International Journal
2015, Vol. 70(1) 119–136
!The Author(s) 2014
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DOI: 10.1177/0020702014562594
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Teaching Tool
MERS and global health
governance
Jeremy Youde
University of Minnesota Duluth, Duluth, MN, USA
Abstract
The contemporary global health governance system has evolved over 150 years to
facilitate cooperation among states in dealing with cross-border health concerns. This
article uses the current outbreak of Middle East respiratory syndrome coronavirus
(MERS-CoV) to examine global health governance’s history, evolution, and status
within the political science literature. In particular, the article focuses on the
International Health Regulations and the World Health Organization as leading elem-
ents of the global health governance system in order to examine both how the system
operates and what its shortcomings are.
Keywords
Global health governance, Middle East respiratory syndrome coronavirus, international
health regulations, World Health Organization
On 13 June 2012, a 60-year-old man in Saudi Arabia entered the hospital in
Jeddah. He exhibited a week-long cough, shortness of breath, and renal failure.
Diagnostic tests found signs of an infection—but not one previously before seen by
doctors. Lab tests confirmed that the man’s infection came from an unknown
coronavirus.
1
Three months later, a 49-year-old Qatari man who had recently
travelled to Saudi Arabia arrived at a British hospital with an acute respiratory
syndrome and kidney failure. The United Kingdom’s Health Protection Agency
compared a sample from the Qatari man with one from the Saudi man and found a
Corresponding author:
Jeremy Youde, Department of Political Science, University of Minnesota Duluth, 1049 University Drive,
Duluth, MN 55812, USA.
Email: jyoude@d.umn.edu
1. Ali M. Zaki, Sander van Boheemen, Theo M. Bestsbroer, Albert D.M.E. Osterhaus, and Ron A.M.
Fouchier, ‘‘Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia,’’ New
England Journal of Medicine 367, no. 19 (2012): 1814–1820.
99.5 percent match between the two. Based on the Qatari man’s recent travels and
the fact that this new coronavirus had appeared in multiple countries, British
authorities were obligated to alert the World Health Organization (WHO) to the
existence of this new illness.
2
If British officials had not done so, healthcare workers
or nongovernmental organizations could have made the report. Within a week, the
WHO alerted all member-states to the new virus and began tracking new cases.
3
Within 8 months, the new virus had a name—Middle East respiratory syndrome
coronavirus (MERS-CoV)—and the WHO continued to collect and disseminate
information about new infections while cautioning states not to introduce trade or
travel restrictions.
4
By late July 2014, the WHO had reported 837 laboratory-con-
firmed cases of MERS and at least 291 deaths in 22 countries.
5
During this same period, serious concerns arose over whether states were abid-
ing by the virus-sharing protocols, intellectual property rights rules, and timely
reporting requirements that are supposed to facilitate the international commu-
nity’s effective response to an infectious disease outbreak.
6
These actions raised
questions about how completely states had actually embraced the changes in the
global health governance architecture.
Global health governance processes have evolved significantly since the nine-
teenth century. Under the current regime, nearly all countries are legally obligated
to report new illnesses to an international organization that serves as an informa-
tion hub and facilitates sharing of data among laboratories. This process represents
a major shift: the previous system relied wholly on voluntary disclosures by states
of specific illnesses; this one obligates states to maintain robust surveillance net-
works for an expansive range of diseases and allows for broader participation. It
also demonstrates how key elements of contemporary global health govern-
ance—particularly the International Health Regulations and the WHO—work
together. That said, the current case of MERS-CoV shows that the global health
governance system does not operate ideally. States still express reluctance to report
cases of new infectious diseases, and issues of virus sharing and intellectual prop-
erty rights stymie research. The WHO, which should serve as the hub for global
health cooperation, also faces serious shortfalls and reform pressures that may
weaken its ability to respond to infectious disease outbreaks in a timely manner.
2. World Health Organization, ‘‘Novel coronavirus infection in the United Kingdom,’’ 23 September
2012, http://www.who.int/csr/don/2012_09_23/en/ (accessed 27 May 2014).
3. World Health Organization, ‘‘Novel coronavirus infection—update—revised interim case defin-
ition,’’ 29 September 2012, http://www.who.int/csr/don/2012_09_29/en/ (accessed 27 May 2014).
4. World Health Organization, ‘‘Novel coronavirus infection—update (Middle East respiratory syn-
drome-coronavirus),’’ 23 May 2013, http://www.who.int/entity/csr/don/2013_05_23_ncov/en/
index.html (accessed 27 May 2014).
5. World Health Organization, ‘‘Middle East respiratory syndrome coronavirus (MERS-
CoV)—update,’’ 23 July 2014, http://www.who.int/csr/don/2014_07_23_mers/en/ (accessed 28
July 2014).
6. Helen Branswell, ‘‘Saudi silence on deadly MERS virus outbreak frustrates world health experts,’’
Scientific American, 7 June 2013, http://www.scientificamerican.com/article/saudi-silence-on-deadly-
mers-virus-outbreak-frustrates-world-health-experts/ (accessed 28 July 2014).
120 International Journal 70(1)
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