An International Institutionalist Approach to the Globalization of Emerging Infectious Diseases
Nieto, Andres Alejandro
2005
- Submitted in partial fulfillment of the degree Master of Arts in Law and Diplomacy at the Fletcher School of Law and Diplomacy. Abstract: Globalization is often discussed in the context of economics, through telecommunications, international trade, manufacturing strategies, and global capital flow. Whether or not a state is democratically elected, the effects of globalization are more often than ... read morenot seen yielding state sovereignty to industrialists, investment bankers, media moguls and other transnational actors. Over the past forty years these processes of globalization have caused a dramatic increase in the emergence and reemergence of more deadly forms of infectious disease. Professor David Fidler asserts that because of the eroding boundaries between and within states, the effects of globalization have undermined that ability of sovereign states to protect their citizens from emerging infectious diseases in the conventional ways. The unprecedented speed of the spread of infectious disease has eroded the distinction between national and international public health. While politicians, scholars and business leaders recognize that the forces of globalization are among the most potent at work within late twentieth century international relations, they have yet to realize the extent to which the evolving boundaries of state sovereignty in the global community will affect the spread and combat of emerging infectious disease (EID). Infectious diseases more readily cross borders as a result of the proliferation of interstate travel and trade, this increases contact among humans with dissimilar immune capacities and facilitates the transmission of disease by increasing the availability of vulnerable hosts. This has raised concerns that have threatened the international state system for centuries. In the 14th Century, quarantine procedures were first introduced to help curb the impact of infectious agents carried aboard commercial ships. While commercial shipping remains a channel for disease transmission, air travel has raised new and more complex dangers with respect to transmission. Poor air circulation aboard international flights can infect an entire flight with respiratory viruses such as SARS, and air travel facilitates the spread of highly contagious hemorrhagic viruses such as the Ebola virus of central Africa, as well as Mad Cow disease and other prion-like illnesses that could be transmitted on the shoes of contaminated individuals. The structure of the state system with its focus on sovereignty further complicates the challenges posed by the spread of infectious disease. Traditionally, state sovereignty has protected the way individual states regulate their physicians and pharmaceuticals, thus keeping international regulation at bay. With few enforceable incentives to cooperate and regulate antibiotics, private actors mismanage and overuse antibiotics. More often than not antibiotics are over prescribed, sold over the counter, or sold on the black market. Overuse of antibiotics dramatically increases the extent to which microbial agents develop resistance in the developing world, this overuse has contributed to increased resistance in such cases as malaria, tuberculosis, and more recently, syphilis. Beyond the added challenge of drug resistance there are the socioeconomic concerns that follow when new microbes proliferate in developing countries. Although early warning mechanisms might protect other states in the immediate future, they have the potential to destroy the already unsteady economies of the developing states by engendering fear among tourists. This not only makes it more difficult to combat the disease, but also provides a disincentive for states to warn people of emerging illness. The current international health regulation policies of the World Health Organization have met limited success. The WHO, does not have the necessary enforcement power to effectively combat the newly emerging illnesses that pose the greatest threat to the world community. International health institutions have yet to neither develop the necessary resources nor take advantage of the international institutional mechanisms available to meet their public health goals. I will argue that through the development of global public policy (GPP) networks in the context of the international institutionalist approach, laid out by Robert Keohane, one will not only strike the necessary balance between the protection of state sovereignty and the protection of the health of individual citizens, but also find the most effective and efficient approach. In the following section, I will discuss the relevant international theoretical approaches to enforcement of international rules and regulations, in order to describe the framework and policy guidelines that have lead to my conclusions about the effectiveness of GPP networks as they apply to EID. In section II, I will discuss to origins and nature of the threat posed by EID along with the current economic and social implications. In section III, I will discuss three internationally significant EIDs, how they are spread, describe the globally significant consequences of such threats and how GPP networks can not only help to limit disease proliferation but pool together valuable resources that can facilitate the finding of a cure. Finally in section IV, I will summarize the GPP approach, and describe its future potential.read less
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