Suchergebnisse

AbstractInternational institutions should be as equal as they claim to be, especially since many of them assert superordinate normative authority based on having egalitarian governance structures. However, when defining equality with respect to states' real‐world influence in determining substantive outcomes, it is evident that there is an equality‐influence gap between the rhetoric of parity among states and the reality of international politics. This is problematic because it undermines trust in those international institutions that falsely claim to embody equality among states when empirically they do not. Focusing on the United Nations System, this paper identifies three main causes of this disproportional influence among states in global decision making: (a) external imbalances in political capital; (b) internal economic barriers; and (c) surreptitious influence through non‐state actors, funding and training. Six pragmatic strategies are proposed for mitigating these inequalities: (1) building capacity for leadership in global advocacy; (2) supporting global networks owned by developing countries; (3) equalizing multi‐party partnerships; (4) facilitating evidence‐informed global decision making; (5) enhancing accountability and independent evaluation; and (6) encouraging further discussion on institutional reforms. Notwithstanding sovereign equality's deep flaws, it is hoped that challenging the egalitarian presumptions of global decision making will encourage further debate on this issue among those who can act upon it.Policy Implications
 Inequalities of influence among states should be mitigated in order to avert the moral fraud and distrust that results from international institutions' claims of superordinate normative authority based on fictional sovereign equality.
 NGOs can help mitigate inequalities but they can also inadvertently deepen them by prioritizing the interests of the powerful states, wealthy elites and private industries that frequently fund them and to whom they are legally accountable.
 It is both desirable and possible to achieve more equal decision making in global governance, especially throughout the United Nations System which celebrates the principle of sovereign equality and benefits from an institutional architecture that naturally supports it.
 Mitigating this equality‐influence gap may help foster better global decision making and a more peaceful, secure and prosperous international society.

"To Save Humanityl" is a collection of short, honest essays on what single issue matters most for the future of global health. Authored by the world's leading voices from science, politics, and social advocacy, this collection is both a primer on the major issues of our time and a potential blueprint for post-2015 health and development. This unparalleled collection will provide illuminating and thought-provoking reading for anyone invested in our collective future and well-being"--

Antimicrobial resistance (AMR) is a natural process where microbes develop the ability to survive the antimicrobial drugs we depend upon to treat and prevent deadly infections, such as antibiotics. This microscopic evolution is further propelled by human activities, where each use of an antimicrobial drug potentially induces AMR. As microbes can spread quickly from animals to humans and travel around the world through humanity's global circuits of movement, the use of any antimicrobial drug has potentially global consequences. As human-induced AMR occurs, mortality and morbidity increase due to increasingly or sometimes completely ineffective antimicrobial treatments. This article considers AMR as a product of the evolving and complex interplay between human societies and invisible microbial worlds. It argues that as a political challenge, AMR requires robust institutions that can manage human–microbial interactions to minimize the emergence of drug resistance and maximize the likelihood of achieving effective antimicrobial use for all. Yet, current governance systems for AMR are ill-equipped to meet these goals. We propose a conceptual paradigm shift for global AMR governance efforts, arguing that global governance could better address AMR if approached as a socioecological problem in need of sustainable management rather than solely as a medical problem to be solved. In biodiversity governance, institutions are designed to fit the biological features of the ecosystems that they are attempting to manage. We consider how a similar approach can improve global AMR governance. Employing the concept of ecological fit, which is defined as the alignment between human social systems and biological ecosystems, we diagnose 18 discrepancies between the social institutions that currently govern AMR and the ecological nature of this problem. Drawing from lessons learned in biodiversity governance, the article proposes five institutional design principles for improving the fit and effectiveness of global AMR governance.

There is continuing interest in using the best available research evidence to inform public health policy. However, all too often efforts to do so rely on mechanistic and unrealistic views of the process by which public policy is made. As a result, traditional dyadic knowledge translation (KT) approaches may not be particularly effective when applied to public policy decision making. However, using examples drawn from public health policy, it is clear that work in political science on multiplicity, hierarchy and networks can offer some insight into what effective KT might look like for informing public policy. To be effective, KT approaches must be more appropriately tailored depending on the audience size, audience breadth, the policy context, and the dominant policy instrument.

AbstractThe devastating 2014–16 West African Ebola outbreak challenged the authority of the World Health Organization (WHO) to enforce the legally bindingInternational Health Regulations(IHR) that govern pandemic responses. Under Article 43 of theIHR, states parties can only implement additional health measures beyond the WHO's recommendations if public health rationales or scientific evidence justify such measures. Yet at least fifty-eight states parties enacted additional health measures, mainly travel restrictions to or from Ebola-affected countries. This article explains why Canada's visa restrictions targeting Ebola-affected countries failed to meet theIHR's requirements and therefore violated international law. Specifically, Canada's response went against public health authorities' consensus views, the best available scientific evidence on disease transmission, and the WHO's recommendations. In light of its traditional role as a global health champion, Canada must lead by example and abide by international law, including theIHR, instead of picking and choosing which rules to follow and thereby encouraging other countries to do the same.

BackgroundThere is widespread recognition that the existing global systems for innovation and access to medicines need reform. Billions of people do not have access to the medicines they need, and market failures prevent new drugs from being developed for diseases that primarily affect the global poor. The World Health Organization's Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG) analyzed numerous proposals for reform. The aim of this article is to build on these previous inquiries.MethodsWe conducted a structured analysis that grouped proposals into five broad opportunities for global policy reform to help researchers and decision makers to meaningfully evaluate each proposal in comparison with similar proposals. Proposals were also analyzed along three important dimensions—potential health impact, financial implications, and political feasibility—further facilitating the comparison and application of this information.FindingsUpon analysis, no one solution was deemed a panacea, as many (often competing) considerations need to be taken into account. However, some proposals, particularly product development partnership and prizes, appeared more promising and feasible at this time and deserve further attention.ConclusionMore research is needed into the effectiveness of these mechanisms and their transferability across jurisdictions.

Evaluating the success of adjudicative tribunals is an important but elusive undertaking. Adjudicative tribunals are created by governments and given statutory authority by legislatures for a host of reasons. These reasons may and often do include legal aspects, policy aspects and partisan aspects. While such tribunals are increasingly being asked by governments to be accountable, too often this devolves into publishing statistics on their caseload, dispositions, budgets and staffing. We are interested in a different and more basic question – are these tribunals successful? How do we know, for example, whether the remedies ordered by a tribunal actually do advance the purposes for which it was created? Can the success of an adjudicative tribunal be subject to meaningful empirical validation? While issues of evaluation and accountability cut across national and jurisdictional boundaries, the authors argue that this type of question can only be addressed empirically, by actually looking to the practice of a particular board or boards, in the context of a particular statute or statutes, and in particular jurisdictions at particular times. Such accounts can and should form the basis for comparative study. Only through comparative study can the value and limitations of particular methodologies become apparent. This study takes as its case study the role of adjudicative tribunals in the health system. The authors draw primarily from Canadian tribunal experience, though examples from other jurisdictions are used to demonstrate the potential of empirical evaluation. The authors discuss the relative dearth of empirical study in administrative law and argue that it ought to be the focus of the discussion on accountability in administrative justice.

Abstract Antimicrobial resistance (AMR) has the potential to threaten tens of millions of lives and poses major global economic and development challenges. As the AMR threat grows, it is increasingly important to strengthen the scientific evidence base on AMR policy interventions, to learn from existing policies and programmes, and to integrate scientific evidence into the global AMR response. While rigorous evaluations of AMR policy interventions are the ideal, they are far from the current reality. To strengthen this evidence base, we describe a framework for planning, conducting and disseminating research on AMR policy interventions. The framework identifies challenges in AMR research, areas for enhanced coordination and cooperation with decision-makers, and best practices in the design of impact evaluations for AMR policies. This framework offers a path forward, enabling increased local and global cooperation, and overcoming common limitations in existing research on AMR policy interventions.

We assessed what impact can be expected from global health treaties on the basis of 90 quantitative evaluations of existing treaties on trade, finance, human rights, conflict, and the environment.

The costs of any proposal for new international law must be fully evaluated and compared with benefits and competing alternatives to ensure adoption will not create more problems than solutions. A systematic review of the research literature was conducted to categorize and assess limitations and unintended negative consequences associated with the proposed Framework Convention on Global Health (FCGH). A critical analysis then interpreted these findings using economic, ethical, legal, and political science perspectives. Of the 442 documents retrieved, nine met the inclusion criteria. Collectively, these documents highlighted that an FCGH could duplicate other efforts, lack feasibility, and have questionable impact. The critical analysis reveals that negative consequences can result from the FCGH's proposed form of international law and proposed functions of influencing national budgets, realizing health rights and resetting global governance for health. Four options for revising the FCGH proposal are developed to address its weaknesses and strengthen its potential for impact. Adapted from the source document.

This article critically examines the use of national border closures at the outset of the COVID-19 pandemic. After explaining why targeted border closures generally do not work and how they violated international law at the time, we examine the unprecedented case of total border closures. Positing that since the current instruments and institutions of global health governance did not anticipate this phenomenon, the legality of total border closures rests on less certain grounds. Then, after asking why nearly every government implemented some form of border closure in March 2020 if neither science nor law provided adequate motivation for their use, we conclude that in the face of a global health emergency, border closures represent an opportunity for political leaders to show determined action, redirect blame to other jurisdictions, and reinforce nationalism. We proceed to argue that both targeted and total border closures have profound legal, epidemiological, and political significance as performances that contradict global realities while undermining notions of global solidarity. Such political theatre means that citizens must weigh these consequences against any perceived benefits of border closures as they would any other politically driven government action, and contest and challenge them appropriately. Citizens must not unduly defer to scientists or lawyers on early COVID-19 border closures because these were primarily political—not scientific or legal—decisions. In this vein, we conclude with some guiding political considerations for scrutinizing government decisions to close borders and observations for the future of global health cooperation during infectious disease outbreaks.

Governments and international organizations frequently convene scientific advisory committees (SACs) to support decision‐making with scientific advice. In this study, thematic analysis of interviews with 35 senior WHO staff identified five main themes characterizing WHO's experience with designing SACs to ensure quality, relevance, and legitimacy of scientific advice. First, in addition to technical matters, SACs are established to serve broader strategic objectives, including consensus building to promote high‐level political messages. Second, for SACs to be fully independent, they must have autonomy from the institutions convening or funding them, from the institutions from where SAC members are recruited, and from the institutions to whom the advice is directed. Third, since choices affecting quality, relevance, and legitimacy are closely linked, designing SACs often require trade‐offs among these three attributes. Fourth, staff supporting SACs need to balance between safeguarding SACs from external influence and being receptive to the external political environment. Fifth, the design of SACs need to balance the involvement of stakeholders with the power to act on recommendations against the need to protect the independence and integrity of the scientific process. Overall, this study highlights key choices conveners of SACs must make when seeking to promote quality, relevance, and legitimacy of scientific advice.