Making International Health Regulations Work: Lessons from the 2014 Ebola Outbreak

Abstract

Many legal scholars believe that the lack of enforcement mechanisms provided by the International Health Regulations (IHR) in part explains the slow containment of the deadly Ebola virus disease outbreak in West Africa in 2014. In contrast, some global health practitioners deem funding for global health emergencies as a key remedy to the ineffective international infectious disease control regime. Such belief underpinned the creation of the Pandemic Emergency Facility (PEF), the World Bank’s new financing initiative, aiming to finance global disaster response. Some commentators hope that the establishment of the PEF will resuscitate international interest in global health security and cooperation. Although current discussion touches upon how to integrate the PEF with the existing international infectious disease control regime, much remains unclear about how the PEF will relate to the IHR operationally and normatively. Relatedly, legal scholars and global health practitioners continue to talk about IHR enforcement and global health emergency funding as two different things, without exploring how the latter can incentivize the former.

Starting from the IHR as a pillar of global health security, this Article focuses on strengthening the IHR enforcement mechanism — thus far overlooked in the current discussion — vis-à-vis the PEF. It also argues that such linkage is important in ensuring consistent, rapid global health emergency responses. Drawing on lessons from the 2014 Ebola outbreak, the Article demonstrates that the proposal is normatively desirable and politically feasible. The Article makes a timely intervention, as the PEF has tremendous potential in shaping the international infectious disease regime, creating new opportunities and anxiety simultaneously.