Wednesday, May 25, 2005

New rules at WHO--for some

The idea of national sovereignty goes back to the Peace of Westphalia, ending the Thirty Years War in 1648. Globalization and other factors have weakened the nation-state system and the threat of emerging infectious disease with pandemic potential has highlighted further the difficulties of allowing each country to determine its own public health course when what happens in one can threaten its neighbors and even entire regions or the global community. But WHO's original International Health Regulations (IHR) still assumed the Westphalian system, making the agency's ability to require its member states to cooperate difficult or impossible. The IHR have remained essentially intact in that form since 1951. In its last incarnation (1981) the IHR"required" WHO notification of cholera, plague, yellow fever, smallpox, relapsing fever and typhus, but today only the first three remain as diseases requiring immediate notification. And notification was essentially the only substantive requirement.

Now, WHO through its governing body the World Health Assembly, has revamped the IHR (.pdf) in ways that challenge its Westphalian foundations--but not by a lot. It is requiring member nations to notify WHO immediately of the presence within their borders of any of four diseases: bird flu, Severe Acute Respiratory Syndrome (SARS), smallpox and polio. In addition, countries must put in place the capacity for routine preventive measures and monitoring, including specific public health actions at ports, airports and border crossings. If countries don't comply, the WHA voted to establish a standing committee of external independent health experts to advise WHO on actions such as recommending travel and commerce restrictions to affected areas, a clear departure from the notion of pure Westphalian sovereignty. WHO took such actions to a limited extent in the SARS episode and this experience is now being formalized in the new IHR.

Member states have two years to establish these requirements in their own laws and regulations, after which they will automatically be bound by them--except, if they decide to opt out or express reservations. And guess who was the first to do that?
The United States, which welcomed the new rules, was the first country to announce its plans to file a reservation - saying that when it came to US armed forces, it would comply with the rules unless they compromise national security. (AP via Jamaican Observer)
Let me see if I understand this. If a deadly disease (say, for the sake of argument bird flu) breaks out in the military, the US isn't bound to notify any other country or its own people? Because of national security? I guess I don't get what "national security" means. I thought it had something to do with keeping us safe.