8. International Health Regulations and Epidemic Control
- IHR ineffective tool to temper protective national (over) reaction to outbreaks occurring in other countries
- Serious hurdle for control through IHR is ‘precautionary principle’ in international trade
- Countries demand that other countries inform the world about outbreaks, but do not wish to do so themselves
Overall, the IHR has not been a very effective tool for the WHO to temper protective national (over) reaction to outbreaks occurring in other countries. To some extent, this is due to ignorance: present-day civil servants working in Departments of Trade or Border Control may often be unaware of an international agreement brokered by people in another field more than a generation ago.
A serious hurdle for control through the IHR is the increasing acceptance of the so-called 'precautionary principle' in international trade. Even the WTO, with its stringent demands on a scientific basis for any import restrictions based on health arguments, allows countries to temporarily raise their trade barriers in situations of uncertainty. In an outbreak, the use of this precautionary principle could always over-ride any public health-based attempts from the WHO to issue directives on what would be necessary and sufficient to control international spread. Protectionist states are reluctant to let an international organisation make any decisions on their behalf. It seems very natural for those states to demand that other - often much more economically vulnerable - countries should inform the world about potentially dangerous outbreaks, but much less natural to accept that this demand requires some assurance, for the country hit by an outbreak, that reporting will not be punished by over-reaction from the rest of the world.
If the IHR is to enable the final GPGH of less risk from international epidemics, they thus have to deal both with the incentive problem involved in alert and control from free-riding (e.g. in the equal sharing of surveillance information), and with the prisoners' dilemma inherent in the application of the precautionary principle.