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Kavanagh MM, Wenham C, Massard da Fonseca E, Helfer LR, Nyukuri E, Maleche A, Halabi SF, Radhakrishnan A, Waris A. Increasing compliance with international pandemic law: international relations and new global health agreements. Lancet 2023; 402:1097-1106. [PMID: 37678291 DOI: 10.1016/s0140-6736(23)01527-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 09/09/2023]
Abstract
Across multiple pandemics, global health governance institutions have struggled to secure the compliance of states with international legal and political commitments, ranging from data sharing to observing WHO guidance to sharing vaccines. In response, governments are negotiating a new pandemic treaty and revising the International Health Regulations. Achieving compliance remains challenging, but international relations and international law research in areas outside of health offers insights. This Health Policy analyses international relations research on the reasons why states comply with international law, even in the absence of sanctions. Drawing on human rights, trade, finance, tobacco, and environmental law, we categorise compliance mechanisms as police patrol, fire alarm, or community organiser models. We show that, to date, current and proposed global health law incorporates only a few of the mechanisms that have shown to be effective in other areas. We offer six specific, politically feasible mechanisms for new international agreements that, together, could create compliance pressures to shift state behaviour.
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Affiliation(s)
- Matthew M Kavanagh
- School of Health, Georgetown University, Washington, DC, USA; O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA.
| | - Clare Wenham
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | | | - Elvin Nyukuri
- Faculty of Law, University of Nairobi, Nairobi, Kenya; Centre for Advanced Studies in Environmental Law and Policy, University of Nairobi, Nairobi, Kenya
| | - Allan Maleche
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA; Kenya Legal & Ethical Issues Network on HIV and AIDS, Nairobi, Kenya
| | - Sam F Halabi
- School of Health, Georgetown University, Washington, DC, USA; O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA
| | - Adi Radhakrishnan
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA
| | - Attiya Waris
- Faculty of Law, University of Nairobi, Nairobi, Kenya
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Affiliation(s)
- Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC
| | - Sam F Halabi
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC
| | - Kevin A Klock
- Foundation for the National Institutes of Health, North Bethesda, Maryland
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Packer C, Halabi SF, Hollmeyer H, Mithani SS, Wilson L, Ruckert A, Labonté R, Fidler DP, Gostin LO, Wilson K. A survey of International Health Regulations National Focal Points experiences in carrying out their functions. Global Health 2021; 17:25. [PMID: 33676512 PMCID: PMC7936598 DOI: 10.1186/s12992-021-00675-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/18/2021] [Indexed: 11/15/2022] Open
Abstract
Background The 2005 International Health Regulations (IHR (2005)) require States Parties to establish National Focal Points (NFPs) responsible for notifying the World Health Organization (WHO) of potential events that might constitute public health emergencies of international concern (PHEICs), such as outbreaks of novel infectious diseases. Given the critical role of NFPs in the global surveillance and response system supported by the IHR, we sought to assess their experiences in carrying out their functions. Methods In collaboration with WHO officials, we administered a voluntary online survey to all 196 States Parties to the IHR (2005) in Africa, Asia, Europe, and South and North America, from October to November 2019. The survey was available in six languages via a secure internet-based system. Results In total, 121 NFP representatives answered the 56-question survey; 105 in full, and an additional 16 in part, resulting in a response rate of 62% (121 responses to 196 invitations to participate). The majority of NFPs knew how to notify the WHO of a potential PHEIC, and believed they have the content expertise to carry out their functions. Respondents found training workshops organized by WHO Regional Offices helpful on how to report PHEICs. NFPs experienced challenges in four critical areas: 1) insufficient intersectoral collaboration within their countries, including limited access to, or a lack of cooperation from, key relevant ministries; 2) inadequate communications, such as deficient information technology systems in place to carry out their functions in a timely fashion; 3) lack of authority to report potential PHEICs; and 4) inadequacies in some resources made available by the WHO, including a key tool – the NFP Guide. Finally, many NFP representatives expressed concern about how WHO uses the information they receive from NFPs. Conclusion Our study, conducted just prior to the COVID-19 pandemic, illustrates key challenges experienced by NFPs that can affect States Parties and WHO performance when outbreaks occur. In order for NFPs to be able to rapidly and successfully communicate potential PHEICs such as COVID-19 in the future, continued measures need to be taken by both WHO and States Parties to ensure NFPs have the necessary authority, capacity, training, and resources to effectively carry out their functions as described in the IHR. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-021-00675-7.
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Affiliation(s)
- Corinne Packer
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cres, Ottawa, K1G 5Z3, Canada
| | - Sam F Halabi
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, 600 New Jersey Ave NW, Washington, DC, 20001, USA.,University of Missouri School of Law, Columbia, MO, 65211, USA
| | - Helge Hollmeyer
- International Health Regulations Coordination Department, World Health Organization WHO, 20 Avenue Appia, 1211, Geneva 27, Switzerland
| | - Salima S Mithani
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Lindsay Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Arne Ruckert
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cres, Ottawa, K1G 5Z3, Canada
| | - Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cres, Ottawa, K1G 5Z3, Canada
| | | | - Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, 600 New Jersey Ave NW, Washington, DC, 20001, USA
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada. .,Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Canada. .,Bruyère and Ottawa Hospital Research Institutes, Ottawa, Canada.
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von Tigerstrom BJ, Halabi SF, Wilson KR. The International Health Regulations (2005) and the re-establishment of international travel amidst the COVID-19 pandemic. J Travel Med 2020; 27:5880460. [PMID: 32749458 PMCID: PMC7454819 DOI: 10.1093/jtm/taaa127] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 11/13/2022]
Abstract
As countries modify or lift travel restrictions implemented in response to the COVID-19 pandemic, some variation in approaches is to be expected, but harmonization is important to re-establishing international travel. Despite challenges, the International Health Regulations (2005) and WHO recommendations can provide a balance of consistency and flexibility.
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Affiliation(s)
| | - Sam F Halabi
- O'Neill Institute for National and Global Health Law, Georgetown University and Center for Global Health Science and Security, Georgetown University, Washington, D.C., USA
| | - Kumanan R Wilson
- Bruyère Research Institute, Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Abstract
Anthropogenic climate change is causing temperature rise in temperate zones resulting in climate conditions more similar to subtropical zones. As a result, rising temperatures increase the range of disease-carrying insects to new areas outside of subtropical zones, and increased precipitation causes flooding that is more hospitable for vector breeding. State governments, the federal government, and governmental agencies, like the Animal and Plant Health Inspection Service (APHIS) of USDA and the National Notifiable Disease Surveillance System (NNDSS) of the U.S. Centers for Disease Control and Prevention, lack a coordinated plan for vector-borne disease accompanying climate change. APHIS focuses its surveillance primarily on the effect of illness on agricultural production, while NNDSS focuses on the emergence of pathogens affecting human health. This article provides an analysis of the current framework of surveillance of, and response to, vector-borne infectious diseases, the impacts of climate change on the spread of vector-borne infectious diseases, and recommends changes to federal law to address these threats.
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Affiliation(s)
- Sam F Halabi
- Sam F. Halabi, J.D., M.Phil., is the Manley O. Hudson Professor of Law at University of Missouri-Columbia School of Law and a Scholar at the O'Neill Institute for National and Global Health Law at Georgetown University. He is the Co-Chair of the Ethical, Legal, and Social Implications Working Group of the Global Virome Project and a member of the Executive Board of USAID's One Health Workforce-Next Generation project. He received a B.A. and a B.S. from Kansas State University in Manhattan, Kansas, an M.Phil. from University of Oxford in Oxford, United Kingdom, and a J.D. from Harvard Law School in Cambridge, Massachusetts
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Affiliation(s)
- Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC
| | - Sam F Halabi
- University of Missouri School of Law, Columbia
- Centre for Health Law, Policy, and Ethics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Halabi SF. Off-Label Marketing's Audiences: The 21 st Century Cures Act and the Relaxation of Standards for Evidence-Based Therapeutic and Cost-Comparative Claims. Am J Law Med 2018; 44:181-196. [PMID: 30106659 DOI: 10.1177/0098858818789420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Sam F Halabi
- Fulbright Canada Research Chair in Health Law, Policy, and Ethics at the University of Ottawa, Ontario; Associate Professor of Law at the University of Missouri-Columbia; Scholar at the O'Neill Institute for National and Global Health Law at Georgetown University. J.D. Harvard, MPhil Oxford (St. Antony's College), B.A., B.S., Kansas State University. The author thanks Jacqueline Fox, Joan Krause, Fran Miller, Kevin Outterson, Jordan Paradise, and Christopher Robertson for helpful comments and suggestions. The author also thanks the faculty and student organizers of the American Journal of Law & Medicine's 2018 Symposium, with particular thanks to Fran Miller, Andrea-Gale Okoro, Sana Shakir, and Jordan Shelton. Finally, the author thanks Alison Matusofsky for excellent research assistance
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Halabi SF, Omer SB. Legal Complexities of Global Vaccine Compensation Systems-Reply. JAMA 2017; 317:1912. [PMID: 28492896 DOI: 10.1001/jama.2017.4432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sam F Halabi
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC
| | - Saad B Omer
- Rollins School of Public Health, Emory University, Atlanta, Georgia
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Affiliation(s)
- Sam F Halabi
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC2University of Missouri School of Law, Columbia
| | - Saad B Omer
- School of Medicine, Emory University, Atlanta, Georgia
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Halabi SF, Lin CF. Assessing the Relative Influence and Efficacy of Public and Private Food Safety Regulation Regimes: Comparing Codex and Global G.A.P. Standards. Food Drug Law J 2017; 72:262-294. [PMID: 29140660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An extensive global system of private food regulation is under construction, one that exceeds conventional regulation thought of as being driven by public authorities like FDA and USDA in the U.S. or the Food Standards Agency in the UK. Agrifood and grocer organizations, in concert with some farming groups, have been the primary designers of this new food regulatory regime. These groups have established alliances that compete with national regulators in complex ways. This article analyzes the relationship between public and private sources of food safety regulation by examining standards adopted by the Codex Alimentarius Commission, a food safety organization jointly run by the Food and Agricultural Organization and the World Health Organization and GlobalG.A.P., a farm assurance program created in the late 1990s by supermarket chains and their major suppliers which has now expanded into a global certifying coalition. While Codex standards are adopted, often as written, by national food safety regulators who are principal drivers of the standard setting process, customers for agricultural products in many countries now demand evidence of GlobalG.A.P. certification as a prerequisite for doing business This article tests not only the durability and strength of private sector standard setting in the food safety system, but also the desirability of that system as an alternative to formal, governmental processes embodied, for our purposes, in the standards adopted by Codex. In many cases, official standards and GlobalG.A.P. standards clash in ways that implicate not only food safety but the flow of agricultural products in the global trading system. The article analyzes current weaknesses in both regimes and possibilities for change that will better reconcile the two competing systems.
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Halabi SF. The Scope of Preemption under the 2009 Family Smoking Prevention and Tobacco Control Act. Food Drug Law J 2016; 71:300-326. [PMID: 29140057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Halabi SF. The Codex Alimentarius Commission, Corporate Influence, and International Trade: A Perspective on FDA's Global Role. Am J Law Med 2015; 41:406-421. [PMID: 26591826 DOI: 10.1177/0098858815591525] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The FDA Food Safety Modernization Act (FSMA) is by all accounts the most sweeping and comprehensive update to U.S. food laws in seventy years, aiming to confront the reality that the nation's food supply has undergone fundamental shifts in its sources, distribution channels, and intermediate handlers. The law's intent is to prevent problems that can cause foodborne illness and enable the Food and Drug Administration (FDA) to keep a record of facilities processing food for sale in the United States, a mandate that expands FDA's already global regulatory activities. FSMA gives FDA broad new powers to prevent food safety problems, detect and respond to food safety issues, and improve the safety of imported foods. Because the law specifically aims to update FDA authority in light of the reality of global food and food additive markets, Section 305 FSMA calls for FDA to develop a comprehensive plan to expand the “technical, scientific, and regulatory capacity of foreign governments and their respective food industries in countries that export foods to the United States.”
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