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Ebola Again Shows the International Health Regulations Are Broken

What Can Be Done Differently to Prepare for the Next Epidemic?

Published online by Cambridge University Press:  06 January 2021

Trygve Ottersen ,
Steven J. Hoffman  and
Gaëlle Groux
Trygve Ottersen*
Affiliation:
Oslo Group on Global Health Policy, Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
Steven J. Hoffman*
Affiliation:
Global Strategy Lab, Centre for Health Law, Policy & Ethics, University of Ottawa, Ottawa, Ontario, Canada
Gaëlle Groux*
Affiliation:
Global Strategy Lab, Centre for Health Law, Policy & Ethics, University of Ottawa, Ottawa, Ontario, Canada
*
Contact information: Trygve Ottersen, +47-228-505-37, Email: [email protected]
Contact information: Steven J. Hoffman, +1-613-562-5800 ext 8811, Email: [email protected], @shoffmania
Contact information: Gaëlle Groux, +1-613-562-5800 ext 3258, Email: [email protected]@gaellegroux
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Abstract

Epidemics are among the greatest threats to humanity, and the International Health Regulations are the world's key legal instrument for addressing this threat. Since their revision in 2005, the IHR have faced two big tests: the 2009 H1N1 influenza pandemic and the 2014 Ebola epidemic in West Africa. Both exposed major shortcomings of the IHR, and both offered profound lessons for the future.

The objective of this Article is twofold. First, we seek to compare the lessons learned from H1N1 and Ebola for reforming the IHR in order to test the hypothesis that they are similar. Second, we seek to examine the barriers to implementing these lessons and to identify strategies for overcoming those barriers.

We find that the lessons from H1N1 and Ebola are indeed similar, and that opportunities to act on lessons from H1N1 were woefully missed. We identify many political barriers to global collective action and implementation of lessons for the IHR. On that basis, we describe strategies to overcome these barriers, which will hopefully be deployed now to reform the IHR before the policy window following Ebola closes, and before the inevitable next epidemic comes. The emerging threat of the Zika virus underscores that we have no time to waste.

Type
Articles
Information
American Journal of Law & Medicine , Volume 42 , Issue 2-3: Global Infectious Diseases: New Challenges and Solutions , May 2016 , pp. 356 - 392
Copyright
Copyright © American Society of Law, Medicine and Ethics and Boston University 2016

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Footnotes

*

This article was submitted in December 2015, accepted for publication in February 2016 and last updated in April 2016. Since then, further lessons from the Ebola outbreak about the International Health Regulations have been offered. In particular, the report of the Review Committee on the Role of the International Health Regulations (2005) in the Ebola Outbreak and Response was presented to the World Health Assembly in May 2016.

References

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2 See The World Bank, People, Pathogens and Our Planet: Towards a One Health Approach for Controlling Zoonotic Diseases 7-11 (2010); Morse, Stephen S. et al., Prediction and Prevention of the Next Pandemic Zoonosis, 380 Lancet 1956, 1956-59 (2012)Google Scholar.

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6 Id.

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9 See, e.g., WHO, Strengthening Response to Pandemics and other Public-Health Emergencies: Report of the Review Committee on the Functioning of the International Health Regulations (2005) and on Pandemic Influenza (H1N1) 2009 (2011), http://apps.who.int/iris/bitstream/10665/75235/1/9789241564335_eng.pdf [http://perma.cc/C8RB-YM7V] [hereinafter WHO, Response to Pandemics]; Mackey, Tim K. & Liang, Bryan A., Lessons from SARS and H1N1/A: Employing a WHO–WTO Forum to Promote Optimal Economic-Public Health Pandemic Response, 33 J. Pub. Health Pol’y 119 (2012)Google Scholar; Wilson, Kumanan, Brownstein, John S. & Fidler, David P., Strengthening the International Health Regulations: Lessons from the H1N1 Pandemic, 25 Health Pol’y & Plan. 505 (2010)Google Scholar.

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12 Declich, S. & Carter, A. O., Public Health Surveillance: Historical Origins, Methods and Evaluation, 72 Bull. World Health Org. 285, 285 (1994)Google Scholar; Gensini, Gian Franco et al., The Concept of Quarantine in History: From Plague to SARS, 49 J. Infection 257, 258 (2004)Google Scholar.

13 Gensini et al., supra note 12, at 258.

14 Id.

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17 David P. Fidler, International Law and Infectious Diseases 22-23 (1999).

18 Hoffman, supra note 15, at 512.

19 Fidler, supra note 16, at 327-28 (defining the ”classical regime” as a period between 1851 and 1951).

20 Id. at 328.

21 Davies, Kamradt-Scott, and Rushton, supra note 15, at 5.

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23 Fidler, supra note 16, at 328-29.

24 Id. at 333.

25 Davies, Kamradt-Scott, and Rushton, supra note 15, at 5.

26 Id. at 21; Fidler, supra note 16, at 333.

27 von Tigerstrom, supra note 22, at 36 (limiting the focus to plague, cholera, and yellow fever).

28 Id. at 37; Hoffman, supra note 15, at 514.

29 Fidler, David P. & Gostin, Lawrence O., The New International Health Regulations: An Historic Development for International Law and Public Health, 34 J. L. Med. & Ethics 85, 90 (2006)Google Scholar.

30 Fidler, supra note 16, at 342; Katz, Rebecca & Fischer, Julie, The Revised International Health Regulations: A Framework for Global Pandemic Response, 3 Global Health Governance 1, 2 (2010)Google Scholar.

31 Rodier, Guénaël et al., Global Public Health Security, 13 Emerging Infectious Diseases 1447, 1448 (2007)Google Scholar.

32 See Inst. of Med., Learning from SARS: Preparing for the Next Disease Outbreak 4 (Stacey Knobler et al. eds., 2004).

33 See Fidler, supra note 16, at 355 (“In May 2003, the [World Health Assembly] supported WHO’s responses to SARS and called for the IHR revision process to move forward to completion.”).

34 See, e.g., id. at 354; Davies, Kamradt-Scott, and Rushton, supra note 15, at 44; Inst. of Med., supra note 32, at 113-115.

35 Davies, Kamradt-Scott, and Rushton, supra note 15, at 44.

36 Id. at 47-48.

37 See Fidler, supra note 16, at 361.

38 See id at 358.

39 See id.

40 See id.

41 See id.

42 States Parties to the International Health Regulations (2005), WHO (2016), http://www.who.int/ihr/legal_issues/states_parties/en/ [http://perma.cc/MS5B-S6C7].

43 IHR, supra note 8, at art. 2.

44 See, e.g., WHO, Response to Pandemics, supra note 9, at 8; Fidler & Gostin, supra note 29, at 86- 91.

45 IHR, supra note 8. at art. 5.

46 Id., at art. 13.

47 See WHO, Checklist and Indicators for Monitoring Progress in the Development of ihr Core Capacities in States Parties 15-17 (2013), http://apps.who.int/iris/bitstream/10665/84933/1/WHO_HSE_GCR_2013.2_eng.pdf [http://perma.cc/YG2N-3XMJ] (explaining the core capacities).

48 IHR, supra note 8, at art. 54.

49 World Health Assembly, Sixty-First World Health Assembly: Resolutions and Decisions Annexes, at 3-4, WHA61/2008/REC/1 (2008), http://apps.who.int/gb/ebwha/pdf_files/WHA61-REC1/A61_REC1-en.pdf [http://perma.cc/9YUR-E3HL].

50 IHR, supra note 8, at arts. 5, 13.

51 Id.

52 Id. at art. 44.

53 Id. at art. 6.

54 Id. at art. 1.

55 Id.

56 Id. at Annex 2.

57 Id. at art. 6.

58 Id. at art. 7.

59 Id. at art. 10.

60 Id. at art. 8.

61 Id. at art. 11.

62 Id.

63 Id. at art. 9.

64 Id. at art. 10.

65 Id. at art. 12.

66 Id.

67 Id.

68 Id. at art. 15.

69 Id.

70 Id. at art. 18 (listing recommendations with respect to persons, baggage, cargo, containers, conveyances, goods and postal parcels).

71 von Tigerstrom, supra note 22, at 41-48.

72 IHR, supra note 8, at art. 31.

73 Id. at art. 32.

74 Id. at art. 42.

75 Id. at art. 43.

76 Id.

77 Id.

78 Id.

79 Id.

80 WHO, Response to Pandemics, supra note 9, at 29.

81 See id.; see also WHO, New Influenza A(H1N1) Virus Infections: Global Surveillance Summary, May 2009, 84 Wkly. Epidemiological Rec. 173, 173 (2009) [hereinafter WHO, New Influenza].

82 See Davies, Kamradt-Scott, and Rushton, supra note 15, at 95; WHO, RESPONSE TO PANDEMICS, supra note 9, at 29.

83 See WHO, Response to Pandemics, supra note 9, at 29; see also The 2009 H1N1 Pandemic, Ctrs. for Disease Control & Prevention [CDC] (Aug. 3, 2010), http://www.cdc.gov/h1n1flu/cdcresponse.htm [http://perma.cc/7D3W-733H] (summarizing key events of the 2009 H1N1 pandemic).

84 WHO, Response to Pandemics, supra note 9, at 29.

85 See id. (“Coincident with the outbreaks in Mexico, at the end of March two children in adjacent counties in southern California in the USA, became ill with acute respiratory illnesses.”).

86 WHO, New Influenza, supra note 81, at 174.

87 See id. (noting that the Director-General declared a PHEIC on April 25, 2009); WHO, Response to Pandemics, supra note 9, at 32 (noting that April 25, 2009 was also the first time the Emergency Committee convened).

88 Margaret Chan, World Now at the Start of 2009 Influenza Pandemic, WHO (June 11, 2009), http://www.who.int/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/en/ [http://perma.cc/WE72-2KRF] (statement to the press by the WHO Director-General).

89 WHO, Response to Pandemics, supra note 9, at 40.

90 H1N1 in Post-Pandemic Period, WHO (Aug. 10, 2010), http://www.who.int/mediacentre/news/statements/2010/h1n1_vpc_20100810/en/ [http://perma.cc/MQ9M-5KRP] (Director-General’s opening statement at a virtual press conference).

91 WHO, Response to Pandemics, supra note 9, at 27.

92 Dawood, Fatimah S. et al., Estimated Global Mortality Associated with the First 12 Months of 2009 Pandemic Influenza A H1N1 Virus Circulation: A Modelling Study, 12 Lancet Infectious Diseases 687, 687 (2012)Google Scholar.

93 See One Year into the Ebola Epidemic: A Deadly, Tenacious and Unforgiving Virus, WHO (Jan. 2015), http://www.who.int/csr/disease/ebola/one-year-report/ebola-report-1-year.pdf?ua=1.

94 Id.

95 See id.

96 See id.

97 Id.

98 Id. The Institut confirmed that the causative agent was a filovirus on March 21st, which narrowed the diagnosis to either Ebola or Marburg hemorrhagic fever, but it was not until the next day that the lab was able to confirm it was indeed Ebola.

99 Id.

100 Id.

101 Ebola Outbreak in Guinea Unprecedented - MSF, BBC News, Mar. 31, 2014, http://www.bbc.com/news/world-africa-26825869 [http://perma.cc/9CVS-GL4D].

102 Ebola in West Africa: Epidemic Requires Massive Deployment of Resources, MÉdecins Sans FrontiÈres (June 21, 2014), http://www.msf.org/article/ebola-west-africa-epidemic-requires-massive-deployment-resources [http://perma.cc/4BCR-3N9Q].

103 See MÉdecins Sans FrontiÈres, Pushed to the Limit and Beyond: A Year into the Largest Ever Ebola Outbreak 12 (2015), http://www.msf.org/sites/msf.org/files/msf1yearebolareport_en_230315.pdf [hereinafter MÉdecins Sans FrontiÈres, Pushed to the Limit].

104 See Stephens, David S. et al., Ebola Virus Disease: Experience and Decision Making for the First Patients Outside of Africa, 12 Pub. Libr. Sci. Med. 1, 1 (2015)Google Scholar.

105 Id.

106 WHO, Statement on the First meeting of the IHR Emergency Committee on the 2014 Ebola Outbreak in West Africa (2014), http://www.who.int/mediacentre/news/statements/2014/ebola-20140808/en/.[http://perma.cc/6T2M-WU99] (“It was the unanimous view of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have been met.”).

107 WHO, Response to Pandemics, supra note 9, at 4.

108 Id. at 8.

109 Id. at 19; United Nations, Global Ebola Response, Making A Difference: Progress Report 2015 9-15 (2015), http://ebolaresponse.un.org/progress-2015 [http://perma.cc/YHJ2-ZW6E].

110 Id. at 14.

111 Latest Ebola Outbreak Over in Liberia; West Africa is at Zero, but New Flare-Ups are Likely to Occur, WHO (Jan. 14, 2016), http://www.who.int/mediacentre/news/releases/2016/ebola-zero-liberia/en/ [http://perma.cc/PZB7-7JVA] [hereinafter WHO, Latest Ebola Outbreak].

112 See generally WHO, Ebola Situation Report - 30 December 2015 (2015); WHO, Ebola Situation Report - 20 January 2016 (2016).

113 WHO, Latest Ebola Outbreak Over, supra note 111. West Africa is at zero, but new flare-ups are likely to occur. Id.

114 WHO, Response to Pandemics, supra note 9, at 19.

115 WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 6.

116 Moon et al., supra note 10, at 2204.

117 Comm’n on a Global Health Risk Framework, supra note 5, at 2.

118 Protecting Humanity from Future Health Crises: Report of the High-Level Panel on the Global Response to Health Crises 11 (Advanced Unedited Copy 2016).

119 WHO, EB138/20: Implementation of the International Health Regulations (2005): Progress Report of the Review Committee on the Role of the International Health Regulations (2005) in the Ebola Outbreak and Response 20 (2016) [hereinafter WHO, Implementation of the IHR].

120 IHR, supra note 8, at arts. 5, 13.

121 Id.

122 WHO, Response to Pandemics, supra note 9, at 112.

123 Id.

124 Wilson, Brownstein, & Fidler, supra note 9, at 506; James Osborne, Mexico Criticized for Slow Response to Swine Flu, Fox News (Apr. 28, 2009), http://www.foxnews.com/story/2009/04/28/mexico-criticized-for-slow-response-to-swine-flu.html [http://perma.cc/TEV4-DSDD].

125 WHO, Response to Pandemics, supra note 9, at 113; Davies, Kamradt-Scott, & Rushton, supra note 15, at 100.

126 Fineberg, Harvey V., Pandemic Preparedness and Response — Lessons from the H1N1 Influenza of 2009, 370 New Eng. J. Med. 1335, 1339 (2014)Google Scholar.

127 See, e.g., WHO, Response to Pandemics, supra note 9, at 112; Davies, Kamradt-Scott, & Rushton, supra note 15, at 136; PREVENT Project, Beyond Pandemics: A Whole-of-Society Approach to Disaster Preparedness 69-102 (2011), http://photos.state.gov/libraries/usun-rome/164264/PDF/tasw.pdf; Fineberg, supra note 126, at 1341; Wilson, Brownstein, & Fidler, supra note 9, at 506; Gostin, Lawrence O., Influenza A(H1N1) and Pandemic Preparedness Under the Rule of International Law, 301 JAMA 2376, 2376-78 (2009)Google Scholar.

128 WHO, Response to Pandemics, supra note 9, at xviii.

129 Katz & Fischer, supra note 30, at 13.

130 WHO, Response to Pandemics, supra note 9, at 112; Gostin, supra note 127, at 2377; Wilson, Brownstein, & Fidler, supra note 9, at 508.

131 Bogich, Tiffany L. et al., Preventing Pandemics Via International Development: A Systems Approach, 9 Pub. Libr. Sci. Med 1, 2 (2012)Google Scholar; Katz & Fischer, supra note 30, at 14-15.

132 Wilson, Brownstein, & Fidler, supra note 9, at 508.

133 See, e.g., WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 5; Heymann et al., supra note 10, at 1888; Kamradt-Scott, Adam, WHO’s to Blame? The World Health Organization and the 2014 Ebola Outbreak in West Africa, 37 Third World Q. 401, 404 (2016)Google Scholar.

134 Kai Kupferschmidt, In Wake of Ebola Epidemic, Margaret Chan Wants Countries to Put Their Money Where Their Mouth Is, Science (Oct. 14, 2015, 3:30 PM), http://news.sciencemag.org/health/2015/10/wake-ebola-epidemic-margaret-chan-wants-countries-put-their-money-where-their-mouth [http://perma.cc/8CP2-573F].

135 Global Health Observatory (GHO) Data: International Health Regulations (2005) Monitoring Framework, WHO (2016), http://www.who.int/gho/ihr/en/ [http://perma.cc/A8N6-SZVN].

136 Id.

137 Global Health Observatory Data Repository: Legislation Data by Country, WHO (2016), http://apps.who.int/gho/data/view.main.IHRCTRY01v?lang=en [http://perma.cc/E6R7-GRTQ].

138 For the Table above, the number of countries are represented by the Y-axis, and the various capacities are represented on the X-axis. See Global Health Observatory Data Repository: All Capacities Data by Country, WHO, http://apps.who.int/gho/data/node.main.IHR00ALLN?lang=en [http://perma.cc/28RQ-5K2G]; Summary of States Parties 2013 Report on IHR Core Capacity Implementation: Regional Profiles, WHO (2005), http://www.who.int/ihr/publications/WHO_HSE_GCR_2014.10/en/ [http://perma.cc/6JAE-PDSB].

139 See, e.g., Garrett, Laurie, Ebola’s Lessons: How the WHO Mishandled the Crisis, 94 Foreign Aff. 80, 89–90 (2015)Google Scholar (noting that Guinean authorities made no attempts to notify their Sierra Leonean counterparts when the disease first emerged); Gostin & Friedman, supra note 10, at 1903-1906; Moon et al., supra note 10, at 3.

140 See Gostin & Friedman, supra note 10, at 1902; Kevin Sack et al., How Ebola Roared Back, N.Y. Times (Dec. 29, 2014), http://www.nytimes.com/2014/12/30/health/how-ebola-roared-back.html.

141 See, e.g., Comm’n on a Global Health Risk Framework, supra note 5, at 3; WHO, Implementation of the IHR, supra note 118, at 6; WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 2, 10-11; Simon Wright et al., A Wake Up Call: Lessons from Ebola for the World’s Health Systems 1–50 (2015); Protecting Humanity from Future Health Crises, supra note 118, at 32; Gostin, DeBartolo & Friedman, supra note 10, at 3; Gostin & Friedman, supra note 10, at 1906; Moon et al., supra note 10, at 1; Siedner, Mark J. et al., Strengthening the Detection of and Early Response to Public Health Emergencies: Lessons from the West African Ebola Epidemic, 12 Pub. Libr. Sci. Med 1, 6 (2015)Google Scholar; The Lancet, supra note 10, at 1321.

142 See source cited supra note 141.

143 See e.g., Comm’n on a Global Health Risk Framework, supra note 5, at 4; Protecting Humanity from Future Health Crises, supra note 118, at 63-64; WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 11, 20; Wright et al., supra note 141; Gates, Bill, The Next Epidemic — Lessons from Ebola, 372 New Eng. J. Med. 1381, 1381-84 (2015)Google Scholar; Gostin, Lawrence O., Ebola: Towards an International Health Systems Fund, 384 Lancet e49, e50 (2014)Google Scholar; Gostin, DeBartolo, & Friedman, supra note 10, at 3; Gostin & Friedman, supra note 10, at 1907; Katz, Rebecca & Dowell, Scott F., Revising the International Health Regulations: Call for a 2017 Review Conference, 3 Lancet Glob. Health e352, e353 (2015)Google Scholar; Moon et al., supra note 10, at 1; The Lancet, supra note 10, at 1321.

144 See, e.g., Comm’n on a Global Health Risk Framework, supra note 5, at 4; Gostin & Friedman, supra note 10, at 1906; Katz & Dowell, supra note 143, at 21; Moon et al., supra note 10, at 5; The Lancet, supra note 10, at 1321.

145 See, e.g., WHO, Implementation of the IHR, supra note 119, at 6; WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 6; Gostin, DeBartolo, & Friedman, supra note 10, at 3; Moon et al., supra note 10, at 5-6.

146 See, e.g., Gostin, Ebola, supra note 143, at e50; Gostin, DeBartolo, & Friedman, supra note 10, at 3.

147 Moon et al., supra note 10, at 1.

148 Comm’n on a Global Health Risk Framework, supra note 5, at 3.

149 Gostin & Friedman, supra note 10, at 1906.

150 IHR, supra note 8, at art. 6.

151 Id. at art. 12.

152 Id. at art. 44.

153 Davies, Kamradt-Scott & Rushton, supra note 15, at 102; Lawrence O. Gostin, Global Health Law 202 (2014); Katz & Fischer, supra note 30, at 5.

154 Wilson, Brownstein, & Fidler, supra note 9, at 506.

155 See Zhang, Ying et al., Did Advances in Global Surveillance and Notification Systems Make a Difference in the 2009 H1N1 Pandemic?— A Retrospective Analysis, 8 Pub. Libr. Sci. One 1, 5 (2013)Google Scholar.

156 WHO, Response to Pandemics, supra note 9, at 29.

157 See id. at 54; see also Peter Piot et al., Ensuring Health for All: Towards a New Paradigm for Health for All (2010), http://www3.weforum.org/docs/WEF_HE_EnsuringHealthForAll_2010.pdf [http://perma.cc/8MK5-QWZE].

158 See Keller, Ann C. et al., Improving Pandemic Response: A Sensemaking Perspective on the Spring 2009 H1N1 Pandemic, 3 Risk Hazards Crisis Pub. Pol’y 1, 15–16 (2012)Google Scholar.

159 See, e.g., Mackey & Liang, supra note 9, at 125; Nuzzo, Jennifer B. & Gronvall, Gigi Kwik, Global Health Security: Closing the Gaps in Responding to Infectious Disease Emergencies, 4 Global Health Gov. 1, 10 (2011)Google Scholar; Wilson, Brownstein, & Fidler, supra note 9, at 507.

160 See Nuzzo & Gronvall, supra note 159, at 11.

161 See id. at 10; Mackey & Liang, supra note 9, at 128-37.

162 See Mackey & Liang, supra note 9, at 124; Nuzzo & Gronvall, supra note 159, at 10; von Tigerstrom, supra note 22, at 42; Wilson, Brownstein, & Fidler, supra note 9, at 507.

163 See Hardiman, Maxwell Charles, World Health Organization Perspective on Implementation of International Health Regulations, 18 Emerging Infectious Diseases 1041, 1042 (2012)Google Scholar.

164 See Anema, Aranka et al., Descriptive Review and Evaluation of the Functioning of the International Health Regulations (IHR) Annex 2, 8 Globalization & Health 1, 7 (2012)Google Scholar; Nuzzo & Gronvall, supra note 159, at 5-6.

165 See, e.g., WHO, Report of the Secretariat: Ebola Virus Disease Epidemic in West Africa 2 (Nov. 5, 2014), http://www.afro.who.int/index.php?option=com_docman&task=doc_download&gid=9385&Itemid=2593; Daniel Flynn & Stephanie Nebehay, Aid Workers Ask Where Was WHO in Ebola Outbreak?, Reuters (Oct. 15, 2014), http://uk.reuters.com/article/2014/10/05/us-health-ebola-who-idUKKCN0HU03Q20141005 [http://perma.cc/5GFR-UEH9].

166 See generally Sack et al., supra note 140; Garrett, supra note 139.

167 See MÉdecins Sans FrontiÈres, Pushed to the Limit, supra note 101, at 8; The Politics Behind the Ebola Crisis, Int’l Crisis Grp. (Oct. 28, 2015), http://www.crisisgroup.org/en/regions/africa/west-africa/232-the-politics-behind-the-ebola-crisis.aspx.

168 See Sack et al., supra note 140.

169 MÉdecins Sans FrontiÈres, Pushed to the Limit, supra note 101, at 8.

170 Id. at 7-8.

171 See WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 13; Maria Cheng & Raphael Satter, Emails Show the World Health Organization Intentionally Delayed Calling Ebola A Public Health Emergency, Business Insider (Mar. 20, 2015, 12:21 AM), http://www.businessinsider.com/report-the-world-health-organization-resisted-declaring-ebola-an-international-emergency-for-economic-reasons-2015-3 [http://perma.cc/W3WS-YWEA].

172 See Cheng & Satter, supra note 171.

173 See Katz & Fischer, supra note 30, at 5 (describing travel and trade restrictions in Mexico in response to H1N1, as well as the economic cost of the epidemic response); Keogh-Brown, Marcus Richard & Smith, Richard David, The Economic Impact of SARS: How Does the Reality Match the Predictions?, 88 Health Pol’y 110, 117-19 (2008)Google Scholar (quantifying the economic decline in countries affected by the SARS outbreak to certain sectors of the economy and discussing the implications); Rassy, Dunia & Smith, Richard D., The Economic Impact of H1N1 on Mexico’s Tourist and Pork Sectors, 22 Health Econ. 824, 831 (2013)Google Scholar (“The repercussions of H1N1 influenza on the tourism and pork industry coincide with the economic effects experienced by Southeast Asian nations following SARS ….”).

174 See WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 12 (“[I]ncentives are needed to encourage notification of health threats.”); Protecting Humanity from Future Health Crises, supra note 118, at 67; Moon et al., supra note 10, at 1 (recommending different ways in which governments and the WHO should better respond to disease outbreaks).

175 Comm’n on a Global Health Risk Framework, supra note 5, at 56.

176 See, e.g., Comm’n on a Global Health Risk Framework, supra note 5, at 6, 56-60; Protecting Humanity from Future Health Crises, supra note 118, at 65; WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 11-12; Moon et al., supra note 10, at 6.

177 Moon et al., supra note 10, at 6; see also Comm’n on a Global Health Risk Framework, supra note 5, at 6, 57 (recommending establishing “protocols for avoiding suppression or delays in data and alerts”).

178 See Comm’n on a Global Health Risk Framework, supra note 5, at 57 (recommending that a new mechanism should hold governments accountable for performance during a global health risk); WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 11-12 (“[M]ore than 40 countries implemented additional measures that significantly interfered with international traffic,” which increased the burden on affected countries); Moon et al., supra note 10, at 6-7 (suggesting that “alternate governance mechanisms are needed to prevent isolating countries when outbreaks strike”).

179 Comm’n on a Global Health Risk Framework, supra note 5, at 53-54.

180 See Gostin, DeBartolo & Friedman, supra note 10, at 3 (“The World Health Assembly could amend the decision instrument to reduce States Parties’ reporting discretion, avoiding delayed notification or verification.”); Kamradt-Scott, supra note 133, at 12-13 (concluding that intergovernmental organizations are “ultimately the creations of governments” that are subject to poor political leadership with respect to international health regulation).

181 IHR, supra note 8, at art. 11.

182 Id. at arts. 12, 15.

183 See WHO, Response to Pandemics, supra note 9, at xix (“WHO performed well in many ways during the pandemic, confronted systemic difficulties and demonstrated some shortcomings.”); Katz & Fischer, supra note 30, at 8-9 (“The IHR (2005) provided a functional framework for communications and the dissemination of informed guidance to coordinate responses throughout the 2009 pandemic.”).

184 Id.; see also Davies, Kamradt-Scott & Rushton, supra note 15, at 96.

185 See WHO, Response to Pandemics supra note 9, at 116; Imogen Foulkes, World Health Organization to Review Swine Flu Response, BBC, Jan. 12, 2010, http://news.bbc.co.uk/2/hi/health/8455035.stm [http://perma.cc/YS6J-UJUK]; Eben Harrell, Was the Threat of H1N1 Flu Exaggerated?, Time, Jan. 26, 2010, http://content.time.com/time/health/article/0,8599,1956608-2,00.html.

186 Wilson, Brownstein & Fidler, supra note 9, at 507.

187 See Paul Flynn, Rapporteur, Council of Europe Parliamentary Assembly, The Handling of the H1N1 Pandemic: More Transparency Needed (Provisional Version), at 17 (2010) (“For the rapporteur, the main concerns regarding the current H1N1 influenza include … the transparency of relevant decision- making processes, including the possibility of undue influence by the pharmaceutical industry ….”); WHO, Response to Pandemics, supra note 9, at xx, 116 (“Although confidentiality represented an understandable effort to protect the members from external pressures, this paradoxically fed suspicions that the Organization had something to hide.”); Cohen, Deborah & Carter, Philip, WHO and The Pandemic Flu “Conspiracies,” 340 Brit. Med. J. 1274, 1274 (2010)Google Scholar (questioning “why the composition of the emergency committee … remain[s] a secret known only to those within WHO”).

188 See supra text accompanying note 193.

189 See WHO, Response to Pandemics, supra note 9, at 127-45 (listing members and their disclosures); List of Members of, and Advisers to, the International Health Regulations (2005) Emergency Committee Regarding Ebola, WHO, http://www.who.int/ihr/procedures/emerg_comm_members_20140806/en/ [http://perma.cc/LF7W-6UZR]; Biographies of the Members of, and Advisers to, the IHR Emergency Committee Regarding the Ebola Outbreak in West Africa, WHO, http://www.who.int/ihr/procedures/biographies_ebola_review_committee/en/ [http://perma.cc/F37L-37HU]; see also Gostin, DeBartolo & Friedman, supra note 10, at 3 (indicating that WHO’s decision to release member names and conflicts improved public trust, but WHO could also “publish full meeting minutes, provide web access to documents, and offer live updates through social media platforms”).

190 See Beyond Pandemics, supra note 123, at 14, 41 (recommending harmonizing the measures in the report with the IHR (2005) and other WHO guidance relating to pandemic response in order to strengthen overall preparedness).

191 See id. at 18, 33, 103 (showing how the interconnectedness of pandemic threat requires a coordinated response).

192 Flynn, supra note 187, at 2; see also Kamradt-Scott, Adam, Strengthening Multisectoral Preparedness in Asia: Report on High-Level ASEAN Consultation Meeting, 4 Health Dipl. Monitor 14, 15 (2013)Google Scholar.

193 WHO, Response to Pandemics, supra note 9, at 120.

194 See generally One Year into the Ebola Epidemic, supra note 93.

195 See Moon et al., supra note 10, at 3 (“This phase underscored the problem of inadequate investments in health infrastructure, despite national governments’ formal commitments to do so under the International Health Regulations (2005) ….”); Sack et al., supra note 140 (citing a WHO official saying “modest further intervention efforts at that point could have achieved control”).

196 Moon et al., supra note 10, at 3.

197 See generally id.; MÉdecins Sans FrontiÈres, Pushed to the Limit, supra note 103; WHO, Report of the Ebola Interim Assessment Panel, supra note 10.

198 WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 5.

199 See Sheri Fink, W.H.O. Leader Describes the Agency’s Ebola Operations, N.Y. Times, Sept. 4, 2014, http://www.nytimes.com/2014/09/04/world/africa/who-leader-describes-the-agencys-ebola-operations.html.

200 WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 12-13.

201 Id. at 12.

202 See generally United Nations, Global Ebola Response, supra note 109 (documenting the progress of the disease response as of May 2015); WHO, One Year into the Ebola Epidemic, supra note 93 (summarizing disease response efforts after one year in a series of papers); Moon et al., supra note 10, at 4 (describing the third and fourth phases of the epidemic response).

203 See Moon et al., supra note 10, at 3-4.

204 See generally Comm’n on a Global Health Risk Framework, supra note 5; WHO, Report of the Ebola Interim Assessment Panel, supra note 10; Garrett, supra note 139; Gostin & Friedman, supra note 136; Gostin, DeBartolo, & Friedman, supra note 10; Moon et al., supra note 10.

205 See Gostin, DeBartolo & Friedman, supra note 10, at 3.

206 See id. at 3 (noting that “[t]ransparent Emergency Committee deliberations showing independence would build public trust”); Moon et al., supra note 10, at 9 (recommending that the Emergency Committee issues an annual report describing its activities and be free from financial conflicts).

207 Moon et al., supra note 10, at 9 (recommending a standing committee with a clear mandate to declare public health emergencies).

208 WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 13; WHO, Implementation of the IHR supra note 119, at 6; Gostin, DeBartolo & Friedman, supra note 10, at 4;

209 Comm’n on a Global Health Risk Framework, supra note 5, at 5; WHO, Advisory Group on Reform of WHO’s Work in Outbreaks and Emergencies: First Report, 4, 10 (2015), http://www.who.int/about/who_reform/emergency-capacities/advisory-group/first-report.pdf?ua=1 [http://perma.cc/6QV9-EVUJ] [hereinafter WHO, Advisory Group on Reform, First Report]; WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 7, 25; Moon et al., supra note 10, at 7-8;

210 Comm’n on a Global Health Risk Framework, supra note 5, at 55.

211 WHO, Advisory Group on Reform of WHO’s Work in Outbreaks and Emergencies: Second Report 10, 14 (2016), http://www.who.int/about/who_reform/emergency-capacities/advisory-group/second-report.pdf?ua=1 [http://perma.cc/FQ62-4MPX] [hereinafter WHO, Advisory Group on Reform, Second Report]; WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 23; WHO, Implementation of the IHR, supra note 119, at 7; Protecting Humanity from Future Health Crises, supra note 118, at 53-54; Gostin, DeBartolo & Friedman, supra note 10, at 4.

212 See, e.g., Comm’n on a Global Health Risk Framework, supra note 5, at 66; WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 16; Protecting Humanity from Future Health Crises, supra note 118, at 50-51; Moon et al., supra note 10, at 1.

213 See, e.g., Comm’n on a Global Health Risk Framework, supra note 5, at 53; WHO, Advisory Group on Reform, First Report, supra note 209, at 3, 12; WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 6; Protecting Humanity from Future Health Crises, supra note 118, at 65; Gostin, supra note 139, at e50; Gostin, DeBartolo & Friedman, supra note 10, at 4; Report by the Director-General to the Special Session of the Executive Board on Ebola, WHO (Jan. 25, 2015), http://www.who.int/dg/speeches/2015/executive-board-ebola/en/ [http://perma.cc/D4KQ-QCR2].

214 See generally WHO, Report of the Ebola Interim Assessment Panel, supra note 10 at 16; Gostin & Friedman, supra note 140; Gostin, DeBartolo & Friedman, supra note 10; Moon et al., supra note 10.

215 See sources cited supra note 214; see also Comm’n on a Global Health Risk Framework, supra note 5, at 5, 52; Kamradt-Scott, supra note 133, at 410.

216 See Protecting Humanity from Future Health Crises, supra note 118, at 64; Kamradt-Scott, supra note 133, at 411.

217 See Kamradt-Scott, supra note 133, at 403-04; WHO, One Year into the Ebola Epidemic, supra note 90.

218 See Garrett, supra note 139, at 97.

219 See Kamradt-Scott, supra note 133, at 405.

220 See MÉdecins Sans FrontiÈres, Pushed to the Limit, supra note 103, at 1, 7; Garrett, supra note 139, at 90; Kamradt-Scott, supra note 133, at 404; Moon et al., supra note 10, at 3.

221 See Garrett, supra note 139, at 94; Kamradt-Scott, supra note 133, at 404, 407.

222 Kamradt-Scott, supra note 133, at 406-07.

223 WHO, Programme Budget Performance Assessment Report 2010-2011, http://www.who.int/about/resources_planning/performance_assessment-report_2010_2011.pdf?ua=1 [http://perma.cc/LZT5-A494] (allocating 350 million for “Outbreak and Crisis Response”); WHO, Programme Budget 2014-2015, http://www.who.int/about/resources_planning/PB14-15_en.pdf?ua=1 [http://perma.cc/S6PC-K6EE] (proposing 228 million for “Outbreak and Crisis Response”).

224 IHR, supra note 8, at art. 43.

225 Swine Influenza: Statement by WHO Director-General, Dr. Margaret Chan, WHO (Apr. 25, 2009), http://www.who.int/mediacentre/news/statements/2009/h1n1_20090425/en/ [http://perma.cc/P273-PMSA].

226 Swine Influenza Statement by WHO Director-General, Dr. Margaret Chan (Apr. 27, 2009), http://www.who.int/mediacentre/news/statements/2009/h1n1_20090427/en/ [http://perma.cc/QH2W-9DCL].

227 Id.

228 WHO, Response to Pandemics, supra note 9, at 62.

229 Katz & Fischer, supra note 30, at 5.

230 Davies, Kamradt-Scott & Rushton, supra note 15, at 103.

231 Andrew Browne, China Forces Dozens of Mexican Travelers Into Quarantine, Wall St. J. (May 4, 2009), http://www.wsj.com/articles/SB124137876507580987 [http://perma.cc/9ZLY-2QRN].

232 See WHO, Response to Pandemics, supra note 9, at 62; The World Response to Flu Crisis, BBC (May 5, 2009), http://news.bbc.co.uk/2/hi/americas/8022516.stm [http://perma.cc/Z7HP-W6BJ].

233 See The World Response to Flu Crisis, supra note 232.

234 Gostin, supra note 127, at 2377-78; Hodge, James G. Jr., Global Legal Triage in Response to the 2009 H1N1 Outbreak, 11 Minn. L. J. Sci. & Tech. 599, 607 (2010)Google Scholar; Katz & Fischer, supra note 30, at 6.

235 The World Response to Flu Crisis, supra note 232.

236 Joint FAO/WHO/OIE/WTO Statement on influenza A(H1N1) and the Safety of Pork, WHO (May 2, 2009), http://www.who.int/mediacentre/news/statements/2009/h1n1_20090502/en/ [http://perma.cc/4J86-VH8Z]; Swine Influenza – Update 3, WHO (Apr. 27, 2009), http://www.who.int/csr/don/2009_04_27/en/ [http://perma.cc/FN43-GE2B]. The H1N1 virus was commonly referred to as “swine flu” given it resembled a virus found in pigs, which facilitated the spread of an unfortunate myth that linked the virus to pork consumption—thereby resulting in unnecessary culling of pigs and unjustifiable bans on pork importation. See Origins of 2009 H1N1 Flu (Swine Flu): Questions and Answers, CDC (Nov. 25, 2009), http://www.cdc.gov/h1n1flu/information_h1n1_virus_qa.htm [http://perma.cc/YSN9-5WEB].

237 IHR, supra note 8, at art. 43.

238 WHO, Response to Pandemics, supra note 9, at 62.

239 Id. at 112.

240 Id. at 113; Wilson, Brownstein & Fidler, supra note 9, at 508.

241 WHO, Response to Pandemics, supra note 9, at 63.

242 Nuzzo & Gronvall, supra note 159, at 10.

243 See, e.g., Hoffman, Steven J., Making the International Health Regulations Matter: Promoting Universal Compliance through Effective Dispute Resolution, in Routledge Handbook on Health Security 239, 248 (Rushton, Simon & Youde, Jeremy eds., 2015)Google Scholar; Mackey & Liang, supra note 9, at 120; Wilson, Brownstein & Fidler, supra note 9, at 508.; Nuzzo and Gronvall, supra note 159, at 10.

244 Mackey & Liang, supra note 9, at 126.

245 Nuzzo & Gronvall, supra note 159, at 10.

246 Statement on the 1st meeting of the IHR Emergency Committee on the 2014 Ebola Outbreak in West Africa, WHO (Aug. 8, 2015), http://www.who.int/mediacentre/news/statements/2014/ebola-20140808/en/ [http://perma.cc/8CX3-BVZN].

247 Id.

248 See IHR Emergency Committee Regarding Ebola, WHO, http://www.who.int/ihr/ihr_ec_ebola/en/ for a compilation of the WHO's published statements.

249 WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 11.

250 Nick Thompson & Inez Torre, Ebola Virus: Countries with Travel Restrictions in Place, CNN (Dec. 2, 2014), http://www.cnn.com/2014/11/04/world/ebola-virus-restrictions-map/ [http://perma.cc/C6WE-XNFK].

251 Nicholas Keung & Jennifer Yang, Canada Won’t Issue Visas to Residents of Ebola-Affected Countries, Toronto Star (Oct. 31, 2014), http://www.thestar.com/news/canada/2014/10/31/canada_wont_issue_visas_to_residents_of_ebolaaffected_countries.html; Euan McKirdy, Australia Instigates Ebola-Prompted Ban on Travel from West Africa, CNN (Oct. 28, 2014), http://edition.cnn.com/2014/10/28/world/asia/australia-immigration-policy-ebola/.

252 See WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 12.

253 See id. at 12; Gostin, DeBartolo & Friedman, supra note 10, at 4.

254 See Comm’n on a Global Health Risk Framework, supra note 5, at 6, 57; Gostin, DeBartolo & Friedman, supra note 10, at 4; Moon et al., supra note 10, at 6.

255 See Gostin, DeBartolo & Friedman, supra note 10, at 2.

256 See id. at 3-4; WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 12; Davies, Kamradt-Scott & Rushton, supra note 15, at 125; Protecting Humanity from Future Health Crises, supra note 118, at 68. Feler, Lane, Ebola Postmortem: Treating the World Health Organization’s Regulatory Maladies, 13 Colum. J. Transnat’l L. Bull. 13, 28 (2015)Google Scholar; Moon et al., supra note 9, at 6-7.

257 See Moon et al., supra note 10, at 2, 12-13.

258 See Hoffman, Steven J. & Ottersen, Trygve, Addressing Antibiotic Resistance Requires Robust International Accountability Mechanisms, 43 J. L. Med. & Ethics 53, 56 (2015)Google Scholar.

259 United Nations, Charter of the United Nations, Article 25 (1945).

260 See Gostin, DeBartolo & Friedman, supra note 10, at 4.

261 See generally Hoffman, Steven J. & Røttingen, John-Arne, Assessing the Expected Impact of Global Health Treaties: Evidence From 90 Quantitative Evaluations, 105 Am. J. Pub. Health 26 (2015)Google Scholar.

262 WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 11; von Tigerstrom, supra note 22, at 42.

263 David P. Fidler, Ebola Report Misses the Mark on International Health Regulations, Chatham House (July 17, 2015), http://www.chathamhouse.org/expert/comment/ebola-report-misses-mark-international-health-regulations [http://perma.cc/Z7P7-Y7HY].

264 See generally John W. Kingdon, Agendas, Alternatives, and Public Policies (1995).

265 See Shiffman, Jeremy & Smith, Stephanie, Generation of Political Priority for Global Health Initiatives: A Framework and Case Study of Maternal Mortality, 370 Lancet 1370, 1371 (2007)Google Scholar.

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267 Shiffman & Smith, supra note 265, at 1370.

268 Id. at 1371.

269 Id.

270 Id.

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272 Beyond Pandemics, supra note 127, at 40.

273 Heymann et al., supra note 10.

274 WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 10; Heymann et al., supra note 10, at 1888-89.

275 WHO Reform Milestones, WHO, http://www.who.int/about/who_reform/chronology/en/ [http://perma.cc/DU2C-QPVH].

276 See Garrett, supra note 139, at 94.

277 Hoffman, Cole & Pearcey, supra note 271, at 18-20.

278 See World Bank Grp. [WBG], World Development Report 2014: Risk and Opportunity 18 (2013).

279 See Kickbusch, Ilona et al., Addressing Global Health Governance Challenges Through a New Mechanism: The Proposal for a Committee C of the World Health Assembly, 38 J. L. Med. & Ethics 550, 558 (2010)Google Scholar.

280 Shiffman & Smith, supra note 265, at 1371.

281 Molenaar, Bente, General Support for the IHR Review Committee Report, 2 Health Dipl. Monitor 20, 21 (2011)Google Scholar.

282 See WBG, supra note 278, at 17-18.

283 See Commission on a Global Health Risk Framework, supra note 5, at 29-32; WHO, Report of the Ebola Interim Assessment Panel, supra note 10, at 10-11; Gostin, supra note 127, at 2377; Moon et al., supra note 10, at 13; Wilson, Brownstein & Fidler, supra note 9, at 506-07;

284 Shiffman & Smith, supra note 265, at 1372.

285 See WHO, Programme Budget 2010-2011, supra note 223, at 178-80; WHO, Programme Budget 2014-2015, supra note 223, at 108-11; WHO, Programme Budget 2004-2005: Performance Assessment Report 13-15 (2006), http://apps.who.int/iris/bitstream/10665/69315/1/PBPA_04-05_eng.pdf; World Health Organization, Programme Budget 2006-2007: Performance Assessment Report 262 (2008), http://apps.who.int/iris/bitstream/10665/69921/1/PBPA_06-07_eng.pdf.

286 See Fidler, supra note 16, at 355.

287 Comm’n on a Global Health Risk Framework, supra note 5, at 35-37; Inst. for Health Metrics & Evaluation, Financing Global Health 2013: Transition in an Age of Austerity 19-20 (2014).

288 Shiffman & Smith, supra note 265, at 1371.

289 See Jones, supra note 1, at 2 (providing examples).

290 Summers, supra note 3.

291 Osterholm, Michael T., Preparing for the Next Pandemic, 352 New Eng. J. Med. 1839, 1839 (2005)Google Scholar.

292 See Kamradt-Scott, Adam, Implementation of the International Health Regulations, 1 Health Dipl. Monitor 10, 11 (2010)Google Scholar.

293 Compare Joint United Nations Programme on HIV/Aids [UNAIDS] & WHO, AIDS Epidemic Update 7 (Nov. 2009) (“It is estimated that 2 million [1.7 million–2.4 million] deaths due to AIDS-related illnesses occurred worldwide in 2008.”) with Associated Press, Indonesia Stops Announcing Bird Flu Deaths on Case-by-Case Basis, Jakarta Post (June 5, 2008), http://www2.thejakartapost.com/news/2008/06/05/indonesia-stops-announcing-bird-flu-deaths-casebycase-basis.html (stating 241 recorded fatalities worldwide at time of posting).

294 Comm’n on a Global Health Risk Framework, supra note 5, at 17; Jones, supra note 1, at 7- 8.

295 Comm’n on a Global Health Risk Framework, supra note 5, at 2, 8.

296 See Theresa MacPhail, Global Health Doesn’t Exist, LIMN.IT (July 10, 2015), http://limn.it/global-health-doesnt-exist/ [http://perma.cc/7278-ARZQ].

297 See e.g., Årdal, Christine et al., International Cooperation to Improve Access to and Sustain Effectiveness of Antimicrobials, 387 Lancet 296 (2016)Google Scholar; Steven J. Hoffman et al., Strategies for Achieving Global Collective Action on Antimicrobial Resistance, 93 Bull. World Health Org. 867.

298 Global Health Security Agenda, (Mar. 7, 2016), http://ghsagenda.org/about.html [http://perma.cc/55NY-HMT4].

299 Kates et al., The U.S. Response to Ebola: Status of the FY2015 Emergency Ebola Appropriation 4 (2015).

300 See Liu, Bin et al., Strengthening Core Public Health Capacity Based on the Implementation of the International Health Regulations (IHR) (2005): Chinese Lessons, 4 Int. J. Health Pol’y Mgmt. 381, 382-83 (2015)Google Scholar.

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302 See id. at 11.

303 See Sania Nishtar, Disease Diplomacy, Heartfile.Org (July 1, 2007), http://www.heartfile.org/viewpoint-21-disease-diplomacy/ [http://perma.cc/5ZRF-WARB]

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308 Rizvi, Zain & Hoffman, Steven J., Effective Global Action on Antibiotic Resistance Calls for Careful Consideration of Convening Forums, 43 J. L. Med. & Ethics 74, 75 (2015)Google Scholar.

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310 See, e.g., Comm’n on a Global Health Risk Framework, supra note 5; WHO, Advisory Group on Reform, First Report, supra note 209; WHO, Advisory Group on Reform, Second Report, supra note 211; WHO, Report of the Ebola Interim Assessment Panel, supra note 10; Protecting Humanity from Future Health Crises, supra note 118; Moon et al., supra note 10; The Review Committee on the Role of the International Health Regulations (2005) in the Ebola Outbreak and Response, WHO, http://www.who.int/ihr/review-committee-2016/en/ [http://perma.cc/YM89-49DJ].

311 Charles Clift, Is Yet Another Ebola Report a Symptom of the Problem or the Solution?, Chatham House (Nov. 13, 2015), http://www.chathamhouse.org//node/19170 [http://perma.cc/W7ZH-EQND].

312 WBG, supra note 278, at 4; Hoffman, S.J. & Justicz, V., Automatically Quantifying the Scientific Quality and Sensationalism of News Records Mentioning Pandemics: Validating a Maximum Entropy Machine-Learning Model, 75 J. Clinical Epidemiology 47, 47 (2016)Google Scholar.

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315 United Nations, Global Ebola Response, supra note 109, at 14 fig.4.

316 See Fidler, supra note 16, at 355.

317 See generally Andresen, Steinar & Hoffman, Steven J., Much Can Be Learned About Addressing Antibiotic Resistance from Multilateral Environmental Agreements, 43 J. L. Med. & Ethics 46 (2015)Google Scholar; Hoffman, Steven J. & Outterson, Kevin. What Will It Take to Address the Global Threat of Antibiotic Resistance?, 43 J. L. Med. & Ethics 363 (2015)Google Scholar;

318 See Comm’n on a Global Health Risk Framework, supra note 5, at 35; Protecting Humanity from Future Health Crises, supra note 118, at 15; Jamison, Dean T. et al., Global Health 2035: A World Converging Within a Generation, 382 Lancet 1898, 1941-42 (2013)Google Scholar.

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