The Containment Bias of the WHO International Health Regulations

Abstract

Abstract The ordinary meaning of the term ‘prevention’ is to prevent harm from occurring. But what ‘harm’? For over 170 years, the system now embodied in the World Health Organization’s (WHO) International Health Regulations (IHRs) has answered this question by focusing on the prevention of disease ‘spread’ across countries, rather than on the ‘spillover’ of pathogens from animals to humans, which constitute the main source of pandemic risk today. This bias towards the containment of disease has deep roots. In the historical context from the IHRs emerged, focusing on pathogen spillover was beyond the possibilities of the science of the time; it was also pointless to the extent that the effort focused on pathogens which were already prevalent in humans, causing diseases such as cholera or plague. Transposed to the present day, this containment bias has important consequences for global health governance. Most importantly among these is that the global health security architecture still lacks a specific system to prevent spillovers of pathogens at the origin of outbreaks and subsequent spread of diseases such as COVID-19, SARS, MERS or Ebola. This article investigates the roots of this focus on containment. Relying on the proceedings of the International Sanitary Conferences that preceded the IHRs, as well as on an untapped documentary archive relating to the revision of the IHRs between 1995-2005, the article explains the reasons underpinning this enduring bias and its implications for global health governance.