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Appendix 9A. International public health diplomacy and the global surveillance of avian influenza


I. Introduction

II. The changing role of the World Health Organization

III. Background on avian influenza

IV. Case study: Indonesia

V. Conclusions


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Influenza has caused some of the most devastating epidemics in human history, and experts widely agree that another influenza pandemic is on the horizon. Avian influenza, a variation of the H5N1 virus, is a likely candidate for the next strain to cause a global influenza pandemic.


Globalization has multiplied the quantity and types of international flows of people and goods. Given the potential for globalization to cause or exacerbate public health problems in different parts of the World, the World Health Organization (WHO) is likely to play an important role as part of a collective effort to build societal security. The role of the WHO in governing global health is changing, as evidenced by the revised International Health Regulations (IHR) that were adopted in 2005 and began to be implemented in June 2007. Because of the IHR’s long history of ineffectiveness and non-compliance by a minority of member states, the WHO revised the IHR using a legal framework that gives the WHO an unprecedented legal authority over the global disease surveillance and reporting requirements of the member states. The new IHR have serious implications for the actions required of countries with cases of severe acute respiratory syndrome (SARS) and H5N1.


Indonesia is currently the ‘hot zone’ of the H5N1 outbreak in both humans and poultry, but in December 2006 the Indonesian Government withheld samples from the WHO because of uneven distribution of influenza vaccines, especially those made from virus samples collected in Indonesia. The Indonesian Government demanded that prior approval be obtained for the development of a vaccine from a virus found in the country and that a discount price for such a vaccine be negotiated for countries where the H5N1 virus is endemic. This stalemate was in violation of the revised IHR. However, in early 2008, Indonesia received assurance that its rights to vaccines produced from avian influenza samples would be recognized, and the country sent 12 avian influenza samples to the WHO.


The revised IHR reflect a shifting paradigm in global health as well as the changing role of the WHO. The future will show if the WHO can maintain impartiality and neutrality throughout the implementation of the revised IHR. If the WHO cannot prove its credibility to both developing and developed countries, it will lose its place as the leading international global health organization and global health will be further dictated by individual countries’ foreign policy.



Bernice Raveché (United States) was an Intern with the SIPRI Chemical and Biological Warfare Programme in the summer of 2007.