Date: 5 November 2012 (Monday)
Time: 10 – 11.30am
Venue: RSIS, Nanyang Technological University (NTU), Nanyang Avenue, Block S3.1, Level B3 (New Wing), Seminar Room 2
Speaker: Dr Sara Davies (Senior Research Fellow, Griffith Asia Institute, Griffith University; Program Convenor, Prevention of Mass Atrocities Workstream, Asia Pacific Centre for the Responsibility to Protect, Australia)
Chairperson: Assoc. Prof. Mely Caballero-Anthony, Head, Centre for NTS Studies, RSIS, NTU
The 2005 revision of the International Health Regulations (IHR) expanded the reporting obligation of states to encompass any suspected ‘public health emergency of international concern’, which includes outbreaks of pandemic influenza (such as H5N1). States have to report cases within 24 hours and confirm each case within 48 hours. In this seminar, Dr Sara Davies examines the degree to which states appreciate this new obligation by examining disease reporting behaviour during outbreaks of human cases of H5N1 in Cambodia, China, Indonesia, Thailand and Vietnam from 2004 to 2010. She asks: is there an evolving ‘duty to report’ norm in East Asia?
Click here to view the seminar slides.
Dr Davies argued that East Asian states do accept and comply with the duty to report infectious disease outbreaks. She suggested that the assertion of sovereignty and non-interference in response to global health governance frameworks has not systematically inhibited reporting compliance. The states covered by her research study generally reported suspected cases and confirmed cases regularly; and thus, most of their official reports are relatively more extensive compared to those reported to the World Health Organization (WHO) each year.
In analysing the performance of affected states, Dr Davies identified three reporting behaviours. Positive reporters include countries that experienced reporting gaps due to a lack of capacity rather than the intent to deceive. Vietnam and Cambodia fall in this category. Uneven performers are those countries which, although suspected of concealing information, were given the benefit of the doubt because they may have had capacity gaps in diagnosis. China is an example. Negative reporters are those criticised for delayed reporting of human cases of infection. Among them are Indonesia and Thailand.
She noted that even prior to the revision of the IHR in 2005, perceived poor performers such as Vietnam and Indonesia had for the most part, reported outbreaks to the WHO even though they had not been legally bound to do so. In terms of frequency, states such as Indonesia, Thailand and China, which were commonly criticised in the media for non-compliance and uneven reporting, reported outbreaks as frequently as positive reporters such as Vietnam and Cambodia.
She argued that Indonesia’s reluctance to share virus samples for vaccine development at the global level is due to concerns that vaccines are priced beyond the reach of developing countries, and that this should not be perceived as non-compliance to the IHR. In reality, Indonesia’s Ministry of Health and the regional WHO offices maintained a cooperative relationship during the H5N1 outbreak.
To address the gaps in the argument that states are resisting their reporting obligations, outbreak reporting behaviour should be understood as part of a larger story beginning in 2004, rather than focusing on one-off events during the H5N1 human infection period. While there is always the potential for states to backtrack on their duty to report new outbreaks, Dr Davies found that the behaviour of states reveal progressive local adaptation of the international obligation to report.
Three themes emerged from the discussion, namely: (1) the dynamics of states’ disease reporting behaviour; (2) the dynamics of risk communication strategies and disease reporting behaviour; and (3) the impact of funding on capacity development.
During the discussion, it was noted that the disease reporting behaviour of states, particularly cases of uneven reporting, can be attributed both to state sovereignty and to the securitisation of global health. The securitisation of health, as well as the concepts of human security and the Responsibility to Protect, has indirectly led states to perceive that a strong state ought to be able to manage disease outbreaks within its borders. States may thus feel that they have to conceal disease outbreaks or delay reporting them. Dr Davies argued that that does not have to be the inevitable result of the securitisation of health, and reiterated a point made during her presentation – that it is important for all involved, including scholars of international relations, to shift from focusing on disease reporting behaviour during individual outbreaks and instead emphasise the overall pattern of reports by countries since 2004.
A state’s duty and motivation to report can also be influenced by considerations of risk communication, as governments want to both avoid raising panic among its population and protect the interests of the state. Dr Davies noted that the real politics in disease reporting happens within a 24- to 48-hour window, when risk analysis can lead to a clash between science and politics. The political will among states to acknowledge the science of risk analysis and to fulfil international obligations determines when a state will delay or refuse to report a disease outbreak. There is increasing recognition among states that risk communication is critical when reporting disease outbreaks to local communities. This is also evident regionally with the adoption of the IHR in the Asia Pacific Strategy for Emerging Diseases, an information sharing network on emerging diseases in the region, and the ASEAN Risk Communication Resource Centre. Dr Davies asserted that a risk communication strategy that is effective normalises disease reporting at all levels by building good media relations and adapting to the local demography. Determining the information that is required in disease reporting from the information that may be unnecessary will eventually define how states will meet both their international and domestic obligations for disease reporting.
Reporting behaviour, especially the failure to report, can also be attributed to the blame game. Dr Davies noted that certain local communities hesitate to report an outbreak for fear that they will be seen as the origin of the disease. That this is an important factor is supported by the observation that regional WHO committees had begun to refrain from using a security rhetoric, mindful of the reality that securitising an issue could place undue focus on who is to blame. To tackle the problem, the identification of appropriate communication protocols – having different categories of risk communication for example – as tools for procedural notification at all levels is important. Such protocols enable health practitioners to elevate concerns to high-level decision-makers for policy formulation.
The main challenge for the state is to strike a balance between the urgency to report and managing the response to the outbreak. However, some states may lack the capacity to report disease outbreaks promptly due to a decentralised political structure and the delegation of authority. Dr Davies highlighted that capacity development is dependent on the way the scientific community is framing priorities for the policy community. This framework can be further influenced by the working relations between the ministries of foreign affairs and health and international organisations. Dr Davies underlined that there should be parallel efforts to improve the capacity of states to report and manage disease outbreaks and to encourage states to fulfil their reporting obligations. In order to address the current lack of funding for capacity development, multilateral donor organisations must recognise that pandemic preparedness and response also involves the strengthening of national health systems. Dr Davies concluded that disease reporting may seem to be an affront to sovereignty but it really is a reinforcement of responsible sovereignty.
About the speaker:
Sara Davies is a Senior Research Fellow at the Griffith Asia Institute, Griffith University, Australia. Dr Davies is the recipient of two Australian Research Council (ARC) Discovery Grants, including an ARC Postdoctoral Research Fellowship Award. She has recently been appointed Program Convenor of the Prevention of Genocide and Mass Atrocities projects funded by the Asia Pacific Centre for the Responsibility to Protect and AusAID. Dr Davies has published on international refugee law, global health governance, and the Responsibility to Protect. She is author of The Politics of Global Health (Polity Press) and The Legitimacy of Rejection: International Refugee Law in South East Asia (Martinus Nijhoff).