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The COVID-19 pandemic has affected virtually every aspect of life, for individuals, communities, nations, regions, and the international system In this forum, scholars from around the world with diverse areas of expertise consider the contributions of international relations (IR) scholarship in our understanding of the politics and governance challenges surrounding the pandemic The seven essays that follow together examine how our current state of knowledge speaks to the theme of ISA 2020: "Multiple Identities and Scholarship in a Global IR: One Profession, Many Voices " Each essay features a research area and body of scholarship that both informs our understanding of the COVID-19 pandemic and reflects on how the pandemic challenges us to push our scholarship and intellectual community further Together, these essays highlight the diversity of our discipline of IR and how its many voices may bring us together in one conversation La pandemia de COVID-19 ha afectado practicamente a todos los aspectos de la vida para las personas, las comunidades, las naciones, las regiones y el sistema internacional En este foro, los academicos de todo el mundo con diversas areas de experiencia consideran las contribuciones de los estudios de las relaciones internacionales (International Relations, IR) a nuestro entendimiento de la politica y los desafios de gobierno que rodean a la pandemia Los siete ensayos a continuacion analizan en conjunto como nuestro estado de conocimiento actual aborda el tema de la Asociacion de Estudios Internacionales (International Studies Association, ISA) de 2020: "Multiples identidades y estudios en una IR global: una profesion, muchas voces " Cada ensayo presenta un area de investigacion y un cuerpo de estudios que conforman nuestro entendimiento de la pandemia de COVID-19 y tambien reflexionan sobre como esta nos desafia a impulsar aun mas a nuestra comunidad academica e intelectual En conjunto, estos ensayos destacan la diversidad de nuestra disciplina de relaciones internacionales y como sus numerosas voces pueden juntarnos en una conversacion La pandemie de COVID 2019 a affecte pratiquement tous les aspects de la vie, que ce soit les individus, les communautes, les nations, les regions ou le systeme international Dans cette tribune, des chercheurs du monde entier specialises dans divers domaines d'expertise reflechissent aux contributions des recherches en relations internationales a notre comprehension des defis politiques et de gouvernance entourant la pandemie Les sept essais ainsi reunis examinent la maniere dont l'etat actuel de nos connaissances aborde le theme de la convention 2020 de l'Association d'etudes internationales : « Identites et recherches multiples dans des relations internationales globales : une profession, de nombreuses voix » Chaque essai presente un domaine de recherche et un corpus d'etudes qui eclaire notre comprehension de la pandemie de COVID 2019 tout en amenant une reflexion sur la facon dont la pandemie nous remet en question et nous pousse a aller plus loin dans nos recherches et notre communaute intellectuelle Ensemble, ces essais mettent en evidence la diversite de notre discipline des relations internationales et la maniere dont ses nombreuses voix peuvent nous reunir dans un debat [ABSTRACT FROM AUTHOR] Copyright of International Studies Review is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

The World Health Organization (WHO) is obligated to pursue the control and eradication of infectious disease. This mandate was enshrined in the 1946 constitutive treaty and has been repeatedly reinforced by World Health Assembly resolutions, programmes, and campaigns. In 1951 a purpose-built instrument – the International Sanitary Regulations – was adopted to strengthen the international organization’s means for preventing the international spread of disease while minimising disruption to international traffic and trade. The Regulations – which are now known as ‘the International Health Regulations’ (IHR) – were substantively revised in 2005 and are integral to the WHO’s mission. Importantly, however, as custodian of the revised IHR the WHO has periodically failed to take full advantage of the treaty’s provisions or use it as intended. This article discusses the importance of the IHR, the WHO’s obligations with respect to ensuring the correct functioning of the 2005 treaty, and outlines some measures that will enable the WHO to main stream the treaty and ensure fuller utilization.

Many countries show a growing willingness to use militaries in support of global health efforts. This Series paper summarises the varied roles, responsibilities, and approaches of militaries in global health, drawing on examples and case studies across peacetime, conflict, and disaster response environments. Militaries have many capabilities applicable to global health, ranging from research, surveillance, and medical expertise to rapidly deployable, large-scale assets for logistics, transportation, and security. Despite this large range of capabilities, militaries also have limitations when engaging in global health activities. Militaries focus on strategic, operational, and tactical objectives that support their security and defence missions, which can conflict with humanitarian and global health equity objectives. Guidelines-both within and outside militaries-for military engagement in global health are often lacking, as are structured opportunities for military and civilian organisations to engage one another. We summarise policies that can help close the gap between military and civilian actors to catalyse the contributions of all participants to enhance global health.

The twenty-first century has already witnessed a number of public health emergencies of international concern. Current indications suggest this trend is set to continue. Traditionally, health crises have resulted in a different set of actors responding to the event than if it is declared a humanitarian disaster, and vice versa. The 2014 Ebola outbreak in West Africa blurred these boundaries though, as the event proved to be both a public health crisis as well as a humanitarian disaster. In an unprecedented move, during the outbreak over 5000 foreign military personnel were deployed to assist civilian authorities contain the spread of the virus, build treatment facilities, train health workers, and provide medical care, while domestic military forces were engaged to enforce quarantine, provide protection, and in some instances, assist with burials. The involvement of military personnel in a health emergency has generated concern amongst some communities though that it is yet further evidence of the “militarisation” of humanitarian assistance, while some militaries have since indicated they would be prepared to assist in future health emergencies. This chapter examines the ethical and legal issues arising from the involvement of military personnel in health emergencies. Drawing on work undertaken on civil-military cooperation in humanitarian disaster contexts, the chapter considers the extent to which health crises are qualitatively different from other disasters and what this may mean for the involvement of military personnel and other actors. It explores questions around the types of activities military personnel can be expected to perform and whether these differ between foreign or domestic militaries, how militaries conduct themselves during health emergencies, as well as the limits of military assistance.

When WHO declared the COVID-19 outbreak a Public Health Emergency of International Concern (PHEIC) on Jan 30, 2020, under the provisions of the International Health Regulations (2005) (IHR), it recommended against “any travel or trade restriction”. The recommendation was based on data available at the time, evidence from previous outbreaks, and principles underpinning the IHR. It formed an important part of WHO's messaging about how states could effectively respond in a coordinated way. Instead, over the following months, according to WHO, 194 countries adopted some form of cross-border measure—eg, travel restrictions, visa restrictions, border closures, among others—with little reproach from WHO or other actors in the international community. This response is a sharp increase from at most 25% of member states that imposed trade and travel restrictions during the 2009 H1N1 influenza pandemic and the 2013–16 outbreak of Ebola virus disease in west Africa. Indeed, WHO's recommendation against measures such as travel restrictions and border closures became a point of criticism of the organisation's role at the early stages of the COVID-19 pandemic.

In the wake of several prominent disease outbreaks like Ebola and Zika, global health security is once again high on the international agenda. For its part, the Australian government has co...

Global health issues are once again high on the international agenda. In New York, we have seen the United Nations hold several high-level meetings on topics extending from eliminating tuberculosis to promoting universal health cover to tackling health crises. Half a world away in Europe, governments expanded the World Health Organization’s (WHO) remit to assume a more operational role in responding to health emergencies. New intergovernmental entities such as the Joint External Evaluation (JEE) Alliance and the Coalition for Epidemic Preparedness Innovations (CEPI) have been created, tasked with duties ranging from health system strengthening to providing innovative funding mechanisms for the development of new pharmaceuticals. Where individual governments have reduced funding for global health and instituted foreign aid policies that (once again) restrict access to basic services like family planning, other governments have responded by announcing their willingness to fill the leadership and financial void left by those departing the field. This has occurred even as yet other governments have demonstrated their blatant disregard for long-held international norms such as those prohibiting the use of chemical weapons. In short, as the second decade of the twenty-first century nears its end, global health politics are as fraught and politically charged as ever.

The current outbreak of Ebola virus disease (EVD) in the Democratic Republic of the Congo (DRC) is the second largest in history. Only the 2014–2016 West African EVD outbreak has exceed it. The current outbreak is characterised by community mistrust, opposition to vaccination and treatment, and ongoing conflict in the region. The combination of these factors has meant that, despite the best efforts of the WHO, the DRC government and aid agencies in the region, cases and deaths continue to grow on a weekly basis. The severity of the outbreak, as well as the potential for cross-border spread has led to a number of calls for the WHO to declare the outbreak a Public Health Emergency of International Concern (PHEIC) under the International Health Regulations 2005 (IHR 2005). It is hoped that such a declaration would instigate the delivery of badly needed resources to contain the outbreak. Despite this, no PHEIC declaration has been forthcoming. Under the IHR 2005, the WHO Director-General is empowered to declare a PHEIC. In making this determination though, the Director-General is required to take into account a number of factors including the risk to human health, the risk of international spread and the advice of a technical expert committee—the IHR EC.1 Each EC is convened by the Director-General with its membership drawn from a list of technical experts that have been preapproved and recommended by governments. Importantly, however, ECs are not standing committees; they are assembled on ad hoc basis with each committee’s membership purposively selected according to aetiological agent involved (if known) and/or nature of the event. Once convened, the EC reviews all available data on the event and then advises the Director-General whether the conditions for a PHEIC have been met. If the EC ascertains the conditions have been met, the committee …

Since 2001 the World Health Organization (WHO) has been actively promoting its credentials for managing ‘global health security’. However, the organisation’s initial response to the 2014 Ebola outbreak in West Africa has attracted significant criticism, even prompting calls for its dissolution and the creation of a new global health agency. Drawing on principal–agent theory and insights from previous disease outbreaks, this article examines what went wrong, the extent to which the organisation can be held to account, and what this means for the WHO’s global health security mandate.

The participation of military personnel in health-related activities remains highly controversial. Drawing on four case studies that extend from peacetime to post-conflict situations, this chapter analyses where, and under what circumstances, military actors have previously engaged in providing health assistance. It also examines the controversies, criticisms, and perceived benefits that have accompanied that activity. The chapter advances an analytical framework for understanding the types of situations in which military actors have been called upon to assist, and what these signal for future health crises.

This chapter explores the ideas, concepts, norms, and agendas that have shaped the structures and actors governing the field of pandemic influenza preparedness. It begins by tracing the historical origins of the disease, then discusses the World Health Organization’s attempts to better respond to influenza pandemics through the development of biomedical knowledge and tools. The chapter then examines how, since the end of the Cold War, pandemic influenza has gained new prominence, in part as a result of its portrayal as a social, economic and political ‘threat’, which has prompted a transformation in the governance arrangements regarding the disease. The governance of pandemic influenza thus serves as a microcosm of the trends, actors, challenges and obstacles confronting global health governance more broadly.

Since 2001, the World Health Organization (WHO) has been actively promoting its ability to manage global health security. Recent events such as the 2009 H1N1 influenza pandemic and the 2014 Ebola outbreak have, however, led to questions being raised about the WHO’s abilities and extensive calls for the organisation’s reform. This chapter examines a series of mistakes and the structural, cultural, political and epidemiological factors that contributed to the WHO’s mishandling of the first pandemic of the twenty-first century and the world’s largest ever outbreak of Ebola. The chapter then concludes by examining the reforms currently being implemented to strengthen the WHO’s global health security capabilities and what these signify for the future.

The growing trend toward the securitization of infectious disease has legitimated a role for national militaries in responding to public health crises. This apparent “militarization” of health has met with resistance from the health and security sectors alike, who argue that it risks politicizing health outcomes while also draining limited military resources. This article attempts to place such concerns within the broader historical context of military involvement in public health. With specific reference to pandemic influenza—a disease of great historical import and a current policy priority in the context of securitized global public health—this article details the pedigree of military involvement in fighting the disease and draws on the established record to demonstrate the role that militaries can play in improving public health outcomes. The article argues for an ongoing military role in the global fight against pandemic influenza, both in augmenting civil influenza programs and in improving their own preparation and response mechanisms for future pandemics.

While still significant, the 2009 H1N1 (A) influenza pandemic was generally viewed as comparatively mild in contrast to past influenza pandemics. Even so, the conventional response of many governments to protect their populations against the threat from the H1N1 virus was to ensure adequate vaccine production and/or access to supplies of vaccines and antiviral medications. In this article, I examine the influence of biomedical knowledge (and the professionals that wield it) in determining the acceptable and rational limits of influenza public policy from 1918 to today. Particular attention is given to the role that medical practitioners have played in shaping post-World War II influenza policy and governance structures, together with the development, deployment, and political effect of more recent biomedical techniques—such as evidence-based medicine—in reinforcing the importance attached to influenza vaccines and antivirals. The article concludes by discussing how the intense focus on pharmaceutical-based solutions reflects a particular view of biomedicine that has had serious political implications in distorting global health governance arrangements, and I argue that only by unpacking these structures and revealing the political authority in play can alternative policy responses more appropriate to a wider proportion of humanity be considered.

This article examines how pandemic influenza has been framed as a security issue, threatening the functioning of both state and society, and the policy responses to this framing. Pandemic influenza has long been recognised as a threat to human health. Despite this, for much of the twentieth century it was not recognised as a security threat. In the decade surrounding the new millennium, however, the disease was successfully securitised with profound implications for public policy. This article addresses the construction of pandemic influenza as a threat. Drawing on the work of the Copenhagen School, it examines how it was successfully securitised at the turn of the millennium and with what consequences for public policy.

It is widely recognised that the adverse impacts that transnational forces are having on health determinants and outcomes require more effective collective action. The Asian region has been among the most acutely affected by the health impacts of globalisation, while many health issues in the region have potentially far reaching consequences. The rapidly rising economic status of many Asian countries, coupled with their vulnerability to global health, points to the need to better understand their contributions to Global Health Governance (GHG). This article analyses Asian contributions to three key instruments underpinning GHG – the International Health Regulations (IHR), Pandemic Influenza Preparedness Framework (PIPF), and Framework Convention on Tobacco Control (FCTC). It finds that, if Asian countries are to move, from rule takers to rule makers, there is a need to address weak capacity in the region, to go beyond traditional notions of sovereignty, and to build trust and policy processes across the region. Policy implications • The impacts of globalisation on health within the region, and the potential for health issues in the region to have global consequences, suggest that strengthening GHG requires increased Asian engagement commensurate with the region’s growing economic strength. • Emergent forms of GHG have been shaped to date by a small number of high income countries. Asian state and nonstate actors have been increasingly inclined to challenge existing institutional arrangements and rules. • Without stronger technical capacity and political processes to enable meaningful participation in global health governance negotiations, Asian countries will remain rule takers rather than rule makers.

This paper takes a constructivist approach to examining one of the new norms embodied in the recently revised International Health Regulations (IHR). The paper focuses on the provisions that seek to restrain states from applying disproportionate international travel and trade restrictions in response to a disease outbreak occurring in another country. This new norm, which aims to limit unjustified ‘additional health measures’, has significant implications for state sovereignty. Using the example of the 2009 H1N1 ‘swine flu’ pandemic, the paper examines whether state behaviour and the discourse surrounding that outbreak supports a constructivist contention that a new norm has been created and that most states can be expected to comply with that norm most of the time. We conclude by discussing what the discourse over H1N1 suggests about the extent to which the new norm concerning additional health measures has been internalized by states.

According to the latest World Bank estimates, over the past decade some US $4.3 billion has been pledged by governments to combat the threat of pandemic influenza. Presidents, prime ministers, and even dictators the world over have been keen to demonstrate their commitment to tackling this disease, but this has not always been the case. Indeed, government-led intervention in responding to the threat of pandemic influenza is a relatively recent phenomenon. I explore how human understandings of influenza have altered over the past 500 years and how public policy responses have shifted accordingly. I trace the progress in human understanding of causation from meteorological conditions to the microscopic, and how this has prompted changes in public policy to mitigate the disease's impact. I also examine the latest trend of viewing pandemic influenza as a security threat and how this has changed contemporary governance structures and power dynamics.

The revised International Health Regulations (IHR) entered into force on 15 June 2007. In accordance with this new international treaty, every member state of the World Health Organization has been given five years in which to review their existing health systems and structures, and where necessary, improve their capacity for the detection, reporting, assessment of, and response to public health emergencies of international concern. Of course, for developed countries, it is unlikely that establishing and maintaining these core capabilities will be difficult. For many less developed countries, however, the revised IHR obligations pose a challenge on a number of fronts. This article explores some of the challenges that less developed countries face in meeting their new IHR obligations prior to discussing the role that the Australian government can play in assisting its Asia-Pacific neighbours achieve these measures.

Since the initial deliberations in 1946 regarding the need for a new universal health organization, a strong correlation has existed between public health and international security. Having said this, the WHO secretariat’s explicit adoption of security-related concepts and language to reframe its public health mandate is a fairly recent phenomenon that only emerged from 2001 onwards. Moreover, the WHO did not lead the charge to securitize public health — this was accomplished by a host of other actors. Admittedly, one of the WHO’s proximal principals — the United States — was a key player in advocating this new way of viewing acute, fast-moving health issues (Smith III 2014), but the WHO secretariat itself lagged well behind, in some quarters even initially staunchly resisting the push to reframe public health in security terms. It is in this regard that the events of the mid-1990s, both within and external to the WHO, marked a distinct turning point. The WHO secretariat’s advancement of the phrase ‘global health security’ in its 2001 report to member states signalled its firm embrace of this new worldview, and for more than a decade the WHO has been on the path of re-casting its public health mandate in a security frame.

The WHO’s delegation contract with its member states to prevent, control, and ideally eradicate infectious diseases continues to exist as a fluid and malleable one. This is principally because, as noted in Chapter One, the ‘contract’ — such as it is — is essentially comprised of several provisions and stipulations laid out in a variety of documents, such as WHA resolutions and the WHO’s constitutive treaty. Within that array of documents, arguably there is none more important or as comprehensive in outlining member states’ obligations and the extent of the WHO’s disease eradication powers as the IHR. Originally adopted in 1951, the IHR have continued to form the centrepiece of the WHO’s disease eradication health-for-security delegation contract, principally because they represent the only international framework agreement designed to prevent the global spread of infectious disease while minimizing disruption to international trade and travel. Not long after their adoption, however, the IHR came to be viewed as ineffective and insipid, were openly derided, and were frequently ignored. In 1995 the WHO’s member states voted to revise and update the IHR. The process subsequently took over 10 years to complete, but following the passage of resolution WHAS8.3 Revision of the International Health Regulations on 23 May 2005 the revised IHR entered into force on 15 June 2007.

As government officials met in Geneva at the 58th WHA to endorse the revised IHR (2005), alarm was mounting that the world confronted an imminent new menace. The emergence and progressive spread of the highly lethal H5N1 avian influenza ‘Bird Flu’ virus from 2004 onwards had captured the international community’s attention. It had also directly fed into the ‘threat’ from the emerging and re-emerging infectious diseases narrative that had been actively promoted since the 1990s — and in the particular case of influenza — that the world was ‘overdue’ for another pandemic. Ultimately however, Bird Flu did not become the etiological agent for the first influenza pandemic of the new millennium. Rather, it was another novel strain of H1N1 influenza (A) usually found in pigs that was first identified in a small Mexican village in 2009 that achieved human-to-human transmission and spread around the world.

In many ways, the 2003 SARS outbreak was a remarkable event in the history of human interaction with infectious diseases. By the time the disease had been contained in July 2003, it had infected 8,422 people and caused the deaths of approximately 916 individuals (Huang 2011, see also WHO 2006a). Compared to numerous other infectious diseases at the time, such as malaria, HIV/AIDS, TB, and cholera, the human morbidity and mortality caused by the 2003 outbreak was relatively minor. Yet in some of the most affected areas the outbreak triggered social and political upheaval, and the global economic impact of the outbreak was estimated to have been between US$ 11 billion and US$ 100 billion (Asian Development Bank 2003, US GAO 2004).

In 1946 when the WHO’s constitution was written, some 22 functions and duties were ascribed to the organization. Of these, the WHO’s chief function is the control and eradication of infectious diseases. Although often unspoken, the priority attached to this particular task is understandable when reviewing the historical origins of the WHO and the events of the immediate post-war period. The focus of this chapter is to outline the WHO’s delegated authority for eradicating infectious diseases, noting the terms and limitations of that authority, and the mechanisms by which member states have sought to exercise control over the IO to prevent agency slack. The chapter will also survey the historical origins of the WHO, with a particular focus on identifying the key ideas that both informed and shaped its creation and overall mandate. This chapter thereby establishes the foundation upon which the rest of the book is based, as it is only from an understanding of this delegated authority that we can, firstly, appreciate why so much importance has been assigned to this one central task, and secondly, understand why the organization’s approach to managing global health security has changed and adapted over time.

Virtually upon its creation, and at the urging of the organization’s member states, the WHO secretariat immediately set about exercising its newly bestowed powers in disease prevention, control, and eradication. This chapter explores three of the WHO’s disease eradication initiatives — the MEP, the SEP, and the WHO’s attempts to eliminate tuberculosis (Global TB Programme). Drawing on Haas’ typology of IO learning (1990, pp. 17–49), attention will be given to identifying where there is evidence of epistemic communities having formed alliances with key partners to advance their own agenda. In addition, the chapter identifies and compares the roles that the WHO secretariat assumed throughout the eradication campaigns, as well as the organization’s overall governance approach. In so doing, it is apparent that there is evidence to suggest that the IO learned from past mistakes and developed a standard or classical approach to managing infectious disease threats — an approach which, as will be discussed in the next chapter, was then radically reshaped around the time of the 2003 SARS outbreak.

The creation of a virulent mousepox virus in Australia and publication of this experiment in 2001 are often argued to mark a dangerous turn in dual use research (1). After this experiment and – far more consequential – September 11 and the anthrax letters, the oversight of dual use research in the life sciences received considerable attention in the United States. We argue that the American experience provides valuable lessons for Australia, three of which are highlighted here. First, the international community is ill-equipped to govern the life sciences. Like the United States, Australia should therefore help itself through national regulations and oversight. Second, like most special interest groups, scientists prefer self-regulation. While this may be a practical solution for scientific publications, federally funded research warrants independent review as a condition of funding. Third, in order to provide independent review, oversight should be truly multidisciplinary, including social, political, and biological expertise. A multidisciplinary approach stands the best chance of balancing the risks and rewards of dual use research.

Background: The term global health governance (GHG) is now widely used, with over one thousand works published in the scholarly literature, almost all since 2002. Amid this rapid growth there is considerable variation in how the term is defined and applied, generating confusion as to the boundaries of the subject, the perceived problems in practice, and the goals to be achieved through institutional reform. Methodology: This paper is based on the results of a separate scoping study of peer reviewed GHG research from 1990 onwards which undertook keyword searches of public health and social science databases. Additional works, notably books, book chapters and scholarly articles, not currently indexed, were identified through Web of Science citation searches. After removing duplicates, book reviews, commentaries and editorials, we reviewed the remaining 250 scholarly works in terms of how the concept of GHG is applied. More specifically, we identify what is claimed as constituting GHG, how it is problematised, the institutional features of GHG, and what forms and functions are deemed ideal. Results: After examining the broader notion of global governance and increasingly ubiquitous term “global health”, the paper identifies three ontological variations in GHG scholarship - the scope of institutional arrangements, strengths and weaknesses of existing institutions, and the ideal form and function of GHG. This has produced three common, yet distinct, meanings of GHG that have emerged – globalisation and health governance, global governance and health, and governance for global health. Conclusions: There is a need to clarify ontological and definitional distinctions in GHG scholarship and practice, and be critically reflexive of their normative underpinnings. This will enable greater precision in describing existing institutional arrangements, as well as serve as a prerequisite for a fuller debate about the desired nature of GHG.

The focus of this chapter is the World Trade Organization’s (WTO’s) Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS) as a central component in trade-related governance affecting the pharmaceutical industry. TRIPS is therefore illustrative of how health issues and outcomes are not necessarily determined by actors and institutions primarily associated with health. The chapter begins by discussing how intellectual patent rights and access to medicines came to be understood as a global health issue with the coming into force of TRIPS in 1995. Second, the chapter traces the manner in which TRIPS and its adverse health impacts were subsequently challenged by counter-framings based on human rights. Finally, we link TRIPS to the emergence of institutions and actors involved in addressing the access to medicines issue.

The authors examine how health governance is being transformed amid globalization, characterized by the emergence of new actors and institutions, and the interplay of competing ideas about global health. They explore how this has affected the governance of specific health issues and how it relates to global governance more broadly.

This chapter discusses the relationship, in an age of globalisation, between global health governance and the governance of individual health issues such as HIV/AIDS, pandemic influenza, tobacco control and access to medicines. It does this within the context of changes to global governance more generally. It proposes a new way of envisaging this relationship, which captures the evolving political dynamics. In particular the chapter identifies a narrative of transformative change in global health governance based on three elements: the globalisation of health; the emergence of competing visions of global health governance; and the changing institutional landscape.

This chapter identifies how transformations in global health governance are reflected in the governances of specific health issues such as human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), pandemic influenza, tobacco control and access to medicines. It illustrates the importance of ideas such as security, rights, economics, development and bio-medicine in the formation and legitimisation of interests in global health. The chapter explains the link between global health governance and other areas of global governance. It also underscores the multisectoral nature of global health governance and how this is reflected in institutions and actors. Finally it suggests that the way forward in improving global health governance is to link health and other concerns both in the framing of issues and in institutional architecture.