Sustaining Global Surveillance and Response to Emerging Zoonotic Diseases (2009) / Chapter Skim
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7 Governance Challenges for Zoonotic Disease Surveillance, Reporting, and Response
7 Governance Challenges for Zoonotic Disease Surveillance, Reporting, and Response
Pages 205-234
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Governance challenges can only be effectively met through strong partnerships among the diverse set of experts needed to craft feasible responses to emerging zoonotic diseases. The drivers underlying the emergence of infectious diseases are in large 0
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National Governance National governance refers to the way in which a country organizes political power within its territory and controls interactions among local, subnational, and central governmental authorities. The allocation of jurisdiction is particularly important for disease surveillance, which is often a state or provincial function rather than the responsibility of the central or federal government.
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Privatized human health and veterinary services also change the context in which a country's governance takes place, particularly with respect to managing private economic incentives that may be in competition with the production of public goods. The demands that global disease threats generate make decentralization and privatization in national human and animal health governance even more challenging.
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Global governance strategies cut across traditional boundaries developed in national and international governance. Governance and Hard and Soft Law These forms of governance produce diverse normative strategies to channel political power and human behavior to work toward identified goals.
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Zoonotic Disease Surveillance, Response Capacities, and Governance Conducting zoonotic disease surveillance to detect threats to human and animal health that cross political borders and to intervene against those threats requires governance strategies and mechanisms that encourage countries to share information and collaborate on responses. For disease surveillance and response systems to be effective, countries must implement international and global governance approaches within their territories, from the local to the national level, and beyond to the international community, through both formal legal rules and informal modes of collaboration.
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. The landscape of global health governance has also changed with the explosion of new actors and programs, particularly involving nonstate actors (Garrett, 2007)
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At the same time the fragmentation in governance, at these same levels, has complicated the development and implementation of strategies to advance governance within each level and to integrate initiatives across all three levels. GOVERNANCE PROBLEMS FACING INTEGRATED SURVEILLANCE AND RESPONSE SYSTEMS FOR EMERGING ZOONOTIC DISEASES Traditional Governance "Silos" for Human and Animal Health Historically, given their different missions and principal concerns, the approach taken by WHO to develop and adopt the International Health Regulations of 1969 (IHR 1969)
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As a consequence, they had little in the way of enforcement provisions. Much of the governance innovation taking place today with respect to human and animal health and emerging zoonotic diseases attempts to break out of traditional patterns and ways of thinking about disease surveillance, prevention, and control and their subsequent effect on human and animal health at the local, national, and international levels, and to provide greater imperatives to action.
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Environmental governance at the international level, for example, does not have a central mechanism as international trade law has in WTO. International environmental law and other forms of global environmental governance have been largely ineffective in affecting the drivers of climate change, which, in turn, could exacerbate the impact of environmental degradation on the emergence of zoonotic diseases and become subject to the governance principles for human and animal health.
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This reality heightens the importance of having disease surveillance and response capacities in order to detect and intervene in a timely manner against outbreaks. Other Drivers Food Security Chapter 3 also identified food security as a driver contributing to zoonotic diseases.
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rather than addressing the underlying causes of migration. GOVERNANCE INNOVATIONS SUPPORTING INTEGRATED DISEASE SURVEILLANCE AND RESPONSE IN HUMAN AND ANIMAL HEALTH Four objectives for foreign policy and diplomacy were described as conceptually important innovations for surveillance and response capacities in Chapter 1.
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Recent strategic thinking about what human and animal disease surveillance and response systems ought to monitor and address, through the application of hard and soft law, has pushed WHO and OIE to attempt to broaden national and global disease surveillance systems to capture more than a limited number of diseases. Disease surveillance experts have also realized that a more direct connection between human and animal disease surveillance capabilities would provide a more comprehensive picture of disease trends of known or unknown potential threats.
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For the first time in international law on infectious diseases, it contains requirements for state parties to develop and maintain minimum response capabilities in addition to disease surveillance activities (IHR 2005, Articles 5 [disease surveillance] and 13 [response]
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The capabilities created by new technologies have supported a proliferation of early-warning and disease surveillance networks, described more fully in Chapter 4, including "networks of networks," such as WHO's Global Outbreak Alert and Response Network. OIE's World Animal Health Information System (WAHIS)
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Involvement of Nonstate Actors A second operational innovation has been the involvement of nonstate actors in governance functions for human and animal health, especially early warning and disease surveillance activities. As described in Chapter 4, nonprofit entities such as ProMED-mail, pioneered the use of information technologies and networks of stakeholders, and transformed early warning and disease surveillance strategies.
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. IHR 2005's inclusion of nongovernmental sources of information and WHO's verification authority represents an excellent example of global governance for human health.
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. Using this authority, OIE collects and analyzes information from nongovernmental sources, as illustrated by OIE's participation in networks such as GLEWS that receive and assess unofficial information for early warning and disease surveillance purposes.
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OIE does not have the policy or legal authority to declare an animal health emergency of international concern and to issue recommendations about how OIE member states should respond to such emergencies; and 4. OIE members do not have legally binding obligations to develop and maintain minimum core disease surveillance and response capabilities for risks to animal health, including zoonotic diseases.
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In the end, the HLSC recommended that the UK government pursue the creation of a disease reporting system for animal diseases in the image of IHR 2005. The approach would create substantive harmonization of the rules in the human and animal health governance realms.
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. Given the implicit mandates within IHR 2005 regarding zoonotic diseases, the treaty may not need to be amended to explicitly include zoonotic diseases within its disease surveillance approach.
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The committee concludes that implications of including minimum core disease surveillance and response capacities for animal health at national levels are enormous. In many countries, and particularly in the poorest ones, the disease surveillance and response capabilities of public and private veterinary services are limited and fragmented.
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However, it would be feasible with sufficient pressure and resources. MOVING TOWARD A GLOBAL, INTEGRATED DISEASE SURVEILLANCE AND RESPONSE SYSTEM: FUTURE GOVERNANCE STRATEGIES The threat that zoonotic diseases currently pose, and will continue to pose for the foreseeable future, counsels against complacency and in favor of strengthening national, international, and global governance strategies concerning disease surveillance and response capabilities -- even though progress has been made in governance contexts in and between human and animal health.
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It would also use the available resources of the technical agencies. Intensified Implementation: Integrated Human and Animal Health Capabilities A third option, but not mutually exclusive with the second option, would involve intensifying efforts to implement and integrate WHO and FAO/OIE activities that seek to strengthen local, subnational, and national disease surveillance and response capabilities.
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For human health, IHR 2005 would provide the strategy for intensified implementation, especially helping developing countries comply with their obligations to develop and maintain core disease surveillance and response capabilities. Nonetheless, the intensified implementation strategy faces daunting challenges.
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Rules on Trade-Restricting Measures to Protect Human or Animal Health Trade agreements have provided one way of handling problems related to human and animal diseases. In 2002, WHO and WTO jointly published "WTO Agreements and Public Health: A Joint Study by the WHO and WTO Secretariat," which describes the increasingly coordinated activities on the technical and policy levels for the organizations with acknowledgement of the common ground between trade and health.
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. The report also acknowledges the formal mechanisms and activities used for coordinated communication and mutual participation between and among WTO, WHO, FAO, and OIE -- such as WTO's reliance on WHO's scientific expertise to resolve trade disputes arising from health concerns, the mutual observer status and active participation to provide advice on the SPS Agreement, Technical Barriers to Trade Agreement, Trade-Related Aspects of Intellectual Property Rights Agreement, and World Health Assembly meetings; and their mutual participation in regional and national meetings related to capacity building for disease surveillance to detect and control diseases that could pose a threat to health, especially via trade activities.
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The potential in WTO's recognition of international standards as a "safe harbor" arises because this approach increases the incentives of exporting nations and exporters to upgrade their SPS strategies and capabilities at home and in export sectors. Such upgrades could help the effort to protect against zoonotic diseases by providing incentives to produce food and agricultural products according to the highest internationally accepted standards.
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CONCLUSION The current environment to integrate and improve surveillance and response capabilities for diseases of zoonotic origin is fraught with structural problems in the form of governance "silos" for human health and animal health as well as fragmentation and weaknesses in regimes that address the drivers of zoonotic disease emergence and spread. Despite these structural problems, conceptual, strategic, and operational governance innovations have improved disease surveillance and response capabilities nationally
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Aspects of this are also apparent in other governance contexts, such as the manner in which WTO recognizes OIE and Codex standards and the ability of IHR 2005's disease surveillance strategy to catch zoonotic disease emergence or reemergence. Although governance challenges can look foreboding, never before has there been so much policy and diplomatic activity focused on zoonotic disease threats.
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2007. Ensuring good governance to address emerging and re-emerging animal disease threats -- Supporting the veterinary services of developing countries to comply with OIE international standards on quality.
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