ABSTRACT
Evolving or threatening pandemics constitute dramatic manifestations of global interdependence, calling for coordinated action. The World Health Organization (WHO), a member of the United Nations (UN) family created in 1948, is the international organization we today expect to provide that coordinated action at the outbreak of new potential pandemics, such as bird flu, SARS or swine flu. Yet the first pandemic in the age of globalization, HIV/AIDS, illustrates that the “fit” between issue and organization is far from perfect. This chapter will trace shifts in the organizational landscape con-
cerning the international response to HIV/AIDS since the late 1980s and inquire into the kind of action taken. Unlike the other chapters in this volume, this one does not focus on one individual organization but rather on a sequence of organizations of different types, ranging from traditional intergovernmental organizations (IOs) to public-private partnerships. This chapter contrasts principal-agent (PA) explanations with constructivist accounts. PA theory views IO action as a result of delegation from principals (be they member states or other stakeholders) and addresses questions concerning the scope for independent IO action. Constructivism emphasizes the role of norms and institutional factors in accounting for specific IO actions. Two sets of questions will guide the analysis. First, I will inquire into
the “actorness” of IOs. To what extent can we speak of independent IO action? As I am looking at different organizations, how can we account for varying autonomy? The second, complementary set of questions
concerns the kind of actions actually taken, or not taken. Why did IOs resort to this type of action or inaction, rather than other available alternatives? It should be noted from the outset that HIV/AIDS differs from other
health issues and previous epidemics in several significant respects. First, it represents a “long-wave event” where large-scale effects emerge gradually over decades (Barnett 2006). While more people have died from other epidemics in the past, the unabated continuation of a lethal epidemic for more than a quarter century is unprecedented (Lisk 2010: 5). As a result of the sexual nature of transmission, the long viral life cycle (it may take 10 years between infection and disease), and the high mutation potential, the full wavelength of the HIV epidemic curve is probably 50-120 years. Such long-term ramifications require long-term thinking, falling outside the normal time horizons of politicians (Barnett 2006: 302, 304; Panos 2003: 36-38). Unlike the victims of earlier epidemics, HIV-infected persons are
normally in their productive and reproductive age. This, in combination with the long incubation time, means that they are able not only to accelerate the spread of the pandemic, but also to organize in order to get their voices heard. For the first time in history, patients-people living with HIV/AIDS (PLWHA)—have been able to create effective pressure groups. Whereas virtually every measure of disease control implies an ele-
ment of social control, empowering the medical profession while reducing the diseased to the role of patients, the human rights aspects of AIDS are particularly prominent. Unlike other infectious diseases, AIDS has been associated with stigmatization, discrimination, persecution and a wide range of human rights abuses (Tomasevski 1992a; Csete 2007). The complexity and sensitivity of HIV/AIDS as a policy problem
should not be underestimated, as we inquire into the types of actors that have been and are involved on the global stage, and what kind of action has been taken or not taken. After a brief chronology of the international response to the pandemic, this chapter will analyze the actions and “actorness” of WHO in the early stage of the pandemic, and of the public-private partnerships emerging as WHO’s successors around the turn of the millennium.
