chapter  2
18 Pages

Sisyphus in the Microbial World Revisited: Global Governance, Antimicrobial Strategies, and Humanity’s Health

WithDavid P. Fidler

CONTENTS 2.1 Introduction ................................................................................................. 24 2.2 The Fourth Epidemiological Transition .................................................. 24 2.3 The Governance Revolution in Global Health....................................... 25

2.3.1 The Axis of Evil: Biological Weapons, Biological Terrorism, and Public Health’s New Security Importance ..... 26

2.3.2 The Axis of Illness: Emerging and Reemerging Infectious Diseases ............................................................................................ 27

2.3.3 Prominence in Perspective: The Axes of Evil and Illness in a Dangerous World ....................................................... 30

2.4 The New Way of Working: The New International Health Regulations .................................................................................................. 30 2.4.1 From the Classical Regime to the IHR 2005............................... 31 2.4.2 Expanding the Scope of the IHR’s Governance Strategy......... 32 2.4.3 Granting WHO Increased Authority and Power ...................... 33 2.4.4 Integrating Human Rights Principles.......................................... 34

2.5 Is the New Way of Working Actually Working? The Quest for Governance Architecture for Global Health .................................... 35 2.5.1 What Do President Bush, Bill Gates, and Bono Have

in Common? .................................................................................... 35 2.5.2 Beyond Unstructured Plurality: Whither Global Health

Governance? .................................................................................... 36 2.6 Conclusion ................................................................................................... 37 References ............................................................................................................. 38

Chapter 1 analyzes some fascinating and frightening aspects of the challenges pathogenic microbes create. This chapter explores a different manifestation of the pathogenic challenge because it considers the radical changes in governance that have characterized global health activities against infectious diseases in the first years of the twenty-first century. In an earlier companion volume to this book published in 2000, the editors invited me, an international lawyer, to reflect on broader political, economic, cultural, and legal issues that affected antimicrobial strategies at the local, national, and global levels [1]. As described below, I posited that humankind was on the cusp of a fourth epidemiological transition, the nature of which would be determined not by science and technology but by how societies individually and collectively governed pathogenic threats. I used the image of Sisyphus to capture the labors the global community might have to endure to address the emerging and reemerging threats posed by infectious diseases.