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Globalization, International
Law, and Emerging Infectious Diseases
http://www.cdc.gov/ncidod/EID/vol2no2/fidler.htm
David P. Fidler,
J.D.
Indiana University
School of Law, Bloomington, Indiana, USA
________________________________________
The global nature of the threat posed by new and reemerging
infectious diseases will require international cooperation in
identifying, controlling, and preventing these diseases. Because
of this need for international cooperation, international law
will certainly play a role in the global strategy for the
control of emerging diseases. Recognizing this fact, the World
Health Organization has already proposed revising the
International Health Regulations. This article examines some
basic problems that the global campaign against emerging
infectious diseases might face in applying international law to
facilitate international cooperation. The international legal
component of the global control strategy for these diseases
needs careful attention because of problems inherent in
international law, especially as it applies to emerging
infections issues.
The growing literature on new and reemerging infectious
diseases often emphasizes the global nature of their threat; the
U.S. Centers for Disease Control and Prevention (CDC) defines
these diseases as “diseases of infectious origin whose incidence
in humans has increased within the past two decades or threatens
to increase in the near future" (1). The World Health
Organization has asserted that emerging infections “represent a
global threat that will require a coordinated, global response”
(2). The threat is global because a disease can emerge anywhere
on the planet and spread quickly to other regions through trade
and travel. The global challenge of emerging infections has
serious consequences for national and international law; a
state’s ability to deal with them is eroded because microbes do
not respect internationally recognized borders (3). Experts
grappling with these diseases no longer consider that the
pursuit of a strictly national public health policy is adequate.
The need for global cooperation increases the importance of
international law in the public health arena. Part of the effort
to create a global response to emerging infections should be an
understanding of the problems that may arise from relying on
international law in dealing with these diseases. This article
outlines issues that will have to be confronted in using
international law to combat emerging infections.
Globalization
The assertion that emerging infections are a global problem
requiring a global strategy echoes observations made in other
spheres of public policy: the traditional distinctions between
national and international political, social, and economic
activities are losing their importance (4). Globalization is
eroding traditional distinctions between domestic and foreign
affairs. Globalization has been defined as the “process of
denationalization of markets, laws, and politics in the sense of
interlacing peoples and individuals for the sake of the common
good” (5). Globalization is distinguished from
internationalization, which is defined “as a means to enable
nation-states to satisfy the national interest in areas where
they are incapable of doing so on their own” (5).
Internationalization involves cooperation between sovereign
states, whereas globalization refers to a process that is
undermining or eroding sovereignty.
Globalization arises from the confluence of something old and
something new in international relations. It involves the very
old process of political and economic intercourse among
sovereign states. The new element is the intensification and
expansion of such intercourse made possibleby technological
advances in travel, communications, and computers. Encouraging
such intensification and expansion is liberal economic thinking,
which posits that economic interdependence makes all states
economically better off and builds order and peace in the
international system (6).
The changes wrought by new technologies unleashed in the
receptive international milieu created by liberal trade and
economic policies have led to the belief that these developments
are undermining sovereignty. Observers of international
relations frequently note that governments no longer have
control over economic forces at work within their countries. The
speed and volume of international capital flows illustrate the
denationalization of economics occurring through the process of
globalization (7). Another example is the development of the
global company—an enterprise that can no longer be considered
national because of the global reach of its operations,
financing options, markets, and strategies (7). The
globalization of finance and business has ramifications for
politics and law as leaders and legal systems adapt to the
global era (8).
In public health, a similar combination of old and new
factors can be seen. States have historically cooperated on
infectious disease control, first through international sanitary
treaties and later through the World Health Organization (WHO)
(9). While international cooperation is not new, current global
circumstances confronting the control of infectious disease are.
Globalization is also at work in public health. The assertion
that a country cannot tackle emerging infectious diseases by
itself demonstrates that public health policy has been
denationalized.
Globalization has affected public health in three ways.
First, the shrinking of the world by technology and economic
interdependence allows diseases to spread globally at rapid
speed. Two factors contributing to the global threat from
emerging infections stem directly from globalization: the
increase in international travel (2, 10) and the increasingly
global nature of food handling, processing, and sales (2, 10).
HIV/AIDS, tuberculosis, cholera, and malaria represent a few
infections that have spread to new regions through global travel
and trade (10). The beneficial economic and political
consequences of economic interdependence may have negative
ramifications for disease control. In the European Union, for
example, the free movement of goods, capital, and labor makes it
more difficult for member states to protect domestic populations
from diseases acquired in other countries (11).
Second, the development of the global market has intensified
economic competition and increased pressure on governments to
reduce expenditures, including the funding of public health
programs, leaving states increasingly unprepared to deal with
emerging disease problems. Industrialized as well as developing
countries confront deteriorating public health infrastructures
(12). Referring to the United States, one author described this
deterioration as the “thirdworldization” of the American health
care system (13).
Third, public health programs have also “gone global” through
WHO and health-related nongovernmental organizations. Medical
advances have spread across the planet, improving health
worldwide. The worldwide eradication of smallpox in 1977 is a
famous example. The global reach of health care advances has,
however, a darker side. The globalization of diseasecontrol has
contributed to the population crisis because people are living
longer. Overpopulation creates fertile conditions for the spread
of disease: overcrowding, lack of adequate sanitation, and
overstretched public health infrastructures (2). Further, the
widespread use and misuse of antibiotic treatments has
contributed to the development of drug-resistant pathogens (1,
2). Finally, the success of control efforts in previous decades
caused interest in infectious diseases to wane in the
international medical and scientific communities and is now
hampering emerging infectious disease control efforts (14).
International Solutions to Emerging Infections
International efforts are under way to respond to the threat
of emerging infectious diseases. WHO and CDC have drafted action
plans that stress the need to strengthen global surveillance of
these diseases and to allow the international community to
anticipate, recognize, control, and prevent them (1, 14, 15).
WHO has also established a new unit to control and prevent
emerging infections by mobilizing resources rapidly at the first
signs of outbreaks (16). The Pan American Health Organization
has also adopted a regional plan for controlling emerging
infections in the Americas (17). Health authorities from Central
American countries have adopted an emergency plan to control the
epidemics of dengue and dengue hemorrhagic fever that recently
swept through Central and South America (18). Physicians in the
European Union recognize the need for better surveillance of
infectious diseases (11). A U.S. government interagency working
group has underlined the importance of international cooperation
in dealing with the emerging infections threat (19). The U.S.
Senate Labor and Human Resources Committee held hearings in
October 1995 on “Emerging Infections: A Significant Threat to
the Health of the Nation” (20). At the Halifax Summit in 1995,
the major industrialized countries adopted a pilot project
called “Toward a Global Health Network” designed to help
governments deal with emerging infections and other health
problems (19) (Table 1). Clearly, the emerging infections threat
and the need for action are on the international diplomatic and
public health agendas
|
Table 1. Some common elements of global
emerging-disease control plans |
|
———————————————————————————— |
|
Strengthen international
surveillance networks to detect, control, and reduce
emerging diseases. |
|
Improve the international public
health infrastructure (e.g., laboratories, research
facilities, technology, and communications links. |
|
Develop better international
standards, guidelines, and recommendations. |
|
Improve international
capabilities to respond to disease outbreaks with
adequate medical and scientific resources and expertise. |
|
Strengthen international research
efforts on emerging diseases, particularly with regards
to antibiotic-resistant strains of diseases. |
|
Focus attention and resources on
training and supporting medical and scientific
expertise. |
|
Encourage national governments to
improve their public health care systems, devote
resources to eliminating or controlling causes of
emerging diseases and coordinate their public health
activities with WHO and the international community. |
|
———————————————————————————— |
|
Sources: refs. 1, 14, 15, 19. |
Although international control plans would involve private
organizations like universities and nongovernmental
organizations, the primary actors on the emerging infections
stage are sovereign states. The action plans are predominantly
blueprints for cooperation among states and represent a call for
the internationalization of responses to a problem caused by
globalization. Put another way, the proposed solutions to the
emerging infections threat rely on the sovereign state, while
the threat feeds off the impotence of the state in addressing
global disease problems. When it comes to public health
activities, globalization erodes sovereignty, but the proposed
solution makes sovereignty and its exercise critical to dealing
with the threat of emerging infections.
The consequences of the unavoidable emphasis on international
cooperation in the proposed action plans for emerging infections
are troubling. To achieve the desired objectives (Table 1),
states will have to agree on many issues and translate such
agreement into guidelines or rules. International law becomes
important to the effort for emerging infections control.
Political leaders, diplomats, and scholars have long recognized
the weakness of international law in regulating state behavior.
At first glance, the prospect of having to rely on a notoriously
weak institution of international relations as part of the
global effort to combat emerging infections is unsettling.
International Law and Infectious Disease Control
We might have been less unsettled if our experience with
international law in controlling infectious diseases had been
more positive. The success of WHO in globalizing disease control
programs might suggest that the defects of international law
have not hobbled its effectiveness in improving health care
worldwide. However, despite having the authority to do so, WHO
has been reluctant to use international law (21, 22). The
International Health Regulations administered by WHO represent
the most important set of international legal rules relating to
infectious disease control, but the regulations only apply to
plague, yellow fever, and cholera (23). The importance of health
is mentioned in international declarations (for example, see the
Universal Declaration of Human Rights, art. 25 [1]) and treaties
(for example, see the International Covenant on Economic, Social
and Cultural Rights, art. 12), leading some legal scholars to
argue that international law creates a “right to health” (24);
but this “right” does not directly address the control of
infectious diseases. WHO has refrained from adopting rules on
trade in human blood and organs, which does raise issues of
infectious disease control as illustrated by the sale of
HIV-contaminated blood in international commerce (25). Issues of
disease control also appear in specialized treaty regimes
outside WHO, such as treaties controlling marine pollution from
ships (26). Other areas of international public health law, for
example, rules about infant formula and guidelines on
pharmaceutical safety, do not deal with the control of
infectious diseases (25).
The effectiveness of existing international law on infectious
disease control has been questioned. A 1975 WHO publication
stated that the International Health Regulations have not
functioned satisfactorily at times of serious disease outbreaks
(27). More recently, WHO’s efforts with the International Health
Regulations have been called a failure, and noncompliance with
these regulations has increased in connection with reporting
disease outbreaks (25). The HIV/AIDs crisis dramatically
illustrated the weaknesses of the health regulations. Since AIDs
was not originally (or subsequently) made subject to the
regulations, states had, and continue to have, no notification
requirements in connection with this new disease. Further, as
HIV/AIDs spread globally, many states adopted exclusionary
policies that, according to experts, violated provisions of the
health regulations (25). In relation to one of the biggest
disease crises of this century, parts of the International
Health Regulations were irrelevant, and other parts were openly
violated.
WHO’s reluctance to apply international law has been
attributed to its organizational culture, which is dominated by
scientists, doctors, and medical experts. Perhaps the current
weakness of international law on infectious disease control
reflects WHO’s nonlegal strategy rather than the inherent
problems in international law itself. In connection with
emerging infections, however, WHO is advocating an international
legal strategy by recommending revision of the International
Health Regulations (28). This recommendation suggests that WHO
acknowledges the need for international legal agreement in
dealing with emerging infections. The global threat posed by
these infections represents in many ways a test case for
international public health law.
The Challenge to International Law
The threat of emerging infectious diseases poses two
challenges to international law: first, theemerging infections
problem exacerbates basic weaknesses in the law. Second, these
infections pose specific difficulties in the law, which are
related to the nature of disease and its prevention.
Basic Weaknesses
The effectiveness of international law depends on the consent
of states, which means that sovereignty and its exercise
determine the fate of international legal rules (29). In
adopting a legal strategy for its emerging infectious disease
action plan, WHO has to convince its member states to take
certain actions in response to disease emergence. The
sovereignty of states looms large in formulating a global
response to emerging infections, despite the fact that the
process of globalization undermines the sovereignty of the state
to deal nationally with these infections. In other words, the
problem by-passes the state, but the solution has to rely on the
state through the medium of international law. The central
importance of the state and its sovereignty constitutes a basic
weakness in international law because international legal rules
tend to reflect the compromises necessary to achieve agreement
and the unwillingness of states to restrict their freedom of
action through international law. Part of the reason that the
existing International Health Regulations cover only a few
diseases might be the unwillingness of WHO member states to
commit to more serious infectious disease control measures. The
vagueness and lack of specificity in the so-called “right to
health” also illustrate this problem. What is scientifically and
medically necessary to combat emerging diseases may not be what
states are willing to agree to undertake.
A second basic weakness follows from the “sovereignty
problem”—the lack of effective enforcement of international law.
States often agree to an international legal obligation without
any serious intent of fulfilling it. The alleged failure of the
International Health Regulations may be due to the failure of
WHO member states to fulfill the duties they accepted. Neither
the regulations nor WHO has any power to enforce compliance
(25). An international legal regime on emerging diseases would
also face this enforcement problem.
Specific Difficulties
The very nature of the emerging disease threat poses special
difficulties for international law. The global scope of the
problem necessitates agreement by most states to control
emerging diseases. If any major country or group of countries
does not participate, a gap in the global surveillance and
control network threatens the efficacy of the entire effort. The
negotiation of agreements involving many states is usually
difficult, because each state knows that its nonparticipation
threatens the success of the entire venture. This problem has
occurred in international environmental law, where global
regimes have been needed to deal adequately with environmental
threats, such as ozone depletion.
A second specific difficulty arises from the extent of
medical and scientific resources needed to establish an
effective global surveillance and control network for emerging
diseases. Fundamental aspects of the proposed action plans
involve improving surveillance networks, public health
infrastructures, scientific research, and medical and scientific
training (Table 1). Some states, particularly in the developing
world, do not have the medical, scientific, and financial
resources to undertake such measures. Unless more affluent
countries provide theresources, developing states may use the
inequity of wealth in the international system as an argument to
complicate negotiating a global agreement. The so-called
“North-South problem” has made the negotiation of international
environmental agreements more difficult, as developing countries
have bargained for more lenient treatment or a transfer of
resources from affluent countries to help them improve
environmental protection. A similar dynamic may appear in any
negotiations for a global emerging disease effort. The U.S.
interagency working group on emerging diseases has observed that
major U.S. contributions to developing countries for emerging
disease control purposes “is not a likely prospect during this
period of deficit reduction and downsizing” (19), which suggests
that resource availability will probably complicate
international efforts in this area.
The problems associated with using international law in a
global strategy to combat emerging diseases raise the question
whether international law can provide an adequate foundation for
the control of these diseases. The uncomfortable position of
having no choice but to rely on international law when its
weaknesses are substantial highlights the importance of thinking
through the international legal aspects of a global emerging
disease plan carefully.
WHO’s Proposed Legal Strategy
WHO wants to revise the International Health Regulations as
part of its global emerging disease strategy (28). WHO’s
proposal deserves some critical attention. It is not clear that
the organization has adequate authority to incorporate
comprehensive emerging disease control measures within the
international regulations. Under Article 21 of the WHO
Constitution, the World Health Assembly can adopt binding
regulations in sanitary and quarantine requirements and other
procedures to prevent the international spread of disease (22).
The World Health Assembly adopted the International Health
Regulations under Article 21. While Article 21 and the
regulations are relevant to emerging disease control efforts, it
is doubtful whether the regulations can serve as a foundation
for a comprehensive emerging disease control plan. The
disease-outbreak notification requirements in the regulations
could be expanded to include more diseases, but nothing in
Article 21 gives the World Health Assembly the authority to
require WHO member states to strengthen public health
infrastructures, which is considered critical in the emerging
disease actions plans proposed to date (Table 1). It has been
argued that attempting to address such infrastructure problems
“is a solution which cannot be obtained by an international
instrument but only by the improvement of the health conditions
of the peoples of WHO’s member states” (30). But, as the history
of administering the International Health Regulations has shown,
notification requirements have not worked satisfactorily and are
weakened by the absence of adequate public health resources.
Further, Article 22 of the WHO Constitution makes regulations
promulgated under Article 21 automatically binding on WHO member
states, except for member states that reject such regulations or
make reservations thereto (31). Article 22 relates to the
sovereignty problem and may deter WHO member states from
agreeing to serious revisions of the regulations. Analysis of
the regulations may question the wisdom of using the regulations
as the legal basis for dealing with emerging diseases.
The World Health Assembly has the power to adopt conventions
or agreements within WHO’s competence (21). The Assembly could
use this authority to address aspects of the global emerging
disease control strategy that cannot be handled with a revision
of the regulations.However, parceling up emerging disease
control measures between the International Health Regulations
and separate agreements would be legally complicated. Further,
WHO has not used this power to adopt conventions or agreements,
which explains its unwillingness to explore all legal options
open to it.
Possible Alternative Legal Strategies
Alternative legal strategies to revising the International
Health Regulations range from reliance on the development of
customary international law to the adoption of multilateral
treaties specifically on emerging-disease control (Table 2). An
issue related to these alternative approaches is the substantive
nature of the obligations contained in legal documents. We have
to ask not only how states might agree on control rules but also
what these states might agree to do. The proposed revision of
the regulations apparently would only apply the notification
duties (currently found in the regulations) to more diseases. As
indicated earlier, WHO cannot address in its revision of the
regulations any of the improvements in public health
infrastructures, surveillance networks, scientific research, or
medical and scientific training at the heart of proposed
emerging disease action plans. Further, it is not clear whether
WHO intends to supplement expanded notification duties with any
mechanism to monitor or enforce such duties.
|
Table 2. Alternative international legal
strategies to revising the International Health
Regulations |
|
Alternative legal strategies |
Possible advantages |
Possible disadvantages |
|
1. WHA incorporates emerging
disease control as part of the
proposed World Health Charter
scheduled for initial negotiations
in 1997 |
Integrates emerging disease control
measures into the overall WHO
approach to international health
issues |
a. Emerging disease control would
not be primary focus
b. World Health Charter is likely to
be more aspirational than
obligatory |
|
2. WHA adopts an emerging
disease-specific convention under
Article 19 of the WHO Constitution |
a. Avoids IHR model
b. Has potential to set out
comprehensive global approach
to emerging diseases |
a. WHA has no experience with
using Article 19
b. Large multinational treaties tend
to contain general obligations
rather than specific duties |
|
3. States negotiate a framework
multilateral treaty on general
emerging disease obligations,
accompanied by disease-specific or
region-specific protocols containing
detailed and specific commitments
on emerging disease control |
a. Takes emerging disease control
out of WHO, eleminating
problem of WHO's reluctance to
use international law
b. Allows for new protocols to be
adopted for new diseases
c. Framework-protocol approach
has been used with some success
in international environmental
law on ozone depletion |
a. WHO has to play central role in
any emerging disease plan
b. Frameowrk-protocol approach
might not be appropriate model
for emerging disease control
because the emerging disease
problem differs from ozone
depletion |
|
4. Encourage regional arrangements
and integrate them into global
regime over time |
a. Builds on strong regional
systems
of cooperation and coordination
b. Offers "legal laboraties to try
various approaches to emerging
disease control
c. Avoids diplomatic headaches
involved in trying to negotiate
truly global legal regimes |
a. Emerging diseases require a
global approach not just a
regional approach
b. Amounts to emerging disease
control for rich regions, leaving
many developing countries
outside legal regime
c. Risks inconsistencies in how
emerging diseases are handled
by different regions |
|
5. Encourage a bilateral approach
in
which individual contries
negotiate detailed and specific
commitments on emerging
diseases and perhaps condition
trade benefits and aid on emerging
disease performance |
a. Gives states flexibility in
constructing legal obligations
b. Permits possibility for sanctions
for failure to live up to emerging
disease obligations |
a. Does not address global nature
of
emerging disease problem
b. Sanctions element is unrealistic
and might be unfair to
developing countries lacking
the resources necessary to
implement adquate emerging
disease control measures |
|
6. Incorporate emerging disease
control as part of international
"right to health," making emerging
diseases a human rights issue |
a. Links emerging disease control
with larger, powerful concepts
of human welfare
b. Builds on existing international
law on the "right to health" |
a. International "right to health"
has
no definitive meaning or scope
and thus is a bad foundation for
emerging disease control
b. Human rights are inherently
divisive in the international
system; linkage with such a
controversial area would hurt
emerging disease control prospects |
|
7. Rely on customary international
law to develop emerging
disease-control norms |
Customary international norms on
emerging disease control would be
binding on all states except persistent
objectors |
a. It will be nearly impossible to
develop general and uniform state
practice recognized by states as
legally binding in the emerging
disease-control area
b. Any customary norms that might
form will probably be vague and
hard to identify definitively
c. Customary norms can take a very
long time to develop |
|
WHA = World Health Assembly; WHO =
World Health Organization; IHR = International Health
Regulations. |
International environmental law had to overcome some of the
same obstacles encountered by WHO’s international legal effort
for emerging disease control. States realized that they could
not handle global environmental problems without international
cooperation and rules (32). Further, states knew that addressing
environmental concerns would require changes for governments and
companies within states and that developing states might have
financial and technological difficulties implementing
international agreements (32). In developing international
environmental law, states, international organizations, and
nongovernmental organizations did not rely on old approaches but
instead crafted new international legal rules to deal with the
global nature of the threats posed, the resource issue, and
compliance and enforcement problems (33). Whether international
environmental law has been successful is controversial; but it
is important that states have not been willing to admit that
improving environmental conditions within states is a solution
that cannot be obtained by international agreements. Models and
precedents from international environmental law are not in all
respects helpful to the challenge of emerging-disease control;
but, at the very least, those grappling with an international
strategy for the emerging-disease threat could analyze
international environmental law and other innovative legal
responses to globalization to look for ways of making WHO’s
international legal strategy on emerging diseases as effective
as possible.
Those currently designing global emerging-disease control
strategies will eventually have to translate what is
scientifically and medically needed to combat these diseases
into international agreement and cooperation through
international law. The movement from science and medicine into
the realm of international law will not be easy. Relying on the
International Health Regulations as the centerpiece of
international law on emerging-disease control may not be the
most effective international legal strategy. Whatever
international legal approach is eventually taken will have to
confront somehow a fundamental paradox: globalization
jeopardizes disease control nationally by eroding sovereignty,
while the need for international solutions allows sovereignty to
frustrate disease control internationally. The combination of
the process ofglobalization and the unavoidable need to rely on
international law produces a most unattractive medium in which
to wage potentially one of the most important medical and
scientific endeavors in history.
Mr. Fidler is associate professor of law at Indiana
University School of Law, Bloomington, where he teaches public
and private international law. He has a master of philosophy
(M.Phil.) degree in international relations from Oxford
University, a J.D. from Harvard Law School, and a bachelor of
civil law degree from Oxford University. Before joining the
faculty at Indiana University School of Law, Mr. Fidler
practiced law with Sullivan & Cromwell in London, England, and
with Stinson, Mag & Fizzell, P.C., in Kansas City, Missouri.
Address for Correspondence:
David P. Fidler, J.D., Indiana University School of Law,
Third Street and Indiana Avenue, Bloomington, IN 47405-1001 USA;
fax: 812-855-0555; e-mail: davidfidler@law.indiana.edu
Acknowledgments
I thank Jack Bobo, research assistant, for his valuable work
during the preparation of this article, and Lane Porter and
Allyn Lise Taylor for their helpful comments on earlier drafts
of this article. I also thank my colleagues on the faculty of
Indiana University School of Law for their helpful comments on
an earlier draft presented at a faculty colloquium.
References
1. Centers for Disease Control and Prevention.
Addressing emerging infectious disease threats: a prevention
strategy for the United States. Atlanta: U.S. Department of
Health and Human Services, Public Health Service, 1994.
2. World Health Organization. Communicable disease
prevention and control: new, emerging, and re-emerging
infectious diseases. WHO Doc. A48/15; Feb. 22, 1995.
3. Garrett L. The return of infectious disease.
Foreign Affairs Jan.-Feb. 1996;66-79.
4. Aman AC. Introduction. Indiana Journal of Global
Legal Studies 1993;I:1-8.
5. Delbrück J. Globalization of law, politics, and
markets—implications for domestic law—a European perspective.
Indiana Journal of Global Legal Studies 1993;I:9-36.
6. Gilpin R. The political economy of international
relations. Princeton, NJ: Princeton University Press, 1987.
7. Kennedy P. Preparing for the twenty-first century.
London: Harper Collins, 1993.
8. Shapiro M. The globalization of law. Indiana
Journal of Global Legal Studies 1993;I:37-64.
9. McNeill WH. Plagues and peoples. New York:
Doubleday, 1976.
10. Wilson ME. Travel and the emergence of infectious
diseases. Emerging Infectious Diseases 1995;1:39-46.
11. Desenclos J-C, Bijkerk H, Husiman J. Variations in
national infectious disease surveillance in Europe. Lancet
1993;341:1003-6.
12. Berkelman RL, Bryan RT, Osterholm MT, Leduc JW,
Hughes JM. Infectious disease surveillance: a crumbling
foundation. Science 1994;264:368-70.
13. Garrett L. The coming plague: newly emerging
diseases in a world out of balance. New York: Penguin Books,
1994.
14. Emerging infectious diseases: memorandum from a WHO
meeting. Bull World Health Organ 1994;72:845-50.
15. World Health Assembly. Communicable diseases
prevention and control: new,emerging, and re-emerging infectious
diseases. WHO Doc. WHA 48.13, May 12, 1995.
16. World Health Organization. Press Release. WHO/75,
Oct. 17, 1995.
17. Epstein DB. Recommendations for a regional strategy
for the prevention and control of emerging infectious diseases
in the Americas. Emerging Infectious Diseases 1995;1:103-5.
18. World Health Organization. Press Release. WHO/72,
Sept. 28, 1995.
19. National Science and Technology Council Committee
on International Science, Engineering, and Technology Working
Group on Emerging and Re-Emerging Infectious Diseases.
Infectious disease—a global health threat. Washington, DC:
CISET, 1995.
20. Emerging infections: a significant threat to the
nation’s health: hearing before the comm. on labor and human
resources. 104th Cong., 1st Sess. 298 (1995).
21. WHO Constitution, art. 19.
22. WHO Constitution, art. 21.
23. World Health Organization. International health
regulations. Geneva: World Health Organization, 1983.
24. Taylor AL. Making the world health organization
work: a legal framework for universal access to conditions for
health. Am J Law Med 1992;18:301-46.
25. Tomasevski K. Health. In: Scachter O, Joyner CC,
editors. United Nations Legal Order. Cambridge, UK: Cambridge
University Press, 1995.
26. Churchill RR, Lowe AV. The law of the sea. 2nd ed.
Manchester, UK: Manchester University Press, 1988.
27. Delon PJ. The International Health Regulations: a
practical guide. Geneva: World Health Organization, 1975.
28. World Health Assembly. Revision and Updating of the
International Health Regulations. WHO Doc. WHA 48.7, May 12,
1995.
29. Brownlie I. Principles of public international law.
4th ed. Oxford, UK: Oxford University Press, 1990.
30. Fluss S. International public health law: an
overview. In: Oxford Textbook of Public Health. In press.
31. WHO Constitution, art. 22.
32. Hurrell A, Kingsbury B. The international politics
of the environment: an introduction. In: Hurrell A, Kingsbury B,
editors. The international politics of the environment. Oxford,
UK: Oxford University Press, 1992.
33. Birnie P. International environmental law: its
adequacy for present and future needs. In: Hurrell A, Kingsbury
B, editors. The international politics of the environment.
Oxford, UK: Oxford University Press, 1992.
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