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University of Chicago Legal Forum

Abstract

COVID-19 revealed deeply embedded inequalities in countries’ capacity to respond to public health disasters. From 2020 to 2024, the content and scope of international health law expanded to address these deep inequities, including a new pandemic agreement and significant changes to the International Health Regulations (IHR). Recent moves by the Trump Administration leveled significant losses on this new global health law infrastructure. At the heart of this infrastructure is the World Health Organization (WHO)—the UN’s specialized agency, which for 77 years has led the world toward realizing the human right to the highest attainable standard of mental and physical health. Even before then, there were essential weaknesses in the WHO’s ability to manage emergencies and disasters. The most important infectious disease preparedness and response accord, the IHR could not prevent governments from failing to collect crucial information or share data with others; gagging doctors and other health officials from speaking the truth about outbreaks; or requiring wealthy countries invest in the capacities of foreign governments that, for their own benefit, they wish those governments to possess. The IHR (2005) never required any commitment by wealthy countries to ensure that life-saving medicines, vaccines, and medical equipment flow efficiently, equitably, and rationally to the people and places that needed them most. Even with amendments adopted in May 2024, many of these gaps remain. To make matters worse, the pandemic accord drafted over the last four years will proceed without U.S. involvement and perhaps even be impeded by its opposition. This Article addresses law in times of disaster both discretely—how the WHO can improve using two recent mpox public health emergencies as a case study—and broadly—how U.S. withdrawal and hostility to the WHO will produce a disaster for global health governance.

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