The new old world order in international health

This past weekend was a historic one in international health. The signal event, the coming into force of new International Health Regulations (the first since 1969), was marked by only a few outside WHO. The remarkable thing about them is the new IHR bring the system of international health into line with a new reality of emerging infectious diseases. Unfortunately, it was the new reality of fifty years ago. Events have outrun the new regulations to make them already obsolete.

Many reading this will be surprised that until a few days ago WHO was essentially without ability to release any health information without the consent of the member nation involved. We discussed the background to this at some length on the other site (posts: here, here, here, here and here). Prior to this member states were only required to report occurrences of cholera, plague and yellow fever. The new rules have added viral hemorrhagic fevers (such as Ebola and Marburg), if they cause a serious public health impact or pose a risk of international spread; smallpox; SARS; and novel influenza strains, the flu strains to be provided to WHO collaborating centers in a timely fashion.

The revised IHR also require countries to report natural, accidental, or deliberate use of biological or chemical agents or radionuclear material.

To encourage more openness about health threats and to speed the international response, the new rules require member countries to:

  • Notify international officials of a public health emergency within 24 hours of assessment
  • Designate a national IHR focal point to stay in constant communication with the WHO
  • Develop and maintain core public health capacities for monitoring and responding to emerging threats, including those related to chemicals, radiologics, and food
  • Report health measures, such as border screening and quarantine, implemented in response to disease outbreaks, with a focus on measures that could impair international trade or travel (via CIDRAP)

Moreoever the only source of information WHO officially recognized was that provided by member states. Now other information sources, such as NGOs, are also legitimate sources.

While the IHR came into force on June 15, the start date for various countries differs, depending on individual reservations and understanding expressed by a member nation (the US version of the IHR takes effect July 17). For many other countries the date is later. The existence of these reservations and understandings is recognition that the IHR are voluntary. This may be surprising, but an international system that gives primacy to national sovereignty can do little else. We don't (yet) have a a structure above the nation state.

This is a situation out of step with the realities of the Twenty First Century, including the reality of global health. It always interests me that people assume the future will be just like the present. In particular Americans naturally assume that in fifty years there will still be a United States, just like the one they live in now. Much more likely is that people living in the territory now called the United States will be part of a larger geographic, regional or multi-continent federation or confederation.

When and if that happens, the immigration debates of 2007 will look like a historical weirdness. Which they are.

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In fifty years Revere you think we will be a federation? The United States of CANAMEXICO was posited almost 100 years ago and we are still the US of A and only because of the resistance to socialism. Socialism removes individualism and that would be a tough pill to swallow, even with UHC being the touted requirement for participation in the New World Order. Hmmmm... Adoph Hitler said the same thing in 1938. .

The EU is moving towards that already, or trying to. Tony Blair just this past week was working to create just that position in the EU and without any voting by the people of the UK. Merkle of Germany as well. No voting on it. You just submit... or else. It was posted in their papers this past week. The real sticking points? They wouldnt be able to stop immigration. Only the EU would be able to decide what their annual quota of immigrants would be. The EU will also decide what an illegal is as well. Hilary would be very happy with this development.

The IHR, socialism and UHC are all tied in together. Once they get control of the health care system, it all falls into place behind this. I agree, its 20th century thinking in a 21st century environment. It hasnt evolved any farther because that it removes the rights of the people to protest or just say no.That includes national sovereignty in these issues. It will also reduce the standard of living in the West to bring up the level in the East. Automatic rebellion when that starts. Resistance to the new IHR is out there and I respectfully disagree that we will be federation of any kind. It might get started but then fold up like a pair of 2's in front of a flush. Its going to just be too expensive, increase the population even higher and thats when it would collapse.

It is though a logical progression thought though Revere if you take that path. In fifty years, I believe we will have shot more than one nuclear exchange that takes out a majority of the worlds population, or the system will correct itself with a bird flu bug or something equally smokin'. Thats a very real logical progression in todays world. Globalists like Carter, Bush2, Clinton, H. Clinton all believe that what we need to do to is bring everyone into the melting pot thought and everything will just be peachy. Hard to nuke your cuzzin Fawad Johnson in Tel Aviv if you are living in Baghdad James Abdullah Berg kind of thing. Tell Al Qaeda that they have to love them boys in Tel Aviv and not be hatin'. Uh-huh.

Everytime the known world moved towards this (Alexander, Rome, Kublai Khan, Xerxes, Shaka, Victorian Britain, Attila and on) it lasted only for comparatively short times. Single life spans or in the case of the Chinese and Romans hundreds of years. But as you assert, the US's days are numbered as we know them. Always, some single or group of event(s) came thru and screwed it up and the end result was a fracturing of the situation back into its nearly lowest common denominator.

You might be right about the federation thing. The South might remove itself from the Union if it happens IMO though. There is a general thought that the NE has tried to run the country for years and of course the thing with slavery that really set things off. Remember the one single or group of events? There would have to be a lot more movement towards this than the IHR changes though to get to world socialism. Ultimately all socialistic systems collapse as well. Anyone want to take bets on what would break it up? Mine? Taxes.

By M.Randolph Kruger (not verified) on 18 Jun 2007 #permalink

Randy: I surely hope you are wrong, for my children and my two grandchildren's sake. I prefer a world government that is libertarian socialist in flavor but I'll be dead by then, so it won't matter to me and no one can see 50 years ahead. But I am pretty confident the future won't look like today. Better or worse or whether you think one outome is better or worse is up in the air.

Revere you are right, I might be around for my grandkids but nothing more than that. I was always taught to leave it in better shape than when you found it and we have done a muck up job of it. Where do we go from here? Global Climate Change if you ascribe to the effects of man on the environment thing can be ended by the one clear known factor, elimination of humans. Uhrp!? Letting people die instead of helping them? The IHR attempts to thwart the natural processes for fixing the problem with the earth. Maybe its not such a bad idea to just not comply? Maybe?

I personally believe that we're headed for a showdown and some would call it an end of days. I take a lot more pragmatic view of that and that is that we just got too damned many people on the big blue marble. All of us want to live beyond what our normal life expectancy is (whatever the number truly is) but its always been based upon the food supply against the total of people. We are about to go to war for oil and to kick some crazies off the planet. But crazies in who's eyes? Iranians in my eyes are crazy just as Saddam was, but are we there for ideological reasons or oil. You decide when you turn on the lights or fire up the car or get a grant, or just about anything. We wont hit them because they are crazy. We will hit them because they threaten to upset the balance.

If we add another billion point five in the next 20 years I cant see anything but disaster on the planet for the food, the water, the air. One pop of a nuke in the open air and all Hell is going to break loose. Everyone is adjacent to everyone who has one now or will get one. International health? We will be doing good to preserve the ability to put a band-aid on soon. Do we have the resources to support that many people? Everytime we help someone it puts another unproductive human (In the eyes of what is productive types and not another goat herder) on this planet. They till no soil, they feed no one, and they are always trying to make yet more babies.

As for the IHR, we have a group in SE Asia who want to treat a bug as a pet petri dish experiment. In Africa, cholera is running. The US Andrew Speakers (and others) are lying about without regard to their fellow man. As for me and I have spoken of it before, its the dumbing down so that God, the Grim Reaper, or call it nature can take its course. We are doing some of the most stupid stuff and its reminiscent of the days before the Plague. We are no longer the survival of the fittest, but a world of politically correct. This slows the natural order and that is one of elimination of the weaker ones. Politically correct means Darfur, Mogadishu, Ethiopia, AIDS/TB in the world and particularly S. Africa get fed, treated and all at someone elses expense. We have IMO come full circle. Its time for a human cull.

The War College covers this with a big paintbrush and we are there. There being that the have nots are coming after the haves. Here its our legal system and one that fails to acknowledge that the poor have to be bought off rather than as it was at the turn of the 1800's to just let them go. Since the 20's we have been doing just that, buying them off with social programs and now we have UHC that there is simply no way to pay for even with the single payer plan. Everyone is too old to bring it on now. To pay for it would break the bank thats already broken.

IHR is yet another shining example of how those that would control us fail to do so. Dont get me wrong here. I think that the original proposals for it and how they were mandatory were a good idea. But its all about the control. Those countries that aint playing ball are the ones that are holding it in their hands. Soon it will become warm, then very hot, then glowing red and thats when they'll scream... buy me off! This time around, everyone should just stand back and let it happen IMO. Is it acceptable to lose say 1/3rd of Indonesia? Only if you are holding the ball and wont let anyone play. Bet they would be your best big buddy if you had a bag of ice to cool it.

You know as well as anyone the effects of a stagnated species and global change biology. Adaptation and survival of the fittest interrupted is whats happening. Right now its survival of the fittest by the weapon. What do we do if it becomes survival of the fittest by biology? I actually hope it is biological instead of the nuke. We would destroy the planet in whole rather than a part of it. No natural selection in a nuke.

By M. Randolph Kruger (not verified) on 18 Jun 2007 #permalink

I believe the brave new world of the 21st century will result in less democratic governments not more.This process has started in the USA where your own government using the populations fear of terrorism has already started wars and compromised individual freedoms to undermine the democratic system.
Mr. Krugers comment that a nuclear war or pandemic will correct the system is simply the fantasy of a 20th century attitude that we can go back to the way things were.
The biggest new variables are huge populations and new technologies. I wish I could predict the future but I also have spent most of my life with 20th century attitudes. But that world is gone and the new world will require people with ideas and ideologies that we 20th century people have not yet imagined.
I hope my comments have made sense.

Wayne: Not much today makes sense. I'm hoping for the best although the number of roads from here to there are so many that I have no iea what choices will be made or forced on us. I'm pretty sure of one thing, though. The future won't be like the present.

Two extra points. If I understand it correctly, the IHR is the first time that the WHO can look at health issues across borders. That until now each country was treated as a separate entity and its health issues siloed by WHO.

If we are to have any hope of dealing with a pandemic, its a first step. But the next question is how we even attempt to establish a system that can detect accurately the outbreak of a pandemic, assuming that it may NOT be H5N1 for example, and then communicate that quickly enough to be ahead of the propagation wave front.

If we got it right it might still be the last message carried by the telecoms networks before they fail in its wake.

On the other point of the political future of large scale organisations, I would bet the other way. As peak oil cuts severely into a globalised economy, communities will be required to produce more and more of their own goods and services rather than be involved in high volume, high velocity, trade. That will tend towards fragmentation as cetralised authorities lose their ability to act and become less relevant.

I would bet on the original 13 states becoming one "nation", but the bigger they are and the more distance between population centres, the more likely the other states will gravitate towards self reliance and harder borders.

Earl: Yes, you are right. There are some other new wrinkles in the IHR as well. But basically they are stuck in a Westphalian system with their toe in the water of what needs to be.

While IHR(2005) may be a step forward from its 1969 predecessor it is not fit for purpose. The States that signed off on it have left us with an excellent set of ideals (WHO hotline, 24 hr reporting, support from WHO etc.) but it lacks any kind of compulsion and reeks of States protecting their sovereignty. If the WHO is suspicious about a country�s reporting � or lack thereof � it has no authority to demand information or access. If a country does supply information the WHO is not at liberty to share it, the exception to this rule is if they think it may spread across a national boundary then they can inform that state but the state can not divulge the information. The WHO can confirm information if it is already in the public domain. What power is divested by this agreement is squarely in the hands of the Director General it is quite strange in this respect and is executive branch heavy. So, how this system will operate in practice largely depends on how Dr. Margaret Chan attempts to interpret her powers and how the Nation States react to her interpretation. If all the States fully comply with the spirit of the law then this will be a great system, if � heaven forefend � their situation reports are not as punctual or frank as hoped the DG has no stick and precious few carrots. There is a disputes mechanism but this is legal in nature and � on the time scales of an infectious disease outbreak - its machinations are glacial.

JJ-Pretty good analogy, but as you acknowledge its not going to change much. We have to comply almost immediately, they dont. Kind of like Kyoto. We have to comply and destroy our economy when we are not the major polluters of the world and they get 50 years to comply. I thought Al G. said we we would be tipping over in ten. Hmmm.... Same thing applies to IHR. Immediate compliance on all parts else what the f is going on here. Its okay to have a bug running about in your country (A. Speaker) but you dont have the authority to detain or stop it. You are aware of a bug in another country (Indonesia) and we bring it to your attention but you do nothing about it and scream we gotta pay you for your efforts.

I am glad we only have a toe in the water as Revere says, any more and we could all lose a foot.

By M. Randolph Kruger (not verified) on 19 Jun 2007 #permalink

Randy who are 'we' and 'they'. I am not concerned about the WHO upholding their end of the bargin my doubts are that the nation states will comply in a timely fashion. As to the Kyoto protocol I dont see its relevance and if 'we' is the US in your case and the UK in mine then yes we are the major polluters of the world and have been for decades.

JJ-The references are that the US is always the bad guy. Yesterday the Dutch confirmed what we have known for over 10 years and that is that the US is NOT the major world polluter, its China. We sign Kyoto and they dont have to comply for 50 years. We have to immediately. Hamstrung. Same with the IHR. They complain, whine, extort and demand we send them money and then when its time to comply, we get the short end of the stick. Again, hamstrung. Economics is one thing. World health is truly another. If they cant fix their problems then why in Hell dont they allow people in who can? We gave up almost a billion point five to the Indonesian for bird flu control. What did we get? MORE cases. The US contributes 25% of the worlds pollution, the EU 20. China 9 and thats increased by huge leaps and bounds. I have the cutest little picture from five years ago that shows CO which is the most dangerous gas out there and the EU, the US, So. America all have little colorizations over us during winter. Over in China it goes from light green (normal) to dark black (extreme). That floats over into the US, into Alaska and California and Canada. We could shut everything off here and we wouldnt be able to comply with the Clean Air Act. If you want a copy of the pictures just hit me at memphisservices@bellsouth.net and I'll e it to you. When you see it you might get pretty pissed off. All of these controls, emissions standards and reformulated gasoline mean not one whit. They send us their pollution across the Pacific and it goes all the way around to the EU as well.

As for the nation states complying. Forget it. Its not going to happen unless we pay for it.

By M. Randolph Kruger (not verified) on 21 Jun 2007 #permalink

Randy I am not sure if you have been reading a different version of the Kyoto protocol but I have pasted a link to it below with some crib notes I wrote a while ago.

KYOTO Protocol notes

For the full text of the Protocol follow this link UN - Document - Kyoto Protocol.pdf

The aim of these notes is to help you read the Protocol. It is often hard to follow as each article may make reference to other articles. Eg article 8.1 refers to Articles 7, 7.1, 7.2 and Annex I this doc shows 8.1 to be about the work of the expert review teams and 7.1 & 7.2 are the annual returns & supplementary data returned by the parties to the convention.

CP.1 Berlin Mandate
CP.2

Articles

[1] Defines terms
Montreal Protocol on Substances that Deplete the Ozone layer 16 Sept 1987
Intergovernmental Panel on climate change World Met. Org./UN Env. Prog. 1988
Convention on Climate Change NY 9 May 1992
[2] Binds parties to good practices.

[3]
3.1 binds parties to aggregate Annex A emissions in line with their Annex B reductions commitments & binds them to a 5% reduction (from 1990 base) by the commitment period 2008 to 2012.
3.2 binds parties to demonstrate progress by 2005
3.3 Forestry & agricultural practice binds parties to report on sources, stocks & sinks to show compliance with their commitments.
3.4 binds parties to Annex I to provide evidence of their 1990 base position prior to the 1st session. And binds them at that session of work out a plan to advance reductions.
3.5 Parties to Annex I who are undergoing a change to a market economy my request a non 1990 base date
3.6 Conference agrees to allow parties in 3.5 some latitude.
3.7 In the 2008 to 2012 period parties agree to average no more than their quotas in Annex B
3.8 Parties to Annex I can use 1995 as their base Year for PFCs, HFCs & SF6
3.9 At least 7 years before the end of the first period (i.e before 2005) the parties should start to reach agreement of limits for later period which will form amendments to Annex B
3.10 Sets up trading offsets between parties
3.11 If you let another party use some of your allowance you must deduct it from your quota.
3.12 as 3.11
3.13 permits you to carry credits forward to later periods.
3.14 parties must make sure that their efforts to achieve their commitments do not do so in a way that impacts adversely on developing countries and should try and aid these countries (technology transfers etc.)
[4]
4.1 If parties agree to form a group (e.g. the EU) and the group meets its commitment then so have the parties.
4.2 If you want to comply as a group the group must submit its rules at ratification.
4.3 Any group agreement must be for the duration of the period (2008-2012)
4.4 If a group (e.g. the EU) changes its membership then it dose not effect the groups commitments.
4.5 If the group fails each member is responsible for meeting their own commitment to that group.
4.6 As 4.5
[5]
5.1 All parties to have a system to monitor sources and sinks of gases not covered by Montreal in place by 2007.
5.2 The IPCC to set acceptable methods of measuring gas in 5.1
5.3 The IPCC to set the CO2 equivalence values of gases in 5.1.
[6]
6.1 States parties may trade emission reduction units from sink projects.
6.2 Empowers the first session to set up a verification/reporting regime for trading.
6.3 Allows parties to employ offset traders.
6.4 If your compliance to [8] is in question you can go on trading but you can not count these credits toward your commitments to [3].
[7]
7.1 Parties must make annual reports on 5.1 gases sources & sinks.
7.2 And supplementary information to show compliance.
7.3 Parties to submit reports annually starting 2008
7.4 The first session should set up systems of reporting, how, what & when.
[8]
8.1 Allows for the setting up of expert review teams to analyse annual submissions.
8.2 review teams answer to the secretariat
8.3 review team to prepare reports
8.4 empowers first session to modify review process.
8.5 the conference shall consider compliance in the light of 8.3 reports & questions from parties
8.6 in light of 8.5 they shall take decisions required to aid implementation.
[9]
9.1 empowers the conference to set up reviews in light of updated scientific, social & economic data and take action.
9.2 The 1st review to be at the 2nd conference.
[10]
parties to setup systems to reduce emissions and cooperate with each other
[11]
parties should set aside funds and help developing parties with funds.
[12]
12.1 setup clean development mechanism
12.2 purpose of 12.1 is to help countries which are not party to Annex I in their development in line with the aims of the convention.
12.3 allows for parties which have setup projects in non parties to use that projects credits.
12.4 states 12.1 is subject to the authority of the conference
12.5 sets up rules for 12.3 projects
12.6 states 12.1 can assist in funding 12.3 projects.
12.7 first session to set up auditing systems for 12.1 projects
12.9 12.3 projects many involve private or public bodies.
12.10 credits from 12.3 projects between 2000 and 2007 inc. can be used for 2008/12 compliance.
[13]
13.1 the conference is the supreme body of the convention.
13.2 parties to the convention who are not parties to the protocol can act as observers but not make decisions.
13.3 much as above
13.4 the conference is charged with continuously reviewing the progress toward the protocols aims in light of changing circumstances.
13.5 rules and procedures can be changed by consensus of the conference.
13.6 the secretariat will decide the date of the first conference. Main conferences will be annual.
13.7 extraordinary conferences can be call by the conference or by any party if they can get 1/3 of the parties to agree to it.
13.8 the UN, IAEA etc. may attend as observers other bodies can apply to be observers as long as < 1/3 of parties object.
[14]
14.1 sets up the secretariat
14.2 empowers the secretariat
[15]
15.1 sets up the Subsidiary bodies for Scientific & Technical Advice and for Implementation
15.2 empowers parties to observe the sessions 15.1 bodies.
15.3 if a member of a 15.1 body is from a party to the conference but not to the protocol they must be replaced by a member of both when dealing with protocol business
[16]
parties to the protocol must amend the protocol in accordance with conference decisions.
[17]
the conference shall define the rules for verification, reporting etc.
[18]
the first session is charged with defining the consequences of non compliance and adopting them into the protocol.
[19]
the secretariat is the arbiter of disputes
[20]
20.1 any party can propose amendments to the protocol
20.2 parties are to have 6 months notice of amendments and conference then considers them.
20.3 parties should accept changes by consensus if this fails 75% carries changes.
20.4 procedure for enactment of changes inc. 90 days before coming into force.
20.5 changes can not be forced on parties that voted against them?
[21]
21.1 states that the Annexes are to be read as party of the protocol & limits the nature of any future annexes.
21.2 as with the main protocol any party can propose changes to the annexes.
21.3 rules for changes to annexes as main protocol
21.x other annex rules substantially the same as for main protocol
[22]
22.1 One party one vote
22.2 If parties form part of a group to the protocol e.g. the EU then the group votes with the strength of its membership and the individual parties do not vote.
[23]
The Secretary-General of the UN shall be the depositary of this Protocol.
[24]
24.1 the protocol was open for ratification by parties to the convention from 16 Mar 1998 to 15 Mar 1999 and went into force from 16 March 1999.
24.2 groups of parties should decide how parties to the groups should effect their commitments
24.3 groups are to declare the extent of their competence
[25]
25.1 the protocol goes into force 19 days after two criteria are met 1st 55 parties sign up and 2nd these parties account for > 55% of 1990 CO2 emissions.
25.2 tightens up what is meant by 25.1s 55%
25.3 protocol goes into force for groups in the same way as individual parties.
25.4 groups are not additional to parties in reaching 25.1 criteria.
[26]
No reservations may be made to this Protocol
[27]
27.1 any party may withdraw after 3 years
27.2 withdrawal is one year after notification of intent
27.3 withdraw from convention and you withdraw from the protocol.
[28]

Annex A
Lists greenhouse gases & the processes that generate them

Annex B
Lists the parties and the % of 1990 base levels they have contracted to achieve.

JJ-I have an answer for this one... Just everyone comply at once. Right now. Today. I dont give anyone a pass including the US when it comes to this. I certainly dont give anyone an advantage over us when their economy is growing at almost 10.3 percent annually and buying weapons with it using our money.

By M. Randolph Kruger (not verified) on 21 Jun 2007 #permalink

Randy: I agree with you about one thing: I don't give the US a pass using my money to buy weapons.

Randy, I always knew it was going to be a tall order to win you over from the dark side but I am begining to see it may be even more difficult than I thought.
Don't give up hope I haven't given up yet.