Columbia International Affairs Online: Working Papers

CIAO DATE: 08/2010

The Challenges of Global Health Governance

David P. Fidler

May 2010

Council on Foreign Relations


Three crises in 2009 revealed the inadequacy of global health governance. The outbreak of pandemic influenza A (H1N1) found countries scrambling for access to vaccines, an unseemly process that led the World Health Organization to call for a new “global framework” on equitable influenza vaccine access. The global economic crisis damaged efforts to achieve the Millennium Development Goals, most of which involve health problems or address policy areas affecting health. The year ended with the fractious Copenhagen negotiations on global climate change, a problem with fearsome portents for global health. Unfortunately, concerns about global health governance are not limited to these epidemiological, economic, and environmental crises. Experts also warned about issues: the failure to prevent HIV/AIDS, antimicrobial resistance, counterfeit drugs, the global prevalence of noncommunicable diseases related to tobacco consumption and obesity, the migration of health workers from developing to developed countries, and the deterioration in the social determinants of health. Efforts to address these and other global health problems often acknowledge that existing institutions, rules, and processes are insufficient to support collective action.