Re-imagining Possibilities of Governance for Global Health

• Citation: Vol. 49 No. 3
• Publication year: 2021

Re-Imagining Possibilities of Governance for Global Health

Alicia Ely Yamin^*

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Transcript of Remarks

Thanks very much. I also want to add my thanks to the University of Georgia and the Dean Rusk International Law Center for the invitation to participate, as well as to Sarah Quinn, in particular, for her extraordinary organization of this conference.

I am going to broaden the question and my response because I think how we define the question reveals some of our ethical and normative commitments. I'd like us to think not just about "global healthcare governance," as the panel is titled, but global governance for health. And I'd suggest we think not just in relation to a narrow understanding of pandemic preparedness but more broadly in terms of health system resilience.

My short answer to the question that you posed, Fazal, as to why the structures in place failed to prevent this pandemic, is that it failed because they are manifestly dysfunctional. In contrast to what Ben Mason Meier said, I would say that this pandemic has not so much "shaken the foundations of global health governance" but rather, it has revealed the foundations of those multilateral governance structures to be fundamentally colonialist, and the architecture to be neoliberal. I would argue that we find ourselves in a multilateral order that is very, very far from the one that we imagined 75 years ago as a guarantor of peace, justice, and security.¹

I want to be clear that I say that as a committed multilateralist. I teach international human rights law and comparative constitutional law relating to health, as well as being an advocate and practitioner. I'm on a number of World Health Organization ("WHO") technical advisory groups, as well as the United Nations ("UN") Secretary General's Independent Accountability Panel for Women's, Children's, and Adolescents' Health in the Sustainable Development Goals ("SDGs") and I work with an organization called Partners in Health, which is a global health and social justice organization.² So, my remarks should be taken as those of someone who is deeply distressed by the state of affairs that we find ourselves in. At the same time, I am radically optimistic that we can do more than tweak around the edges.

I wholeheartedly agree with what Tom Bollyky said, that reforming the IHR, while important, is not remotely going to approach the sorts of changes that we actually need for better responses, not just to future pandemics (which invariably we will face) but to all of the other intersectional threats that we face from climate

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change, from forced migration, and from staggering social inequalities within and between countries.

So, in my few minutes of remarks, I thought I would borrow from some of the exchanges between Sandy Levinson and Jack Balkin on democracy and dysfunction³ in our U.S. constitutional framework, which I imagine is required reading in most constitutional law courses these days.

Levinson and Balkin exchange views on the diagnosis—and therefore remedy—for democratic dysfunction in the U.S. system. Levinson views it as structural, requiring structural fixes. Jack Balkin takes the position of a political scientist, which is that we need more representation more agency to combat what he calls "constitutional rot."⁴ In the context of global governance for health, I would say that it's a little...