IOs are facing serious challenges in continuing their active role in managing collective problems, whether being climate change, migration, cybersecurity, pandemics, or economic and financial stability. Diagnoses range from: ‘the growing gap between yesterday's structures and today's problems’ (Goldin, 2013: 3); that the large, rich, and powerful states continue to use a combination of options – threat to exit, voice, and the creation of alternative institutions – to dominate the agenda (Morse and Keohane, 2014); the increasingly diverse number of members have caused constant gridlocks and impasses that paralyse decision making; that IOs have become ‘the Frankenstein problem’ themselves – that is, they develop preferences independent of the governments that created them, leading states to fight back by refusing to cooperate (Newman, 2010; Guzman, 2013); that a lack of popular elections and insulation of organizational leaders and bureaucrats creates a ‘democratic deficit’ (Koppell, 2008; Hurd, 2008); and the inability of IOs to manage the challenges stems from a lack of leadership, especially leadership of leading powers. All of these statements have some merit and capture aspects of the development of a complex IO world.

Our intervention starts with the straightforward point that the inclusion of the countries we now call SIDS in IOs has occurred against this backdrop. In the next chapter we show how SIDS sought to pursue their agenda in IOs. In this chapter we explain why IOs accommodated their involvement. We argue that the key reason they have created groupings like SIDS is that it contributes to their ongoing attempt to resolve these challenges, all of which threaten to undermine their legitimacy as authoritative global actors. To be effective IOs needed to be trusted by their member states to represent their interests. Without legitimacy, nothing will be achieved; legitimacy is a necessary condition for success but not a sufficient one. The significance of this research agenda derives from Buchanan and Keohane's (2006: 407) argument that ‘[t] he perception of legitimacy matters because, in a democratic era, multilateral institutions will only thrive if they are viewed legitimate by democratic publics’.

The legitimacy of IOs is the subject of intense academic debate (Agne et al, 2015; Gronau and Schmidtke, 2016; Lenz and Viola, 2017; Tallberg and Zürn 2019).

On 30 January 2020, Dr Tedros Adhanom Ghebreyesus, Director General (DG) of the World Health Organization (WHO) declared the novel coronavirus outbreak (COVID-19) to be a Public Health Emergency of International Concern (PHEIC), using his authority derived from the International Health Regulations (IHR) (2005). The IHR are the singular binding legal treaty governing global health security. In his press conference, he stated:

He continued:

This statement helpfully highlights the key tensions within the PHEIC mechanism: is the PHEIC a tool of international law to be enacted whenever the objective criteria are met, or a political, normative device within the securitization of health to get governments to pay attention to a health emergency, or does the PHEIC fall ambiguously between the two? COVID-19 was declared a PHEIC on the recommendation of the IHR Emergency Committee (EC), advice accepted by the DG, which believed: that the outbreak was unusual or unprecedented; that it posed a public health risk to other states through the international spread of disease; and that it might require a coordinated international response. These are the three criteria for a PHEIC, as prescribed at Article 1 of the IHR.

Yet, beyond a legal instrument, DG Tedros recognized the extent of the normative power within the PHEIC mechanism. A week prior, DG Tedros had (upon the advice of the EC) delayed declaring COVID-19 a PHEIC, despite it appearing that the criteria to do so were met.

This book has sought to explain the interaction between IOs and small states and how it has changed over the last three decades in particular. We used SIDS as a proxy for small states as they represent the smallest of the small; if these states want to be involved, however marginally, in the activities of IOs, then the findings on their strategies should be applicable to other slightly larger states too. Their experience reveals two perpetual dilemmas. SIDS argue they need to participate in IOs to safeguard their sovereignty, extract resources, and promote a permissive liberal order. The problem is that the costs of participation are disproportionately high for the smallest who face acute capacity constraints. The IOs’ dilemma is that while the norms of sovereign equality and the right to development impel them to be inclusive of those who have been approved as members, the active participation of an increased membership can increase ineffectiveness due to gridlock and delay. IOs thus attempt to balance inputs and outputs by way of throughputs in order to include states in such a way that it enhances, rather than constrains, their effectiveness.

By competently performing their vulnerability SIDS are able to both demonstrate that they are functioning states worthy of system membership and illustrating that they require S&DT to remain viable, especially in the face of climate change. For IOs, the establishment of groupings, and thereby collective participation, represented here by the SIDS category or analogous examples like the SVEs at the WTO, allows them to achieve a level of support from its member states by way of ‘throughputs’: that is, adopting processes and practices that both include small states, thereby honouring their commitment to sovereign equality, but also sharing responsibilities for outcomes with them. Labels such as SIDS that incorporate otherwise disparate member states are therefore useful to both small member states and IOs even though the constitutive norm they represent – in this case, differentiated development – remains contested by larger and more powerful countries.

The existence of the label SIDS also reveals a number of internal problems. The countries we now call SIDS had a vision for collective action, and have put out their ‘tentacles and planted SIDS issues’ across the multilateral system, but we find no evidence of a shared grand strategy

On 11 July 2018 the United Nations Security Council (UNSC) met to debate the nexus between climate change and security. In total, 19 countries participated in the discussion. In addition to the president (Sweden) and the permanent members, statements were invited from countries for whom climate change is already having a significant impact, including regional representatives from Africa, Central America, the Middle East, the Caribbean, and the Pacific. A statement was also delivered by the Maldives on behalf of the Alliance of Small Islands States (AOSIS). Egypt was invited to make a statement as chair of the G77 but declined at the last minute. No nation explicitly dissented to the discussion taking place. This was not the first time the UNSC had debated the nexus between climate change and security, having previously discussed the issue in 2007 and 2011. At the 2007 meeting more than 50 countries participated. In 2011 that number grew to over 60. On both occasions, views were essentially split with EU countries and some climate-affected small states on one side, and the G77 plus China on the other. This latter group were opposed to the UNSC, rather than the United Nations Framework Convention on Climate Change (UNFCCC) or the Second Committee, being used as the forum for these discussions.

The difference between 2007 and 2011, and 2018, raises important questions. First, why did climate change get placed on the UNSC agenda in 2007 and 2011, and again in 2018, despite initial opposition from large and powerful states in the G77 plus China grouping? Second, why is there such a difference in the number of countries speaking on this issue and their views, as evidenced by the strong statement of the G77 against using the UNSC as a venue to debate climate change in 2007 and 2011, and their silence in 2018? The short answer is the increased level of coordinated engagement of the smallest members of the international system – Small Island Developing States (SIDS) and those from the Pacific (PSIDS) in particular – who learnt from the experience of 2011 and adapted their strategy for 2018.

To date there have been six PHEIC declarations, as well as several other health emergencies that have been considered as potential PHEICs. These non-PHEIC events fall into two distinct categories: those considered by an EC, but not declared a PHEIC; and those for which an EC was never convened, but which objectively met the criteria for declaration. In this chapter we examine each of the health emergencies declared a PHEIC in turn, followed by the non-PHEIC events. In doing so we explore how the criteria to declare a PHEIC have been understood and applied by the DG and the EC, as well as the wider considerations that each of these actors might have taken into consideration when fulfilling their functions in respect of a PHEIC under the IHR. In doing so, we demonstrate the overarching findings of this book: that the criteria to declare a PHEIC have been subject to broad interpretation by the EC beyond the legal text, which have been subsequently improperly validated by the DG in accepting the advice of EC. We structure each section first with a background to the context of the health emergency, second with detailed analysis of the apparent PHEIC decision making, third with consideration of the TRs recommended, and finally with analysis of the additional lessons learned about the broader PHEIC, IHR process and global health security. In the analysis we centre on the initial declaration of the PHEIC, and only consider later EC meetings for each disease outbreak if they are a noteworthy change in advice provided or justification.

2009-H1N1

The United States (US) first reported cases of 2009-H1N1, a novel influenza virus with human pandemic potential, on 18 April 2009. By the end of April 2009, more than 1,300 suspect cases and approximately 84 deaths were attributed to the outbreak. Under Annex 2 of the IHR, notification by states to the WHO must occur if there is a positive response to two of four criteria, or if a health emergency is caused by poliomyelitis, smallpox, human influenza caused by a new subtype or SARS. In response to this notification, on 25 April the DG convened an EC, which recommended 2009-H1N1 to be declared the first PHEIC under the revised IHR.

Further to the case studies in the previous chapter, we also sought to understand whether the same inconsistencies were present in outbreaks that were not declared a PHEIC. Within this chapter we consider events for which the DG convened an EC, but which did not result in a PHEIC declaration and second, we also consider events the DG did not convene an EC for, despite the criteria appearing to be met. Considering these events enables us to have a clearer understanding of the use of executive discretion by the DG in regard to the PHEIC, particularly in respect of when an EC is convened, and the relationship between the DG and the EC. We find that multiple DGs failed to convene ECs to consider an event a potential PHEIC, despite the criteria to do so appearing to be met. We further show that the DG is unwilling to go against the advice provided by the EC, even when, as was the case with MERS-CoV, it was apparent that the criteria to declare a PHEIC had been met. This is unusual, given the advice of an EC is one of multiple considerations the DG needs to consider when determining whether a PHEIC declaration is warranted, and goes some way towards demonstrating the extent to which certain aspects of the DG role have been fettered away to the EC.

MERS-CoV

Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic virus, which is transferred to humans from camels. It was first reported to the WHO in 2012, and since then has been detected in 27 countries, and has led to at least 858 deaths and 2,494 reported cases, with an estimated 35% mortality rate. The majority of these have occurred in Saudi Arabia, although there was a notable outbreak in South Korea.

A considerable issue with the initial global response to MERS was the lack of clear and transparent information. For example, a case was detected in the UK in a passenger recently arriving from Saudi Arabia, after the initial analysis by Public Health England MERS was confirmed, the UK was obligated to report this case to the WHO under Article 6 of the IHR.

The emergence of a distinct SIDS grouping and identity in relation to climate change is a ‘most likely’ case for their influence on IOs. It is an issue on which they hold the moral high ground as the first and worst effected: the canaries in the coal mine. A much higher threshold for their influence is whether similar strategies would be successful in other IOs and especially those that deal with economic affairs. In these IOs SIDS are not the poorest – most are middle-or upper middle-income countries – and account for a very low proportion of global trade. And yet, they have unique economic circumstances and vulnerabilities that are likely to be exacerbated by climate change.

This chapter documents the interaction between small states and the key economic IOs. The story is not as straightforward as the climate change story; the initiative does not always come from the SIDS; there is as often leadership from other countries; it is determined in part by the mores of the IOs themselves, by their traditional practices, and by their institutional rules, leading to a range of intermediaries speaking on behalf of the SIDS. Despite this complexity, the claim that the countries we now call SIDS have uniquely vulnerable economies due to their heavy reliance on a small number of economic sectors has become orthodoxy in IOs. The WB and IMF both recognize the SIDS agenda. The WTO has created the SVEs. These are important successes for SIDS that emerges from the complex interaction between large and small member states, donors, IOs’ leaders, and their secretariats. But there is less evidence that this recognition has been translated into tangible benefits for SIDS or IOs. Our economic story is thus less optimistic about SIDS influence than our account of climate change.

The chapter follows a similar structure to the last. We start by explaining the SIDS circumstance. We show how concerns about their economic viability explain their delayed decolonization and that despite some variations the perception of enduring vulnerability has persisted into the postindependence period. We show how this has become synonymous with an argument about ‘differentiated development’ – that economic development models designed for large states will not work for small ones.

Two cases that touch on the rights and obligations of States in disputed maritime areas, which have been rendered prior to the entry into force of the LOSC, are Aegean Sea Continental Shelf (Interim Measures) and Guinea-Bissau v. Senegal. After the LOSC became binding on the States parties thereto, the scope and content of Articles 74(3) and 83(3) LOSC were dealt with in Guyana v. Suriname, with both sides to the dispute alleging breaches of the two obligations contained therein. Two more recent cases are Ghana/Côte d’Ivoire and Somalia v. Kenya. Here, the States concerned faced several difficulties because of activities having been undertaken unilaterally within their disputed areas. In the maritime boundary dispute between Ghana and Cȏte d’Ivoire, both the judgment and the interim measures order given by the Special Chamber elaborate on the lawfulness of acts that were unilaterally undertaken by Ghana in their disputed maritime area. The chapter also addresses how the case law relating to the indication of interim measures of protection has an influence on disputed maritime areas, and the rights and obligations that States have in this regard.