The COVID-19 pandemic elicited a surge in the use of digital tools to replace “classic” manual disease tracking and contact tracing across individuals. The main technical reason is based on the disease surveillance needs imposed by the magnitude of the spread of the SARS-CoV-2 virus since 2020, particularly how these needs overwhelmed governments around the world. Such developments led to stark variations across countries in terms of legal approaches towards the use of digital tools, including self-reporting software and mobile phone apps, for both disease tracking and contact tracing. Against this backdrop, in this article I highlight some of the normative challenges posed by the digitalization of disease surveillance, underscoring its almost non-existent regulation under international law. I look back at the historical emergence of the epidemiological principles underlying this procedure, by referring to John Snow’s trailblazing work in cholera control. I emphasize how the COVID-19 pandemic prompted both technical and normative shifts related to the digitalization of these procedures. Furthermore, I refer to some of the overarching obstacles for deploying international law to tackle future tensions between the public health rationale for digitalized disease tracking and contact tracing, on the one hand, and normative concerns directly related to their legality, on the other hand. Lastly, I put forward conclusions in light of the current juncture of international health law reforms, and how they so far display limited potential to herald structural changes concerning the legality of the use of digital tools in disease surveillance.

Despite being acknowledged as a major global health challenge, growing levels of antimicrobial resistance (AMR) in pathogenic and commensal organisms have proven an awkward fit for international health frameworks. This article surveys the history of attempts to coordinate international responses to AMR alongside the origins and evolution of the current international health regulations (IHR). It argues that AMR, which encompasses a vast range of microbial properties and ecological reservoirs, is an awkward fit for the ‘organismal’ philosophies that centre on the rapid control of individual pathogens that have characterised international policy-making since the 19th century.

This is a pivotal moment in the global governance response to pandemic threats, with crucial global health law reforms being undertaken simultaneously in the coming years: the revision of the International Health Regulations, the implementation of the GHSA Legal Preparedness Action Package, and the negotiation of a new Pandemic Treaty. Rather than looking at these reforms in isolation, it will be necessary to examine how they fit together, considering: how these reforms can complement each other to support pandemic prevention, preparedness, and response; what financing mechanisms are necessary to ensure sustainable health governance; and why vital norms of equity, social justice, and human rights must underpin this new global health system.

Under the International Health Regulations (IHR), States must consider decision-making criteria in applying travel restrictions during a public health emergency of international concern. Interpretation on the legal parameters of such restrictions varies widely. This article considers whether and how the permissibility of travel restrictions under the IHR may have changed given recent developments, including evolving scientific evidence about their efficacy and shifting World Health Organization (WHO) advice. It is argued that such determinations must conform to the principles of necessity and proportionality as articulated by the IHR, and must also be accompanied by the correlative IHR duties of collaboration and assistance rooted substantively in global solidarity.

Antimicrobial resistance (AMR) is one of the defining global health threats of our time, but no international legal instrument currently offers the framework and mechanisms needed to address it. Fortunately, the actions needed to address AMR have considerable overlap with the actions needed to confront other pandemic threats.

The current international framework that purports to regulate the spread of communicable disease in the context of maritime traffic is a fragmented, internally inconsistent, and inadequately enforced patchwork of treaties (including the International Health Regulations (2005)) and customary international law. The COVID-19 pandemic has tested the current framework and revealed it to be inadequate to deal with a major global health emergency. States have imposed or failed to impose varying control measures, the effects of which have been witnessed on board passenger vessels around the world. The cruise industry, in particular, has a significant global economic impact; therefore, appropriate, enforceable international regulation is necessary to ensure the adequate control of future communicable disease outbreaks.

Analyses related to the Covid-19 pandemic have mainly addressed measures adopted in response to this event without paying attention to provisions included in the 2005 International Health Regulations which require States to develop predefined core capacities to prevent, control and provide a public health response to the international spread of disease. The legal architecture related to these obligations has, however, various shortcomings and States have largely failed to implement the required measures. Only recently has some practice been developed by the WHO to address these deficiencies, and further action is still required to finally implement this (neglected) cornerstone of the global health system.

This two-part article examines the global public health (GPH) information system deficits emerging in the coronavirus disease 2019 (COVID-19) pandemic. It surveys past, missed opportunities for public health (PH) information system and operational improvements, examines current megatrend changes to information management, and describes a new multi-disciplinary model for population-based management (PBM) supported by a GPH Database applicable to pandemics and GPH crises.

For a large number of health care providers world-wide, the coronavirus disease 2019 (COVID-19) pandemic is their first experience in population-based care. In past decades, lower population densities, infectious disease outbreaks, epidemics, and pandemics were rare and driven almost exclusively by natural disasters, predatory animals, and war. In the early 1900s, Sir William Osler first advanced the knowledge of zoonotic diseases that are spread from reservoir animals to human animals. Once rare, they now make up 71% or more of new diseases. Globally, zoonotic spread occurs for many reasons. Because the human population has grown in numbers and density, the spread of these diseases accelerated though rapid unsustainable urbanization, biodiversity loss, and climate change. Furthermore, they are exacerbated by an increasing number of vulnerable populations suffering from chronic deficiencies in food, water, and energy. The World Health Organization (WHO) and its International Health Regulation (IHR) Treaty, organized to manage population-based diseases such as Influenza, severe acute respiratory syndrome (SARS), H1N1, Middle East respiratory syndrome (MERS), HIV, and Ebola, have failed to meet population-based expectations. In part, this is due to influence from powerful political donors, which has become most evident in the current COVID-19 pandemic. The global community can no longer tolerate an ineffectual and passive international response system, nor tolerate the self-serving political interference that authoritarian regimes and others have exercised over the WHO. In a highly integrated globalized world, both the WHO with its IHR Treaty have the potential to become one of the most effective mechanisms for crisis response and risk reduction world-wide. Practitioners and health decision-makers must break their silence and advocate for a stronger treaty, a return of the WHO’s singular global authority, and support highly coordinated population-based management. As Osler recognized, his concept of “one medicine, one health” defines what global public health is today.

The devastating 2014–16 West African Ebola outbreak challenged the authority of the World Health Organization (WHO) to enforce the legally binding International Health Regulations (IHR) that govern pandemic responses. Under Article 43 of the IHR, states parties can only implement additional health measures beyond the WHO’s recommendations if public health rationales or scientific evidence justify such measures. Yet at least fifty-eight states parties enacted additional health measures, mainly travel restrictions to or from Ebola-affected countries. This article explains why Canada’s visa restrictions targeting Ebola-affected countries failed to meet the IHR’s requirements and therefore violated international law. Specifically, Canada’s response went against public health authorities’ consensus views, the best available scientific evidence on disease transmission, and the WHO’s recommendations. In light of its traditional role as a global health champion, Canada must lead by example and abide by international law, including the IHR, instead of picking and choosing which rules to follow and thereby encouraging other countries to do the same.

The US Department of Defense continues to deploy military assets for disaster relief and humanitarian actions around the world. These missions, carried out through geographically located Combatant Commands, represent an evolving role the US military is taking in health diplomacy, designed to enhance disaster preparedness and response capability. Oceania is a unique case, with most island nations experiencing “acute-on-chronic” environmental stresses defined by acute disaster events on top of the consequences of climate change. In all Pacific Island nation-states and territories, the symptoms of this process are seen in both short- and long-term health concerns and a deteriorating public health infrastructure. These factors tend to build on each other. To date, the US military's response to Oceania primarily has been to provide short-term humanitarian projects as part of Pacific Command humanitarian civic assistance missions, such as the annual Pacific Partnership, without necessarily improving local capacity or leaving behind relevant risk-reduction strategies. This report describes the assessment and implications on public health of large-scale humanitarian missions conducted by the US Navy in Oceania. Future opportunities will require the Department of Defense and its Combatant Commands to show meaningful strategies to implement ongoing, long-term, humanitarian activities that will build sustainable, host nation health system capacity and partnerships. This report recommends a community-centric approach that would better assist island nations in reducing disaster risk throughout the traditional disaster management cycle and defines a potential and crucial role of Department of Defense's assets and resources to be a more meaningful partner in disaster risk reduction and community capacity building.

Reaves EJ, Termini M, Burkle FM Jr. Reshaping US Navy Pacific Response in Mitigating Disaster Risk in South Pacific Island Nations: Adopting Community-Based Disaster Cycle Management. Prehosp Disaster Med. 2014;29(1):1-9 .

Global public health surveillance is critical for the identification and prevention of emerging and reemerging infectious diseases. The World Health Organization recently released revised International Health Regulations (IHR) that serve as global legislation and provide guidelines for surveillance systems. The IHR aim to identify and prevent spread of these infectious diseases; however, there are some practical challenges that limit the usability of these regulations. IHR requires Member States to build necessary infrastructure for global surveillance, which may not be possible in underdeveloped countries. A large degree of freedom is given to each individual government and therefore different levels of reporting are common, with substantial emphasis on passive reporting. The IHR need to be enforceable and enforced without impinging on government autonomy or human rights. Unstable governments and developing countries require increased assistance in setting up and maintaining surveillance systems. This article addresses some challenges and potential solutions to the ability of national governments to adhere to the global health surveillance requirements detailed in the IHR. The authors review some practical challenges such as inadequate surveillance and reporting infrastructure, and legal enforcement and maintenance of individual human rights. (Disaster Med Public Health Preparedness. 2007;1:117–121)