Learning lessons from SARS and H1N1/A: Employing a WHO-WTO forum to ensure balance in economic and public health actions in emergency response

With the globalization of diseases through movement of people and trade worldwide, health and economic threats of disease outbreaks have been recognized as a major issue in global public health. The first challenge in this new paradigm was the SARS outbreak in 2003, which exposed weaknesses of the global health governance framework in addressing balances of protecting often competing interests of public health and trade. The revised International Health Regulations of 2005 attempted to address these issues, and were tested during the H1N1/A outbreak of 2009 with mixed results. Though improvements have occurred, challenges remain in providing a coordinated forum to address economic and trade reactions to public health concerns of countries that suffer from disease outbreaks. International legal frameworks which aim to promote global disease surveillance systems and international cooperation during disease outbreaks have not provided the appropriate incentives for individual state actors to adhere to future reporting requirements due to fear of economic harm. By instituting a joint WHO-WTO committee to adjudicate these conflicts, these concerns can be addressed. Failure to resolve this problem leads to potential disincentives in surveillance reporting, a crucial component of compliance under IHR, and hampering the prevention of the next global pandemic.