The Politics of Public Health Emergencies of International Concern

Abstract The declaration of a Public Health Emergency of International Concern (PHEIC) was created by the International Health Regulations (2005) and is WHO's highest level of alert for a health emergency. PHEICs are declared by the WHO Director-General on the basis of a recommendation provided by the International Health Regulations (IHR) Emergency Committee. This paper challenges the orthodox thinking around PHEIC declarations, using a methodological approach that has not been used in this space, through a series of interviews with those involved in the PHEIC declaration process. This paper provides vital insights into the PHEIC process, allowing us to fully understand what happens “in the room” during these deliberations, something which until now, has not been possible. We argue that the PHEIC declaration, and the Emergency Committee's role in this process, is not a politically neutral technocratic one, as is commonly claimed by WHO, but a highly politicized process that is driven by a range of factors beyond the criteria set down in IHR. We show that the PHEIC is informed by health surveillance practices that operate within the colonial construction of “global health security,” which is clearly embedded within every level of the PHEIC declaration process.