What role can regional initiatives play in risk reduction? The recent Brexit vote might indicate a global trend towards national fragmentation. In this context, it is important to remember the role of regional organisations in reducing and managing large-scale risks such as pandemics. Institutions like the EU or ASEAN not only develop integrated systems to test and circulate medicines, they also build a sense of mutual trust and shared interests that help coordinate national reactions in times of crisis.
International coordination and national action are both vital to pandemic preparedness and response efforts. But regional coordination systems – such as regional offices of the World Health Organisation or regional organisations like the European Union (EU) or the Association of South East Asian Nations (ASEAN) – can also have great value. They can reduce costs to individual states by centralising medicine authorisation procedures, they can help identify and fill gaps in national capacities, and they can develop strategies more responsive to the particular context, structures and vulnerabilities of their members. More generally, regional efforts can build relationships and trust between states, providing the basis for good communication and coordination during crisis events.
The European Union’s systems have developed substantially over the past fifteen years in response to various outbreak events, including SARS, H5N1 influenza, and H1N1 influenza. The recent British vote to leave the EU – generally referred to as Brexit – raises questions regarding continued participation of the UK in European pandemic management systems. The EU systems are reasonably comprehensive and include disease prevention and control, vaccine and medicines authorisation and emergency systems for outbreaks. It seems unlikely, therefore, that the UK would choose to withdraw from these systems. However, it would probably be expected to pay to maintain its participation, and could find its influence diminished in areas such as the design of prevention and response strategies. Brexit may also result in a reduction of the UK’s contributions to global health research efforts and networks, particularly those funded by the EU and/or involving collaboration with partners in other member states. This would represent a loss to other states as well as the UK, which is currently a leader in medical and scientific research. This is something we should strive to avoid.
“Regional efforts can build relationships and trust between states, providing the basis for good communication and coordination during crisis events.”
Not all regions have established strong pandemic preparedness and response systems. But apart from the EU, there has been a notable expansion of efforts in the South East Asia and Western Pacific regions over the past decade. This includes work by ASEAN improving communication and information sharing between states and across government departments, laboratory networking, and standard setting for outbreak investigation and response. There is also a joint initiative of the two regions focused on capacity building, the Asia Pacific Strategy for Emerging Diseases. In regions with lower capacities and greater vulnerabilities to outbreaks, political fragmentation is likely to have a more severe impact on individual states than political fragmentation in Europe, where – on both an individual and regional basis – institutions and systems are well established.
There are, however, more significant forms of political fragmentation that are damaging to global pandemic responses. The way states behaved during the 2009 H1N1 influenza pandemic is illustrative of these. During the outbreak, states seemed to revert to a narrow conception of national interest. Rather than seeking a distribution of resources (such as vaccines and anti-virals) optimal to containing the outbreak – e.g. by targeting countries most affected or vulnerable – they sought primarily to secure resources for their own populations, with advance orders from a small group of developed countries taking up almost all vaccine manufacturing capacity.
In the end, the 2009 H1N1 pandemic was not as severe as anticipated, but such behaviour in the future could easily result in failure to contain an outbreak in its early stages, causing higher damage globally. An intermediary level of coordination, based on trust and tested systems could be a significant contributor to better global outcomes. The significant contribution that regional coordination efforts can make to management of pandemics and other global catastrophic risks should motivate us to try to address the dynamics of political fragmentation, and build relationships that will enable states to collaborate effectively during crises.