The New International Health Regulations and the Federalism Dilemma

I n the aftermath of severe acute respiratory syndrome (SARS) (Figure 1) and in anticipation of avian fl u, the international health community has recognized that pandemic planning and response is an inherently multigovernmental concern. The ability of pathogens to cross borders and rapidly spread around the globe requires highly coordinated public health responses that involve the cooperation of local, regional, national, and supranational governments (Figure 2). The understanding of this reality has informed the current International Health Regulations (IHR) revision process. Approved in May 2005, the revised IHR have increased the disease surveillance requirements of " states parties " in an effort to better inform the pandemic response process and to protect the health of the global community [1]. Furthermore, the revisions have also outlined recommendations that the World Health Organization (WHO) could issue if an outbreak originating in one country is perceived to be a threat to other countries. The revision of the IHR is both long overdue and eminently necessary to face the challenges of an increasingly globalized world [2]. The practical implementation of these proposals, however, may encounter obstacles. This is particularly true for those WHO member nations that have federal systems of government (federations), and could ultimately threaten their ongoing support of the new regulations. Federalism is a type of political system in which the advantages of shared rule are combined with those of regional government [3]. Countries with federal governments make up about 40% of the world's population, and include the second most populous country (India) and the world's largest economy (United States) [4]. Federal systems of government offer many advantages, including allowing for the distinctiveness of the regions within a nation to be recognized and for region-specifi c policy approaches to be developed. However, one of the limitations of federations is that the division of powers can create an obstacle to the development of centralized approaches to national challenges. Such scenarios can arise when the country's constitution distributes the key powers in question to the regions. This characteristic of federal systems poses a dilemma when international treaties are signed by a federal government, but the cooperation of regional governments (states, provinces, etc.) is necessary for compliance with the treaty. Canada's experience with SARS outlines the challenges of such constitutional division of powers when it comes to managing public health crises. During SARS, the Canadian federal government's ability to obtain data from the Province …