How does the World Health Organization declare global health emergencies?: the politics of public health emergency of international concern (PHEIC)

• Ano de defesa: 2025
• Autor(a) principal: Pagotto, Barbara Frossard
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: eng
• Instituição de defesa: Biblioteca Digitais de Teses e Dissertações da USP
• Palavras-chave em Português: Emergências em Saúde; Global Health Emergencies; Global Health Security; International Health Regulations; Regulamento Sanitário Internacional; Segurança em Saúde Global
• Link de acesso: https://www.teses.usp.br/teses/disponiveis/6/6140/tde-24062025-151338/

This thesis investigates the decision-making processes surrounding the declaration of a Public Health Emergency of International Concern (PHEIC) to unpack the complex interplay of factors underlying this political decision and examine the mechanisms that govern global health emergencies within the framework of the International Health Regulations (IHR). Positioning the PHEIC decision within the WHOs emergency response framework, the study goes beyond the role of the Emergency Committees (EC), delving into the less visible yet critical assessments, criteria, and procedures that inform these decisions, often overshadowed in literature. Additionally, this research considers the global health security paradigm as the main ideational factor guiding the governance of global health emergencies. This thesis analyzes the historical and ideological origins of both the IHR and global health security paradigm, revealing a legacy rooted in colonial-era practices focused on disease containment and the protection of Western interests. This legacy has shaped WHOs bureaucratic culture, where a health security lens permeates daily practices like disease surveillance and risk assessment, and underpins the WHOs expert authority to classify and respond to health risks. The case study of the Ebola outbreak in the Democratic Republic of the Congo (DRC) (2018-2020) highlights the complexities of determining a PHEIC, showing how local political, security, and logistical challenges influence the timing and nature of a PHEIC declaration. The case study also illustrates how the global health security paradigm shapes both the interpretation of the PHEIC criteria within the EC and the global health response on the ground. By expanding the analysis beyond the PHEIC decision itself to include the operational procedures and norms that guide it, this research argues that global health security is operationalized not solely through high-level declarations but also through the everyday practices of surveillance and risk management embedded within the WHOs emergency response framework. By unpacking these mechanisms, this thesis offers new insights into the governance of global health emergencies, illustrating how historical legacies and ideational factors shape what constitutes an event of international concern and inform the WHOs approach to global health crises.