2020
Securitization of Global
Health Crises
WESTERN OPPOSITION TO WHO PHEIC SECURITIZATION
Wordcount: 14998
Abstract: This thesis aims to add to the understanding of the relationship
between the WHO and the Netherlands in the securitization of a PHEIC declaration. As the debate in global health governance centres on the question whether the West and WHO align on their preferences to securitize infectious diseases, this thesis provides a country-level analysis of the securitization of the 2014 Ebola and 2016 Zika PHEIC declarations by the Dutch government. The findings of this research indicate that the Dutch government does not unconditionally follow the WHO’s preference in securitizing global health crises. The Dutch government’s decision-making process toward securitization was not guided by the WHO’s PHEIC declaration. It was primarily guided by national considerations, such as its own public health, and regional or national actors, such as its national health institute - the RIVM - and the European health institute - the ECDC. It opposed the WHO, because it lacks a policy or strategy toward global health and global health governance. The research showed the Dutch government is sceptical of the WHO because of its lack in transparency, causing the government to react in a self-serving manner when faced by a global health crisis.
Table of Contents
Introduction 2
Literature Review 5
Methodology 12
The 2014 Ebola Epidemic 15
The 2016 Zika Epidemic 22
Conclusion 29
Discussion: The 2020 COVID-19 Pandemic 32
Introduction
“Global report: Trump threatens to pull out of WHO over 'failed response' to pandemic”
- The Guardian (2020, May 19)
The current global health crisis sees large parts of the world in some way under an enforced lockdown. Governments take measures ranging from banning public events and issuing stay-at-home advice, to forcing stay-stay-at-home orders enforced by the police and even the military. These extraordinary measures are, as Prime Minister Mark Rutte from the Netherlands stated in his national-address, unprecedented in peacetime and are warranted only because of the existential threat coronavirus, specifically SARS-CoV-2 (Rutte, 2020). Infectious diseases have become the main focus of global health governance in the past fifteen years. As a result of globalization, infectious diseases can spread more easily worldwide. When an infectious disease threatens to spread internationally or worldwide as we see now, it becomes a global health crisis and international actors, such as the World Health Organisation (WHO), move to securitization (Curley et al., 2011).
Securitization is a process whereby political actors frame an issue as an existential threat warranting extraordinary measures (Buzan et al., 1998, p.23-24). Extraordinary measures resemble enforced lockdowns, travel bans or drawing from emergency funds. After the SARS outbreak in 2003, which was a disease caused by another type of coronavirus, the International Health Regulations (IHR’s) were revised and the WHO obtained the power to declare a Public Health Emergency of International Concern (PHEIC) (Anema et al., 2012). A PHEIC acts as a warning signal to the world and urges member states to securitize a disease and follow the WHO’s lead. In the case of Corona, a PHEIC was declared on January 30, 2020. There seems to have been a delay in following the WHO’s call to securitize this disease by Western states, with the result being widespread international infection and the WHO declaring the current health crisis as a pandemic (WHO, 2020c). When countries resist following the WHO’s securitization move, they restrain the WHO in executing its mandate.
There is a recurring link between securitization theory and global health governance. An increasing amount of health crises are being securitized, with the Coronacrisis being the
sixth PHEIC in history. Every PHEIC declaration was followed by controversy and are therefore a much-debated subject. The scholarly debate centres on the relationship between the WHO and the West, with one group of scholars arguing they serve each other’s’ interests and the other arguing the West is sceptical of the WHO. This debate is the result of widespread Western scepticism to the WHO’s first PHEIC declaration for the 2009 Influenza pandemic. The debate has been fuelled once more by the current US critique on the WHO’s handling of the Coronacrisis. However, the lack of scholarly consensus can be attributed to the absence of empirical country-level research of specific Western countries and the WHO, as previous research centred on ‘the West’ and the WHO in general.
In this respect, this research looks at the relationship between the Dutch government and the WHO in the cases of PHEIC declaration securitization of the 2014 Ebola epidemic and the 2016 Zika epidemic. In 2014, the WHO declared a PHEIC when an outbreak of Ebolavirus spread in West Africa. In 2016 an outbreak of Zikavirus in the Americas was declared a PHEIC. This thesis aims to add empirical research on the relationship between the Netherlands and the WHO, to fill a gap in country-level research. This research intends to contribute to the debate among scholars on the nature of the relationship between the West and the WHO and reveal how the process of securitization happened in the Netherlands during these crises. The research focusses on why the Dutch government opposed the WHO’s securitization. Therefore, the research question for this thesis is: how and why has the Dutch government
restrained the WHO’s mandate after the first PHEIC declaration of 2009?
The chosen cases for this research are viable to analyse for they are the first PHEIC declarations that received international attention and were actively dealt with by the Dutch government after 2009. This research is done with the method of process tracing to produce a qualitative interpretative account of securitization by the Dutch government. Preference attainment is used to determine which actors are decisive in the formation of Dutch policy where empirical data is unavailable. The sources used for this thesis are based on primary sources, including parliamentary debates, parliamentary questions and answers from the government, reports from the WHO, United Nations (UN), the European Centre for Disease Prevention and Control (ECDC) and the Rijksinstituut voor Volksgezondheid en Milieu (RIVM)1
1 The RIVM is a Dutch research institute doing research into health and the environment. Its core tasks are to
and secondary sources like news articles. This thesis ends with a discussion of its findings in light of the current global health crisis and the securitization of COVID-19 in the Netherlands. This thesis argues that the Dutch government opposed the securitization attempts by the WHO during the 2014 and 2016 PHEIC declarations, restraining the WHO’s mandate. The Dutch administration remained the same during both crises, which should result in consistency of policy. The findings show that the Dutch government securitized both the Ebola and Zika crises but there was inconsistency in policy and considerations by the government, debunking the hypothesis. The Dutch government did not unconditionally follow the Ebola securitization by refusing requested support from the WHO until the UN intervened in the crisis, which resulted in securitization by the government. Zika was securitized before the WHO’s PHEIC declaration as the government was already fearful for the threat posed by exotic mosquitos. Securitization of Zika served the Dutch government’s and WHO’s interests. These findings show the Dutch government follows PHEIC securitization when it considers a health crisis a threat to its domestic public health. It does not follow securitization by the WHO unconditionally, thus restraining the WHO’s mandate. The government is ambiguous to the WHO’s mandate because it lacks a policy or strategy towards global health.
This research shows that the Netherlands and the WHO are aligned once the Netherlands considers an infectious disease that is declared a PHEIC as a possible threat and is otherwise not willing to unconditionally contribute to the execution of the WHO’s mandate. In light of the scholarly debate, this research adds to the belief that Western states are more inclined to serve their own interests and use the WHO when they need to and oppose it when they do not. This self-serving approach to global health fuels the realist-liberalist debate in International Relations studies as it adds to the realist understanding of International Relations. Future studies on the subject on a country-level approach will provide a more conclusive understanding of the West’s relationship to the WHO.
Literature Review
History of Global Health Governance
Global health governance is a world order. It is a system governed by a select group of states and institutions that set the standards and rules for the functioning of international health (Lisk et al., 2019). A distinction is made between the West and developed countries, with the West referring to North America, Europe and Australia. The history of global health governance is one of victories and setbacks, with the current pandemic considered to be a failure (Hameiri, 2020). The order of global health governance has developed immensely, from focussing on sanitary standards to preventing the spread of infectious disease. It is an order founded by international professionals, which is internationalised by countries but consists of other actors, like international organisations and NGO’s. The nature of this order is constantly changing, and the current crisis is a prelude to a change in the global order of health governance. For these reasons, global health governance can be considered as a global order and its history is suitable to study for the MA Program Global Order in Historical Perspective. Internationalisation of public health began in the 19th century when international
sanitation conferences were held from 1851 onward to discuss epidemics like Cholera (Amrith, 2017). The professionalisation, standardisation and centralisation of medical sciences were the basis for the conferences and resulted in the establishment of the first international health organisation, the Office International d’Hygiène Publique. When public health was further institutionalized by the League of Nations, these ideas spread internationally. After WWII, the values of anti-fascist and anti-colonial order would be captured in the UN and its specialized agency, the WHO, to form a global order built around sovereign states. The WHO was formed in 1946 and its constitution would be framed around the ‘right to health’. The WHO’s success in exterminating smallpox and polio in its first 30 years of existence, made global health officials confident that the threat of infectious disease was over (Davies, 2008, p.298; Coutinho, 2020, p.12).
This changed during the 1980s when the HIV/Aids pandemic was responsible for 2 million deaths annually at its peak, and it became a threat to stability and security of some states (McInnes et al., 2017, p.1316). Global health governance adopted transnational, international and national actors when it responded to the HIV/AIDS pandemic and this
marked a major change in the nature of global health governance. The WHO quickly realised that the disease spread internationally and considered it a major international concern. The HIV/AIDS pandemic is considered as the beginning of global health governance’s focus on infectious diseases. Amrith (2017) argues that the history of global health governance has always been a history of globalization and this has intensified in the 21st century, as
globalization has contributed to the international spread of infectious diseases.
The first time this happened in the 21st century was with SARS. The rapid international
spread of the disease showed that infectious diseases spread more easily in a globalized world (Jin et. al, 2015). After the WHO’s success in averting a disaster during the SARS outbreak of 2003, the IHRs were updated, locking the new powers of the WHO in international law. The WHO’s mandate was reformed, and it obtained the power to declare a health emergency a PHEIC. The WHO heralded the most contemporary change in global health governance, the increasing securitization of infectious diseases.
Securitization
Security is socially constructed. The Copenhagen School is the founder of Securitization Theory and they envisaged that speech acts are the tools of politicians in securitization. Social construction happens through speech acts (Jin et al., 2011, p.181). However, Balzacq et al. have noted that not only speech acts can serve as securitizing moves and that the original theory of securitization by the Copenhagen School is evolving. More and more securitization processes are also understood through a focus on practices and actions of politicians (Balzacq et al., 2016, p.507).
It is important to understand what exactly is meant when we say that a problem or thing has been securitized. Broadly, securitization is described as a political process where an issue is addressed by political actors ‘as an existential threat to security requiring emergency measures and justifying actions outside the normal bounds of political procedure’ (Buzan et al., 1998, p.23-24). Elbe (2010, p.478) notes that it is important to understand that the word ‘security’ does not necessarily have to be used by actors, the issue merely has to be presented to, and then accepted by the public as being an existential threat to them and more importantly the state. If the securitizing actors are successful in convincing its audience that the issue is a threat, they can take extraordinary measures that are outside the bounds normally available to politicians to securitize the issue (Jin et al., 2011, p.182).
In short, an issue can become an existential threat because it is presented as such and does not necessarily have to be a threat. When studying securitization theory, one looks at the actors that initiated securitization moves and the securitization measures taken by those actors. It is important to analyse the policies that were presented by these actors and the argumentation they proposed. In case of the securitization by the declaration of a PHEIC, securitization succeeds when countries follow securitization initiated by the WHO, taking extraordinary measures to securitize a global health crisis.
Securitizing Infectious Diseases
A distinction must be made between infectious diseases and the viruses responsible for the disease. In practice, both are securitized by international, regional and national actors but the literature and media use the terms inconsistently and mixed, referring to Coronavirus and COVID-19 as the same. As all terms refer to the same issue, they may be used interchangeably. Infectious disease became an international security issue after the SARS outbreak in 2003, as SARS was perceived as a security threat. After SARS, the US was the first Western state to use its power to influence the decision-making of the WHO to prioritize infectious disease (Abraham, 2011, p.801). As the US was the largest single financial contributor to the UN organisation, the WHO followed the US’s preference and prioritized infectious disease. Other Western states realized the importance of securitizing infectious disease and combined their influence to change global health governance (Ibid.). This was done in 2005 when the new IHR was adopted, focussing on the threat of infectious disease. Since 2005, the West has secured its interests by strengthening the focus of global health governance on infectious diseases (Curley et al., 2011, p.149).
Davies (2008) wrote on the relationship between the securitization of infectious disease and the WHO and Western countries’ role in this process. Like Curley and Herrington, Davies notes that the WHO was the primary securitizing actor in securitizing infectious disease, and the West followed soon after. The West became aware of the possible threat that infectious diseases posed and formulated a global securitization strategy (Davies, 2008, p.301). The WHO assisted the West and took advantage to assert its position as the leading actor in global health governance (Davies, 2008, p.308). The WHO proposed two initiatives, the first was creating an infectious disease surveillance system, the Global Outbreak Alert and Response Network (GOARN), and second, to revise the IHR to include infectious disease. Both
initiatives prioritized the interests of the West (Davies, 2008, p.309). It financed and agreed to the revision of IHR because it was in its interests. The West delegated the task of responding and surveying infectious diseases to the WHO for its own interest. The West and the WHO served each other’s interests in securitizing infectious disease.
Davies’ argumentation is supported by other scholars who note that securitizing infectious diseases is not in the interest of non-Western states. Elbe (2010) focusses on a prime example, during the 2009 Swine Flu PHEIC, that shows the WHO follows Western priorities. The WHO had delivered Indonesian disease samples to Western states so they could develop vaccines, which Indonesia could not afford to buy. The WHO did not handle out of Indonesia’s interests which turned into a diplomatic crisis, with the WHO having to assure Indonesia it would receive its vaccines. After reforming the IHR, scholars noted the WHO’s policy agenda highly favoured the foreign policy agendas of Western states (McInnes et al., 2006, p.12). The WHO supports the focus on infectious disease and therefore is seemingly working together with Western states to provide what it called ‘global health security’. More recently, this position seems to still apply. This was evident during the Zika epidemic of 2016 as the WHO’s IHR policies provided security for Western countries and made sure the disease stayed where it belonged, in the undeveloped world (Ventura, 2016, p.3). The theory of Barnett and Finnemore applies to the WHO as ‘international organizations seek to shape agendas and rules to build their institutional power in global politics’ (Jin et al., 2011). The WHO is no exception and has committed itself to securitize infectious diseases to strengthen its position. The focus of the WHO and global health governance neglects and diverts resources away from other underlying, long-term health issues like building health-systems and fighting tuberculosis or malaria (Enemark, 2007).
The main argument among these scholars is that the WHO and the West are working together in securitizing global health crises. Securitizing infectious diseases serves the interests of Western states, as they are protected from disease outbreaks emerging in the developing world. The WHO follows this process, as by doing so it reaffirms its position in global health governance. Other long-term health issues are side-lined. The combined effort of the WHO and the West in creating short-term solutions for problems serves their combined interest in securing their respective positions.
WHO and West Collide
Empirical research has found that the West and the WHO may not be working together. Kittelsen (2013, p.225) notes in empirical research that the EU was critical of how the WHO handled the 2009 Swine Flu PHEIC. The EU reconsidered its relationship with the WHO and was concerned about the lack of transparency in the decision-making process of the WHO, which worried the Council of Europe (Ibid., p.220). The EU did agree that securitizing Pandemic Influenza was necessary but concluded it would rather do this on the Union level than on the WHO’s orders.
This empirical research reflects an argument among scholars that Western states are increasingly questioning the decision-making procedures and the lack of transparency and democracy within the WHO. The general concern was that the WHO had developed competencies that were far greater than its member states had envisioned it to have (Hanrieder et al., 2014, p.332). The WHO has become too powerful. Hanrieder and Kreuder-Sonnen (Ibid., p.338) note that the WHO lacks transparency and constitutional checks and balances and evaded public scrutiny during global health crises. The EU’s worries were voiced through a request for ‘more democratic accountability regarding public health decisions’ by having the Council of Europe function as a horizontal check on WHO’s decision-making (Hanrieder et al., 2014, p.342). This argument opposes the previous argumentation and shows that Western states are no longer aligned with the WHO after the 2009 Swine Flu PHEIC.
This argument is supported by several authors suggesting that there is a growing divide between the West and the WHO. McInnes (2016, p.388) argues that the Ebolacrisis in 2014 was a crisis in global health governance. It was coined as global health governance crisis because it demonstrated the inadequacies of existing governance mechanisms, like the WHO, and the need to urgently address capacities for collective action. The WHO failed and was criticized, and the international community discussed its function, use and even existence. McInnes (2015, p.1313) wrote that as a result of the failings of the WHO its authority was changing. In 2015, the WHO proposed an emergency fund of $100.000.000 and a ‘clear and extended mandate as the global leader in response to public health emergencies’. This proposal met with unenthusiastic member states that did not want to go along with the proposal. The 2014 Ebola crisis resulted in widespread criticisms, mainly that the WHO should have responded faster and declared a PHEIC earlier (Kamradt-Scott, 2016, p.407). This crisis resulted in questions about the WHO’s leadership ability in global health governance. The
WHO was conflicted for it wanted to achieve its purpose and signal an escalating health crisis but held itself back due to the criticism it received after the PHEIC declaration of 2009.
WHO research revealed that 31% of the WHO’s member states, including Western states, ignored the WHO’s recommendations during the Ebolacrisis, imposing travel bans on people coming from Ebola-affected regions, undermining and challenging the WHO’s mandate (Rhymer et al., 2017, p.12). However, there was a distinction among Western states and their relationship with the WHO as Australia and Canada imposed travel bans, while no other Western states did. Another, more pressing example, was visible during the Ebolacrisis. Countries like Denmark, Norway and the UK were quick to respond to the WHO’s securitization, visible through the height and speed that donations were provided to the WHO, while Germany and the Netherlands were slow to react, indicating they did not follow the WHO’s securitization (WHO, 2016g). These findings indicate that during a health crisis, not all Western states are inclined to base their securitization decision on the WHO’s PHEIC declaration (Harrison, 2015, p.676).
This argument challenges the argument of scholars like Davies. It suggests there is a divide between Western states and the WHO as a result of how the WHO acted during the PHEICs of 2009 and 2014, for which it received widespread criticism. Western states are no longer supporting the WHO’s development and are even critical of the direction this has taken in the past. This is the result of a developing scepticism among Western states about the growing powers of the WHO and the lack of accountability. This process started after 2009 but intensified as the WHO was criticized for its handling of the Ebola crisis, with the West questioning its competency to lead global health governance.
Infectious diseases are increasingly securitized by global health governance when they become a global health crisis. There is a stark divide among scholars in the debate on the relationship between the WHO and the West in the securitization process of infectious diseases. The first group argues that the WHO and the West are aligned in their interests and objectives to securitize infectious diseases. Western states allow the WHO to securitize outbreaks of infectious diseases and the WHO obliges as it reaffirms its position and authority in global health governance. The second group argues that the West grows more sceptical of
the increasing power and the lack of transparency and accountability of the WHO. Additionally, there is a lack of empirical studies of key cases regarding the securitization of infectious diseases (Curley et al., 2011, p.142). The global securitization of Corona is but the most recent development in the history of securitizing infectious disease, with the Ebola and Zika crises its direct historical predecessors.
In the literature, scholars dealing with this subject generalize the West as a singular entity while this should not be the case. However, the WHO’s findings indicate that Western countries react differently to its authority and securitization moves. This was evident in the stark divide between Western countries’ reaction to the Ebola PHEIC declaration. Therefore, the West should not be generalized as a singular entity as the literature has done and this controversy can be resolved through a country-level analysis, adding an understanding through what measures a country can restrain the WHO’s mandate and what considerations it has to oppose the WHO. When using a country-level approach, this produces a better understanding of differing opinions of Western countries and their relationship with the WHO. In short, there are two gaps in the literature that this thesis will address. The first is the lack of empirical research into key cases of the securitization of infectious diseases. The second is that in the literature on the securitization of infectious disease, there is a generalization of the West as a singular actor while Western countries have reacted differently to the securitization of infectious disease. Therefore, the research question will be: how and
why has the Dutch government restrained the WHO’s mandate after the first PHEIC declaration of 2009?
Methodology
This thesis studies the understanding of the changing relationship between Western states and the WHO. The literature review showed that the increase in securitization of infectious diseases and global health crises is widely debated among scholars. By applying a country-level approach, this thesis challenges the argument of scholars like Davies, who argue that the WHO and Western states are aligned in the securitization process of global health crises. This thesis analyses the relationship between the Netherlands and the WHO during two global health crises in a contemporary historic perspective and reflect its findings on the current global health crisis, the COVID-19 pandemic.
The Netherlands is chosen to be studied for a couple of reasons. The Netherlands has a large and active scientific community and pharmaceutical industry which works together with the WHO in conducting essential research (CBS, 2016). The innovative and efficient nature of the Dutch scientific medical community has been proven during the current pandemic, and its significance for global health is evident, producing a coronatest, possible medicine and reproducible ventilator (Lindhout, 2020) (Wijnen, 2020) (Cremers, 2020). Up to 2013, the Netherlands was in the top ten of largest WHO contributors, contributing to the WHO directly and through the EU, which gives it influence within the WHO (Ministry of Foreign Affairs, 2016). The Dutch government used this influence when it was a part of the WHO’s board from 2016-2019. It intended to actively pursue its own policy agenda and priorities within the WHO (Rijksoverheid, 2016). The Netherlands is interesting to be studied because the Dutch government was a vocal critic of the WHO after the Ebola crisis, voicing its intentions to reform the organisation and being an advocate of creating an emergency fund, to prevent requests for funding by the WHO in future crises (IOB, 2016, p.16). Despite belonging to the WHO’s board, this show the Dutch government was not acting out of a Western interest but its own. This further demonstrates the position that the West should not be generalized as one entity and justifies the study of the relationship between the Netherlands and the WHO. This thesis conducts a comparative study by having two case studies; the 2014 Ebola epidemic and the 2016 Zika epidemic. During both crises, the administration in office was Rutte II, with responsible ministers remaining in office during both crises. Given that the same administration is in government during these two crises, it is presumable that there should be consistency in the execution and formulation of policy by the Dutch government. These crises
were the only PHEICs after 2009 that received widespread attention by the international community. To fill in the academic gaps, namely the lack of empirical studies into key cases of securitization of infectious diseases and the generalization of the West as a singular actor in global health governance, this thesis provides a country-level approach. In this way, this thesis contributes to an understanding of how and why a particular Western state has acted to restrain the WHO’s mandate and provide a contemporary historical perspective on the global order of health.
This thesis applies process-tracing to produce a qualitative interpretative account of the relationship between the Netherlands and the WHO in securitizing infectious diseases by analysing the securitization of Ebola and Zika. Process-tracing is a strong method when dealing with securitization as it can analyse the causal mechanisms in the process of securitization. Plus, process-tracing is an increasingly more common research method for securitization theory (Balzacq, 2010, 49). The method aims to identify the social mechanisms which underline a phenomenon and to study the causation of events that lead to a certain outcome. Since there can be difficulties with collecting empirical data suitable for process-tracing (Dür, 2008, p. 563), preference attainment is used to determine which actors’ preference is followed during securitization (March, 1955, p 445). By introducing this method, policy decisions are reviewed and compared to distinguish each influential actors’ preferred outcome. This enables a scholar to observe when policy changes in favour of a certain actor. If the Dutch government’s policy follows that of the WHO, the securitization is considered complete. Combining these methods will develop a conclusive understanding of the Dutch government’s securitization process.
There are two main groups of data sources used for this thesis. Primary sources are used and include documents produced by official authorities or institutions like the Dutch government, RIVM, ECDC, WHO and UN. Parliamentary letters, debates and questionnaires of opposition parties serve as data to distil the Dutch government’s policy as these sources contain the most extensive commentary and explanation of the government on its policy. Secondary sources used in this thesis include three Dutch newspapers, namely a left-wing newspaper De Volkskrant, a right-wing newspaper De Telegraaf, and a more centre newspaper the Algemeen Dagblad (AD). By having newspapers with different political biases, this thesis can triangulate between the collected data to increase the validity of the analysis.
Following the design of Trachtenberg (2006), each analysis indicates the most important accounts of the Dutch and WHO policies and outline their preferences during each crisis. Each analysis deals with (1) the episodes in which the policies of both actors changed, (2) how and when policy development occurred, and (3) what reason the government had for its decision. Each analysis includes a review of the preference attainment for each actor, to distinguish which actor the Dutch government follows. Each analysis concludes with an examination of the outcome from the argument of Davies and Hanrieder & Kreuder-Sonnen, to distinguish to which argument the development correlates. A conclusion is made to answer the research question as to how and why the Dutch government restrained the WHO’s mandate.
The analysis of the causation between the development of the Dutch government’s policy toward securitization is important to understand as it reveals to what extent this was based on WHO’s PHEIC declaration or if it was guided by other actors or considerations. If the policy and securitization decision was guided by other actors and considerations, and the Dutch government was sceptical of the WHO, Hanrieder & Kreuder-Sonnen’s argument is confirmed, and the thesis is confirmed. If the policy and securitization decision was guided by the WHO’s PHEIC declaration, Davies’ argument is confirmed, and the thesis is refuted.
The 2014 Ebola Epidemic
The WHO declared its third PHEIC in history in 2014 during the Ebola epidemic that heavily affected the Western African states of Guinea, Liberia and Sierra Leon. Ebolavirus causes Ebola Virus Disease (EVD), with high fever, shock and organ failure. With no treatment available, EVD causes death to 50% of infected people. Highly infectious through bodily fluids, the burial practices in affected countries resulted in a wide-spread infection in certain communities, even spreading to other countries in the region. Due to the risk of economic malaise to the region and its effects to the world, combined with the poor health systems of the region that could not deal with the epidemic, the WHO declared a PHEIC.
The WHO had to assist affected countries in executing infection control and on a technical level but lacked the resources to properly deal with the crisis. Therefore, it requested assistance from the international community. Its policy revolved around the goal ‘to stop Ebola transmission in affected countries within 6-9 months and [to] prevent international spread’ (WHO, 2014a). The WHO took up the role to coordinate the response. It was hesitant to declare the Ebola outbreak a PHEIC in 2014, as it had received widespread criticism from the international community after its controversial PHEIC declaration in 2009.
The Netherlands was not directly affected by the crisis. The Dutch government was involved in the UN Multidimensional Integrated Stabilisation Mission in Mali (MINUSMA) and was concerned that Ebola could spread to Mali. The government was advised by the WHO, ECDC and RIVM, and repeatedly stated that it valued the advice of the WHO. However, the Netherlands did not step up its assistance to the WHO after it declared a PHEIC. The policy and priorities of the Netherlands were not directed to deal with a threat as the crises was not considered as such by the government, RIVM and ECDC. The Netherlands increased its contribution to the crisis once the UN intervened, and followed its preference.
The argument of Hanrieder & Kreuder-Sonnen applies to the Ebolacrisis, as the Netherlands opposed securitization by the WHO. The WHO was exceeding its mandate by providing technical support and asking for support in securitizing the Ebolacrisis. The Dutch government was not willing to provide support, restraining the mandate of the WHO by not obliging to its request to securitize Ebola and increasing support while also heeding its advice on proposed measures.
Ebola Surges
The WHO notified the world for the first time about Ebola in April 2014 (WHO, 2014b). The WHO was under the impression that it could deal with the outbreak together with local authorities of Guinea, Liberia and Sierra Leone. Quickly after the WHO joined in dealing with the outbreak, Liberia and Sierra Leone outed fears that the disease had already spread to their territories. Not knowing the total extent of the outbreak, the WHO was confident of successfully dealing with the outbreak together with local authorities alone (WHO, 2014c).
Dutch newspapers started reporting on the Ebola outbreak on a regular, unbiased basis. De Volkskrant wrote on 22 March, stating that the WHO detected Ebola outbreaks and the disease had claimed dozens of lives (Volkskrant, 2014a). The newspapers initially only reported on technicalities and not on the role of the Netherlands as it was not yet involved. The Dutch government reacted much later in May when several ministries reported on the progress of MINUSMA. A joint statement by the Ministry of Defence, Foreign Affairs, Foreign Trade and Development Aid, and the Ministry of Security and Justice was sent to parliament. The ministries alerted parliament about an Ebola outbreak in Mali and assured the UN was taking preventive measures, not going into any details (Timmermans et al., 2014). The first development signalled that the media was very involved during the Ebolacrisis as they were ahead of the government when it came to reporting about the outbreak.
In August, the government was questioned on its knowledge about the Ebola outbreak. Specifically, the questions centred on the possible threat to the Netherlands. Minister Ploumen of Development Aid answered the parliamentary questions and explained how the government intended to assist the WHO. Ploumen revealed that the WHO requested $100.000.000 for its response, but that the government had no intention to provide additional funds to the WHO (Ploumen, 2014b). Ploumen leaned on the advice of the RIVM and explained that it took guidance from the WHO and ECDC, who stated there was no threat to the Netherlands. Ploumen put effort to demonstrate that the Netherlands participates in several funds that are deployed to deal with the crisis and there was no need for increased funding.
When the government was asked about the Ebola outbreak for the first time, its initial response was to satisfy the opposition by adopting the position of the ECDC and the RIVM, namely that there was no threat to the Netherlands. In doing so, the government absolved itself to heed the WHO’s request. The government de-securitized the Ebola outbreak in its first response on August 14. In the meantime, on 8 August 2014, the WHO declared the Ebola
outbreak in Western Africa a PHEIC (WHO, 2014c). The Ebola outbreak was considered an ‘extraordinary event’ with possible international consequences and therefore a coordinated international response was deemed necessary by the WHO. Whilst the WHO chose to securitize this event, the Netherlands did otherwise by de-securitizing.
WHO Securitization: PHEIC Declared
The WHO changed its policy once it declared a PHEIC in early August. The WHO became more vocal as it expanded its recommendations to all states worldwide and increased the scope of its policy, calling on the West for assistance. The PHEIC declaration internationalized the crisis and extended the WHO’s mandate. Furthermore, it placed the responsibility to implement and monitor the new policy with itself. The WHO made the Ebola outbreak an international crisis and changed its policy accordingly. The most important policy document for the WHO is the Ebola Response Roadmap published in late August with the goal to scale up international response (WHO, 2014a). This was the primary concern for the WHO during the crisis and its tool to accomplish this was through securitization. International technical and operational support strengthened national capacities of affected countries. The WHO positioned itself in the middle of the crisis, coordinating the response to the crisis and continuing its request for more resources.
Newspapers were vital in the opposition’s argumentation to the government and were used extensively in parliamentary questions in August and September. An important factor was the WHO’s increasing request for financial assistance. Left-wing party SP referred to de Volkskrant, the WHO and the RIVM when asking the government on its approach to developments mentioned in the media (Schippers, 2014b) (Schippers, 2014c). They noted that the WHO increased its financial request multiple times, its highest to $1.000.000.000 (Volkskrant, 2014b). The right-wing party Bontes/Klaveren played into the aspect of fear and proposed to close the borders to protect the population from the outbreak (Schippers, 2014a). All questions were posed in early August, signalling the opposition and media were ahead of the government when reacting to the PHEIC declaration.
The Dutch government only reacted to the Ebolacrisis on September 1, which was 22 days after the PHEIC declaration. The government took its time to formulate a response, not only to the PHEIC declaration but to the opposition, society and the media as well. In six policy documents, including a general debate on the Ebola outbreak in parliament, the government
lined out its approach to the Ebolacrisis. Prime Minister Mark Rutte assured the parliament that the government worked in line with WHO recommendations (Tweede Kamer, 2014b). The government prepared its argumentation on financial support, arguing it supported the response to the outbreak by contributing €500.000 to Médecins Sans Frontières, €322.600 to the Red Cross, and contributed to the EU emergency fund, the UN and the WHO directly through contribution (Schippers, 2014b). The government was unchanged on its intention to contribute more financially (Schippers, 2014c). Although the government’s argumentation was well-prepared, Minister Schippers conceded in early September to review the WHO’s request once more.
The government repeatedly stated that it based its policy on the recommendations of the RIVM, the ECDC and the WHO. The Rapid Risk Assessments (RRA) of the ECDC, the government’s guiding advice on the possible risk of Ebola to Europe, downplayed the risk of an Ebola outbreak in Europe from March to September (ECDC, 2014). In multiple RRA’s, the ECDC assessed that an Ebola outbreak in Europe was unlikely. Most importantly, the ECDC gave European countries an incentive not to deploy resources to the WHO, stating that despite the substantial financial commitment of the international community, personal protective equipment (PPE) is still in short supply (ECDC, 2014). Schippers replied to questions on the WHO’s handling of the crisis by saying that she valued the WHO’s guidance and coordination and the government wanted to work together with the WHO (Tweede Kamer, 2014a). Schippers added that the PHEIC declaration is best understood as a signal function, calling for coordinated response through the WHO (Tweede Kamer, 2014b).
The Dutch government would not work closer with the WHO but deviated more from the WHO after the PHEIC declaration. The reluctant approach to securitization by the government toward Ebola after the PHEIC declaration can be attributed to the fact that the government followed the preference of the ECDC and the RIVM. As the ECDC said that Ebola was no threat to Europe and questioned the ability of the WHO to deploy the resources provided to it effectively, the government gladly followed the ECDC’s assessment. Moreover, Schippers relied more on the RIVM, stating that its sole purpose is to advise the government. Up to this point, the Netherlands followed the general WHO guidelines on not implementing travel restrictions. However, the Netherlands did not securitize the crisis or provided the WHO with additional funds as was repeatedly requested, thus restraining the WHO’s mandate.
Securitization After UNMEER
The most dramatic change in policy for the WHO and the Dutch government can be observed after the UN intervention in the crisis. On 17 September, Secretary-General Ban Ki-Moon wrote a letter to the UNSC and the UNGA, expressing his decision to form a UN Mission (Ban, 2014a). On September 18, 2014, the UN Security Council accepted Resolution 2177, in which it stated, ‘that the unprecedented extent of the Ebola outbreak in Africa constitutes a threat to international peace and security’ (UNSC, 2014). The following day the UNGA accepted Resolution 69/1 and agreed to form a UN mission requested by the Secretary-General, the UN Mission for Ebola Emergency Response (UNMEER) (UNGA, 2014). The primary objective of UNMEER was a ‘rapid and massive mobilization of international human, material, logistic and financial resources, under a single overarching framework’. The other objective was to reaffirm the WHO’s leading role in health issues (Ban, 2014a). In three days, the Secretary-General securitized Ebola at the UN level, securitizing Ebola by framing the outbreak as a ‘threat to international peace and security’. By its serious description of the crisis, the UN further internationalized the crisis, overruling assessments of the ECDC that the crisis was no threat to Europe. Forming a special UN mission for a health crisis, for the first time in history, can be considered as an extraordinary measure by an official authority, effectively pushing more states to securitize the Ebola outbreak.
The UN Secretary-General felt obliged to step into the crisis as he had received numerous requests from leaders of affected countries (UNSC, 2014). Ban chose to defend the criticized WHO and assist it in its quest to increase the international response through financial means. The Secretary-General argued the WHO was not the first responder and its job was to provide technical support and guidance as it had done to this point (Eliasson, 2014). To make up for the lacking health systems, the WHO requested international support, which it did not receive sufficiently. The mission built on the guiding role of the WHO and the UN’s ability to coordinate and ramp-up support. To that end, Ban convened a High-level Meeting after discussing the crisis with selected world leaders on September 25, in which he secured support from world leaders including large contributions from France and Germany (Ban, 2014b). In just a week, the Secretary-General had managed what the WHO could not: the securitization of Ebola by the international community with commitments from the West. The UN replaced the WHO in the securitization process of Ebola.
The UN’s intervention in the Ebolacrisis made the Dutch government’s policy change quickly on two accounts, showing it followed UN leadership and the Secretary-Generals preference. The first change in policy was a larger financial commitment to securitize Ebola by the government after receiving a direct emergency request from the Secretary-General. The request was received on September 16 and Minister Ploumen (2014b) announced on September 19 that the Netherlands would commit €15.000.000 emergency of which $6,226,650 was provided in November (WHO, 2016g). The second was a particular special occasion when Ban Ki-Moon met with Queen Máxima of the Netherlands and Prime Minister Rutte and discussed the urgent need for international efforts to combat the Ebola epidemic, asking for increased support from the Netherlands (Ban, 2014c).
After the formation of UNMEER, the media and opposition called upon the government to increase its commitment to helping in the crisis. The coercion by the Secretary-General, media and opposition bared their fruits on October 8, when the government took its most extreme measure by revealing its intentions to deploy the marine vessel the Karel Doorman with Dutch marines to Western Africa (Tweede Kamer, 2014c). It followed commitments from the US and the UK to deploy military personal to the region as they securitized the crisis. Securitization by the Netherlands would not reach a further point. This indicates that the UN was responsible for the Dutch government’s decision to securitize Ebola as the UN’s securitization was swiftly attained after the Secretary-General called upon the Netherlands directly for emergency aid and assistance, and the government changed its policy according to the preference of the UN.
IOB Report on Dutch Relation to WHO
The Ebolacrisis had alerted many parliamentarians about the defect in the relationship between the Netherlands and the WHO, as many parliamentary questions were addressed regarding the failure of the WHO and if the Netherlands should step up against this. After the Ebolacrisis, opposition parties called for an investigation into the relationship between the Netherlands and the WHO. This report, Voorkomen is beter dan genezen, analysed the relation between the Netherlands and WHO between 2011-2015. The most important conclusion of this report was that the Netherlands acknowledges that Dutch public health is reliant on international public health but is unwilling to aid in strengthening this, even decreasing its funding to the WHO in recent years (Directie Internationaal Onderzoek en Beleidsevaluatie
(IOB), 2016, 28). An important part of the report dealt with the mandate of the WHO and concluded that the Netherlands had restrained the organisation to execute its mandate (Ibid., 54). The Netherlands values the normative role that the WHO’s mandate plays in defining global health over its broader role like preventing disease outbreaks and operating in emergencies (Ibid., 45). The report concluded the Netherlands recognizes the WHO’s mandate but was sceptical of its decision-making body, proposing changes to the decision-making structure.
The report is an important confirmation of Hanrieder & Kreuder-Sonnen’s argument about the West’s scepticism towards the WHO for its lack of transparency. The report concluded that not only opposition parties were sceptical of the WHO, but the government itself as well. The most important conclusion of the report was the need for the government to develop a global health strategy as the RIVM ought it likely a global health crisis in the future might heavily affect the Netherlands due to its high amount of globalization (Ibid., 15).
In short, during the Ebolacrisis, the Netherlands opposed securitization of Ebola on the request of the WHO, restraining its mandate. This was done through refusing requests for additional funding by the WHO and downplaying the threat Ebola posed to the Netherlands and this was in line with the preference of the ECDC and RIVM. The government did not consider Ebola as a threat to the Netherlands and therefore opposed the WHO’s mandate to securitize a health crisis, only following its general advice. When the UN requested support from the Netherlands in dealing with the Ebolacrisis, the Dutch government changed its policy to the preference of the UN. Securitization was achieved through deploying more financial, logistical and military support to deal with the crisis. It was clear the preference of Secretary-General Ban-Ki Moon was followed. The UN had lobbied with Dutch heads of state and achieved the commitment from the Netherlands to follow the securitization effort by the UN. The government’s own report on its relationship with the WHO showed the Netherlands had restrained the mandate of the WHO. This analysis confirms the argument of Hanrieder & Kreuder-Sonnen that the West is sceptical and critical of the WHO.
The 2016 Zika Epidemic
The Zika epidemic, that became the 2016 Zikacrisis, affected parts of North America and South America from 2015 to 2016. Zikavirus was discovered in 1947 but was never understood as a threat to public health as the health complications were mild, only resulting in flu-like symptoms among 80% of infected people (RIVM, 2019). This changed in 2015 when scientific research revealed that Zika was the cause of a surge in Guillian-Barré syndrome cases among adults in America. More worrying was the fact that the Zika epidemic coincided with an increase in birth defects called Microcephaly among babies of women that were infected with Zika during pregnancy. When a Zika epidemic emerged in Brazil and spread to other countries in the Americas, the WHO declared its fourth PHEIC in history on 1 February 2016.
In 2016, Zika was transferred through mosquito bites of the Aedes Aegypti, which is a common species in South America. These mosquitos are zoonoses, meaning they carry the disease and can transmit it to humans. The Zika PHEIC declaration was made in the context of the 2016 Olympic Games, hosted by Brazil in Rio de Janeiro (Gomez et al., 2016). As Brazil was affected by Zika, the perspective of Zika spreading to other parts of the world at the Olympics moved the WHO to securitize the epidemic. On top of this, the causal link between Zika and Microcephaly emerged, which worried the scientific community. The WHO played a guiding role during this crisis, advising affected countries and urging them to securitize the Aedes Mosquito (WHO, 2016a).
The Netherlands played a minor role during the Zika epidemic. The primary worries for the Dutch government were that its citizens would participate and visit the Olympic Games in Rio and that three of its municipalities, Bonaire, Sint Eustatius and Saba were affected by the Zika epidemic. The government was not so worried about the epidemic but more about the mosquitos themselves. The main focus for the Netherlands during the epidemic was delaying invasive exotic mosquitos from settling in the Netherlands.
In light of the theories of Davies and Hanrieder & Kreuder-Sonnen, the Netherlands played its part in the WHO’s plans and did not restrain its mandate. The Netherlands did not oppose the WHO during the crisis but facilitated opportunities to study arboviruses, mosquito viruses, in the Netherlands and funded the WHO’s response. This analysis first deals with the pre-existing Dutch policy toward mosquito threats and then deal with the process of securitization.
Invasive Exotic Mosquito Policy
Six years before the Zika PHEIC declaration, former Dutch Minister of Health, Ab Klink, alerted the parliament about the discovery of three species of exotic mosquitos in the Netherlands at companies that traded in used tires (Klink, 2010). The minister was worried about the Aedes Aegypti, the mosquito that is responsible for the Zikacrisis. The minister concluded, with the advice from the RIVM, that the mosquitos were no threat to public health, but it was necessary to deal with the mosquitos quickly to prevent them from settling permanently in the Netherlands. However, the minister noted that considering the climatic changes in the long term it would not be possible to prevent these mosquitos from settling permanently in the future.
These events sparked a reaction in the government, making a policy known as the Invasive Exotic Mosquito Policy. Edith Schippers followed Minister Klink in June 2010 and Schippers too realized that mosquitos could pose a threat to public health in the future if these mosquitos settled in the Netherlands. Therefore, she added the case to the dossier Prevention for Public Health and reported to parliament in December 2010, stating public health was not yet under threat but vigilance was required to prevent these exotic mosquitos from settling in the Netherlands, lest they become a threat to public health in the future (Schippers, 2010). However, she acknowledged that these species might become native to the Netherlands in the future and a decisive response was necessary. The Invasive Exotic Mosquito Policy was aimed at delaying this process. The Minister presented the definitive policy in June 2013. Schippers attempted to work within an EU context to formulate a European approach to the problem, which met with little urgency (Schippers, 2013). As a result of this, the Minister reached out to the WHO.
Together with the WHO, the Minister took steps to organise international conferences with experts on the issue which were attended by the European Commission in 2013 and 2014. Together with the WHO, the Ministry of Health finances the development of the Regional Framework for surveillance and control of invasive mosquito vectors and re-emerging vector-borne diseases (Ibid.). The Minister repeatedly stated that it was her intention for the Netherlands to take the lead in combatting invasive exotic mosquitos and study the possible dangers to public health. As the development of the policy and international frameworks was underway, the Minister realized that a centralized approach in
the Netherlands was necessary (Schippers, 2015). Schippers displayed her intention to centralize the power to impose measures to control invasive exotic mosquitos from municipalities to herself in the future.
ECDC Warns for Zika and Microcephaly
Since May 2015, the Brazilian government was dealing with an outbreak of Zikavirus (ECDC, 2015). The outbreak spread to neighbouring countries where the Aedes Aegypti was a domestic species, eventually reaching some states in the United States and becoming an epidemic in the affected countries. In November 2015, the Brazilian government declared a public health emergency and reported on the rise in Microcephaly cases in the country which coincided with its Zika outbreak. After Brazil disclosed that it was dealing with a health crisis, more affected countries started to report on the rise of Microcephaly cases. Medical experts convened and concluded that there was likely a causality between Zika and the rise of Microcephaly. The ECDC was quick to pick this up and on 24 November 2015, the ECDC published its first RRA on the Zika epidemic, signalling a possible risk for the EU. It would report three times during December and January, actively advising European governments on the developments of the epidemic.
The ECDC linked Zika to severe complications in humans as a result of the developments between November and January. Between November and January, a rise in cases strengthened the evidence for causality between Zika and Microcephaly and made the ECDC report extensively on the risk for the EU (ECDC, 2016a). The primary concern for the ECDC was the possibility of an infected person importing the Virus to Europe which would enable onward transmission through mosquitos in Europe. The Aedes Albopictus, domestic in many Mediterranean countries, is a known vector for Zikavirus and therefore, the ECDC would start and assessment of how competent the European mosquito population would be in spreading the epidemic to Europe (Ibid.). The ECDC additionally noted that the mosquito population would diminish during the winter season and transmission in Europe would be unlikely. As the ECDC was on high alert, so too was the media.
Dutch newspapers began reporting on Zika in January 2016. De Telegraaf reported on a ‘Killer Mosquito’ in Brazil and that Brazil had started a large-scale offensive against the spread of the virus, stating that 220.000 Brazilian soldiers were deployed to combat the ‘new danger’ (Timmer, 2016). The AD also reported on the deployment of the Brazilian military to
combat the disease, citing Brazilian health minister Castro who said ‘the mosquito is already three decennia in the country and we are losing the battle’ (Wijk, 2016). All newspapers hold one trend in common, which is reporting on the deployment of the military as extraordinary which highlights the gravity of the situation and framed Zika as a threat to public health.
On January 26 Minister Schippers informed parliament on the developments concerning the Zika epidemic (Schippers, 2016a). The Minister stated that she had incorporated the advice from the ECDC and the WHO on advising pregnant women travelling to regions affected by the epidemic. About the risk of mosquitos spreading the virus to the Netherlands, Schippers reported that the mosquito had no chance of settling in the Netherlands and that the Minister had taken necessary measures, referring to the Invasive Exotic Mosquito Policy. The Minister added to this that the execution of this policy would come to rest with the Minister of Health, which would provide Schippers with the power to impose preventive measures and sanction misconduct. The minister had succeeded in transferring the execution of the Invasive Exotic Mosquito Policy from municipalities to her own ministry, giving the minister further powers she could employ in combatting invasive mosquitos. As Zika fuelled the idea that invasive exotic mosquitos posed a threat to the Netherlands, Schippers securitized invasive exotic mosquitos even before the WHO declared a PHEIC.
WHO securitization: PHEIC Declared
The most important account when the WHO’s policy changed during the Zikacrisis was when it declared the epidemic the fourth PHEIC in history on February 1, 2016 (WHO, 2016a). The cluster of Microcephaly cases in areas of Brazil that were new to infection with Zika constitutes the requirements as a PHEIC according to the WHO’s International Health Regulations Committee. The PHEIC declaration called on countries to work together to fight Zika, produce a vaccine for Zika and share data in this process. The WHO decided to declare the Zika epidemic a PHEIC, for it considered the virus as a long-term global threat. The disease was able to spread from Asia to Brazil in a matter of nine years, making it an international problem. The new known complications dramatically changed the diseases’ risk profile, and thus the WHO considered it as a threat to global health (WHO, 2016b).
The declaration was meant to securitize the Zikacrisis but focussed heavily on the disease and not so much on the vector the Aedes Aegypti as minister Schippers had done. In
its Zikavirus Strategic Response Framework published in February, the WHO stated that Zikavirus epidemics may occur globally because environments where these mosquitos can breed are increasing due to climate change (WHO, 2016c). The global threat of Zikavirus was understood in the context of the Aedes mosquitos and the WHO would include the control of these mosquitos in its Zika response, next to fast-tracking the R&D of new health products. Through vector control, virus transmission can be interrupted, and the epidemic can be stopped. The R&D on health products would focus on the production of test kits and producing a vaccine, and the WHO would step in the lead role in this process (Ibid.).
When the WHO declared the Zika epidemic a PHEIC because it considered the virus a threat to global health, the Netherlands had already securitized invasive exotic mosquitos. It had raised awareness of the problem in collaboration with the WHO in previous years and was therefore prepared to react to the crisis. Nevertheless, the Minister was overwhelmed with questions in the parliament on the Dutch preparations for this new global health threat. Schippers regularly convened with the Commission of Public Health on the Zikacrisis, where the Dutch response was debated. This started on February 2 and went on to July 8, the day before the summer recess.
Starting from February, Schippers defended her response and preparation to the epidemic. The minister argued that the RIVM followed all WHO advise unless the circumstances were so different a change was justified (Schippers, 2016b). The first addition Schippers made to the Invasive Exotic Mosquito Policy was doing research, with the WHO and RIVM, on the possibility of Zika being transferred by other Aedes mosquitos (Schippers, 2016c). When faced with questions on the need to declare a PHEIC, Schippers repeatedly agreed with the WHO. Schippers noted that the priorities of the WHO are mosquito control, research on Microcephaly, diagnosing the disease through tests and developing a vaccine (Ibid.). Schippers confirmed her belief that the WHO acted correctly when declaring a PHEIC and she valued the coordination from the WHO (Tweede Kamer, 2016a). The RIVM was actively sharing Dutch knowledge and data, for Schippers states the Dutch Invasive Exotic Mosquito Policy is unique in Europe and aligned with the needs of the WHO. The WHO requested the RIVM to research diagnosing Zika, which was one of the priorities of the WHO (Schippers, 2016e). The Dutch government granted the WHO’s request and instructed the RIVM and Erasmus MC Rotterdam, a WHO collaborative centre, to research detection methods for diagnosing Zika. By making important contributions to the WHO’s Zika response
in several research projects, the Dutch government assisted the WHO in executing its mandate.
As a result of the causal link between the Zika and Microcephaly, and the fact that the vector mosquito is also naturally present at Aruba, Bonaire and Curacao, Schippers incorporated the Invasive Exotic Mosquito Policy in these autonomous regions of the Netherlands (Tweede Kamer, 2016b). These islands in the Caribbean are semi-independent of the Netherlands, arranging their own health care systems. Schippers insisted on improving their health care systems so they would meet the standards required by the IHR’s of the WHO. Minister Schippers was worried that the autonomous regions were unable to detect and treat Zika properly. Therefore, she made agreements with these autonomous regions to implement the IHR’s conform the WHO’s standards in a timely fashion, conforming the entire Kingdom to the standards set by the WHO. Instead of restraining the WHO’s mandate, the Dutch government led by Minister Schippers strengthened its mandate by improving health care systems to IHR standards and helping the WHO to play the central guiding role during the global health crisis. This was in line with Schippers’ own preference, to increase awareness for the threat of invasive exotic mosquitos and therefore, she worked in her own interest and preference.
Postponing the Olympics
The biggest question on everyone’s minds in 2016 was: should the Olympics in Rio de Janeiro be cancelled or postponed? The WHO made a public statement on its assessment of the risk of Zika to the Olympics in May. It assured the world that they were advising the Brazilian government on handling the epidemic and combatting mosquitos, especially Aedes mosquitos, during the Olympics (WHO, 2016d). The WHO assessed it was unnecessary to cancel or postpone the Olympics as it had successfully securitized the Zika epidemic in Brazil. The WHO advised to not cancel the Olympics.
On the other side of the debate, an international group of scientists had written an open letter in the Washington Post, asking the WHO to pressure Olympic authorities to postpone the games. Their biggest concern was that the harmful Brazilian Zikavirus strain could be exported to other countries after the Olympics, making the virus endemic in other parts of the world (Attaran et al., 2016). The WHO argued preventing international spread was already outside its scope as the virus has already spread to 60 countries where continued
transmission among the population is reported (WHO, 2016e). According to the WHO, there was no public health justification to postpone the Olympics based on the fear for international spread as the virus already spread uncontrolled and there was no extra risk of international spread (WHO, 2016f). The Dutch government remained absent from the debate until the start of summer recess on July 8. Schippers supported the position of the WHO, ending the discussion in the Netherlands (Schippers, 2016e). Schippers’ argumentation relied on the assessment by the ECDC that due to winter season in Brazil, the Aedes mosquitos would not be active and therefore there was a low infection risk to visitors of the Olympics (ECDC, 2016b, p.12).
The analysis of the Zikacrisis of 2016 shows the Dutch government did not restrain the WHO’s mandate. The government was alerted on the Zika threat by the ECDC and already understood the threat posed by exotic mosquitos before the PHEIC declaration, having developed its Invasive Exotic Mosquito Policy together with the WHO. The government securitized Zika before the PHEIC declaration, following the preference of the ECDC, by centralizing the implementation of the Invasive Exotic Mosquito Policy and provide the Minister of Health with powers to enforce the policy. As a result of the PHEIC declaration, Minister Schippers intended to make the autonomous regions of the Netherlands in the Caribbean commit to the IHR’s health standards. Lastly, the Dutch government followed the securitization of Zika by the WHO by assisting its research and supporting its Zika assessments, like its assessment not to postpone the Olympic Games, for it served its own interest by doing so. Securitization of Zika by the Dutch government was accomplished because its interests aligned with those of the WHO. This analysis adds to the argument of Davies, as the WHO and Dutch government served each other’s’ interests and worked together during the securitization process of Zika.
Conclusion
This thesis addresses the research question how and why has the Dutch government
restrained the WHO’s mandate after the first PHEIC declaration of 2009? This thesis studies
the process of securitization in the Netherlands after the PHEIC declaration of Ebola in 2014 and Zika in 2016 to reveal the nature of the government’s securitization decision. Its argument is in line with Hanrieder & Kreuder-Sonnen, who argue that the West is sceptical of the securitization of global health crises by the WHO.
The findings for both cases have shown different results, disproving the hypothesis that the Dutch government’s policy would be consistent in both crises. The Dutch government restrained the WHO’s mandate in 2014 because it did not consider Ebola a threat and therefore opposed the WHO’s securitization. The Dutch government refused assistance to the WHO by not providing it required funding for its response to the Ebola outbreak after the PHEIC declaration. Crucially, the IOB report revealed that the government is indeed sceptical of the WHO’s power to declare a PHEIC. The Zikacrisis demonstrated the contrary, showing that the Netherlands quickly followed securitization from the WHO when it believed a health crisis is a threat to its own public health, even working to assert the WHO’s mandate by publicly supporting its decisions, policy recommendations and raising its own level of IHR preparedness. The relationship between the Netherlands and the WHO is best described as inconsistent, as the government realizes the need for global health governance but is only willing to assist its development, maintain its capacity to operate or securitize global health crises and infectious diseases if its own interests are served.
Securitization of global health crises only occurs when the government perceives the crisis as a threat or when certain influential actors’ preferences are followed. Ebola was initially not securitized as the Dutch government did not perceive it as a threat. Contrarily, Zika was securitized exactly because it was perceived as a threat. The IOB report noted that the Dutch government lacked a strategy or policy towards global health governance, signalling it did not attach great importance to it, visible through its decreased funding to the WHO and its scepticism towards its decision-making process. These findings show that the government is not unconditionally aligned with the WHO, which is a new and critical finding to be added in the current scholarly debate.
