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Global Health Governance from the Grassroots

Historically, global health and environmental cooperation has reflected various combinations of top-down and bottom-up measures. To be better prepared for future pandemics, global models and agreements must shape responses that are grounded firmly in local communities and value their engagement, risk ownership, and anxieties.

OXFORD – The World Health Assembly met last week amid a slew of proposals – most recently from the United Nations Independent Panel for Pandemic Preparedness and Response – to create stronger, enforceable global rules for tackling future infectious disease outbreaks. A new global pandemic treaty, more robust and independent international institutions, and an international pandemic financing facility are all in the mix. But a bottom-up strategy might work better.

A separate review by the World Health Organization earlier this year highlighted four ways to strengthen global health governance. It called for a centralized approach to bolstering countries’ preparedness for health emergencies; a worldwide notification system to ensure robust monitoring of compliance; global capacities such as a genomic sequencing infrastructure; and closer coordination among international institutions, including the WHO, the World Organisation for Animal Health, the Food and Agriculture Organization, and the United Nations Environment Programme.

These are all worthy objectives. But is a top-down approach the best way to pursue them? To answer that question, global health experts should pay more attention to successful grassroots efforts to combat disease.

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