New study

China versus the WHO

The outbreak of the highly contagious SARS virus in 2003 gave rise to a norm conflict between China and the WHO. With both parties fearing a backlash, the conflict was never openly acknowledged but exposed in their behavior. In his new study, Christian Kreuder-Sonnen uses this case to exemplify the importance of studying norm contestation that is visible in actions, not words. This more hidden form of “behavioral contestation” had decisive implications for later debates about norms in global health.

In early 2003, a sudden outbreak of Severe Acute Respiratory Syndrome (SARS) quickly spread from the Chinese province of Guangdong primarily to Hong Kong, Singapore, and Canada, triggering a chain of transmission that saw 8,098 people infected and claimed the lives of 774 individuals before the virus was finally contained in May 2003. As Christian Kreuder-Sonnen argues, the crisis brought to the surface a silent battle between two competing norms in global health governance, played out by two central actors: the WHO and China. 

The WHO acted as though the norm of prioritizing global health security – even at the cost of national sovereignty – had already been widely accepted and failed to seek legal and political authorization before issuing travel warnings and putting pressure on the Chinese government. China, for its part, ignored concerns that the outbreak could pose a health and security risk to people beyond its borders and stuck to the principle of national sovereignty. It concealed vital information on the outbreak from the WHO, defied travel warnings, and even obstructed on-the-ground inspections by WHO teams. This normative conflict was not openly articulated at the time, with both actors preferring to take direct action instead.

According to Christian Kreuder-Sonnen, both parties avoided rhetorical confrontation because of the potential damage a backlash would do. By simply acting without justifying their methods, neither China nor the WHO ran the risk of their explanation being rejected. For the WHO, this meant avoiding potential criticism for overstepping its mandates and meddling in the affairs of sovereign states, whereas China could avoid the accusation of abandoning its commitment to global health and focusing solely on its own population. Yet in this case, actions spoke louder than words: Even when the norm conflict was eventually explicitly discussed, the practical effects of the two actors’ initial behavioral contestation had already left their mark in the form of a rhetorical toolbox for each party to legitimize its own normative position and cast doubt on the other. 

Empirically, the WHO’s assertive crisis intervention, despite undermining the norm of national sovereignty, was widely praised for having effectively stemmed the spread of SARS. When revising the International Health Regulations after the 2003 outbreak, the WHO pointed to these positive effects to bolster its own normative position and change the rules in its favor, creating a new normative foundation from which future crises could be handled. As a consequence, the WHO was entrusted with veritable emergency powers to govern public health emergencies of international concern. While a key institutional development of the WHO in its recent past, the consolidated norm of international health security has not ceased to be contested in later crises – both discursively and behaviorally. When the H1N1 swine flu pandemic broke out in 2009–10, the WHO was accused of “staging” the pandemic to benefit the pharmaceutical industry. During the 2014 Ebola crisis, by contrast, the agency came under fire for doing too little, too late.