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A Retrospective and Prospective Analysis of the West African Ebola Virus Disease Epidemic: Robust National Health Systems at the Foundation and an Empowered WHO at the Apex
Get PDFThe West African Ebola epidemic is a pivotal moment for the global health system. Just as the depth of the crisis ultimately spurred an unprecedented response, the failures of leadership demand innovative reforms. This analysis offers a template for these reforms, responding to the profound harms posed by fragile national health systems, delays in the international response, deficient resource mobilization, ill-defined responsibilities, and insufficient coordination. The scope of the reforms must address the failures evident in the Ebola response, as well as entrenched weaknesses that enabled the epidemic to reach its heights, transforming the existing inchoate, organically developed global health architecture into a purposeful, organized system.
At the apex of the global health system should be an empowered, highly capable World Health Organization (WHO), using its powerful normative tools including its treaty-making ability, with technical excellence including anthropologic, legal, and other competencies, and operational capacity. Member states should fund WHO primarily through assessed contributions and at the level required to fully meet its global responsibilities, and enable WHO to re-assert control over the regions, including through Executive Board selection of Regional Directors. In an invigorated global health system, civil society will be able to effectively engage in WHO policymaking. The World Health Assembly would enhance the International Health Regulations, including to improve monitoring of capacities, clarify responsibilities, and increase transparency of the Emergency Committees, while an independent working group would advise the Director-General on declaration public health emergencies of international concern.
National health systems must be strengthened, including with sufficient numbers of well-trained, equitable distributed, sufficient numbers of health workers, particularly at the community-level building trust and engaging communities, working in safe conditions. Global resources need to support national systems, including a global health workforce and new financing, with an International Health Systems Fund to strengthen health systems and emergency contingency fund and Pandemic Emergency Facility to prepare for and respond to health emergencies
An O’Neill Institute Briefing Paper: Ebola, the World Health Organization, and Beyond: Toward a Framework for Global Health Security
Get PDFThe West African Ebola epidemic has demonstrated that the world remains ill-prepared to respond to infectious disease outbreaks. A host of institutions are now reviewing what went wrong, and new institutions are being considered, including an African Centers for Disease Control and Prevention and World Bank-initiated Pandemic Emergency Facility. The World Health Organization itself failed in one of its core functions by allowing a preventable infectious disease to spiral out of control in the world’s poorest region. The 68th World Health Assembly (WHA), held in May 2015, provided an opportunity for the Organization to reflect on what went wrong and reform the organization to be better able to address the next epidemic. In this Briefing Paper we lay out the present landscape, including reforms needed of the International Health Regulations, and assess the strengths and weaknesses of the outcomes of the 68th WHA, including integrating WHO’s outbreak and emergency response programs; creating a global health emergency workforce, deployable on short notice; and setting up a global health emergency contingency fund. We also consider the vital structural issues the WHA failed to effectively address, including bolstering WHO’s core funding, increasing coherence between the WHO headquarters and regional offices, and enhancing civil society engagement
The Americans with Disabilities Act at 25: The Highest Expression of American Values
Get PDFEnacted in 1990, the Americans with Disabilities Act (ADA) is a watershed piece of legislation which enshrines in law a social promise of equality and inclusion into all facets of life, while offering an inspiring model that much of the world has come to embrace. This editorial launches JAMA’s theme issue on the 25th anniversary of the ADA by detailing the Act’s history, main provisions, and far-reaching impacts on health, providing a context for the three Original Investigations and six scholarly Viewpoints that make up the theme issue. The editorial begins with a discussion of the ADA’s history, highlighting the indispensable role of the broad disability rights coalition. The editorial then turns to an overview of the law and its main provisions, before discussing its domestic impact, both in integrating those with disabilities into society and reducing discrimination in health care settings—while acknowledging the law’s unfinished business. Finally, the editorial examines the international influence the ADA has had before concluding by highlighting what remains to be done to integrate those with disabilities fully into American society and calling for the U.S. to ratify the UN Convention on the Rights of Persons with Disabilities
Sexual Assaults Among University Students: Prevention, Support, and Justice
Get PDFSexual assault is common among college-aged women (18 to 25 years), with 1 in 5 reporting having experienced these crimes during their college years. Acute and long-term consequences of sexual assault may include physical trauma, sexually transmitted infections, posttraumatic stress disorder, depression, and substance abuse. Survivors have the option of reporting assaults to the university or to the police, but the goals of these 2 systems—and women’s experiences with them—can be quite different. The criminal justice system’s principal aim is to adjudicate guilt, but the university has the broader purpose of fostering a safe learning environment.
This article explores how university administrators can help prevent sexual assaults and, if necessary, fairly adjudicate claims. The critical points of intervention include nurturing a respectful environment; encouraging reporting; ensuring fair and rigorous investigations; implementing appropriate sanctions for inappropriate behavior; and reintegrating survivors back into the academic community. Importantly, coordination and cooperation between the university and criminal justice systems will improve experiences for survivors of sexual assault
Is Using the Public Trust Doctrine To Protect Public Parkland from Visual Pollution Justifiable Doctrinal Creep?
Get PDFThis Article asks whether the public trust doctrine should be applied to stop the construction of a multistory commercial building that will tower over the tree line of Palisades Interstate Park. The building, which received a variance from a local New Jersey zoning commission, will ruin views of the Park, particularly from scenic overlooks across the Hudson River in New York, like the Metropolitan Museum’s Cloisters and the George Washington Bridge. To make this argument, the author draws on the work of renowned public trust scholars, Professors Joseph Sax and Carol Rose, among others. Based on the doctrine’s adaptability to modern conditions, she finds a sufficient bridge from traditional uses of the doctrine to justify concluding that the proposed building’s interference with scenic views of the Park is an alienation of a trust resource in breach of the doctrine
Revising the U.S. Vertical Merger Guidelines: Policy Issues and an Interim Guide for Practitioners
Get PDFMergers and acquisitions are a major component of antitrust law and practice. The U.S. antitrust agencies spend a majority of their time on merger enforcement. The focus of most merger review at the agencies involves horizontal mergers, that is, mergers among firms that compete at the same level of production or distribution.
Vertical mergers combine firms at different levels of production or distribution. In the simplest case, a vertical merger joins together a firm that produces an input (and competes in an input market) with a firm that uses that input to produce output (and competes in an output market).
Over the years, the agencies have issued Merger Guidelines that outline the type of analysis carried out by the agencies and the agencies’ enforcement intentions in light of state of the law. These Guidelines are used by agency staff in evaluating mergers, as well as by outside counsel and the courts.
Guidelines for vertical mergers were issued in 1968 and revised in 1984. However, the Vertical Merger Guidelines have not been revised since 1984. Those Guidelines are now woefully out of date. They do not reflect current economic thinking about vertical mergers. Nor do they reflect current agency practice. Nor do they reflect the analytic approach taken in the 2010 Horizontal Merger Guidelines. As a result, practitioners and firms lack the benefits of up-to-date guidance from the U.S. enforcement agencies
Breaking BEPS: The New International Tax Diplomacy
Get PDFInternational tax avoidance by multinational corporations is now front-page news. In a time of public austerity, citizens and legislators around the world have focused on the erosion of the corporate income tax base. In response, in 2012 the G-20 — the gathering of the leaders of the world’s twenty largest economies — launched the “Base Erosion and Profit Shifting” (BEPS) project, the most extensive attempt to change international tax norms since the 1920s.
This article is the first to explain that in the course of the BEPS project, the field of international tax has adopted the institutional and procedural architecture for multilateral action used in international financial law. But will that architecture work in the international tax context? To answer that question, the article applies lessons from the international financial law literature to assess international tax agreements that are now being reached through soft law instruments and procedures comparable to those that characterize international financial law. This initial analysis is largely pessimistic. However, the article then describes how model tax treaty law — although also a form of soft law — is highly effective, and differentiates the political economy of international tax law from that of international financial law. As a result, a key theoretical point emerges: bifurcating analysis of multilateral efforts to change international tax norms into their Model Treaty–based and non-Model Treaty–based components is necessary in order to understand the new regime for international tax governance. At a more practical level, bifurcating the analysis highlights that observers should expect the Model Treaty–based parts of the BEPS project to be implemented, as well as most parts of the project focused on tax transparency. By contrast, sustained international coordination in implementing other dimensions of the project is doubtful. In reaching these conclusions, the Article contributes to the broader international economic governance literature by using a high-profile example from international tax diplomacy to show how underlying legal institutions affect the prospects for implementation of international regulatory agreements
Count the Limbs: Designing Robust Aggregation Clauses in Sovereign Bonds
Get PDFOn August 29, 2014, the International Capital Market Association (ICMA) published new recommended terms for sovereign bond contracts governed by English law. One of the new terms would allow a super majority of creditors to approve a debtor’s restructuring proposal in one vote across multiple bond series. The vote could bind all bond holders, even if a series voted unanimously against restructuring, so long as enough holders in the other series voted for it. An apparently technical change, awkwardly named “single-limb aggregated collective action clauses (CACs)” promised to eliminate free-riders for the first time in the history of sovereign bond restructuring. It could also open up new possibilities for abuse.
The markets might have rebelled. Instead, they yawned … and proceeded to adopt the new terms. We consider why such consequential contract change met with less resistance than its relatively modest predecessors, series-by-series and two-limb aggregated CACs. We focus on contract design, and the process by which it came about. Most of the essay is devoted to analyzing the key features of single-limb aggregated CACs and the considerations that shaped decisions about these features. We conclude with observations on contract reform in sovereign debt restructuring and the challenges ahead
cGUPPI: Scoring Incentives to Engage in Parallel Accommodating Conduct
Get PDFWe propose an index for scoring coordination incentives, which we call the “coordination GUPPI” or cGUPPI. While the cGUPPI can be applied to a wide range of coordinated effects concerns, it is particularly relevant for gauging concerns of parallel accommodating conduct (PAC), a concept that received due prominence in the 2010 U.S. Horizontal Merger Guidelines. PAC is a type of coordinated conduct whereby a firm raises price with the expectation—but without any prior agreement—that one or more other firms will follow and match the price increase. The cGUPPI is the highest uniform price increase that all the would-be coordinating firms would be willing to implement without side payments. A larger cGUPPI implies a more pronounced incentive and ability for firms to engage in coordinated price increases. The difference between the post- and pre-merger cGUPPI (i.e. the Delta cGUPPI) is a practical way to score the effect of a merger on coordinated effects concerns
Law, Ethics, and Public Health in the Vaccination Debates: Politics of the Measles Outbreak
Get PDFThe measles outbreak of early 2015 is symptomatic of a larger societal problem–the growing number of parents who decide against vaccinating their children. This failure is causing the resurgence of childhood diseases once eliminated from the United States.
This article explores the legal and ethical landscape of vaccine exemptions. While all states require childhood vaccinations, they differ significantly in the types of religious and/or philosophical exemptions permitted, the rigor of the application process, and available review mechanisms. States with relaxed exemption policies disproportionately experience more outbreaks of vaccine-preventable disease.
Vaccine exemptions are an illustration of the “tragedy of the commons,” in which parents choose not to vaccinate their children, relying on the fact that other parents will vaccinate their children, thus providing community immunity. However, the net result of many individual decisions not to vaccinate is the collapse of herd immunity and thus an upsurge in preventable disease and death.
The failure to vaccinate puts others at risk, thus violating an important ethical principle. However, punishing individual parents could entrench political opposition to vaccine policy. The most ethical and effective solution is for state legislatures to tighten vaccination laws, making it more difficult to obtain non-medical exemptions