Learning from the field: the WHO and a renewed “Health and Security Interface”

With the exception of some realist accounts, major theories of international relations describe International Regimes (especially when associated to formal bodies) as highly resilient structure due to a combination of factor that range from start-up costs, increasing returns from cooperation and social and political intransigence. Nonetheless the longevity of the regime complex does not mean a lack of change within it. On the contrary, a growing number of studies have problematized the ecology of International Organizations by delving into cases of regime contestation, fragmentation, adaptation, integration, etc. Organizational theory based in sociology conceives International Organizations as independent actors in world politics comprised of individuals and groups who display expertise and entrepreneurship to implement strategies which can widely diverge from those of their member states. The first part of the paper opens the floor to a preliminary discussion about the role international bureaucracies can play in regimes development (adaptation, regime shifting, competitive regime creation). The second part of the paper examines how and to what ends international bureaucrats have mobilized expert knowledge in the World Health Organization and with which outcomes. Historically the WHO has faced few competitors for its prominent role as lead actor in international health governance orchestration. Nonetheless, starting in the 1990s the Organization has undergone considerable challenges to its authority. Some of these challenges were successful cases of contestation and ended up increasing the complexity of the regime by adding elements to it and inducing fragmentation. At least in one case (the one of diseases surveillance and response) the increasingly challenging international context led to regime gain-of-function and integration, instead. I argue that in both cases international bureaucrats, expertise mobilization and epistemic knowledge were probably among the most relevant determinant of such institutional outcome.