Explaining the failure of global health governance during COVID-19

Abstract Global health governance (GHG) was one of COVID-19's earliest victims. Soon after the novel coronavirus escaped China, the World Health Organization (WHO) was marginalized, and the International Health Regulations became practically irrelevant, as nations adopted uncoordinated, ad hoc responses. Existing explanations of GHG's collapse are largely utopian, criticizing states for failing to empower the WHO with sufficient supranational authority. This misunderstands how GHG was supposed to work in the first place and hence mistakenly diagnoses the causes of failure. We argue that COVID-19 exposed the pathologies of an entire, neoliberal approach to global governance: metagovernance and state transformation. In this approach, international organizations are hollowed out and their role shifts to metagovernance—developing and disseminating ‘best practice’ policies, institutions and rules for states to embed domestically. Such global regimes' efficacy, therefore, depends on states' capacity to enforce global disciplines. However, nation-states are also hollowed out by neoliberal strictures, undermining practical implementation. Consequently, GHG was failing long before COVID-19, leaving the system dependent on ad hoc interventions by dominant states. With the latter also affected by COVID-19, GHG was left in disarray. Reform proposals should therefore focus less on global institutions and rules and more on building domestic capabilities.