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Canada’s Violation of International Law during the 2014–16 Ebola Outbreak

Abstract
Abstract

The devastating 2014–16 West African Ebola outbreak challenged the authority of the World Health Organization (WHO) to enforce the legally binding International Health Regulations (IHR) that govern pandemic responses. Under Article 43 of the IHR, states parties can only implement additional health measures beyond the WHO’s recommendations if public health rationales or scientific evidence justify such measures. Yet at least fifty-eight states parties enacted additional health measures, mainly travel restrictions to or from Ebola-affected countries. This article explains why Canada’s visa restrictions targeting Ebola-affected countries failed to meet the IHR’s requirements and therefore violated international law. Specifically, Canada’s response went against public health authorities’ consensus views, the best available scientific evidence on disease transmission, and the WHO’s recommendations. In light of its traditional role as a global health champion, Canada must lead by example and abide by international law, including the IHR, instead of picking and choosing which rules to follow and thereby encouraging other countries to do the same.

Résumé

L’épidémie dévastatrice d’Ébola de l’Afrique de l’Ouest en 2014–16 a remis en doute l’autorité de l’Organisation mondiale de la santé (OMS) pour faire respecter le Règlement sanitaire international (RSI), instrument juridiquement contraignant qui régit les réponses aux pandémies. En vertu de l’article 43 du RSI, les États parties ne peuvent mettre en œuvre des mesures en matière de santé au-delà de celles recommandées par l’OMS que si des motifs de santé publique ou des preuves scientifiques justifient de telles mesures supplémentaires. Or, au moins 58 États parties ont adopté des mesures de santé supplémentaires, principalement des restrictions de voyage vers ou à partir des pays touchés par l’Ébola. Ce commentaire explique pourquoi les restrictions de voyages imposées par le Canada à l’endroit des pays touchés par l’Ébola n’ont pas répondu aux exigences du RSI et ont donc violé le droit international. Les mesures imposées par le Canada étaient contraires au consensus d’opinion des autorités de santé publique, aux données scientifiques les plus récentes sur la transmission des maladies, et aux recommandations de l’OMS. Vu son rôle traditionnel de champion mondial de la santé, le Canada doit mener par l’exemple et respecter le droit international, y compris le RSI, plutôt que de respecter certaines règles au choix et ainsi encourager d’autres pays à faire de même.

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References
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1 World Health Organization (WHO), Fact Sheet: Ebola Virus Disease (January 2016), online: <http://www.who.int/mediacentre/factsheets/fs103/en/>.

2 WHO, Ebola Situation Report (30 March 2016), online: <http://apps.who.int/ebola/ebola-situation-reports>.

3 WHO, supra note 1. WHO, International Health Regulations, WHA 58.3, 2d ed (Geneva: WHO, 2005) [IHR].

4 WHO, IHR Procedures and Implementation (2005), online: <http://www.who.int/ihr/procedures/en/>.

5 IHR, supra note 3, art 2.

6 Wendy Rhymer & Rick Speare, “Countries’ Response to WHO’s Travel Recommendations during the 2013–2016 Ebola Outbreak” (2017) 95 Bulletin of the World Health Organization 10 at 11.

7 Ministerial Instructions (31 October 2014) Canada Gazette I (Immigration and Refugee Protection Act), online: <http://www.gazette.gc.ca/rp-pr/p1/2014/2014-10-31-x8/html/extra8-eng.php>.

8 IHR, supra note 3, art 43.

9 Constitution of the World Health Organization, 22 July 1946, 14 UNTS 185.

10 IHR, supra note 3, art 2.

11 Adam Kamradt-Scott, “The Evolving WHO: Implications for Global Health Security” (2011) 6:8 Global Public Health 801 at 804.

12 IHR, supra note 3, art 5.

13 WHO, supra note 4.

14 WHO, Report of the Ebola Interim Assessment Panel (July 2015), online: <http://www.who.int/csr/resources/publications/ebola/ebola-panel-report/en/>.

15 Steven J Hoffman, “The Evolution, Etiology and Eventualities of the Global Health Security Regime” (2010) 25:6 Health Policy and Planning 510 at 517; Steven J Hoffman, “How Many People Must Die from Pandemics before the World Learns?” (2017) 1:1 Global Challenges 30.

16 IHR, supra note 3, art 43(1).

17 Ibid.

18 Christopher W McDougall & Kumanan Wilson, “Canada’s Obligations to Global Public Health Security under the Revised International Health Regulations” (2007) 16:1 Health Law Rev 25 at 30.

19 IHR, supra note 3, art 43(2)–(3).

20 Ibid, art 43(3).

21 Ibid, art 56.

22 Immigration and Refugee Protection Act, SC 2001, c 27, s 87.3.

23 Ministerial Instructions, supra note 7.

24 Ibid.

25 Ibid.

26 Government of Canada, The Health Portfolio: Framework for Action on the 2014 Ebola Virus Disease Outbreak (2014), online: <https://www.canada.ca/en/public-health/services/diseases/ebola/health-professionals-ebola/health-portfolio-framework-action-2014-ebola-outbreak.html>.

27 Isabelle Nuttall, Ebola Travel: Vigilance, Not Bans, Commentary (5 November 2014), online: WHO <http://www.who.int/mediacentre/commentaries/ebola-travel/en/>.

28 Julia Belluz & Steven Hoffman, “The Evidence on Travel Bans for Diseases like Ebola Is Clear: They Don’t Work,” Vox (18 October 2014), online: <http://www.vox.com>.

29 Thomas Frieden, “CDC Director: Why I Don’t Support a Travel Ban to Combat Ebola Outbreak,” Commentary (13 October 2014), online: Centers for Disease Control and Prevention <http://www.blogs.cdc.gov>.

30 Anna Yukhananov, “Ebola Must Be Stopped at Source, Not via Travel Bans: World Bank’s Kim,” Reuters (16 October 2014), online: <http://www.reuters.com>.

31 Ibid.

32 Helen Branswell, “Ebola: Canada Suspending Visas for Residents of Outbreak Countries,” CBC News (31 October 2014), online: <http://www.cbc.ca>.

33 Quoted in ibid.

34 Government of Canada, supra note 26.

35 Helen Branswell, “WHO Asks Canada to Justify Visa Ban for Residents of Ebola-Affected Countries,” Globe and Mail (5 November 2014), online: <http://www.theglobeandmail.com>.

36 Ibid.

37 Branswell, supra note 32.

38 Ibid.

39 John S Brownstein, Cecily J Wolfe & Kenneth D Mandl, “Empirical Evidence for the Effect of Airline Travel on Inter-Regional Influenza Spread in the United States” (2006) 3:10 PLoS Med 1826.

40 Ibid at 1832.

41 Timothy C Germann et al, “Mitigation Strategies for Pandemic Influenza in the United States” (2006) 103:15 Proceedings of the National Academy of Sciences 5935.

42 Ibid.

43 Ibid at 5938.

44 Paolo Bajardi et al, “Human Mobility Networks, Travel Restrictions, and the Global Spread of 2009 H1N1 Pandemic” (2011) 6:1 PLoS ONE 1.

45 Ibid.

46 Ibid.

47 Ibid.

48 Patricia C Priest et al, “Thermal Image Scanning for Influenza Border Screening: Results of an Airport Screening Study” (2011) 6:1 PLoS ONE 1.

49 Ibid.

50 National Advisory Committee on SARS and Public Health, “Learning from SARS: Renewal of Public Health in Canada” (2003), online: Public Health Agency of Canada <http://www.phac-aspc.gc.ca/publicat/sars-sras/naylor/index-eng.php>.

51 Ibid.

52 Ministeral Instructions, supra note 7.

53 Ibid.

54 Government of Canada, supra note 26.

55 Isaac I Bogoch et al, “Assessment of the Potential for International Dissemination of Ebola Virus via Commercial Air Travel during the 2014 West African Outbreak” (2015) 385 The Lancet 29.

56 Public Health Agency of Canada, “Infection Prevention and Control Expert Working Group: Advice on Infection Prevention and Control Measures for Ebola Virus Disease in Healthcare Settings” (2014), online: <http://www.phac-aspc.gc.ca/id-mi/vhf-fvh/ebola-ipc-pci-eng.php>.

57 Ibid.

58 Ibid.

59 Michelle Hayman, “Fear above Science: Canada’s Ebola Related Visa Restrictions,” University of Toronto Faculty of Law International Human Rights Program (blog), online: <http://ihrp.law.utoronto.ca/fear-above-science-canadas-ebola-related-visa-restrictions>.

60 Julia Belluz, Canada’s Ebola Visa Ban Is Dumb, Xenophobic, and Illegal (2014), online: Vox <https://www.vox.com/2014/11/5/7159705/canada-visa-ebola-virus-outbreak>.

61 WHO, Statement on the 1st Meeting of the IHR Emergency Committee on the 2014 Ebola Outbreak in West Africa (8 August 2014), online: <http://www.who.int/mediacentre/news/statements/2014/ebola-20140808/en/>.

62 WHO, IHR Emergency Committee Regarding Ebola (8 August 2014), online: <http://www.who.int/mediacentre/news/statements/2014/ebola-20140808/en/>; WHO, IHR Emergency Committee Regarding Ebola (29 March 2016), online: <http://www.who.int/mediacentre/news/statements/2016/end-of-ebola-pheic/en/>.

63 WHO, Statement on the 4th Meeting of the IHR Emergency Committee on the 2014 Ebola Outbreak in West Africa (21 January 2015), online: <http://www.who.int/mediacentre/news/statements/2015/ebola-4th-ihr-meeting/en/>.

64 Ibid.

65 David L Heymann et al, “Global Health Security: The Wider Lessons from the West African Ebola Virus Disease Epidemic” (2015) 385 The Lancet 1884.

66 Margaret Chan, “WHO Director-General Addresses Institute of Medicine Ebola Workshop,” Speech (1 September 2015), online: WHO <http://www.who.int/dg/speeches/2015/18months-after-ebola-outbreak/en/>.

67 WHO, supra note 63.

68 Helen Branswell, “WHO Objects to Canada’s Ban on Visas to Residents of Countries Affected by Ebola,” iPolitics (9 November 2014), online: <http://ipolitics.ca/2014/11/09/who-objects-to-canadas-visa-ban-for-countries-affected-by-ebola/>.

69 Ibid.

70 Ibid.

71 Ministerial Instructions (19 December 2015) Canada Gazette I (Immigration and Refugee Protection Act), online: <http://gazette.gc.ca/rp-pr/p1/2015/2015-12-19/html/notice-avis-eng.php#ne1>.

72 Rhymer & Speare, supra note 6 at 12.

73 David P Fidler, Ebola Report Misses Mark on International Health Regulations, Commentary (17 July 2015), online: Chatham House <http://www.chathamhouse.org/expert/comment/ebola-report-misses-mark-international-health-regulations>.

74 IHR, supra note 3, art 2.

75 Fidler, supra note 72.

76 WHO, supra note 14 at 12.

77 WHO, Report of the Review Committee on the Functioning of the International Health Regulations (2005) in Relation to Pandemic (H1N1) 2009 (5 May 2011), online: <http://apps.who.int/iris/bitstream/10665/3350/1/A64_10-en.pdf>; Hoffman Steven J, “Making the International Health Regulations Matter: Promoting Compliance through Effective Dispute Resolution” in Rushton Simon & Youde Jeremy, eds, Routledge Handbook on Global Health Security (Oxford: Routledge, 2014); Trygve Otterson, Steven J Hoffman & Gaëlle Groux, “Ebola Again Shows the International Health Regulations Are Broken” (2016) 42:2–3 Am J L Med 356.

78 WHO, supra note 14 at 12.

79 Ibid; Charter of the United Nations, 26 June 1945, 59 Stat 1031.

80 Chan, supra note 67.

81 UN Security Council Resolution 2177, UNSCOR, UN Doc S/RES/2177 (2014).

82 UN General Assembly Resolution 69/1, UNGAOR, 69th Sess, UN Doc A/69/L.2 (2014).

83 Lawrence O Gostin, Mary C Debartolo & Eric A Friedman, “The International Health Regulations 10 Years On: The Governing Framework for Global Health Security” (2015) 386 The Lancet 2222; Steven J Hoffman & John-Arne Røttingen, “Split WHO in Two: Strengthening Political Decision-Making and Securing Independent Scientific Advice” (2014) 128:2 Public Health 188.

84 Gostin, supra note 82 at 2225.

85 Lane Feler, “Ebola Postmortem: Treating the World Health Organization’s Regulatory Maladies” (2015) 54 Colum J Transnatl L Bulletin 13 at 26.

86 Hoffman, supra note 76.

87 WHO, supra note 14 at 10.

88 Fidler, supra note 72.

89 Ibid.

90 Colin McInnes, “WHO’s Next? Changing Authority in Global Health Governance after Ebola” (2015) 91:6 International Affairs 1299 at 1314.

91 Abram Chayes & Antonia Handler Chayes, “On Compliance” (1993) 47:2 International Organization 193.

92 Kumanan Wilson, John S Brownstein & David P Fidler, “Strengthening the International Health Regulations: Lessons from the H1N1 Pandemic” (2010) Health Policy and Planning 1 at 4.

93 IHR, supra note 5, art 44.

94 Edge JS & Hoffman Steven J, “Strengthening National Health Systems’ Capacity to Respond to Future Global Pandemics” in Davies S & Youde J, eds, The Politics of Surveillance and Responses to Disease Outbreaks (Surrey, UK: Ashgate Publishing, 2015) 157.

95 Steven J Hoffman et al, “International Law’s Effects on Health and Its Social Determinants: Protocol for a Systematic Review, Meta-Analysis, and Meta-Regression Analysis” (2016) 5:64 Systematic Reviews 1; Steven J Hoffman, Lathika Sritharan & Ali Tejpar, “Is the UN Convention on the Rights of Persons with Disabilities Impacting Mental Health Laws and Policies in High-Income Countries? A Case Study of Implementation in Canada” (2016) 16:1 BMC International Health and Human Rights 1; Steven J Hoffman et al, “Strategies for Achieving Global Collective Action on Antimicrobial Resistance” (2015) 93:12 Bulletin of the World Health Organization 867; Steven J Hoffman, John-Arne Røttingen & Julio Frenk, “Assessing Proposals for New Global Health Treaties: An Analytic Framework” (2015) 105:8 American Journal of Public Health 1523; Steven J Hoffman & John-Arne Røttingen, “Assessing the Expected Impact of Global Health Treaties: Evidence from 90 Quantitative Evaluations” (2015) 105:1 American Journal of Public Health 26; Steven J Hoffman & Trygve Ottersen, “Addressing Antibiotic Resistance Requires Robust International Accountability Mechanisms” (2015) 43:2 Journal of Law, Medicine & Ethics 53; Steven J Hoffman & John-Arne Røttingen, “Assessing Implementation Mechanisms for an International Agreement on Research and Development for Health Products” (2012) 90:11 Bulletin of the World Health Organization 854.

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Canadian Yearbook of International Law/Annuaire canadien de droit international
  • ISSN: 0069-0058
  • EISSN: 1925-0169
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