When the Background Looms Large over the Foreground: Medical Professionals, Diplomats, and Co-Managing SARS-CoV-2

The Public Health Emergency of International Concern (PHEIC) is the highest alert that the World Health Organization (WHO) can issue. Even though the International Health Regulations (IHR 2005) prescribe tight deadlines and an expeditious decision-making process to determine such a PHEIC, it took many weeks for the alert to be declared to counter the spread of SARS-CoV-2 (coronavirus). What explains the delay? Drawing from recent advances in the literature on international orders, our argument zooms in on the troubled relations between medical professionals and diplomats. Practices enacting a hierarchical relationship between the medical and diplomatic communities of practice (background) undermined crucial parts of the decision-making mechanism laid out in the IHR, which puts medical professionals in a strong position (foreground). This study contributes to a better understanding of PHEICs, global health governance, and, beyond this, to how actors employing different lenses to make sense of the world fail or succeed to manage crises together. Our findings also have important policy implications for discussions about a Pandemic Treaty.