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This chapter outlines how the international community tries to address cross-border health concerns through its system of global health governance. It looks at the historical evolution and contemporary context of the global health governance system. In order to delve more deeply into the strengths and weaknesses of the current system, the chapter looks at the COVID-19 pandemic to assess how various national and international actors responded and where they ran into problems fomenting cooperation in the face of a global microbial threat.

What threat can diseases pose to security? The sheer breadth of possible answers to this question has become increasingly evident during the recent COVID-19 pandemic, which was caused by the SARS-CoV-2 virus. This chapter explores three such links between health and security. First, some diseases are identified as threats to human security. The human security framework draws particular attention to diseases—such as HIV/AIDS, malaria, and tuberculosis—that remain endemic in many low-income countries, that continue to cause millions of deaths annually, and that also pose substantial challenges to the survival and well-being of individuals and communities. Second, some emerging infectious diseases—such as SARS, pandemic flu, Ebola, and COVID-19—are identified as threats to national security because their rapid spread can cause high death tolls and trigger significant economic disruption. Finally, some diseases are also identified as narrower threats to bio-security within the context of international efforts to combat terrorism. Here concerns have focused on the spectre of a terrorist attack using a disease-causing biological agent such as anthrax, smallpox, or plague. The chapter concludes by contrasting two different ways of understanding this health–security nexus: as an instance of securitization or medicalization.