The global spread of COVID-19 infections since the beginning of 2020 has brought about significant changes in every society. Whether it had a transformative impact on the existing international structure and actors’ fundamental interests needs further scrutiny. Since the COVID-19 pandemic was ongoing during editing, this special issue covers various approaches to the theme of IR and health. How can global politics of health be analyzed using existing concepts and models of international relations? Or does global politics of health contribute to the development of new debates in IR?

The articles in this volume deal with the following research themes. The first group of research focuses on global health institutions and norms. Such topics include forming and disseminating international health norms through multilateral processes (Katsuma) and the complex nature of multi-level health governance―double fragmentations of global health governance―constraining policy implementation (Akahoshi). Furthermore, Akiyama inquired how the institutional constraints, especially information exchange and confidence-building, affected the response to the pandemic. As a related study, Komatsu investigated the essential roles of experts in implementing International Health Regulations (IHR).

Area studies can contribute to elucidating how global health policies are implemented in local societies. Tamai analyzes the distinctive and complex nature of vaccination promotion processes in Nigeria.

While previous articles have adopted a positivist approach, this issue also includes studies that attempt to expose the power structure behind global health and international relations by adopting an interpretivist approach. Nishimura critically analyzes the securitization processes of pandemics. The last article by Tosa argues the need to rethink our relationship with non-humans by adopting planetary health approaches.

Further development of the study of global politics of health, such as more collaborative theoretical and empirical projects, will be awaited.

Global Health Governance is considered “a crowded, complex, and fragmented field.” “Health sanctuaries” comprising only World Health Organization (WHO) and health experts no longer exist. Therefore, WHO faces challenges in coordination with other actors, including pharmaceutical companies, foundations, and NGOs. Furthermore, WHO faces an “internal” fragmentation between headquarters and regional or national offices, which implies that WHO is not a “unitary”—but a “collective”—actor. In sum, WHO must deal with horizontal (with other actors) as well as vertical (within the organization) fragmentations under the Global Health Governance architectures.

This study conceptualizes these two fragmentations as “double fragmentations.” Although double fragmentations may precipitate both negative and positive consequences, this study elucidates a novel possible explanation of partnership-building between WHO and other actors. Some programs and regional or national offices of WHO as a collective actor can act independently, which enables them to directly cooperate with other international organizations or NGOs. This phenomenon is akin to “transgovernmental networks,” coined by Anne-Marie Slaughter, which describe disaggregated states and interactions with sub-state actors to deal with global issues. This study illustrates the concept of “double fragmentations” and its mechanisms through three cases of Global Health Governance—namely, HIV/AIDS, COVID-19, and Ebola Crisis (West Africa, 2014–2016).

Regarding HIV/AIDS, Global Programme on AIDS (GPA) within WHO acted independently from its headquarters. Simultaneously, other UN agencies and World Bank initiated their own HIV/AIDS programs due to the multidimensional characteristics of HIV/AIDS effects. Under the pressure from states to unite these different programs into a single body, Peter Piot, the vice-director of GPA, actively communicated with other international organizations toward maintaining their autonomy, which promoted the establishment of the Joint UN Programme on HIV/AIDS as a “joint program” of several UN agencies and the World Bank.

A similar phenomenon is observed in the COVID-19 response. WHO Health Emergency Programme (WHE) is considered a “family” within WHO: WHE directly allocated its budget into regional and national offices to create regional and national WHEs, in order to prevent the interruption of WHE activities owing to internal opposition. WHE collaborated with Access to COVID-19 Tools Accelerator and the UN Office for the Coordination of Humanitarian Affairs (OCHA) to develop coherent policies pertaining to the COVID-19 response.

Contrarily, during the Ebola crisis, which demonstrated WHO’s incapability to address health crises, UN member states attempted to resolve “double fragmentations” for better coordination by establishing a new organization—UN Mission for Ebola Emergency Response. However, this “top-down” coordination did not work efficiently as it precipitated confusion by averting existing OCHA-led coordination mechanisms and excluded local and grassroots NGOs from the mission.

This article aims to identify the first priority of the institutional reform in international society regarding control measures against infectious diseases. Since early 2020, the COVID-19 pandemic has exposed our insufficient preparedness and response. International Relations should not overlook this problem because we found that international cooperation is important in containing the spread of virus and it is difficult to be realized. To explore the current state and outlook of international cooperation, this article employs an interdisciplinary approach linking International Relations and Epidemiology with a focus on border controls, especially travel restrictions.

International Health Regulations (IHR) constitute the key component of the international institutions in the field of infectious disease. They contain “the rule of restriction on travel restrictions”: states should refrain from imposing unnecessary travel restrictions upon other states. In other words, the IHR does not recommend closing borders as an effective means to address the international spread of virus. This principle is important regarding information sharing as travel restrictions could decrease states’ incentives for it.

In the cases of the three major outbreaks, SARS (2003), H1N1 Influenza (2009), and Ebola Disease (2014), the WHO acted according to the principle of the IHR, denying travel restrictions as a control measure and paying attention to the link between the restrictions and information sharing. Meanwhile, it became clear that the WHO does not have sufficient power to make states comply with the rule of restriction on travel restrictions. We observed the same problem in the case of COVID-19. The number of states implementing full border closure, the most stringent travel restrictions, was the highest ever.

When it comes to the science behind travel restrictions, an important change has been underway since 2020. With the case of COVID-19, epidemiological studies have increasingly argued for the positive effect of restrictions compared to previous knowledge, which had deemed the effect very low. This research trend prompts us to rethink what science-informed international cooperation means.

It follows that the international community should change the rule on travel restrictions. In this context, strengthening the powers of the WHO is imperative for its role as a control tower that supports or conducts relevant expert studies and dialogue worldwide. This can be theoretically explained by referencing the Epistemic Community literature in International Relations. The role of the WHO after COVID-19 is to bundle the multiple communities and protect their autonomy against power politics among states. That is the first priority for the institutional reform currently under discussion.

The international norms and goals related to health have been widely diffused after the World War II. Global health diplomacy at the WHO and the United Nations (UN) has played important roles in such norm diffusion. On one hand, the norm diffusion is increasingly characterized as multi-disciplinary, from human rights to development and health, for example. On the other hand, the diplomatic arenas for global health are expanding from global inter-governmental organizations, such as the WHO and the UN, to the G7 and G20 Summits.

After the World War II, the right to health, an international human rights norm, was promoted at the WHO and the UN. The right to the highest attainable standard of health, initially appeared in the WHO Charter, was elaborated further at the Office of the UN High Commissioner for Human Rights.

This human rights norm was diffused to an international development norm, the Health for All (HFA), implying the needs for development cooperation. The HFA norm was then translated into more specific international development goals at the UN, such as the Millennium Development Goals (MDGs) in 2000, and the Sustainable Development Goals (SDGs) in 2015. The Goal 3 of the SDGs has the Target 3.8 to achieve Universal Health Coverage (UHC) that may be considered as a health policy.

The UHC has been discussed as a health policy among health ministers at the WHO’s World Health Assembly in Geneva. However, at the 2017 G20 Summit in Osaka, in June, the first joint meeting of health ministers and finance ministers was organized to discuss health financing for UHC, in which the concept of UHC was expanded as investment in human resources. It was argued that health financing would be important for equitable social development. Then, in September of the same year, the first UN High-Level Meeting on UHC was held in New York where heads of state and government endorsed UHC as a political priority.

Similarly, in May 2023, at the G7 Summit in Hiroshima, the UHC was on the agenda, as Japan promotes it as an issue of human security. It is expected that G7 members will engage in global health diplomacy at the second UN High-Level Meeting on UHC in September 2023, expanding and strengthening partnership for UHC among all UN member states.

The COVID-19 pandemic has exposed shortcomings in the global health regime’s crisis response system under the International Health Regulation (IHR), overseen by the World Health Organization (WHO). This paper focuses on analyzing the constraints within the WHO-centric approach to global health, particularly in the areas of information exchange, and confidence-building through institutional analyses.

Specialized international institutions that rely on technical expertise as a basis of superiority over national sovereignty are vulnerable to highly politicized issues. In designing new institutions (measures) to enhance pandemic preparedness and response and to ensure the effectiveness of the regime, the treatment of the tension between the values provided by the international regime and the principle of emphasis on state sovereignty and institutions to ensure the effectiveness of norms is an important issue.

This paper first discusses how WMD non-proliferation regimes where scientific credibility and objectivity are the basis for the regime’s effectiveness and legitimacy, equipped with intrusive safeguards and inspection mechanisms that limit state sovereignty. By doing so, it identifies the conditions that have enabled the creation of safeguards and inspection regimes with strong authoritative provisions, substantially limiting some aspects of sovereignty, to international organizations. It also assesses the function and failure of mechanisms meant to curb sovereign states from exerting undue influence over international organizations.

Using this analytical framework, this paper will analyze how the global health regime, a framework for international cooperation formed through “de-securitization” of infectious disease issue, has been subject to globalization and the “re-securitization” of the issues, and how provisions embedded in the system that leave discretionary authority to states reveal the limits of the regime’s effectiveness. In the global health regime, when the security aspect became apparent in the response to the pandemic (“re-securitization”), the device embedded in the regime that guarantees the discretion of state sovereignty functioned predominantly, unlike the expectation of the regime that international organizations would respond based on their scientific expertise. There, even if “effectiveness of compliance” is ensured in accordance with the procedures stipulated in the regime, it does not lead to “effectiveness of results,” and the credibility of the regime’s reliance on scientific expertise is undermined.

Since it is difficult for international organizations to be provided greater discretion to international organizations and limit sovereign power, one possible complementary measure would be to strengthen review mechanisms for ongoing, ex post facto responses to situations. In addition to the potential benefits of a post-event review mechanism to deter future noncompliance by states and to encourage compliance with norms, such review mechanisms would allow for more transparent and timely efforts to enhance the effectiveness of responses through international cooperation.

Promoting mass vaccination against certain infectious diseases is not easy for governments, despite clarity regarding the nature of the disease or innovative advancements in medical technology. In developing countries, where health systems are not well developed and the international community has invested much aid, complex political dynamics exist in the interaction between international organizations, governments, communities, and individuals, as several resources are mobilized to promote vaccination. Since the 1990s, particularly polio has been addressed by several international actors. Therefore, this study examines the political dynamics surrounding polio vaccination in Nigeria, the last polio-endemic country in Africa, which achieved eradication in 2020. It focuses on the reasons and mechanisms of Nigeria’s polio eradication efforts that have had a major impact on both promoting vaccination, which was their original purpose, and expanding general healthcare services to improve the people’s health problems in local communities.

Global health governance involves two approaches to tackle infectious diseases and improve health systems: the vertical approach, which relies on top-down implementation of specific disease control measures according to manuals provided by the international community and governments; and the horizontal approach, which aims to solve people’s health problems with the participation and cooperation of local communities. Thus, polio is considered a typical example of a vertical approach, where national governments implemented mass vaccination in a top-down manner.

Despite this, it is noteworthy that polio eradication initiatives in Nigeria were based on a horizontal approach, considering the overall health environment of the local community and extending healthcare services to the population. Most studies have focused on the technical aspects of medical and public health policy. In countries without adequate modern Western means of population control, including Nigeria, the health infrastructure is inadequate and the number of children targeted for vaccination is inaccurate. Since the late 2000s, policies based on the horizontal approach have been implemented in Nigeria because they have empirically demonstrated to be the most effective means of developing statistical data on the target population and ensuring vaccination. In contrast, this study argues that vaccination efforts in Nigeria were implemented as a tool of colonial power, resulting in a strong distrust of modern medicine in local society and massive vaccine refusal. Further, the study argues that the measures to consider the healthcare environment in local communities were implemented to address the conflict caused by such vertical approach-based policies.

This study examines the discursive impacts of human security on the securitization of disease pandemics. While state-centered understandings of communicable disease pandemics are not new phenomena, the Cold War brought the institutionalization of international surveillance procedures through the World Health Organization’s (WHO) International Health Regulation, as well as the legitimate discourse of human security.

Human security refers to individual-centered security, which represents the protection of human rights and the humanitarian discourse after the Cold War. The United Nations (UN) institutions as well as the Western powers find human security legitimate, as it includes the protection of people from the fears against state collapse and international terrorism, although academics criticize it due to the vagueness and all-inclusive nature of this concept.

This study shows that the all-inclusive nature of the human security concept brings unintended contradictions. That is, once one aspect of this concept, such as the fight against communicable disease, is realized, it tramples upon individuals’ freedom and human rights. Furthermore, this concept remains incomplete, as it only protects the individual rights, not the group rights of the vulnerable.

Neoliberalism and the Copenhagen School explain the securitization process of pandemics of infectious diseases. Neoliberalism assumes the coherent and independent role of an epistemic community composed of experts in public health and doctors as teachers of institutional innovations, such as the International Health Regulations. In contrast, the Copenhagen School recognizes that securitizing actors, mostly the power holders of a country, have made the most of the discursive power of the epistemic community. According to the Copenhagen School, the epistemic community has been the object of securitizing actors to convince the audience that the outbreak of disease is an existential threat to the country.

This study furthers discursive interactions with international structures and institutions. It argues that human security has deepened the othering of developing countries and the most repressive groups. After the Cold War, neoliberalism became the hegemonic discourse as the debt crisis in the Third World deepened. The WHO member states, especially in developing countries, perceive the international epistemic community as the instruments of neo-colonialism that have represented the interests of megapharmaceutical companies and deterred the access of local citizens to the best medicines. The end results of this vicious cycle showed that the virus has continuously mutated and has never reached endemic of the disease.

First, this article argues that new emerging and re-emerging infectious disease pandemics are partly caused by excessive extractivism against the nature while pointing out the problematic politics of dualism between health and disease from the Foucauldian perspective. Second, we confirm the fact that politics of bio-security, caused by pandemics, promotes the ubiquitous surveillance apparatus (algorithmic governmentality) based upon absolute unequal gazing power relations as well as multiplications of walls and social divisions. In sum, we point out that the current excessive anthropocentric capitalism leads to planetary health crisis including ‘developo-genic diseases’ as well as the politics of bio-security (illiberal surveillance society). Finally, we argue that we need rethink our relation with non-humans by adopting one health or planetary health approaches in order to avoid repetitive infectious disease pandemics as well as the crisis of the Anthropocene age.

The fact that Stalin demanded the northern half of Hokkaido from President Truman on August 16, 1945, and was denied is evidence of the Soviet Union’s strong interest in influencing and occupying of the main islands of Japan.

The conflict between the U.S. and the Soviet Union over the occupation of Hokkaido has been vividly described in many previous studies, such as Tsuyoshi Hasegawa, Racing the Enemy: Stalin, Truman, and the Surrender of Japan (2005), but the point of contention in those accounts has been the occupation of the Kuril Islands and the relationship of this action to Siberian internment. Generally, such works have examined the documented correspondence between the leaders of the U.S. and the Soviet Union published in Foreign Relations of the United States. In the time since the collapse of the Soviet Union, there have not been many newly published historical records. However, it has been suggested that the Soviet Union’s request for the northern half of Hokkaido was intended to extract a concession from the U.S. in the form of the occupation of all the Kuril Islands.

This underestimation of the seriousness of the Soviet demand has been put forward in the absence of studies treating the discussions that took place within the Soviet Union before and after the demand for Hokkaido. The author has found historical documents in the Foreign Policy Archives of the Russian Federation that shed light on these issues.

These new documents show, first, that the Soviet military hoped to occupy the entirety of Hokkaido, but this was reduced within the Kremlin to the northern half. Furthermore, even after Truman’s rejection of the demand, the Soviet military continued to consider occupying the island. In addition, there were other areas besides Hokkaido within the realm of Soviet ambition. Specifically, the Soviets showed strong interest in the management of the Tsushima Straits, the Tsugaru Straits, and the Soya Straits. In connection with the Tsushima Straits, Soviet military officers and diplomats also included in their memorandums of understanding entering Pusan, Jeju Island, and Tsushima Island. Stalin’s request for the northern half of Hokkaido also appears to have been part of a strait security initiative.

To the best of our knowledge, the series of historical documents utilized in this article have not formed a part of any published research hitherto. Improved knowledge of Soviet plans for the partition and occupation of Japan should also provide additional insight into the territorial origins of the Japan that emerged into the postwar period.