Keywords
Regional Health Governance, Equitable Pandemic Management, Inter-American System, health rights
Document Type
Article
English Abstract
This paper presents insights and implications from a two-day research symposium organized by the Regional Health Governance Study (RHGS) in 2024. The symposium examined how a regional approach to health governance within the Inter-American System, which comprises the Commission, the Court and the Pan-American Health Organization, can support the development of an equitable pandemic management system. It also examines the limitations of WHO-led pandemic response measures, identifies regional governance mechanisms, and offers policy recommendations to strengthen pandemic preparedness in the Americas. A qualitative thematic analysis using the Consolidated Framework for Implementation Research (CFIR) was employed to assess barriers, facilitators, and policy implications. Symposium proceedings, expert discussions, and recent policy developments, including International Health Regulations (IHR) amendments and pandemic treaty negotiations, were analyzed to provide actionable insights. Key themes emerged, including the need for binding regional agreements, strengthened cross-sectoral collaboration, enhanced human rights protections, and equitable resource distribution. The findings also highlighted barriers to regional equitable pandemic management, such as fragmented health policies, limited financing mechanisms, and inequities in healthcare access across the Americas. The findings emphasize the need for a regional governance approach that complements WHO’s global health governance mechanisms while ensuring decentralized decision-making, equity-driven health policies, and improved institutional accountability. By strengthening regional coordination and governance mechanisms, the Inter-American System can serve as a model for resilient and equitable pandemic management.
Citation Information
Ngwaba, Uchechukwu; Viens, A. M.; Bernal, Carlos; Wilson-Mitchell, Karline; Amri, Michelle; Effoduh, Jake Okechukwu; Forman, Lisa; Habibi, Roojin; Poirier, Mathieu; Eyawo, Oghenowede; Fixon-Owoo, Sarah; Ntaganira, Innocent; Salim, Aeda; Haghighi, Aminah; Rai, Saumya; Kaur, Sandeep; Kebreab, Samrawit; Owoyemi, Sekinat; and Fomina, Kateryna.
"Conference Proceedings - Symposium Insights and Implications: Advancing Regional Health Governance in the Inter-American System."
The Transnational Human Rights Review
11. (2025)
: 62-84.
DOI: https://doi.org/10.60082/2563-4631.1113
https://digitalcommons.osgoode.yorku.ca/thr/vol11/iss1/6
References
1 Statement and Declaration: The symposium findings presented in this proceedings paper do not necessarily represent a consensus of views by all the authors. Our gratitude goes to Grace Lowe and Alyssa Shi, the research assistants who supported Dr Uchechukwu Ngwaba in planning and hosting the symposium at the Lincoln Alexander School of Law, Toronto Metropolitan University, on April 29-30, 2024. Our Special gratitude goes to the Lincoln Alexander School of Law Internal grants fund for partially funding the symposium in 2024; and to Dr A.M. Viens for securing matching funds for the symposium from York University's School of Global Health. We thank all participants at the symposium whose rich contributions and insights has enabled the preparation of this proceedings paper.
2 Toronto Metropolitan University; uche.ngwaba@torontomu.ca.
3 York University.
4 University of Dayton.
5 Toronto Metropolitan University.
6 University of British Columbia.
7 Toronto Metropolitan University.
8 University of Toronto.
9 University of Ottawa.
10 York University.
11 York University.
12 UMass Chan Medical School.
13 Former WHO Staff.
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20 Toronto Metropolitan University.
21 Laura J Damschroder et al, "The Updated Consolidated Framework for Implementation Research Based On User Feedback" (2022) 17:75 Implementation Science 1 at 2-16. https://doi.org/10.1186/s13012-022-01245-0
22 Ibid at 2.
23 Ibid.
24 Thomas J Waltz et al, "Choosing Implementation Strategies to Address Contextual Barriers: Diversity in Recommendations and Future Directions" (2019) 14:42 Implementation Science 1. https://doi.org/10.1186/s13012-019-0892-4
25 Laura J Damschroder et al, supra note 21.
26 In the CFIR, Intervention Characteristics describes aspects of an intervention that may impact implementation success, including its perceived internal or external origin, evidence quality and strength, relative advantage, adaptability, trialability, complexity, design quality and presentation, and cost (see Nadia Safaeinili et al, "CFIR Simplified: Pragmatic Application of and Adaptations to the Consolidated Framework for Implementation Research (CFIR) for Evaluation of a Patient-Centered Care Transformation Within a Learning Health System" (2020) 4:1 Learning Health Systems 1 at 2). https://doi.org/10.1002/lrh2.10201
27 "Outer Settings" are external influences on intervention implementation including patient needs and resources, cosmopolitanism or the level at which the implementing organization is networked with other organizations, peer pressure, and external policies and incentives (see Safaeinili et al, supra note 26).
28 "Inner Settings" are characteristics of the implementing organization such as team culture, compatibility and relative priority of the intervention, structures for goal setting and feedback, leadership engagement, and the implementation climate (see Safaeinili et al, supra note 26).
29 "Characteristics of individuals" are individuals' beliefs, knowledge, self-efficacy, and personal attributes that may affect implementation (see Safaeinili et al, supra note 26).
30 "Process of implementation" refers to stages of implementation such as planning, executing, reflecting and evaluating, and the presence of key intervention stakeholders and influencers including opinion leaders, stakeholder engagement, and project champions (see Safaeinili et al, supra note 26).
31 Virgina Braun & Victoria Clarke, "Using Thematic Analysis in Psychology" (2006) 3:2 Qualitative Research in Psychology 77. https://doi.org/10.1191/1478088706qp063oa
32 Symposium Proceedings. Regional Health Governance Symposium (Toronto Metropolitan University, April 29-30, 2024) (Symposium Proceedings 2024) on file with authors.
33 Symposium Proceedings 2024.
34 The Pan American Health Organization (PAHO) is the specialized international health agency for the Americas. It works with countries throughout the region to improve and protect people's health. PAHO engages in technical cooperation with its member countries to fight communicable and noncommunicable diseases and their causes, to strengthen health systems, and to respond to emergencies and disasters. PAHO is committed to ensuring that all people have access to the health care they need, when they need it, with quality and without fear of falling into poverty. Through its work, PAHO promotes and supports the right of everyone to good health. PAHO has 35 Member States and four Associate Members in the region. Under their leadership, PAHO sets regional health priorities and mobilizes action to address health problems that respect no borders and that, in many cases, jeopardize the sustainability of health systems. PAHO wears two institutional hats: it is the specialized health agency of the Inter-American System and also serves as Regional Office for the Americas of the World Health Organization (WHO), the specialized health agency of the United Nations. From its Washington, D.C., headquarters, 27 country offices and two specialized centers in the region, PAHO promotes evidence-based decision-making to improve and promote health as a driver of sustainable development. See Pan American Health Organization, "Who We Are" (last visited 21 December 2025), online: .
35 IACHR, "Special Rapporteurship on Economic, Social, Cultural, and Environmental Rights" (last visited 21 December 2025), online: .
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41 See World Health Organization, "World Health Assembly Agreement Reached on Wide-ranging, Decisive Package of Amendments to Improve the International Health Regulations And Set Date for Finalizing Negotiations on a Proposed Pandemic Agreement" (1 June 2024), online: .
42 Symposium Proceedings 2024.
43 Symposium Proceedings 2024.
44 See Roojin Habibi et al., "The Principles and Guidelines on Human Rights and Public Health Emergencies" (2023) University of Groningen Faculty of Law, Research Paper No 2023/14.
45 Symposium Proceedings 2024.
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60 Symposium Proceedings 2024.
61 The IHR already has consensus driven guidelines provided by the IHR Emergency Committees. They may not be as effectively taken up by Member States, but they are actively produced and disseminated during health emergencies.
62 Symposium Proceedings 2024.
63 David L Heymann et al, "Global Health Security: The Wider Lessons from the West African Ebola Virus Disease Epidemic" (2015) 385:9980 Lancet 1884. https://doi.org/10.1016/S0140-6736(15)60858-3
64 Arush Lal et al, "Fragmented Health Systems in COVID-19: Rectifying the Misalignment Between Global Health Security and Universal Health Coverage" (2021) 397:10268 Lancet 61-67. https://doi.org/10.1016/S0140-6736(20)32228-5
65 Tim K Mackey et al., "The Sustainable Development Goals as a Framework to Combat Health-Sector Corruption" (2018) 96:9 Bulletin World Health Organization 634. https://doi.org/10.2471/BLT.18.209502
66 Global Burden of Disease 2021 Health Financing Collaborator Network, "Global Investments in Pandemic Preparedness and COVID-19: Development Assistance and Domestic Spending on Health Between 1990 and 2026" (2023) 11:3 Lancet Global Health e385.
67 Lawrence O Gostin, Eric A Friedman & Sarah A Wetter, "Responding to Covid-19: How to Navigate a Public Health Emergency Legally and Ethically" (2020) 50:2 Hastings Centre Report 8. https://doi.org/10.1002/hast.1090
68 Rebecca Forman & Elias Mossialos, "The EU Response to COVID-19: From Reactive Policies to Strategic Decision-Making" (2021) 59:1 J Common Market Studies 56. https://doi.org/10.1111/jcms.13259
69 Ramya Kumar et al, "Decolonising Global Health Research: Shifting Power for Transformative Change" (2024) 4:4 PLOS Global Public Health 1. https://doi.org/10.1371/journal.pgph.0003141
70 Ibid at 1.
71 Symposium Proceedings 2024.
72 Symposium Proceedings 2024.
73 Symposium Proceedings 2024.
74 Symposium Proceedings 2024.
75 Symposium Proceedings 2024.
76 Symposium Proceedings 2024.
77 Symposium Proceedings 2024.
78 Symposium Proceedings 2024.
79 Symposium Proceedings 2024.
80 Symposium Proceedings 2024.
81 Symposium Proceedings 2024.
82 Symposium Proceedings 2024.
83 Symposium Proceedings 2024.
84 Symposium Proceedings 2024.
85 Symposium Proceedings 2024.
86 Symposium Proceedings 2024.
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88 Symposium Proceedings 2024.
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Comments
"Statement and Declaration: The symposium findings presented in this proceedings paper do not necessarily represent a consensus of views by all the authors. Our gratitude goes to Grace Lowe and Alyssa Shi, the research assistants who supported Dr Uchechukwu Ngwaba in planning and hosting the symposium at the Lincoln Alexander School of Law, Toronto Metropolitan University, on April 29-30, 2024. Our Special gratitude goes to the Lincoln Alexander School of Law Internal grants fund for partially funding the symposium in 2024; and to Dr A.M. Viens for securing matching funds for the symposium from York University’s School of Global Health. We thank all participants at the symposium whose rich contributions and insights has enabled the preparation of this proceedings paper."