Nouvelles

By Gaëlle Foucault and Catherine Régis^[1]

‍

« The report is timely and essential » (Roojin Habibi)

‍

On June 2, 2025, the webinar “Perspective on WHO’s Normative Leadership: An Empirical and Comparative Analysis of Six States” was held, at which eight speakers presented and commented on the findings of the report entitled The Normative Leadership of the World Health Organization (WHO): A quantitative analysis (2025). Released in 2025, this report provides an in-depth exploration of the use in domestic law of international health law, with a particular focus on the norms produced by the World Health Organization (WHO). It offers several recommendations, including a call for the WHO to engage more broadly with state actors, extending beyond health ministries. Enriched by the expertise of each speaker, the data compiled in this report gave rise to lively reflection and discussion, not least due to the current ambivalent climate surrounding the WHO, marked by both concern (with the announced departure of the USA and Argentina from the WHO) and renewed hope (such as adoption of the “Pandemic Treaty”^[2] ).  

        The webinar opened with a presentation by Catherine Régis (lead researcher), who outlined the objectives of the research project behind this report^[3] . Aimed at understanding the process by which WHO-produced norms land in domestic jurisdictions, and the normative leadership of the latter, this project is based on an interdisciplinary and empirical methodology that paves the way for a fine, concrete understanding of this journey of international norms into domestic law.

  Drawing on an analysis of over 5,800 national instruments (laws, regulations, court decisions) across eight countries (Brazil, Canada, Costa Rica, the United States, France, Israel, New Zealand, and Switzerland), the research presented original results whose relevance was confirmed by all webinar participants, particularly in today’s tense global context for both the WHO and international law.

        The webinar was then enriched by a detailed presentation of the data and comments from six speakers: Miriam Cohen (Brazil), Pierre Larouche (Canada), Hugo Muñoz (Costa Rica), Gaëlle Foucault (France), Sandra Hotz (Switzerland) and Katherine Ginsbach (USA).

All of these presentations highlighted the importance of contextualizing data, which is essential for a preciseunderstanding of the modalities and factors shaping the landing of international norms in domestic law. Thus, in the light of their comments, one conclusion emerges unanimously: there is no “one size fits all” model to explain the journey ofWHO norms. In this respect, the numerous graphs presented in the report illustrate the diverse national profiles that emerge from the data collected. For instance, while references to the WHO in regulations are minimal in Canada and New Zealand (7% and 5%, respectively), they are far less marginal in Costa Rica and France (28% and 30%, respectively). Another striking contrast appears regarding the supreme courts: whereas over 1,000 decisions citing the WHO were found in Costa Rica, Switzerland and Brazil, only 4 decisions were found in the United States, and just one in New Zealand.

National characteristics are thus a determining factor in the use by States of the normative content produced by the WHO, as confirmed by the speakers, which represents a real challenge for the WHO. For example, Hugo Munozexplained that, as a civil law country, Costa Rica is guided by legal formalism, which requires material sources (in this case, non-binding WHO norms) to be incorporated into domestic law by means of an official act, which could explain the large number of regulations citing the WHO found in this research. Similarly, whether it be the specialization of national courts (e.g. in insurance matters) (Sandra Hotz), their jurisdictional scope (Miriam Cohen), or the extent of regulatory power granted to national executive authorities (Gaëlle Foucault), all off these factors can significantly influence the use of WHO norms by national authorities. By drawing on states with diverse characteristics (federal/unitary - monist/dualistic - parliamentary/presidential/hybrid - common law/civil law, etc.), the analysis developed in the report, enriched by insights from national experts, helped identify the characteristics most likely to affect the use (or not) of WHO norms by national authorities.

As in the report, two angles received more unanimous support from the speakers as key factors influencing the use of WHO norms: the crisis context and WHO expertise. The report notes that in 2020, in the midst of the Covid-19 crisis, references to the WHO increased in all the countries studied, albeit to varying degrees. Similarly, while the WHO’s expertise had also been strongly emphasized, particularly in the light of the International Classification of Diseases (ICD), which is the most cited WHO instrument in the corpus of this study (1959 references found), this observation was consolidated by Pierre Larouche’s intervention. His presentation underlined the importance of viewing this international organization not merely as a normative or political entity, but as an expert in scientific knowledge, in order to understand how its norms are mobilized by national experts. In this respect, he particularly emphasized the existence of “parallel channels” to the traditional legislative and regulatory processes, which position experts as key actors in the journey ofWHO norms, especially in the context of disputes brought before national courts.

Katherine Ginsbach’s comments also confirmed the WHO’s unifying role, a role shared by many international organizations. The WHO is indeed to be commended for its efforts to standardize and harmonize positions, for example regarding the signs and symptoms of diseases (see ICD), which are essential in globalized world or within large, federally structured states such as the United States.

The presentations concluded with remarks from Roojin Habibi, who underscored the interest and importance of understanding the impact of WHO norms (and beyond binding instruments alone), a concern made all the more pressing in the context outlined above. Grasping this impact requires close attention to the phase of “translation and integration into domestic law”, a phase made particularly relevant by the recent adoption of amendments to the International Health Regulations and the “Pandemic Treaty”, with a view to amplifying their effects. By shedding light on the landing process of WHO norms in domestic law, and providing both explanatory insights and concrete examples, the report directly addresses the need for a better understanding of the impact of this international organization’s norms – an issue that remains especially challenging^[4] in the absence of any formal feedback or dialogue mechanism between the WHO and the recipients of its norms. It is precisely on this point that Roojin Habibi emphasized the report’s potential contribution to general international law.

        Finally, the question-and-answer session opened the door to a discussion of a pivotal moment for the WHO - which no one could ignore on this June 2, 2025: the organization’s future being threatened by the announced withdrawal of its largest contributor, the United States. According to the interviews conducted during the research project, Catherine Régisemphasized that all key stakeholders (civil society, academics, WHO staff and staff from other organizations, etc.) recognized the irreplaceable nature of the WHO. Yet, as Roojin Habibi reminded the audience, concerns remain over the severity of the financial constraints faced by the WHO. This raises several questions: what is the future of the WHO? How can it pursue its mission “to advance the health of all peoples to the highest possible level” (art. 1 of its Constitution)? In this regard, maximizing WHO’s comparative strengths and focusing on areas where its involvement is indispensable may be strategic options to consider (Catherine Régis).

Doubts are also growing within the United States, not least because of the country’s long-standing collaboration with the WHO. If the question of what the WHO would become without the United States must be asked, the reverse question is equally compelling. As highlighted by Katherine Ginsbach and Pierre Larouche, there is reason for optimism: the scientific community is mobilizing to preserve norms, knowledge and data, and a complete severing of ties between healthcare professionals and the WHO appears unrealistic, despite the intentions of the US government.

        The webinar thus ended on an enthusiastic note, both for global health and for international law research. And the research doesn’t stop there... Buoyed by fascinating exchanges and speakers with rich, stimulating ideas, new avenues of research were proposed to further the reflection on the WHO's normative leadership and its impact at the national level.

·      Exploring how states influence and shape the WHO agenda (Pierre Larouche).

·      Reflect on the development of “hybrid legal frameworks” that would better integrate international soft law norms while maintaining legal certainty (Hugo Muñoz).

·      Analyze the legislative/political process as a whole to address the lack of references to the WHO in the final version of the text (Sandra Hotz and Roojin Habibi).

·      Further explore the adoption and use of WHO norms at the subnational level, particularly in contexts where the federal government is turning away from evidence-based science (Katherine Ginsbach and Roojin Habibi).

·      Explore the competitive context caused by the rise of regional alternatives (Roojin Habibi).

·      Explore the impact of state resources and capacities on the adoption of, and compliance with, WHO norms (Roojin Habibi).

‍

The event is available on the CRDP youtube site at the following address: https://www.youtube.com/watch?v=p2UyFCyt4_0&t=2679s

‍

^[1] We would like to thank Stanislas Boda for its contribution to the blog post.

^[2] On the treaty development process and its next steps, see our previous blog post entitled « L’analyse du “Traité pandémie” par l’Organisation mondiale de la Santé : une prouesse malgré un multilatéralisme fragilisé », available online at: https://www.h-pod.ca/actualite/ladoption-du-traite-pandemie-par-lorganisation-mondiale-de-la-sante-une-prouesse-malgre-un-multilateralisme-fragilise  

^[3] For a detailed presentation of the research project and the team, see the presentation available on the H-pod website: https://www.h-pod.ca/projet-oms

^[4] See in particular: Catherine Régis, Gaëlle Foucault, Jean-Louis Denis, Pierre Larouche and Miriam Cohen, “Challenges for impact evaluation of WHO’s normative output”, (2024) 102-10 WHO Bulletin 683.

‍