My book project examines the design and effectiveness of the World Health Organization's (WHO) International Health Regulations (IHR)—the primary tool for governing the international response to disease outbreaks like Ebola, Middle East Respiratory Syndrome, and H1N1 influenza. The project asks two questions: First, why in 2005, after 50 years of stagnation, did states revise the IHR and delegate increased authority to the WHO during disease outbreaks? Second, why, in spite of signing on to the new regulations, do many states continue to act in ways that undermine their effectiveness? 

I argue that politics within international organizations (IOs) play a key role in facilitating—or inhibiting—institutional revision like the 2005 revision of the IHR. Though IOs can help to overcome barriers to cooperation by constructing a focal point that builds consensus among states, I contend that divided IO preferences can prevent the institution from fulfilling this key function and obstruct agreement. To evaluate this argument, I use thousands of previously unexamined archival documents collected from WHO to process trace four periods of IHR revision (1951, 1969, 1995-2002, 2002-2005). These episodes show that even when states favored IHR revision and wanted WHO to exercise autonomy and facilitate cooperation, divided preferences within WHO over whether and how to expand its mandate delayed revision and obstructed the realization of joint gains. 
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Even after the IHR were finally revised, however, many states continue to undermine their effectiveness. A principal aim of the new regulations is to discourage the use of unnecessarily restrictive trade and travel barriers during outbreaks because these barriers are not effective and they incentivize states to conceal outbreaks in order to avoid economic harm. Despite signing onto the new IHR, during the 2009 H1N1 pandemic and the 2014-15 Ebola outbreak, close to 25% of states still imposed trade and travel barriers in excess of WHO recommendations. I argue that states use these barriers as political cover to prevent a loss of domestic political support that can result from not addressing public fear. As such, governments anticipating high domestic political costs for not imposing barriers during an outbreak—electorally accountable states with weak health infrastructure—will be likely to do so. Analysis of an original dataset coding state behavior during the 2009 H1N1 pandemic (the first test of the new IHR) and the 2014-2015 outbreak of Ebola finds strong support for this theory.

In exploring fundamental questions about state cooperation and the role of IOs in a novel context, the project not only provides insight into the design and performance of IOs, but also sheds light on whether and how these organizations can help to solve real world problems like the challenge of outbreak response.