# Activity 5.1 What is a state? # Activity 5.2 International Organisations Choose an IO of interest to you or with which you have previously engaged. Using the knowledge of international institutions gained in this session and elsewhere on the course, list the ways in which its member-states are affected by their membership of this organisation. Think of the following questions in preparing your answer: In what ways are states able to use these institutions to achieve their aims and objectives? Are some states more able to do this than others?  In what way do these organisations curtail states’ formal (_de jure_) and effective (_de facto_) capacity for (independent) action --- World Health Organization and its Essential Medicine List Indonesia has benefitted from WHO's curation on Medicine (EML) and Diagnostics (EDL) to guide the national's essential medicine list (in Indonesia it's called DOEN), and ultimately, the national h ealth insurance scheme derived its treatment using the drugs listed from DOEN. In short, Indonesia benefits from WHO's normative power in developing standards and guidelines in terms of medicine. Member states such as Indonesia, which, in my perspective, still leans towards protectionist policy regarding [[MNCs]]' influence and market liberalisation, can utilize WHO's guidelines to guide and inform the nation's policy. Other states may be able to utilize it more than Indonesia. For example, Indonesia's national health insurance budget constraint might prevent us from adopting certain innovative medications that are included in WHO's EML, eg, dapagliflozin for diabetes patients. The drug is still in patent and Indonesia only has one supplier, so the cost is too high to be reimbursed by the national health insurance. This fact also underscores the disparity caused by market liberalisation, while it increases access to a state, it does not automatically translate to benefit-for-all, if not, increases health disparity within a state. World Health Organisation, when it guides the essential medicine list, considers the cost-effectiveness for ALL its member states. However, a state might need to reevaluate the component, suppose that its national population is big enough to include innovative medicines that were ruled out by WHO and bring the price lower using the market's supply and demand logic. In conclusion, WHO empowers the state by giving an international guideline on medicines a state should include in their health system, but on the other hand, it might impair the state by limiting the state's view only to see what's already in the list rather and not what's already ruled out. # Activity 5.3 Global Pandemic Preparedness: The Case of SARS This case study and activity focuses on the 2003 SARS outbreak and the consequences of the political responses to this for the role of the state in the governance of communicable and infectious diseases. In your reading list you will see two articles by David Fidler (2004) and James Ricci (2009) who offer very different interpretations of this.  Write a brief commentary on these articles, summarising their arguments (1 paragraph each) and stating which you find more convincing and why (1 paragraph). Finally, what lessons do you think could be drawn from this for the handling of the Covid 19 pandemic? _Post your comments on the Activity 5.3 discussion forum on Moodle board to receive feedback from other students. Comment on at least two other posts made there._