The article examines the historical development of global health from its genesis in colonial-era tropical medicine, to the creation of the World Health Organization – formed to advance health rights for all. The authors call for continued reforms to the global health governance system to mitigate the enduring impact of colonialism.

Researchers involved in research misconduct proceedings are increasingly threatening or bringing legal defamation claims against the institutions, complainants, and publications involved in the proceedings. Although defamation claims do not often succeed, they can nevertheless be costly and lengthy. This article analyzes certain defamation cases in the research misconduct space and provides advice for institutions and other involved parties seeking to minimize potential defamation liability associated with research misconduct proceedings.

In 2023 the Supreme Court of Mauritius cited human rights and public health arguments to strike down a colonial-era law criminalizing consensual same-sex sex. The parliament of Singapore recently did the same through legislative means. Are these aberrations or a shifting global consensus? This article documents a remarkable shift international legal shift regarding LGBTQ+ sexuality. Analysis of laws from 194 countries across multiple years demonstrates a clear, ongoing trend toward decriminalization globally. Where most countries criminalized same-sex sexuality in the 1980s, now two-thirds of countries do not criminalize under law. Additionally, 28 criminalizing countries in 2024 demonstrate a de facto policy of non-enforcement, a milestone towards legal change that all of the countries that have fully decriminalized since 2017 have taken. This has important public health effects, with health law lessons for an era of multiple pandemics. But amidst this trend, the reverse is occurring in some countries, with a counter-trend toward deeper, harsher criminalization of LGBTQ+ sexuality. Case studies of Angola, Singapore, India, Botswana, Mauritius, Cook Islands, Gabon, and Antigua and Barbuda show many politically- and legally-viable pathways to decriminalization and highlight actors in the executive, legislative, and judicial arenas of government and civil society engaged in legal change.

The Inflation Reduction Act (IRA) creates a new process to cap Medicare Part D branded drug prices. It prohibits Medicare from paying more than a specified discount from average private market prices and requires that CMS negotiate with manufacturers to agree on a maximum fair price that Medicare will pay that is lower than the specified discount. This article analyzes the cause of high drug prices and how negotiations to set the maximum fair price might unfold. It compares Medicare’s new pricing process to the way drug prices are set in Medicaid, the Veterans Administration, U.S. private insurers, and European nations. It analyzes how negotiations to set the maximum fair price might unfold in light of negotiation theory and the practices to negotiate prices employed in Europe. It draws inferences from the initial published data on the first round of negotiated prices.

The discipline of public health has begun to recognize the structural inequities of the carceral system as drivers of poor individual and population health. The number of people incarcerated and the length of their incarceration determine the scope and gravity of their exposure to these individual and public health effects. Plea bargains all but guarantee a period of incarceration, often for many years, because prosecutors have significant bargaining power against defendants who often do not fully understand their rights or the likelihood of receiving the sentences that prosecutors would be seeking in trial. I propose and analyze several pathways through which to eliminate or severely restrict the practice of plea bargaining to minimize the health effects associated with incarceration. I conclude that state legislation would be most feasible and effective at eliminating plea bargains but, without concurrent interventions addressing mandatory minima and/or bail, would not fundamentally address the primary concerns of sentence length and overcrowding.

This article first describes shifts in human rights law that have led to improvements in the realization of sexual and reproductive health and rights (SRHR) over the last decade. The article does so, however, with careful attention to the structural factors beyond formal legal mechanisms that may undermine the ability of governments, even with the best of intentions, to fully develop the necessary robust health and justice systems. Second, this article considers two additional factors: the political economy factors that enable or limit the ability of States to realize SRHR, as well as the growing evidence base that supports positive legal transformation.

From its beginnings in the 1978 Declaration of Alma-Ata, universal health coverage (UHC) has been constantly evolving, notably so within the last ten years. Although the 2015 Sustainable Development Goals, which identify both UHC and social protection among its targets, represent an important juncture in this evolution, several States are unlikely to meet the 2030 target deadline. This article traces the history of UHC and social (health) protection in global health law, focusing on their development over the past ten years. It concludes by reflecting on what the future of UHC and social (health) protection should look like and what is needed to fully realize their potential to achieve equity and to meaningfully contribute to the betterment of people and planet, highlighting human rights, One Health, legal and financial considerations as key for the future.

On June 1, 2024, the World Health Assembly reached consensus on a package of amendments to the 2005 International Health Regulations (IHR). These amendments follow nearly two decades of implementation and an intensive multilateral process prompted by the global struggle against COVID-19. This article critically examines whether the amended IHR reflect lessons learned from the pandemic, potentially ushering in a new era for global health law in pandemic preparedness and response, or if they deflect attention from the need for deeper structural reforms. While the IHR remain the only near-universal legal framework for preventing and addressing the international spread of disease, these amendments emphasize equity and solidarity, and potentially shift the IHR from a technical instrument to one focusing on inherently political issues. This analysis examines key IHR amendments and their implications for the future of global health law, particularly in the context of equity, financing, and implementation.

Artificial Intelligence (AI) has the potential to revolutionize public health surveillance by analyzing large datasets to detect outbreaks. However, privacy, consent, and governance issues persist. While the International Health Regulations do not explicitly mention the use of AI in infectious disease surveillance, transparent processes, accountability, and public trust are key for responsibly integrating AI in pandemic preparedness.

Colonialism has produced the global health system, and decoloniality must inform global health law. This article considers the foundational impact of colonialism on the global health system and advocates for adopting decoloniality as a crucial framework to reshape global health law. Through a historical lens, it examines how European colonialism established power dynamics and structures that continue to influence contemporary global health governance. This article calls for overcoming enduring challenges by emphasizing the urgency of dismantling outdated and unjust systems that perpetuate health inequities and hinder effective interventions. It argues for a paradigm shift toward epistemically inclusive, ethical, and equitable practices, emphasizing the active participation of marginalized communities in health policymaking. By addressing the root causes of health disparities and decoupling health systems from racial capitalism, a decolonial approach promises a more just and effective future for global health law.

International law and global governance regimes for environmental health challenges have been slow to reflect the intertwined relationship between the environment and human health. Historical legacies have caused artificial fragmentation between the two that has resulted in distinct fields of international law and institutions for the environment and health. However, new global paradigms for thinking about environmental health have emerged to foster synthesis under global health law, including One Health and Planetary Health approaches, as well as through international human rights law like the recognition of the right to a clean, safe, and healthy environment. Guided by equity, new international law and global governance reforms, including the proposed Pandemic Agreement and Plastics Treaty, are opportunities to synthesize the intersecting dimensions of the environment and global health. However, future paths towards cohesion must explicitly incorporate human rights in environmental health governance, including the rights of Indigenous Peoples, while actively addressing inequities in global health law, between and within countries, and across generations.

The field of global health law encompasses both “hard” law treaties and “soft” law policies that shape global health norms. Transitioning from “international health law” to “global health law and policy,” global health policymakers have increasingly looked to soft law instruments to address public health needs in a rapidly globalizing world – within the World Health Organization and across global health governance. Yet, as policymakers have expanded the landscape of soft law policy instruments to advance global health across state and non-state actors, the COVID-19 response revealed the limitations of this soft law approach to global health threats, with states now seeking hard law reforms to strengthen global health governance. As hard and soft law can provide complementary approaches to preventing disease and promoting health, future research must conceptualize how these normative frameworks interact in advancing global health.

In the decade since the first edition of Global Health Law was published, the world has moved incrementally towards global health with justice, at least by one basic metric: life expectancy has edged up globally, with more rapid gains in low- than high-income countries. But to look around the world, global health with justice still seems a distant dream. Health gaps between people in rich and poor countries remain shocking and unconscionable—as do health inequities within countries. The pandemic also gave salience to profound health injustices—from injustices in access to lifesaving vaccines to gaping disparities in morbidity and mortality based on income, race, and national origin. So did the Trump administration’s decision to pause, and then slash, foreign assistance, bringing an end to lifesaving programs around the world. Guided by the overarching theme of justice, these reflections canvass the history of global health law as a field and discuss developments and challenges in the field across four core themes: multilateralism; equitable distribution of the benefits of scientific advancement; global health law for the poly-crises; and human rights and equity.

The field of global health law has evolved over the past decade to describe new legal and policy instruments that apply to a changing set of public health threats, non-state actors, and regulatory norms that structure the global response to public health challenges. This special issue—bringing together the O’Neill Institute for National & Global Health Law and the Global Health Law Consortium—examines the expansive evolution of the field of global health law and its continuing development to face new health threats.

Scientific advances to fight infectious diseases have been remarkable. International law and global governance have sought, and often failed, to keep pace, secure equity, and stop outbreaks. We trace the law and governance model emerging from early failure in the AIDS response and identify four elements: use of law by national governments to compel sharing; decentralized generic manufacturing; mechanisms for voluntary sharing of patents and technology transfer; international funding. In combination, these created a remarkable new ecosystem. We find that when COVID-19 hit and mRNA vaccines were rapidly developed, global North governments opposed mobilizing this synergistic model. Instead, equity efforts focused on financing purchase of vaccines from originator companies with little use of law. Amidst monopolies and scarcity of doses, vaccine nationalism fatally undermined this effort. Whether more synergistic law and governance emerges from rapidly changing global health law will likely dictate the efficacy of future global infectious disease response.

The tenth anniversary of the publication of Lawrence Gostin’s seminal treatise Global Health Law affords us the opportunity to reflect on his enduring legacy as a preeminent scholar, and one of the field’s founding thought leaders.

Law can function and act on norms, through legislation, regulation, treaties and the like. Law can also be a key accompaniment to activism. The career of Larry Gostin represents both aspects of the law in achieving social change.

Over the last three years, Larry Gostin, I, and many others have urged world leaders to open their minds toward specific subsets of reform in the interest of pandemic response, including mechanisms for transparency, accountability, and, crucially, financial buy-in. With negotiations for a new pandemic accord still incomplete, our focus must remain on reaching global agreement, and keeping at top of mind the immense stakes if that is not possible.

Communities and individuals globally continue to suffer the violent impacts of colonialism and racism, in a global system of governance that remains rooted in unequal and hierarchical power imbalances. The interpersonal, societal, and structural violence that persists around the world exists in violation of human rights, and is evidence of a persistent lack of political will to effectively invest in human rights, including the right to health, as a true priority.

The demand on States and non-State actors to fulfil the human right to health is imperative. Attacks on civilians during times of conflict and catastrophe, as seen in the latest escalation and display of imperial aggression by Israel in the occupied Palestinian territory, demonstrate the consistent uneven application of human rights and commitment to fulfilling them.

Protecting human rights, and specifically the realization of the right to health, is fundamental as it has significant consequences for the realisation of other human rights. Eliminating discrimination requires paying sufficient attention to groups of individuals that suffer historical or persistent prejudice. Fulfilling a commitment to health equity and justice demands creating opportunity and conducive conditions for the dignity for all people.

Retracted research publications reached an all-time high in 2023, and COVID-19 publications may have higher retraction rates than other publications. To better understand the impact of COVID-19 on the research literature, we analyzed 244 retracted publications related to COVID-19 in the PubMed database and the reasons for their retraction. Peer-review manipulation (18.4%) and error (20.9%) were the most common reasons for retraction, with time to retraction occurring far more quickly than in the past (13.2 mos, compared with 32.9 mos in a 2012 study). Publications focused on controversial topics were retracted rapidly (mean time to retraction 10.8 mos) but continued to receive media attention, suggesting that retraction alone may be insufficient to prevent the spread of scientific misinformation. More than half of the retractions resulted from problems that could have been detected prior to publication, including compromise of the peer review process, plagiarism, authorship issues, lack of ethics approvals, or journal errors, suggesting that more robust screening and peer review by journals can help to mitigate the recent rise in retractions.