全球公共卫生治理机制的形成与演变:国家利益
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摘要
《国际卫生条例》(2005)是统领全球公共卫生集体行动最权威的法律框架,但是在实施之初却出现了机制失灵的现象。印尼拒绝向WHO转送流感病毒菌株的不合作行为几乎将《国际卫生条例》(2005)建立的合作机制推至崩溃的边缘。为什么《国际卫生条例》(2005)在实施过程中会出现机制失灵?本文以博弈论为分析工具探讨了《国际卫生条例》(2005)的立法、实施和完善过程,检验并证实了国家利益是全球公共卫生治理机制形成与演变的主要动因之假设。
     检验《国际卫生条例》(2005)的立法过程发现:如果存在共同的利益,即使是对立阵营的国家也会提出相同的立法意见,主权渡让议题中发展中国家与发达国家的立法意见趋同证明了该论断;如果存在利益冲突,即使同一阵营的国家也会产生相互背离的立法意见,规制范围议题中美国与其他发达国家立法意见的冲突证实了该论断。由此可见,国家利益是影响全球公共卫生治理机制形成的重要变量。
     检验《国际卫生条例》(2005)的实施过程发现:病毒菌株具有全球公共物品的属性,其利用牵动着全球社会的公共利益,但是病毒菌株的研发能够衍生丰厚的私人利益却是不争的事实,而且病毒菌株衍生的利益在全球分配失衡;病毒及相关利益分配失衡的情况下,《国际卫生条例》(2005)的立法遗憾致使不能及时提供具体的制度安排来挽救利益分配失衡的状态,乃是《国际卫生条例》(2005)在实施中出现机制失灵的真正原因。由此可见,国家利益是导致全球公共卫生治理机制在实施当中走向崩溃的主要原因。
     检验《国际卫生条例》(2005)的完善过程发现:信息不对称是导致国家能够主张病毒主权权利并拒绝共享病毒菌株的外部环境;该外部环境引发了道德风险问题;解决道德风险问题之路径在于设计激励机制来构建病毒主权权利及相关利益,公平地分配这些利益使得失衡的利益分布状态重新恢复均衡。设计激励机制必须满足最低参与约束和激励相容约束两个必要条件。压缩与放宽这两个必要条件直接牵涉到发展中国家与发达国家的国家利益增减。给定对立阵营国家间的争议,《国际卫生条例》(2005)的完善就是要找到最低参与约束条件和激励相容约束条件的最优参数设定,重构发展中国家与发达国家的利益均衡,并且使双方都不愿意偏离之。由此可见,国家利益是弥补全球公共卫生治理机制立法缺陷不可或缺的一环。
     综上,立法之争证实了国家利益是影响全球公共卫生治理机制成功立法的重要变量;实施之争揭示了国家利益是推动全球公共卫生治理机制走向崩溃的主要原因;完善之争提示了国家利益是弥补全球公共卫生治理机制立法缺陷不可或缺的一环。因此,文章的总体假设——国家利益是全球公共卫生治理机制形成和演变的主要动因被证实了。
The International Health Regulations (2005)(IHR(2005)) is the most authoritative legalframework of the global health collective action in the world. However in the beginning of theIHR(2005)implementation, it appeared mechanism failure. Indonesia refused to transfer WHOthe influenza virus sample. Indonesia’s action almost collapse the cooperation mechanismestablished by the IHR(2005). Why did the IHR(2005)happen to mechanism failure during itsimplementation? After study in the legislation, implementation and improvement process of theIHR(2005)by game theory, this dissertation has tested and verified the hypotheses that nationalinterest is a significant impact factor not only in the emergence and development process but alsothe implement process of global health governance mechanism.
     From testing the legislation process of IHR(2005), the dissertation found that: if there arecommon interest, even opposing faction, the country will hold the same legislative advice.Developing and developed countries proposed the same opinion in the sovereign issue provedthe thesis; if national interest are conflict each other, even if the countries come from the samefaction will also have different legislative opinion. Different opinion about the range issues ofIHR(2005)between the United States and other developed countries proved this thesis.Therefore national interest is an important motivation factor in global health governancemechanism legislation process.
     From testing the implementation process of IHR(2005), the dissertation found that: virusstrains is one kind of global public good, its utilization corelate with the global community.However it can not be denied that plenty of private profits can been derived from virus strainssimple by research and development, meanwhile those interest distribution is unbalance in thewhole world. Under this circumstance, the main reason of mechanism failure happened toIHR(2005) is laid in that legislation defection of IHR(2005) can not govern this global unbalanceinterest structure. Therefore national interest is an important motivation factor which can causemechanism failure when global health mechanism running.
     From testing the improvement process of IHR(2005), the dissertation found that:information asymmetry provides ideal external circumstance in which country can assert its virus sovereignty and refuse to transfer virus strains sample. This external circumstance causes moralhazard problem. The solution of moral hazard problem is to design the incentive mechanism toconstruct virus sovereign rights and related interest. The incentive mechanism can distribute theinterest fairly enough to restore global equilibrium in global health problem domain. Incentivemechanism design must meet with two constraint: individual rationality constraint and incentivecompatibility constraint. Compressing and relaxing the two necessary conditions directly involvethe interest of developing countries and developed countries. Given dispute between opposingfaction, the purpose of improvement process is to set parameters of individual rationalityconstraint and incentive compatibility constraint good enough to reconstruct the global interestequilibrium and make the global interest structure in health issue more stable. Therefore nationalinterest is an important motivation factor which can make compensation for the defection ofglobal health mechanism.
     In conclusion, the dispute in legislation process of IHR (2005) confirm that national interestis an indispensable factor. The dispute in implement process of IHR (2005) confirm that nationalinterest is an important variable. The dispute in improvement process of IHR (2005) confirm thatnational interest is a significant determinant.Therefore, the general hypothesis that nationalinterest is a significant impact factor in global health governance mechanism domain has beenconfirmed in the end.
引文
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    306鸡胚培养灭活疫苗:通过在鸡胚中培养流感病毒来生产疫苗,然后提纯与灭活并制成化学制剂。细胞培养灭活流感疫苗(“cell-细胞培养灭活流感疫苗”,也称“组织细胞培养灭活流感疫苗”),通过细胞培养代替鸡胚来生产灭活疫苗。鸡胚培养活性减毒疫苗(Egg-鸡胚培养活性减毒疫苗,又称“冷适应流感疫苗”)含有活病毒,但活性被弱化到不会引发流感但可诱导免疫反应。资料来源:WHO大流行性流感防范政府间会议.大流行性流感的防范之为共享利益持久筹资的方案:A/PIP/OEWG/3/2[C/OL].(2011-04-04)[2012-08-30]. http://apps.who.int/gb/pip/c/C_Pip_oewg3.html.
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    346当然对于当事成员国来说其所拥有信息优势是得天独厚的,但是并非完美的。因为交易成本总是客观存在,当事成员国对各突发重大公共卫生事件的观察范围受本国的观察能力所限制。例如对同一流行病毒株的基因解码不同科研实力的国家会获得不同程度的研究成果。
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    348不确定性是指,只要事件或决策的可能结果不止一种,就会产生不确定性:[英]伊特韦尔,[美]米尔盖特,纽曼.新帕尔格雷夫经济学大辞典[M].北京:经济科学出版社,1996:785.
    349行为者所面临的随机性能用具体的数值概率来表述(这些概率可以像拿到彩票一样客观地确定;否则就反映了个人自己的主观信念),那么,就可以说这种情况涉及风险。当用彼此排斥和详尽无遗的自然状态(或世界状态)组成的集S={s1,…,sn},而不是用数值概率来反映个人所面临的随机性,即为风险偏好描述:[英]伊特韦尔,[美]米尔盖特,纽曼.新帕尔格雷夫经济学大辞典[M].北京:经济科学出版社,1996:216.
    350期望效用理论讨论的是对于种种行为的选择,而决策者对某项被选的行为将会产生什么后果并不一定知道。当面临着几种行为时,决策者将会选择“期望效用”最大的行为,在这种场合,一种行为的期望效用是全部可能后果的概率与效用的乘积之和:[英]伊特韦尔,[美]米尔盖特,纽曼.新帕尔格雷夫经济学大辞典[M].北京:经济科学出版社,1996:246-249.
    351道德风险,是指从事经济活动的人在最大限度地增进自身效用时作出不利于他人的行动。道德风险存在于下列情况:由于不确定性和不完全的、或有限制的合同使负有责任的经济行为者不能承担全部损失(或利益),因而他们不承受他们的行动的全部后果,同样地,也不享有行动的所有好处:[英]伊特韦尔,[美]米尔盖特,纽曼.新帕尔格雷夫经济学大辞典[M].北京:经济科学出版社,1996:588-591.
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    354如果某一信息是所有参与人都知道的,每个参与人都知道所有参与人知道这一信息,每个参与人都知道所有参与人知道所有参与人知道这一信息,而且如此这般直至无穷,那么这一信息便称为共同知识。[美]艾里克·拉斯缪森.博弈与信息[M].韩松等译.北京:中国人民大学出版社,2009:58.
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    405105thCongress,1stSession, Senate Resolution98of12June1997.
    406WHO大流行性流感防范政府间会议.泰国对大流行性流感的防范政府间会议的建议:A/PIP/IGM/6[C/OL].(2007-11-09)[2012-04-15]. http://apps.who.int/gb/pip/c/C_pip1.html.
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    [17] A/PIP/IGM/8: Reports of the Director–General Establishment of the AdvisoryMechanism.
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    [19] A/PIP/IGM/10: Operational Guidelines and Procedures for Deployment of theAntivirals.
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    [21] A/PIP/IGM/WG/2:Standard Terms and Conditions.
    [22] A/PIP/IGM/WG/3:Terms of Reference.
    [23] A/PIP/IGM/WG/4:Benefit Sharing.
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