How Law Safeguards Global Health: A Dialogue with Georgetown's Lawrence Gostin

In December 2020, at the height of the COVID-19 pandemic's global devastation, I invited Georgetown University Law Center Professor Lawrence O. Gostin for an in-depth dialogue as part of the Zhejiang University International Business School (ZIBS) "Dialogue with Masters" lecture series. Professor Gostin is the founding figure of the global health law field, serving as Director of the WHO Collaborating Center on National and Global Health Law and Human Rights. His book Global Health Law, published by Harvard University Press and translated into multiple languages including Chinese, is the most influential scholarly work in the field. This dialogue centered on the global health governance deficiencies exposed by COVID-19, as Professor Gostin used his unique legal perspective to reveal why law -- not merely medicine -- is the critical force safeguarding global public health.

1. COVID-19 and the Awakening Moment for Global Health Law

Professor Gostin began by pointing out that COVID-19 is the most severe pandemic in a century, comparable in scale to the 1918 influenza pandemic. But unlike a century ago, today's world possesses globalized governance frameworks and legal tools -- the question is whether these tools are functioning properly.

He recounted his experience drafting the Model Emergency Health Powers Act for the United States in the aftermath of the September 11 attacks and the anthrax incidents. This legislation provided a legal framework for U.S. states to implement quarantine, isolation, and resource allocation during public health emergencies. "Law is the core infrastructure of pandemic response," Professor Gostin emphasized. "Without legal authorization, governments cannot implement quarantine, conduct contact tracing, or enforce mask mandates; but without legal constraints, these powers can devolve into violations of human rights."

These words precisely articulate the core tension of global health law: it must simultaneously grant governments sufficient power to respond to crises while establishing clear boundaries to protect individual liberty. The outbreak of COVID-19 was the ultimate stress test for this balancing mechanism.^[1]

2. The Justice Dilemma of Vaccine Distribution: Who Should Be Vaccinated First?

At the time of our dialogue, the first COVID-19 vaccines had just received emergency use authorization, and vaccine distribution had become the most pressing ethical and legal issue. Drawing on his extensive research on vaccine distribution justice, Professor Gostin offered a profound analytical framework.

He argued that vaccine distribution must follow two fundamental principles: First, prioritize protecting the most vulnerable populations -- including healthcare workers, the elderly, and those with underlying conditions; Second, ensure equitable global access -- wealthy nations must not be allowed to hoard vaccines while developing countries become "vaccine orphans."

"We have witnessed disappointing 'vaccine nationalism,'" Professor Gostin stated bluntly. "Wealthy countries have purchased vaccine doses far exceeding their population needs, while healthcare workers in low-income countries cannot even access their first dose. This is not only a moral failure but also an epidemiological folly -- because as long as the virus continues to circulate in any country, it can mutate and threaten the entire world."

He went on to introduce the COVAX mechanism -- a global vaccine distribution platform jointly established by WHO, the Global Alliance for Vaccines and Immunisation (Gavi), and the Coalition for Epidemic Preparedness Innovations (CEPI). COVAX aimed to ensure that every country could vaccinate at least 20% of its population. However, Professor Gostin candidly acknowledged that COVAX faced multiple challenges including insufficient funding, supply chain bottlenecks, and political resistance.^[2]

3. Reforming the International Health Regulations: From "Paper Tiger" to Effective Governance

The most policy-rich segment of our dialogue concerned the reform of the International Health Regulations (IHR). The IHR is WHO's core legal instrument for responding to cross-border public health threats, requiring member states to promptly report public health emergencies and build core surveillance capabilities.

Professor Gostin was unflinching in identifying the fundamental flaws the IHR exposed during COVID-19: "The IHR lacks enforcement power. Countries are obligated to report outbreaks and build public health infrastructure, but when they fail to do so, there are no consequences." He revealed that in a forthcoming commentary in The Lancet, he and his colleagues -- including the former directors of the U.S. Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) -- would propose specific recommendations on how the incoming Biden administration should strengthen global health response.

He particularly emphasized the importance of U.S.-China cooperation: "China and the United States are the world's two largest superpowers. We cannot work against each other -- we must work together to confront this pandemic and future health threats." These words, spoken against the backdrop of highly strained U.S.-China relations at the end of 2020, were remarkably prescient.^[3]

4. Beyond Healthcare: The Legal Determinants of Health

During our dialogue, Professor Gostin introduced a concept that transcends traditional public health thinking -- "Legal Determinants of Health." He pointed out that the factors affecting human health extend far beyond the healthcare system itself to include poverty, education, housing, environmental pollution, and food safety -- a range of social conditions that are, without exception, profoundly shaped by law.

"Global health law is not merely about infectious disease law," Professor Gostin explained. "It encompasses non-communicable diseases -- respiratory diseases, diabetes, cancer, and cardiovascular diseases caused by tobacco, air pollution, unhealthy diets, and lack of exercise. It also covers traffic injury -- particularly in Asia, where this is an enormous public health problem."

This perspective was profoundly illuminating. It means that public health cannot be advanced by health departments alone -- it requires cross-sectoral legal coordination, from tax policy (tobacco taxes) to urban planning (pedestrian-friendly cities), from labor regulations (occupational safety) to environmental legislation (air quality standards). Law is not merely a tool for treating disease but the foundational infrastructure for preventing it.^[4]

5. The Role of Legal Professionals in Global Health

When I asked Professor Gostin for his advice on legal scholars engaging in global health issues, his response was filled with confidence in and high expectations for the legal profession.

"Legal professionals can make enormous contributions," he said. "You can help improve public health laws and emergency health powers legislation at the national level; you can work with legislators, policymakers, and health ministers to develop robust legal powers and safeguards."

He further pointed out that global health law is a rapidly developing field rich with opportunities: from WHO treaty negotiations to regional health agreements, from balancing intellectual property rights with drug accessibility to legal mechanisms for cross-border epidemic reporting, legal professionals play an irreplaceable role at every juncture.

This part of the dialogue reminded me of my own experience conducting fintech regulation research at Cambridge University -- whether in fintech or global health, truly effective governance requires the deep integration of law, technology, and policy. The discipline of "global health law" championed by Professor Gostin is a prime example of this interdisciplinary convergence.^[5]

6. Constitutional Constraints and Public Health: The Boundaries Between Power and Liberty

During the Q&A session, I consulted Professor Gostin on constitutional issues surrounding quarantine measures and vaccination priority orders. His response demonstrated a leading public law scholar's profound understanding of rights conflicts.

Professor Gostin cited the core principle he established in the Model Emergency Health Powers Act: any public health measure must pass the test of "reasonableness" -- it must be based on scientific evidence, proportionate to its objective, constitute the least restrictive means of achieving that objective, and provide due process protections for those affected.

"Quarantine can be lawful," he explained, "but only if it is based on scientific judgment rather than discrimination, does not last longer than necessary, and ensures that quarantined individuals receive basic living necessities and legal recourse." He also noted that vaccination priority orders must follow similar legal principles -- priority should be determined by science-based risk assessment rather than allocated by political considerations or economic status.

The value of this analytical framework lies in its ability to draw clear legal boundaries for government emergency powers during crisis -- neither allowing fear to paralyze action nor permitting power to override rights.^[6]

7. Reflection: Viewing Global Health from a Higher Vantage Point

This dialogue with Professor Gostin profoundly transformed my understanding of law's role in the public sphere.

In terms of global governance, the IHR enforcement deficiencies revealed by Professor Gostin bear striking similarity to what I have observed in financial regulation -- international rules are often formulated well ahead of time, but enforcement and accountability mechanisms lag severely behind. Whether in global health governance or international financial regulation, the core challenge is the same: how to ensure that sovereign nations voluntarily comply with common rules within an international legal framework that lacks coercive power.

In terms of policy design, the concept of "Legal Determinants of Health" prompted me to reconsider the functional boundaries of law. Law is not merely a tool for resolving disputes but the infrastructure for shaping social conditions and preventing systemic risks. This insight is equally applicable to the fintech domain I focus on -- good regulation is not about punishing after the fact but about constructing an institutional environment in advance where innovation and safety can coexist.

In terms of educational philosophy, Professor Gostin's research career itself is the finest demonstration of interdisciplinary integration. He has woven together public health, international law, human rights, and policy analysis to create the entirely new discipline of global health law. This reminds us that in the face of increasingly complex global challenges, the perspective of a single discipline is no longer sufficient -- we need to cultivate interdisciplinary talent capable of moving freely between law, technology, and policy.

As I remarked to Professor Gostin at the close of our dialogue: reading his work had taken me up a mountain to see the full panorama of global health law; and this conversation had carried me to an even higher peak, revealing a more magnificent intellectual landscape. At a time when COVID-19 is reshaping the global order, the view from that summit is more precious than ever.