This case highlights the challenges of managing externalities and sovereignty through the example of pandemic flu. Recent outbreaks of both the H5N1 and H1N1 influenza strains have illustrated that the global institutions charged with preventing and responding to these pandemics are not up to the task. With both, there were significant problems with the development, production, and distribution of flu vaccines. Indeed, stemming a modern day pandemic depends on the rapid development, sufficient production, and equitable, timely access to influenza vaccines, all within a complex global context. Compounding these challenges are the disease-specific “unknowns” related to the emergence of a new virus, including severity levels, transmission ease, human immunity, and drug vulnerability. Specific themes covered in "Ensuring Vaccine Supply for the Next Pandemic Flu: Will the World Be Ready?" include issues of sovereignty; the legitimacy, authority, and credibility of the World Health Organization (WHO); uncertainty and risk; world dependence on private vaccine manufacturers for an essential public health good; health as a security issue; and equity issues in vaccine distribution.

This case examines the United Nations' reactions to the cholera epidemic in Haiti and illuminates contemporary gaps in global governance. In January, 2010, an earthquake devastated Haiti, the poorest country in the Western Hemisphere. The public health community anticipated Haiti to be at risk for many health threats, but did not consider a cholera outbreak a likely possibility. However, in October of that year, the first case of cholera in more than 100 years was reported, sparking a cholera epidemic in Haiti. Scientific evidence later linked the original source of the cholera to poor sanitation management practices at a United Nations (UN) peacekeepers camp run by Nepal. However, the UN refused to acknowledge any responsibility for causing the cholera outbreak. Readers of this case consider the role of global governance and accountability, especially in an environment with a weak nation state.