Getting a Seat at the International Health Table: A Case Study Comparison of China and Vietnam

Global governance institutions are increasingly buffeted by both changing social norms that appeal for greater democratized participation and rapid technological changes that have globalized social risk. In response, global governance institutions have undertaken a variety of institutional reforms to increase participation to address these legitimacy and technical challenges. In this article, we explore how such reforms have played out in practice with regards to China and Vietnam and the following international health organizations: the Vaccine Alliance (GAVI), the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Fund), International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH), International Medical Device Regulators Forum (IMDRF), Global Good Agricultural Practice (GlobalGAP), and the Codex Alimentarius Commission (Codex). We find the degree to which institutional change can encourage greater participation and influence of previously marginalized actors is heavily conditioned by a number of factors, including issue salience, participant resources and institutional specificity. Although issue salience is high for both China and Vietnam across these international health organizations, China's engagement with these international organizations is generally more substantive than Vietnam's, partly because of China's greater economic and political resources. That being said, the nature of participant engagement is often heavily influenced by the nature of the international organization itself and does not always privilege the stakeholder with the greater resources.