International Organizations in Transfer of Infectious Diseases: Iterative Loops of Adoption, Adaptation, and Marketing

Over the past few years increasing attention has been given to the role of international organizations in the diffusion of policy ideas and promotion of particular macro-level policies. Much of the attention has been on the ideological driving forces behind such policies, and on the extent to which the policies are externally imposed. There has been limited discussion on the bread-and-butter, technical policies of international organizations, and how they devise, adopt, adapt, and then promote what come to be seen as policies of global "best practice." This paper seeks to redress this gap by looking at the process of transfer of two infectious disease policies between international and national levels. It demonstrates that international organizations play different roles in policy transfer at particular stages in the process. The paper suggests that health policy transfer is a long adaptive process, made up of several iterative loops, as research and clinical practices developed in one or more countries are adopted, adapted, and taken up by international organizations which then mobilize support for particular policies, market, and promote them. Assumptions that new ideas about policies flow "rationally" into existing decision making are challenged by the processes analyzed here. Policy transfer, given the experience of these infectious diseases policies, goes through separate, "bottom-up," research-oriented, and "top-down" marketing-oriented loops. Individuals and different configurations of networks play key roles linking these loops. In the process, complex, context-specific policies are repackaged into simplified guidelines for global best practice, leading to considerable contestation within the policy networks.