Regionalization in the World Health Organization: locking in a Pan-American head start

The chapter discusses the sequence of events that locked in the regionalized design of the World Health Organization (WHO). The WHO was not built from scratch, but had to integrate pre-existing bodies of international health cooperation. This turned out to be a particular challenge in the face of a coalition of Latin American states, which defended the continued autonomy of their Pan-American health bureau. The institutional bargaining process between 1946 and 1948, protracted due to the onset of the Cold War, led to an unexpectedly regionalized outcome. Regionalization was repeatedly attacked by powerful states and organizational reformers in later years, but locked in too deeply to be reversed. The case study makes a theoretical and methodological contribution to analyzing the depth of change in international institutions. It demonstrates how institutional bargaining and coalition building lock in historical outcomes, and uses reform attempts as real world tests of institutional robustness.