Abstract
The COVID-19 pandemic revealed the complex interplay between national self-interest and global cooperation, demonstrating the need for ethical frameworks that delineate the scope of global health obligations. Nationalist perspectives contend that justice is most effectively and primarily realised within the state, and obligations to non-nationals are often framed as acts of charity rather than duties of justice. Cosmopolitanism, by contrast, challenges the idea that national membership should determine the scope of moral obligation, grounding health justice in the equal moral worth of all humans. The tensions between cosmopolitanism and nationalism were acutely revealed during the COVID-19 pandemic, where calls for global solidarity clashed with vaccine nationalism, border closures, and fragmented institutional responses. As globalisation, urbanisation, and environmental degradation continue to elevate the risk of future global health challenges, an examination of the ethical and political commitments required to strengthen global health governance is necessary.
This thesis addresses the normative and practical question of whether New Zealand has ethical obligations to global health that extend beyond its national borders and whether cosmopolitanism offers a viable and desirable framework to guide these obligations. A multi-method approach is employed, combining ethical analysis, theoretical application, media analysis, and policy review. This thesis contributes to debates on the feasibility of cosmopolitanism by treating it not as an abstract ideal but as a strategically contingent, institutionally embedded framework. New Zealand serves as a case study, a small democracy praised for its pandemic response yet implicated in inward-facing health practices. These methods are unified by a normative inquiry into the ethical legitimacy and practicality of cosmopolitanism in global health.
Part One undertakes a theoretical and discursive investigation into the commitments of nationalism and cosmopolitanism, particularly in relation to global health. It argues that cosmopolitanism offers a more ethically robust and inclusive framework than nationalism, and dispels nationalist myths used to justify New Zealand's geographic compartmentalisation of moral responsibility. A media analysis was undertaken to demonstrate how nationalist discourses were constructed in New Zealand’s pandemic coverage, reinforcing exclusionary boundaries of obligation.
Part Two explores institutional and structural constraints on cosmopolitanism in global health governance. It situates cosmopolitanism within an architecture characterised by ‘gridlock.’ ‘Cosmopolitan moments’ are presented as a partial and frail antidote to the gridlock of global health during the COVID-19 pandemic. Policy analysis of the ‘Pandemic Treaty’ negotiations illustrates both the potential and the fragility of cosmopolitan gains in global health. While early drafts of the treaty embraced principles of justice, such as equity, solidarity, and human rights, later revisions prioritised state sovereignty. The changes over time underscore the need for deliberate institutional design and political commitment.
In Part Three, I conclude that global health operates along a spectrum of interests, where nationalism and cosmopolitanism represent distinct yet interconnected points on a continuum of ethical engagement. Ethical reflection and ethical amnesia shape a state’s position along this spectrum, influencing how obligations to global health are understood and enacted. Nationalism and cosmopolitanism are not mutually exclusive; instead, they inform each other and can shift and evolve depending on context and crisis. Cosmopolitanism is crisis-dependent, tethered and constrained to self-interest. The crisis-dependency makes cosmopolitanism vulnerable to ethical amnesia once the immediate threat subsides, leading to a retreat into inward-looking approaches.
Despite these challenges, cosmopolitanism remains an ethically desirable and politically viable framework for advancing global health justice, if strategically institutionalised and supported by political will. The thesis argues that the goal of global health is to navigate this spectrum between nationalism and cosmopolitanism towards mutual interest, where shared responsibility and interdependence are recognised across borders.