We put forward our paper recognizing that a critical legal analysis of the many proposals to date for a framework convention on alcohol control might not be well received by the alcohol control community. We are encouraged that our paper has inspired such vigorous debate, with two of the responses supporting our argument.
Like Zeigler , we see the glass as being more than half full. There is urgency and opportunity for international regulatory action that has tangible impact. As Rekve  notes, the World Health Organization (WHO) Global Strategy to Reduce the Harmful Use of Alcohol is an essential guiding document. However, it is not specific in establishing norms, responsibilities or associated implementation and monitoring processes. Strengthened action is essential. There is a clear need for the articulation of concrete standards through a process of international negotiation, extending beyond the health constituency, that places limits on the most egregious industry behavior. We found Zeigler's elaboration of steps forward, including the call for a ‘dynamic process of strategic planning’, to be highly valuable.
As Liberman  notes correctly, there is ‘no magic formula’ for identifying the most appropriate international legal instrument to be applied in any particular context: reasonable people can disagree. However, the choice involved is not a simple binary distinction between bold ‘radical’ action, on one hand, and timid ‘baby steps’ on the other hand, as Room  implies. Rather, in any given context, the choice is a complex strategic judgment of how international legal instruments can be employed most effectively to advance cogent change. The authors are not interested in promoting ‘baby steps’ to advance public health. Twenty years ago the lead author of this paper initiated the idea of the WHO's first treaty, the Framework Convention on Tobacco Control (FCTC), and served later as the senior legal advisor for the FCTC negotiations. In the 1990s the time was ripe for WHO to launch unabashedly its first treaty initiative. For the reasons analyzed in our paper, in our collective judgment the current political and economic reality indicates that a measured, incremental legal approach holds the greatest promise of success in advancing global alcohol control at the present time.
Room  underestimates the value of an incremental legal strategy, in part, because he mistakenly equates the potential utility of a global code with the many ineffective domestic codes in this realm. As Liberman  confirms, lawmaking in the domestic arena is not analogous to lawmaking at the international level. As we describe in detail, an internationally negotiated global code of practice adopted by the 194 Member States of the World Health Assembly has a legal and political weight that cannot be equated with industry-sponsored domestic codes.
This is an era of significant change in international lawmaking. In the twenty-first century it is increasingly recognized that the challenges of global governance demand faster and more flexible approaches to international cooperation than can be provided by traditional treaty strategies. Consequently, in many other realms of international concern, ranging from the environment to human rights to arms control, the world community is turning increasingly to the creation of non-binding international norms and other modes of international cooperation. It is time for the global health community to think more strategically and innovatively about the role of international lawmaking to protect public health. We hope that this Addiction debate contributes to a more nuanced discourse on effective global health lawmaking.
Declarations of interest