Since the SARS outbreak of 2003, the Global Health Governance literature has challenged state-based frameworks in the provision of health. With the increased participation by a range of nonstate and transnational actors as primarily driven by globalization, the international has become the global. However, this article argues that this literature has overemphasized globalization and its ability to wrest health authority away from the state and diffuse it to a range of competing and interacting actors. In fact, the state remains at the centre of an international system. This, though, is not a retreat into neorealist and neoliberal orthodoxy and the article offers an alternative to these frameworks in the description of state cooperation in the context of infectious diseases.