Our societies are facing risks for which international organizations such as the WHO, OIE, FAO call for a new international health governance. This paper aims at analyzing the confrontation between this international governance and national specificities. Our analysis is based on empirical research conducted in Vietnam in 2008, on avian influenza (H5N1). It focuses on the period beginning with the first outbreaks in 2003 and ending in 2008. We highlight two phases in H5N1 management by the Vietnamese authorities: a first phase based on past experiences (i.e. SARS) and related to national issues such as the consolidation of the central power in relation to provincial authorities; a second phase more in line with international governance principles and devoted to diplomatic issues such as WTO membership. This analysis concludes that international health governance should not underestimate the complexity of local situations, that taking into account national cultures of risk should not ignore local dynamics, and that focusing on constraints should not mask opportunities associated to risks.