Concluding remarks

All of the examples presented in this chapter demonstrate that tackling complex global health challenges calls for multilevel diplomacy (that is, involvement in negotiations in different forums) combined with multi-stakeholder diplomacy (involving different types of actors), usually over a significant time period. Global health diplomacy efforts on complex issues have become more diffi- cult owing to the large number of actors and the diversity of cultures and diplomatic styles. Togeth- er with a weakening commitment to multilateralism, this is making it harder to reach agreement (as reflected in the failure of the 25th session of the Conference of the Parties to the UNFCCC to agree on global carbon markets) and leads to increasingly unpredictable outcomes.

These examples also illustrate another significant new development in international relations:

the way in which international organizations are becoming important players in multi-stake- holder diplomacy, as shown by the involvement of WHO in G7 and G20 summits and various in- ter-agency arrangements in the above areas. International civil servants are increasingly per- ceived to be defending supranational interests, namely the production and supply of global public goods. This is very much the case with diplomatic efforts on, for example, environmental protection and health.

The examples further serve to illustrate synergistic health diplomacy, which is yet another feature of contemporary global health diplomacy – namely, where States strive for the synergistic interac- tion of diplomatic efforts at various levels and within the framework of different organizations, processes and meetings.

26 The International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights (both adopted in 1966).

Preparing comprehensively for negotiations involves several key actions and the judicious en- gagement of relevant stakeholders and partners at the country level and in Geneva (or wherever the negotiations take place). All the actions are useful (to varying levels depending on the nego- tiation in question) but are not necessarily sequential – often all are done simultaneously, or in a different order depending on the issue and level of negotiation.

Action 1

The first step is to study the history of the matter under discussion. You should consult documents that will help you to understand the background to the resolution or other text to be negotiated.

It is also important to be aware of (a) the positions adopted by your country on the matter in previous negotiations; and (b) the positions adopted both by like-minded countries and by coun- tries known to have different views.

Action 2

The second step is to identify the issues or language in the text under discussion that are likely to provoke controversy during the negotiation process.

Again, looking back at earlier negotiations on the topic is essential. For example, referring to sexual and reproductive rights has always sparked concerns among a specific group of countries across the world while receiving strong support from another group.

Action 3

The third step is to mobilize experts so that you can achieve a comprehensive understanding of the matter under discussion.

The experts may be based in a country’s capital, either within or outside the health ministry, for- eign ministry or another relevant ministry. Further considerations on the role of different sectors are to be found in Chapter 11.

Finally, some of the examples of global health diplomacy discussed in the preceding sections – par- ticularly those related to trade, migration and antimicrobial resistance – highlight, from various angles, the importance (and complexity) of achieving national intersectoral coordination and policy coherence in multilateral processes and negotiations.

Box 17: Preparing for negotiations in Geneva

Requests may also be received by a country’s mission in Geneva to supply the national authorities in the capital with additional expertise. This is because on some issues – as was the case with the outbreak in early 2020 of a poorly understood influenza-like disease in Asia (later named COVID-19) – the most relevant information may reside in Geneva at the World Health Organiza- tion (WHO), rather than in the country’s capital.

Expertise may be national – this includes the expertise of nationals who are working for interna- tional organizations in Geneva – or international. There is a large pool of experts in global health in Geneva in particular, but also in New York, other international hubs and in universities around the world. Great care should be taken to include experts from the Global South.

An important point worth stressing is that it is often best to seek expertise by contacting people from an existing personal network. To continue with the example cited above, an expert opinion on the influenza-like outbreak in Asia (later named COVID-19) would possibly be obtained more readily from an expert known to you personally than by contacting a research institute.

The above recommendation may not be relevant where countries have a strong team of experts based at – or associated with – the ministries concerned. This was the case, for example, with the former Department for International Development in the United Kingdom (now part of the new Foreign, Commonwealth and Development Office). Nor is the recommendation relevant where countries have high-level research institutes that can provide information. It can be much more difficult for low- and middle-income countries to gain access to such information.

Action 4

The fourth step is to mobilize stakeholders and partners in your country and in Geneva so that you can prepare effectively for the forthcoming negotiations.

First, you should get in touch with the diplomats and civil servants who are your contact persons (focal points) in the foreign ministry and the health ministry. They need to be informed about the forthcoming negotiations and be given enough time to gather information, consult others, receive relevant approvals from their immediate superior or from the minister, and, eventually, send you instructions on the position you are to defend.

Typically, instructions from the capital will be developed through coordination among representa- tives from relevant ministries after consultation with experts if needed, and, as is increasingly the case in the field of global health, also with civil society. The instructions will ultimately be ap- proved at the senior level in the lead ministry before being sent to the mission in Geneva. Often coordination is via written exchange. The necessary approval level depends on the negotiation.

As you engage with the national authorities in your capital, you may find them to be helpful or less so, depending on a number of factors: the extent to which the matter under discussion is of interest to the ministries and the government; the ability of focal points in the ministries to mobi- lize expertise and opinions in the capital; and – equally important – your personal relationship with, and style in relating to, the focal points and ministries.

Secondly, you should approach your contacts at WHO and other global health organizations in order to understand, from their perspective, what is at stake in the forthcoming negotiations.

Here again, personal relationships and networks will give better results than addressing requests to an institution in general.

Thirdly, you should contact your counterparts in diplomatic missions in Geneva to gather informa- tion on the positions that their countries will adopt in the negotiations and, in some cases, gather support and build alliances. Again, personal relationships, legitimacy and communication skills are essential. Engaging with counterparts is crucial so that you can find out how others are pre- paring for the negotiations. It is also a necessary step in developing a common position with partner countries within a political entity, such as the European Union or the African Union, or within more informal groupings, such as the Nordic countries.

In Geneva there exists a very important regional coordinator system of health attachés. Each of the six WHO regions has an informal coordinator who usually rotates on an annual basis. These coor- dinators’ activities range from routine communication between WHO governing bodies, the WHO Secretariat and Member State missions to the extraordinary challenge of selecting chairs and vice-chairs for intergovernmental negotiations.

Action 5

At the end of the process you will receive a set of instructions from your capital. The strong en- gagement of specific stakeholders and partners at each step of the process described above is the best guarantee of the instructions being clear and enabling you to defend a coherent nation- al position during the negotiations.

Global health diplomacy is a burgeoning field that combines the priorities of global health with those of foreign affairs. Health challenges of various kinds have acquired an urgency that is unprec- edented in the long history of international health activities. Developments in the field of health are affecting the way in which normative concepts and international legal rules are applied in diplo- matic negotiations. Global health diplomacy involves a number of disciplines, ranging from public health, law and international affairs to management and economics. Understanding and using concepts from different disciplines consistently is therefore essential.

The ABC of Diplomacy is a glossary of alphabetically ordered keywords produced by the Swiss Federal Department of Foreign Affairs. It explains frequently used terms, and provides information about the laws and customs governing international relations:

https://www.eda.admin.ch/dam/eda/en/documents/publications/GlossarezurAussenpolitik/

ABC-Diplomatie_en.pdf

The institutional repository of the Global Health Centre at the Graduate Institute of International and Development Studies contains two resources that explain commonly used concepts:

Æ A glossary of terms used in global health negotiation: a working tool (2013), by Martin Jacques, Ilona Kickbusch and Michaela Told

https://repository.graduateinstitute.ch/record/296833?ln=en

Æ Discussing a definition of global health (2013) by Samantha Battams and Stephen A. Matlin https://repository.graduateinstitute.ch/record/288069?ln=en