Creating alliances in support of health and well-being outcomes Alliances are formed for mutual benefit or to achieve some common purpose, whether or not an

explicit agreement has been reached among the individual members. Alliances for global health may include political alliances. For example, in 2019, France and Germany established the Alliance for Multilateralism, which seeks to bring together all those who believe that strong and effective multilateral cooperation, based on the objectives and principles of the UN Charter, international law and justice, is indispensable to secure peace, stability and prosperity. The Alliance issued a strong statement in support of WHO in the context of the COVID-19 pandemic. Older alliances can also help to advance agendas: for example, the Non-Aligned Movement, a group established in 1961 that now consists of over 120 developing countries not formally aligned with or against any major geopolitical bloc, played a significant role in the negotiations leading to the adoption of the Pandemic Influenza Preparedness Framework in 2011.

Countries with common interests have used a system of “bloc politics” to organize their efforts under the UN framework. Member States often come together as a regional group within which there is consensus on defending a common position when voting at the World Health Assembly or the UN General Assembly. There are five regional groups at the UN: the Group of African States, the Group of Asia-Pacific States, the Group of Eastern European States, the Group of Latin American

and Caribbean States (GRULAC) and the Group of Western European and Other States. The voting correlation varies between regions and depends on the type of resolution that comes to a vote. The EU usually acts as a unified bloc during voting at the World Health Assembly or the General Assem- bly. Although the EU has no voting right as such, its delegation is authorized to speak on behalf of the whole bloc at the UN. EU member countries may express their individual views but they strong- ly align their vote with the consensus EU position.

Health alliances taking many different forms have been set up over the past two decades – often linked to specific diseases, as in the case of the Global Polio Eradication Initiative launched in 1988, which currently has six core partners. Alliances offer distinct advantages in terms of the pooling of resources and capabilities. One of the best known is the Gavi Alliance, established in 2000. Gavi today helps to vaccinate almost half of the world’s children, which gives it vast power to negotiate prices for vaccines that are affordable for the poorest countries and to remove the commercial risks that previously deterred manufacturers from serving those countries.

Alliances are necessary to address public health problems that organizations working alone find it difficult to tackle. Moreover, the health-related targets under the SDGs offer a unique opportunity to create alliances that can influence the determinants of health. In particular, the interface be- tween climate change and health has emerged as a priority area. The Global Climate and Health Alliance was launched in Durban, South Africa, in 2011 to tackle climate change and protect and promote public health. It comprises health and development organizations from around the world that are united by a shared vision of an equitable and sustainable future.

The Global Health Workforce Alliance was created in 2006 to coordinate the engagement of multi- sectoral stakeholders seeking to tackle the crisis in human resources for health. Bringing together national governments, civil society, international agencies, finance institutions, researchers, educa- tors and professional associations, the Alliance was able, over the 10 years of its mandate, to gen- erate significant political will and action for positive change in this area. After the conclusion of its mandate in 2016 it transitioned into the Global Health Workforce Network.

Groups of countries or health advocates at the country level have also come together to launch initiatives such as Friends of WHO or Friends of the Global Fund in order to support the relevant entities in a variety of ways. An example of an alliance for global health created at the national level is the German Health Alliance, which consists of more than 100 partners from virtually all sectors: the private sector and industry, NGOs, civil society and foundations, science and academia.

A recent analysis showed that 80% of global health alliances are successful in their work. A key factor in this respect is achieving a good balance between participation and effectiveness. Success- ful alliances tend to encourage input from, and consultation with, all parties, without necessarily

Science plays a critical role in health diplomacy. The close interface between science diplomacy and health diplomacy is proving ever more important in the promotion of global health. In broad terms, “science diplomacy” refers to the use of science, including its methods and results, for bi- lateral or multilateral diplomacy. It means putting science at the centre of diplomatic efforts aimed at building or maintaining relations and at establishing or achieving foreign or multilateral policy goals. Science diplomacy should ideally be part of the wider interface between policy, society and science. This type of diplomacy has gained traction in the past two decades owing to the speed of technological progress and the importance of science for tackling global challenges such as cli- mate change, the digital divide or pandemics. The recent COVID-19 outbreak and the ensuing pressure to develop a vaccine have very much led to science taking centre stage in global affairs.

Foreign policy and science policy have become increasingly intertwined, particularly in connec- tion with advances in the health and medical sciences. However, other scientific fields, such as climate change or artificial intelligence, also require attention on the part of those responsible for foreign policy. Diplomatic skills and scientific literacy (in some cases also expertise) have both become essential to the design and execution of foreign policy.

The definition of science diplomacy proposed by the American Association for the Advancement of Science acknowledges the fact that while foreign policy decisions may be informed by scientif- ic evidence, they are also or even more so driven by values, ethics, economics and aspirations for leadership. Given the growing diversity of (non-State) actors and the opportunities opened up by digitalization and social media, the playing field for science diplomacy has become increasingly complex – just as with global health diplomacy. In view of rising geopolitical tensions and nation- alistic tendencies, a robust set of overarching values, principles and standards is required if the full potential of science diplomacy is to be harnessed. The Madrid Declaration on Science Diplo- macy issued in 2019 is an ambitious response to that need.

A relatively recent development in science diplomacy is the growing number of alliances estab- lished to promote science and innovation for global health. Two recent examples illustrate the new types of alliances that are emerging to help the scientific community respond to major involving them all in lengthy decision-making processes. Many alliances are created for a short period of time in order to work towards a specific goal; others take the form of loose networks – for example, the Geneva Global Health Hub was set up in 2016 by a group of international NGOs seek- ing to achieve a stronger voice by working together.

Box 4: Science diplomacy meets health diplomacy: recent examples

health challenges. The premise is that science (like health) should be regarded as a global public good, with fair and equitable access ensured for everyone. In order to enable all people to share in scientific advances and their benefits, the concept of open science (open methods, open source, open access, open data and so on) should be at the centre of diplomacy. Diplomats en- gaged in negotiations must also respect and uphold the freedom and independence of scientists.

COVID-19: Many new alliances have been created in the wake of the COVID-19 pandemic, espe- cially to facilitate the development of a vaccine. The Access to COVID-19 Tools (ACT) Accelerator, for instance, is a global collaboration of organizations and governments working to speed up the development and production of, and equitable access to, COVID-19 tests, treatments and possible vaccines. The vaccines pillar of the ACT Accelerator, referred to as COVAX, is jointly led by Gavi, the Vaccine Alliance; the Coalition for Epidemic Preparedness Innovations (CEPI) and the World Health Organization (WHO). The aim of COVAX is to speed up the development and manufacture of COVID-19 vaccines, and to ensure fair and equitable access for every country in the world. It is a key example of multi-stakeholder diplomacy in which the Gavi Alliance, CEPI and WHO are working together with industrial manufacturers, including those based in developing countries.

Antimicrobial resistance (AMR): In 2020, more than 20 leading pharmaceutical companies launched the AMR Action Fund to bridge the current gap in funding for the development of new antibiotics. The concept for the Fund was developed by the International Federation of Pharma- ceutical Manufacturers and Associations (IFPMA), the Biopharmaceutical CEOs Roundtable, and several major biopharmaceutical companies and foundations, in collaboration with WHO, the European Investment Bank and the Wellcome Trust. The Fund seeks to forge partnerships with institutions and philanthropic organizations in order to enhance and accelerate the development of antibiotics. It will also work with governments to ensure that there is a sustainable supply of new antibiotics.

Resources

Gavi, the Vaccine Alliance (2020). What is the COVAX pillar, why do we need it and how will it work? [website]. (https://www.gavi.org/vaccineswork/gavi-ceo-dr-seth-berkley-explains-covax- pillar, accessed 12 October 2020).

IFPMA (2020). The AMR Action Fund [website]. (https://www.ifpma.org/partners-2/the-amr-ac- tion-fund/, accessed 12 October 2020).