Defining global health diplomacy

CHAPTER 2 | GLOBAL

health, for example by establishing major health programmes such as the United States President’s Emergency Plan for AIDS Relief (PEPFAR), launched in 2003, or through the “mask diplomacy” prac- tised by China during the COVID-19 pandemic in 2020. These actions are often bilateral, but they are fully calculated to influence global opinion.

Global health diplomacy is a manifestation of the increased importance of issue diplomacy. It re- fers first and foremost to the negotiation processes in the multilateral system that address collec- tive challenges relating to health. At the core of global health diplomacy are health issues that transcend national boundaries and require global agreements, instruments and alliances if they are to be tackled successfully and sustainably through joint action. However, as indicated above, it also covers many other diplomatic processes: for example, bilateral health diplomacy as manifested in donor relations (though these are not the focus of this Guide). There are also bilateral negotiation processes between agencies and countries, for example between the Global Fund or the World Bank and low- and middle-income countries. In some cases, WHO has special agreements with individual countries.

Global health diplomacy is not only conducted between accredited diplomats and health officials representing nation States but also involves many other major actors in the global arena, as is always the case with multi-stakeholder diplomacy. With health moving beyond the purely medical and tech- nical realm to become an ever more critical element in foreign, security and trade policy, new skills are required to negotiate global regimes and international agreements and treaties, and to maintain good relations with a wide range of actors from other sectors in order to advance global health.

Most diplomats are generalists. When engaging in global health diplomacy, their familiarity with the international context and diplomatic processes is critical to the negotiations, but because of the special nature of the field of health, their general knowledge and experience often need to be complemented by the specific medical and scientific expertise of health professionals, usually from the health ministries. Tensions can arise – also within national delegations – between the national interest that diplomats are expected to uphold and the solidarity at the heart of the concept of

“common goods for health”, which should be the prime concern of global public health action.

With WHO as the directing and coordinating agency for global health, the bulk of global health di- plomacy still consists of formal negotiations between States within its governing bodies, especially when the goal is to reach agreement on international instruments. Yet, as indicated in Section 1.4, all three governance spaces contain critical venues where global health diplomacy is practised.

This proliferation of venues is proving to be a great strain on the departments responsible for inter- national and global health within health ministries, which are often not equipped to deal with the growing number of negotiations and negotiating partners or with the increasing need for coordina-

tion between ministries. This is especially the case in small States and in low- and middle-income countries. Because of the ever-greater complexity of health negotiations, many permanent mis- sions in Geneva now have dedicated “health attachés”. There has also been a tendency in some foreign ministries to increase the number of subject-matter experts among their staff as issue diplo- macy – such as on health – continues to gain in prominence.

However, it is important not to underestimate the role of informal health diplomacy, conducted between health diplomats but also with non-State actors, such as NGOs, academia, foundations and the private sector. Informal multi-stakeholder diplomacy can – and often does – influence the outcomes of formal global health diplomacy. Relationship-building is a critical skill in multi-stake- holder diplomacy. It plays a particularly important role in negotiation hubs such as Geneva and New York, where a large number of events and diplomatic receptions provide plenty of opportuni- ties for informal diplomacy and information-gathering. Chapter 6 examines the role of non-State actors in more detail.

Example: The COVID-19 pandemic has posed a number of challenges to global health diplomacy, as outlined below:

The challenges faced by global health diplomacy during the COVID-19 pandemic reflect to a great extent the difficulties that the multilateral system has experienced over the past decade. Thus, the system’s fragility manifested itself in the initial lack of global cooperation on the response to the pandemic. In particular, the geopolitical stand-off between China and the United States has hampered progress on multilateral approaches not only at WHO but also at the G7, the G20 and the United Nations Security Council. This negative trend was reinforced by the announcement of the United States that it intended to withdraw from WHO.

The challenges in question are considerable even as a new US President takes office: they include the future of WHO, the development of a new legal basis for pandemic preparedness and re- sponse, possibly a further revision of the International Health Regulations, and identifying new approaches to financing common goods in order to keep the world safe and to make a potential COVID-19 vaccine available to all.

New mechanisms have been created to address these challenges – a WHO committee to review the functioning of the International Health Regulations during the COVID-19 response; the Ac- cess to COVID-19 Tools Accelerator, a new type of global collaboration to speed up development, production and equitable access to COVID-19 tests, treatments and vaccines; the COVAX Facility, a global risk-sharing mechanism for pooled procurement and equitable distribution of eventual

2.2 Foundations of the modern understanding