Other international health organizations and entities

Global health diplomacy is characterized by the many innovative features and approaches that have been developed throughout its history. About 20 years ago, a new set of health organizations with very different governing structures began to emerge. The first was UNAIDS – the only co-sponsored joint programme in the UN system – whose work is steered by a multi-stakeholder Programme Coor- dinating Board comprising representatives of 22 governments from all geographical regions; the UN- AIDS Cosponsors; and five representatives of NGOs, including associations of people living with HIV.

Similarly, Gavi, the Vaccine Alliance (a foundation) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (a partnership) are both governed by boards featuring representatives from countries, the private sector, civil society and other international organizations. The Gavi Board also includes indepen- dent, or “unaffiliated”, individuals. The Board of the Global Fund has 20 voting seats, with equal repre- sentation for implementers and donors, including NGOs; communities affected by HIV, tuberculosis and malaria; the private sector; and private foundations. In addition, there are eight non-voting mem- bers, including the Chair and Vice-Chair of the Board; representatives of partner organizations such as WHO and the World Bank; and the Additional Public Donors constituency (see Box 10 and Box 11).

15 See: https://geneva.usmission.gov/2020/05/19/explanation-of-position-covid-19-response-resolution/

Box 10: The governance model of Gavi, the Vaccine Alliance

Gavi, the Vaccine Alliance (formerly the Global Alliance for Vaccine and Immunization, hence the acronym), is an international organization established in 2000 to provide affordable and accessi- ble vaccines for children in the developing world. Today, the Gavi Alliance is one of the most im- portant actors in global health governance.

The Gavi Board has 28 seats in total; there are both permanent and time-limited seats. Board members are appointed in accordance with the Gavi statutes and operating procedures. Repre- sentatives of key partners of the Gavi Alliance hold 18 seats; independent or unaffiliated individ- uals have nine; the Chief Executive Officer of the Alliance holds one. While the Bill and Melinda Gates Foundation, the World Bank, the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) hold permanent seats at the Board, other Gavi partners’ representa- tives serve on a time-limited basis.

The members on “representative” seats are responsible for ensuring that their governments or institutions provide formal inputs to the development of Gavi’s policies and to the management of its operations. Independent or unaffiliated individuals do not have any professional connection to Gavi’s work, but they provide expertise in critical areas such as investment, auditing, and fundraising. They also bring independent and balanced scrutiny to all of the Board’s deliberations.

These members are appointed in their personal capacity on the basis of their skills and networks.

Other types of representatives are alternate Board members and observers. Each eligible organi- zation and constituency may designate one person per Board member as an alternate, who is entitled to act in lieu of the representative Board member. Both Board members and alternates are invited to attend the Board meetings; at least one of them should attend to ensure represen- tation of their constituency. With the Chair’s permission, observers may also participate in the Alliance’s Board or Committee meetings.

Governance structure

The partners of the Gavi Alliance

Æ The governments of implementing countries identify their immunization needs and co finance and implement vaccine programmes.

Æ Vaccine manufacturers make affordable, quality vaccines and cold chain equipment available to implementing countries.

Æ Civil society organizations help to ensure that vaccines reach every child.

Æ Private sector partners contribute resources, expertise and innovation to help achieve the Gavi Alliance’s mission.

Æ The Bill and Melinda Gates Foundation provides funding and expertise, pioneers innovative approaches, and supports research and development work on new vaccines.

Æ Research and technical health institutions help to generate the evidence base and communicate the value of vaccines.

Æ The governments of donor countries make long-term funding commitments and collaborate with Gavi on the ground.

Æ The World Bank helps to support innovative financing mechanisms such as the Internation- al Finance Facility for Immunisation and advance market commitments.

Æ UNICEF procures vaccines and supports countries in maintaining their cold chain systems, improving access and collecting data.

Æ WHO regulates vaccines and supports their introduction in individual countries, with a focus on increasing immunization coverage and improving data quality.

Adapted from: Gavi, the Vaccine Alliance website (https://www.gavi.org, accessed 12 October 2020).

The Global Fund to Fight AIDS, Tuberculosis and Malaria (hereafter referred to as the Global Fund) is an international financing organization founded in 2002, its mission being “[t]o attract, leverage and invest additional resources to end the epidemics of HIV, tuberculosis and malaria and to support attainment of the Sustainable Development Goals”. The Global Fund mobilizes and in- vests more than US$ 4 billion a year to support programmes in over 100 countries. It is a partner- ship between governments, civil society, technical agencies, the private sector and people affect- ed by those diseases.

The composition of the Board of the Global Fund is illustrative of the concept of plurilateral health diplomacy. The Board includes 20 voting members, with equal representation by implementers and donors, and an additional eight non-voting members. The Chair and Vice-Chair chair Board meetings and play roles in advocacy, partnership and fundraising. The 20 voting members repre- sent the constituencies, with an equal number of seats (10) representing donor constituencies and implementer constituencies. One Board member heads each constituency and is seconded by an alternate Board member.

The 20 constituencies (groups of voting members) are as follows: Australia, Canada and Switzer- land; communities of people affected by the diseases; nongovernmental organizations (NGOs) from developed countries; NGOs from developing countries; Eastern Europe and Central Asia;

Eastern Mediterranean Region; Eastern and Southern Africa; European Commission, Belgium, Italy, Portugal, Spain; France; Germany; Japan; Latin America and the Caribbean; “Point Seven”

(Denmark, Ireland, Luxembourg, Netherlands, Norway, Sweden); private foundations; private sector; South-East Asia; United Kingdom; United States; West and Central Africa; and the West- ern Pacific region.

The remaining eight of the Board’s 28 seats are non-voting members: the Board Chair; the Board Vice Chair; the Executive Director; Partners; the Joint United Nations Programme on HIV/AIDS (UNAIDS); the World Health Organization; the World Bank; and “Additional Public Donors”, a constituency created by the Board to accommodate public donors that are not already represent- ed by a voting constituency.

Box 11: The governance model of the Global Fund to Fight AIDS, Tuberculosis and Malaria

Partnership Approach to Governance The Global Fund Board

Public Sector (Governments and Agencies)

Private Sector

Civil Society

Technical Agencies and Partnerships

Donors Recipient Countries

NGOs from Global North NGOs from Global South Communities living with,

and affected by, the diseases

WHO UNAIDS World Bank UNITAID RBM Stop TB Partnership…

Private Sector Private Foundations

Adapted from: Global Fund website (https://www.theglobalfund.org/en/).

The Framework Convention on Tobacco Control, WHO’s first global health treaty which entered into force in 2005, is another newcomer to the global health architecture. It has its own governing body (Conference of the Parties) and a Secretariat hosted by WHO (more details on the FCTC can be found in Chapter 5). In addition, several health partnerships, with their own specific governance structures and operating modes, are hosted by WHO (for example, the Partnership for Maternal, Newborn and Child Health) or other UN system organizations (such as the RBM Partnership to End Malaria, which is hosted by the United Nations Office for Project Services (see Chapter 5).

Countries, like other actors, are involved in negotiations and decision-making at many of the health organizations, but they do not always adopt the same national position in each of these organiza- tions. This is partly because the ministries represented are different: in WHO it is mainly the health ministries, while in the other health organizations it is mainly the development ministries (or the foreign ministries through their development agencies). In many cases, there is a lack of coopera- tion between the various national authorities, which sometimes even compete with one another.