For almost all of this time, Geneva has been the headquarters of the World Health Organization (WHO) and the center of global health diplomacy. The particular focus of this guide is on the World Health Organization and the negotiations in the Geneva Global Health "Ecosystem".
INTRODUCTION
The goal of global health diplomacy is to achieve agreements that are scientifically credible and politically feasible. We also hope it will be used as a supporting tool in teaching global health diplomacy to both national and international institutions.
NOTE TO READERS
PART A
THE BASICS
GLOBAL HEALTH DIPLOMACY IN A CHANGING
- Diplomacy in a changing world
- The increasing politicization of global health
- The move towards multi-stakeholder diplomacy
- Governance spaces for global health diplomacy
- The changing role of diplomats
3 In particular the negotiations that resulted in the adoption of the Astana Declaration in October 2018 (WHO & UNICEF, 2018). New challenges have emerged in the context of the COVID-19 pandemic, as an increasing number of meetings – including World Health Assembly and Governing Council meetings – have had to be held remotely.
GLOBAL HEALTH DIPLOMACY
SYSTEM AND METHODS
Defining global health diplomacy
Informal multi-stakeholder diplomacy can—and often does—influence the outcomes of formal global health diplomacy. The challenges facing global health diplomacy during the COVID-19 pandemic largely reflect the difficulties the multilateral system has experienced over the past decade.
Foundations of the modern understanding of global health diplomacy
The late 20th and early 21st centuries saw a new two-way dynamic in global health. On the other hand, there are the "silent voices" in global health - women, members of the LGBT community, ethnic minorities and indigenous communities, social movements from the Global South, among others.
The global health diplomacy system
However, global health negotiations are increasingly taking place at the United Nations in New York, especially given that health is a core component of the SDGs (especially Goal 3). Many of the global health organizations recently established in Geneva are defined by multi-stakeholder and constituency-based governance.
Relationships in the global health diplomacy system
Global health diplomacy is also carried out at the Bretton Woods institutions, such as the World Bank, particularly on health financing issues, and at specific health organizations such as the Gavi Alliance, the Global Fund and the International Drug Purchase Facility (UNITAID). Summits of country groupings, such as the G7, G20, the BRICS countries and the Commonwealth, now play a very important role in global health diplomacy.
Digital diplomacy
7 DiploFoundation on Cyberdiplomacy: https://www.diplomacy.edu/blog/web-discussion-summary-applicability-internation-al-law-cyberspace-do-we-know-rules-road. 10 DiploFoundation data diplomacy website: https://www.diplomacy.edu/blog/impact-big-data-geopolitics-negotiations-and-diplomatic-modus-operandi.
THE DIMENSIONS OF GLOBAL HEALTH DIPLOMACY
- Negotiating to promote health and well-being in the face of other interests
- Establishing new governance mechanisms in support of health and well-being
- 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
- Building and managing donor and stakeholder relations
- Responding to public health crises
- Improving relations between countries through health and well-being
- Contributing to peace and security
The Alliance issued a strong statement in support of the WHO in the context of the COVID-19 pandemic. From a health diplomacy and governance perspective, several aspects of the BRI are noteworthy.
PART B
NEGOTIATING HEALTH IN
A MULTILATERAL SPACE
MANDATES
AND LEGITIMACY IN GLOBAL HEALTH DIPLOMACY
Multilateralism and the legitimacy of international organizations
However, international organizations have increasingly become actors in their own right and started to take the initiative to set agendas – the MDGs and SDGs are a good example. The right to health is essential to a life of dignity and the enjoyment of all other rights. The Universal Declaration of Human Rights (1948) mentions health as part of the right to an adequate standard of living.
The importance of legitimacy
The most emphatic recent reaffirmation of the right to a minimum attainable standard of health care is the global push for universal health coverage. The quest for universal health coverage is a recurring topic of health diplomacy discussions at the WHO. Political declaration of the high-level meeting on universal health coverage (A/RES/74/2; https://undocs.org/en/A/RES/74/2, accessed 13 November 2020).
Legitimacy and sovereignty of States
Another focus of criticism is the under-representation of women in global health and global health diplomacy (see Box 8). Women make up only 25% of the heads of global health organizations and 25% of the chairs of the boards of those organizations. Women are the health experts who know them best, but their skills and knowledge have not guaranteed them equality in global health diplomacy.
KEY GLOBAL HEALTH INSTRUMENTS
- Introduction to global health instruments
- Instruments adopted by the World Health Organization
- The legal status of WHO instruments
- Entry into force of WHO instruments
- Proposals for new WHO conventions
- Instruments adopted outside WHO
- Steps after the adoption of instruments
Examples in the field of the environment are the Basel, Rotterdam and Stockholm Conventions12, the United Nations Framework Convention on Climate Change (UNFCCC) (entered into force in 1994) and the more recent Minamata Convention on mercury (2017); in international trade, the WTO Agreement on Technical Barriers to Trade (1995), the TRIPS Agreement (1995) and the WTO Agreement on the Application of Sanitary and Phytosanitary Measures (1995); in the field of human rights, the International Covenant on Economic, Social and Cultural Rights (1976) and the Convention on the Rights of Persons with Disabilities (2008). 13 Convention on the Prohibition of the Development, Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on Their Destruction (entered into force in 1975); Convention on the Prohibition of the Development, Production, Stockpiling and Use of Chemical Weapons and on Their Destruction (1997). The TBT and SPS Committees receive for consideration many health-related trade measures notified by members to the WTO.
KEY GLOBAL VENUES AND ACTORS
- The World Health Organization and the changing field of global health The World Health Organization is the key venue for global health negotiations. An intergovernmen-
Official relations are a privilege that the Executive Board can grant to non-governmental organizations, international business associations and philanthropic foundations that have had and have "permanent and systematic cooperation in the interests of the organization". WHO is in the process of compiling a register of non-state actors that, among other things, details their type of engagement with the Organization. By including many stakeholders in the SDG negotiations and adopting Goal 17 on partnerships, the UN has given multi-stakeholder diplomacy a high degree of legitimacy.
HANDBOOK
The objectives and activities of these entities shall be consistent with the spirit, purpose and principles of the WHO Constitution and are expected to contribute significantly to the promotion of public health. There are significant opportunities to further increase the engagement and involvement of non-state actors in WHO's work. Especially within global health, many hybrid organizations as well as alliances and initiatives have been created, which on the one hand derive their legitimacy from the representation and involvement of a large number of stakeholders, and from the focus on results, on the other.
ENGAGEMENT WITH THE
There is a special category of actors that WHO works more closely with: the non-state actors in official relations with WHO. During the COVID-19 pandemic, it became clear that new forms of cooperation must be found, especially with the science and digital technology sector. This type of diplomacy encompasses a remarkably wide range of initiatives and institutions: international organizations, national sectors and agencies, development banks, civil society, private industry, philanthropic and academic institutions, professional associations and dedicated – and sometimes very powerful – individuals.
WORLD HEA LTH ORGANIZAT ION
- Other international health organizations and entities
- Health diplomacy at the United Nations
- The central role of States in global health diplomacy
- The role of non-State actors in global health diplomacy
- Maintaining a balance
- THE ROLE
Today, the Gavi Alliance is one of the most important actors in global health governance. OCT Office of Counter-Terrorism ODA Office for Disarmament Affairs Office of the United Nations OHCHR. The open role of the private sector in global health diplomacy has grown significantly in recent years.
OF REGIONAL ORGANIZATIONS
- The interface between regional bodies, diplomacy and global health
- An overview of regional integration
- Regional integration and health
- Regional integration and global health diplomacy
- POLICY COHERENCE FOR GLOBAL HEALTH
- Creating synergies
- Using existing mechanisms more effectively for policy coherence Policy coherence is about upholding shared values and achieving common goals. By using univer-
- The domestic groundwork for global policy coherence
- The importance of a national global health strategy
16 Organization of the Black Sea Economic Cooperation (BSEC), Shanghai Cooperation Organization (SCO), Economic Cooperation Organization (ECO). Most of the countries that have so far adopted national strategies on global health are donors. One of the main challenges in designing a national global health strategy is to achieve coherence between national policies in various areas.
PART C
THE ELEMENTS OF SUCCESSFUL
ACHIEVEMENTS IN GLOBAL HEALTH DIPLOMACY
- Defining success in global health diplomacy
- Examining success
Due to the diversity and complexity of the issues involved, a strong personality and passionate commitment can make a big difference in many global health negotiations. More details on the negotiations that led to the Political Declaration of the High-Level Meeting on Universal Health Coverage (2019) can be found in Case Study 2. In general, though, the implementation of the Convention's provisions has been quite uneven in many countries.
ANALYSING
NATIONAL AND GEOPOLITICAL INTERESTS
- Understanding the complexity of global health issues
- Building relationships in Geneva and other negotiating hubs Since global health issues are highly interconnected, they may come up for discussion concurrent-
- Gathering available information
- Understanding positions
- Examining negotiation blocs and alliances
- COORDINATION WITH NON-HEALTH SECTORS
- The interface between health and other sectors at the national level
- Emerging linkages to other sectors
- The health sector’s role in cross-sectoral cooperation
- CONDUCTING
In the case of the United States, this may depend on the administration in power. Several global WTO trade agreements – the TRIPS Agreement, the Agreement on Technical Barriers to Trade, the Agreement on the Application of Sanitary and Phytosanitary Measures and the General Agreement on Trade in Services – are strongly related to health. The health impacts of the sectors discussed in the previous section have long been recognized.
GLOBAL HEALTH NEGOTIATIONS
- Competencies for global health diplomacy
- Understanding values
- Negotiation tactics and conflict resolution
- Understanding the rules and procedures
- Understanding global health actors and partners at home
- Understanding the positions of other actors
- Chairing negotiations
- Access to medicines
- EXAMPLES
Æ Awareness of the determinants of global health and an understanding of their links with other aspects of foreign policy. Æ prestige: the chairman has been agreed upon by all the parties and is the recognized leader of the negotiations. One of the most long-standing and controversial issues in global health diplomacy is access to medicines.
OF GLOBAL HEALTH DIPLOMACY
Vaccine diplomacy
Other benefits included measures such as technology transfer and improved access to diagnostic reagents and flu test kits – resources that many low-income countries had previously struggled to secure. This raises important questions about vaccine access for people in developing countries, especially middle-income countries that are not eligible for support from the Gavi Alliance or other international aid mechanisms. The alliance between some EU countries for the advanced purchase of vaccines, for example, requires pharmaceutical companies with which the EU contracts to make part of vaccine supplies available to low-income countries.
Air pollution
City diplomacy is directly involved in pinpointing key global agendas such as the 2030 Agenda for Sustainable Development. While the COVID-19 crisis is potentially paradigm-changing, it has not impacted the impetus for city diplomacy. Nevertheless, the role of city diplomacy in global health remains relatively limited compared to its role in other areas such as migration, climate or resilience.
Trade, intellectual property and health
Antimicrobial resistance
Overall, AMR is one of the major items on the global health agenda of the 21st century.
Migration and health
It is closely linked to other politically and technically complex areas, such as the One Health approach, R&D and innovation, and therefore requires increasing international (and intersectoral) diplomacy and negotiations so that global solutions can be found. Second, health was not identified as a specific topic for thematic sessions at the beginning of the negotiation process for the Global Compact. Another important lesson from the process of including health in the Global Compact is therefore that the use of parallel platforms and leveraging the power of universally recognized existing instruments can play a critical role when promoting health interests during negotiations at the UN on a document of wider scope. .
Concluding remarks
A country's mission in Geneva can also receive requests to provide additional expertise to the national authorities in the capital. 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). The instructions will eventually be approved at the highest level in the lead ministry before being sent to the Geneva mission.
GLOSSARY
Global health diplomacy is an emerging field that combines the priorities of global health with foreign affairs. Global health diplomacy involves a range of disciplines, from public health, law and international affairs to management and economics. Global health security: Reducing collective vulnerability to global threats to public health, both immediate and incremental.
RESOURCES
