Facets of Global Health Diplomacy (GHD) amid COVID-19
After the outbreak of COVID-19 in China, the virus quickly spread throughout the world and caused a global health crisis within a few weeks. The previously unknown virus attacks the respiratory system and can lead to a painful demise. As the death toll rises every day around the world, COVID-19 comes as a reminder that the international community must find a more collaborative approach to battle such pandemic. Beyond economic capabilities, COVID-19 has rattled the livelihoods of many in both developed and developing states and strained economic relations between states as the world economy came to a halt. It was soon recognized that states were not prepared for such a massive outbreak and lacked resources for adequate treatment. Pandemics such as COVID-19 require more than domestic sustainability. COVID-19 has upbrought a cosmopolitan moment with more collaborative and humanitarian states. One example being German and Swiss hospitals taking French patients (Kickbusch, 2020). The solidarity brought hope for states around the globe to revive relations under the much-promoted agenda of Global Health Diplomacy (GDH) making it more prevalent than ever before.
Pandemics have existed since humans have expanded across the globe. Even though stopping the spread beyond borders is pragmatic, it also causes economic downfall for states that are largely dependent on exports and imports. Looking back at history, states typically put their national interest first. Institutions such as the United Nations have worked as a bridge between the differences between states and helped them negotiate on various political and economic issues in the past. The same can be hoped for from the World Health Organization (WHO), which can serve as a mediator for negotiation and building diplomatic relations for battling COVID-19.
Understanding Global Health Diplomacy (GHD)
The concept of ‘medical diplomacy’ was introduced by Peter Bourne in 1978 to help the United States include health in its international relations (Millbank, 2011). According to the WHO, global health diplomacy is an emerging field that connects public health with international affairs, management, law, economics, with a focus on negotiation (Brown et al, 2018). The concept has entered mainstream diplomacy to an extent, but still falls under three categories laid out by Millbank (2011): (1) formal negotiations between states, (2) negotiations between states and with non-state actors that might not lead to binding agreements, and, (3) the interactions that take place between public health actors and their counterparts.
The idea of health diplomacy initially focused mainly on multilateral cooperation but was soon included in the prevention of the spread of any disease within developing countries. The efforts could be unilateral or multilateral. As a rising subset of foreign policy, health diplomacy has become a multi-faceted ‘dual goal’ in improving global health and international relations. During the 2014 Ebola epidemic, for instance, which mainly affected various African countries, China had sent medical experts and resources to tackle the disease and Cuba’s help in anti-Ebola efforts was appreciated immensely by former US Secretary of State, John Kerry. Another example is Cuba which was being favored in the pricing of Venezuelan oil by launching a public health program in Venezuela. Health diplomacy might be the new face of international relations given the global pandemic which the world is presently facing. The formal negotiation, known as ‘core GHD’, accredits Health Attaches and other diplomats to link one state’s public health institution to another. The negotiations between states and between non-state actors, otherwise known as ‘multi-stakeholder GHD’, includes various levels such as lobbying governments, shaping health policy and identifying and engaging powerful institutions, interests and ideological positions within different levels of government (Brown et al, 2018). A significant advancement in GHD are health attachés who represent and link public health organizations in a single government with their partners in another governments. (Adomako et al., 2020) These health attachés’ critical activities include facilitating links between domestic public health agencies and partners in their country and the region and develop connections between public health and foreign affairs stakeholders and institutions in an international setting. Health Diplomacy doesn’t only limit itself in sharing and assisting medical facilities and scientific research, but also incorporates economic and military incentives and interventions in conflict areas like Africa to build trust and interdependency. Lastly, ‘informal GHD’ combines the discussion of non-state actors and actors of various institutions to represent and create a set of tools for public health.
Prospects and fallbacks of Global Health Diplomacy during COVID-19
The WHO has been an undisputable center of the global health system, but COVID-19 has brought major setbacks for the institution. With COVID-19 prevalent and spreading faster across the globe, the WHO was not able to overcome financial uncertainty. This uncertainty has caused a lack of surveillance and engagement. Although several member states have come forward to offer help to the WHO for them to lead the response to the pandemic. While many states have been arguing about travel and export restrictions, there are more pressing issues of creating a comprehensive health policy. These issues remind the world of sovereign states lagging in terms of cooperation when it is most needed. David Heyman, former Executive Director for Communicable Diseases at the World Health Organization (WHO), explained in a recent essay how the roles of medical workers have changed over time and how non-pharmaceutical interventions can reduce the transmission and impact of such infectious diseases (Institute of Medicine (US) Forum on Microbial Threats, 2007). The decision of the United States was not a surprise to many due to its recent tendency of reducing multilateral engagement. Although many states have advanced their healthcare sectors in their states, the overwhelming number of affected people is causing panic and shortages of drugs, testing kits and personal protective equipment.
During this pandemic, the role of diplomacy in health can prove to be extremely vital. Due to the ever-changing elements of diseases, states cannot resolve these through technical means only. They require political and economic assistance, negotiation, and ultimately solutions. States can thrive better in crippling situations of the healthcare system by addressing issues, protecting other states in joint interests, humanitarian health relief, etc. Therefore, there has been an increase in the priority of Global Health Diplomacy for a couple of reasons. Firstly, there are more actors other than WHO, who are actively involved in shaping global policy for health determination (Chattu, 2017). Secondly, many foreign ministries are investing and promoting health when securing policies, national interests, and economic agreements (Chattu, 2017). COVID-19 has shown that such viruses can transcend any border and cause economic meltdowns. Over the years, health policy has become an important addition to foreign policy. However, there has hardly been any mention of tackling emerging diseases in the concept of collective security. During the time of COVID-19, the pandemic could bring new opportunities for collaboration given the complexity of global health. There should be a boost to Health Attaches in different states as situations like this require robust political communication (Bayaa 2020).
There is a fear of letting health diplomacy have undermining effects due to hegemonic narratives of the pandemic and the development of the who-cured-what situation. The first reason for such narration could be due to the intention of securing the international system and legitimize efforts of one or multiple states. As there is a lack of resources and an ongoing attempt to find a cure and get the normal life back on track around the world, states become even more competitive which in turn creates more complexity.
COVID-19 affects more sectors than previously assumed. There are usually two endings to a pandemic, as said by various historians . Firstly, the medical ending, which means that the death rate plummets and secondly, the social ending, which means that the fear of the epidemic fades. Health diplomacy has become a point of amusement and debate for scholars and state advisors. Many have argued that such a type of diplomacy may prove to be a Trojan horse, meaning states being under the veil of goodness might have concealed motives. In the context of GHD, foreign policy interests are intertwined with health diplomacy. There are also a variety of state and non-state actors being actively involved in shaping global policy for health purposes. As health security is no longer a national concern, governments need to become more willing in exchanging and aiding other states to grow their medical capacities. Global health collaboration should be equipped with accountability and transparency among the stakeholders to gain sustainable progress. As stated previously, it is not surprising for states to reconsider cooperation. The only way to battle such pandemic in the present and the future is to communicate and aid one another to prevent further spreading and coming to a feasible solution faster. The use of GHD to form a better and sustaining relationship with other states through international institutions like the WHO can help to battle the pandemic more effectively. Apart from that, the flow of information, exchange of knowledge, accountability and capacity building are the most important goals. Thus, it can be said that the COVID-19 situation opens new doors in the work for a more inclusive and integrated GHD.
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Fahmida Alam is in her final year studying International Relations at the Bangladesh University of Professionals. She researches in matters of international relations and gender.