In this blog post, Sabrina Luh, MSc in Public Policy and Human Development, together with our colleague, Dr Dorina Baltag, Postdoctoral Researcher at the Institute for Diplomacy and International Governance, have raised several key-questions in relation to global health diplomacy at the 51^st Annual UACES conference. They emphasize what is global health diplomacy and what explains the increased attention given to this field, both among scholars and practitioners.

COVID-19 swept the globe, wreaking havoc on even the most modern economies and healthcare systems. This pandemic by far is the most serious global health threat of our time. Already since the beginning of the millennium we now live in, fears have been growing that such epidemics and then pandemics would increase in number and intensity, due in part to the sophistication of international transport, extraordinary urban growth, conflict-ridden refugee flows and/or increasing immunisation fatigue. SARS (2002-2004), H1N5 (2008), and Ebola (2014) have confirmed these alarms, and the unprecedented development of COVID-19 continues to illustrate the full extent of the socio-economic devastation global health crises can cause. The coronavirus not only affected human bodies and state economies but turned out to be a test case for international cooperation. At the epicentre of this is global health diplomacy – that international practice by which the global health policy community engage in, both health- and non-health-related areas, to coordinate solutions, to raise awareness and to promote policies and strategies. Such a multilateral effort facilitates addressing global challenges positioned at the intersection between health and foreign policy.

Why is Global Health Diplomacy important?

Traditional notions of what constituted hard and soft power in diplomatic interactions have been shattered by COVID-19, whose horizontal repercussions go far beyond a single sector. While governments are trying to take stock of millions of deaths, economic collapse, and indecisive leadership, the question on how society prepares for the crises to come arises. COVID-19 is a worldwide endurance and resilience test for health-care systems and the adhesiveness of the international community. In this respect, global health diplomacy is critical in stimulating both state and non-state actors in the implementation of effective and pioneering political choices. The pandemic steered discussions on this topic towards normative concerns oscillating between national security interests, on the one hand, and global altruism, on the other. In the early phases of COVID-19, domestic securities came at the expense of multilateral commitment and cooperation. The Trump administration announcing its leave of the WHO, the EU’s leitmotif of solidarity slowly eroding with Member States failing to live up to their partnerships, and the global South desperately waiting for its access to vaccines while the Northern and Western hemispheres particularly vaccinate their populations with a tightened leash. On the other hand, initiatives such as the COVAX facility, which played a significant role at the global level in addressing immunisation challenges through joint efforts, fills the other side of the picture.

International Cooperation – the driving force for health diplomacy

COVID-19 served as a wake-up call for greater international cooperation because of practices of self-interested diplomacy, or vaccine nationalism. UN Secretary-General António Guterres was right to emphasize that it is not a “surplus of multilateral challenges, but a deficit of multilateral solutions”. In fact, any type of exceptionalism which threatens to derail efforts to ensure a smooth transition to a post-COVID future must urgently give way to more progressive, multilateral global health objectives if we are to be successful in defeating this pandemic. And even though international efforts could not parallel the obstacles produced by the pandemic, the interdependence and the international level of action demands diplomatic practices to rely on cooperation and coordination. Burden and knowledge-sharing as well as communicating and negotiating on health challenges are some of the key processes in global health diplomacy that can lead to a global impact. This includes bilateral agreements between diplomats, negotiating international regulations such as the Framework Convention on Tobacco Control (FCTC) or the revised International Health Regulations (IHR) through the WHO, or initiatives between state and non-state actors such as COVAX, the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM), or the Global Alliance for Vaccines and Immunization (Gavi). The latter, for example, also referred to as ‘the Vaccine Alliance’ was founded in 2000 and is geared towards the equitable access to vaccines. Partnering with the WHO, UNICEF, the World Bank, and the Bill & Melinda Gates Foundation, Gavi supports the scale-up of national vaccination programmes, the introduction of new vaccines and the sustainable financing of vaccination campaigns – whose work was of importance during the pandemic.

Health attachés at the core of health diplomacy

One may identify global health diplomacy in relation to the different levels of diplomacy, such as the individual, national/domestic, and international/global levels. The individual level is less popular in academic circles, although some interest has been dedicated to ‘celebrity diplomacy’, i.e., people in the public eye promoting health causes. The national/domestic and international/domestic have attracted much more interest: on the national level findings show how interest groups, nongovernmental organisations, think tanks and research organisations motivate health-affiliated policies. On the global level, the focus has increased also due to COVID-19, the emphasis is on the promotion and coordination of health in and through the international system. Here the focus is on governments and their delegated attachés; on the agency of international organisations, international nongovernmental organisations, pharma corporations, public-private partnerships, and private-sector organisations.

However, one will uncover that at the core of global health diplomacy are the health attachés: international negotiations on health and health-related matters take place in bilateral and multilateral settings where health attachés have the highest level of legitimacy. And while some, during the pandemic, were wondering where all health attachés disappeared, we have uncovered a diplomatic community of attachés working on matters of health in Brussels. Interviews conducted with EU health attachés led us to identify five distinct roles they play: information-gatherer and -provider; networker and contact supplier; early warner; representer and advisor; and negotiator of draft legislation. They account for the smallest number of practitioners in global health diplomacy. By embracing these roles, they are crucial for sharing knowledge on healthcare system, for policy coordination, contact-building and providing information – a sought resource in times of crisis.

New avenues for practitioner-oriented research

Global health diplomacy is a developing field of research, and the pandemic gave new impetus to addressing questions that are central to both – scholars and policy practitioners. It is an atheoretical field, without one single analytical framework and the body of empirical data needs to be consolidated. Questions such as ‘How does global health diplomacy work or not work?’, ‘How can global health diplomacy be assessed?’, or “Where have all the health attachés gone?” are still in search for answers and need an in-depth case-study analysis.

We would like to say a big thank you to Dr Dorina Baltag and her colleague Sabrina Luh for sharing reflections based on their recent research on the role of (EU) health attachés, recently published in Global Affairs.

If you are interested to directly engage with them, make sure to attend the IDIG Speaker Series in Semester 1, where Dorina and Sabrina will deliver a talk on the subject of health diplomacy on December 16^th . Registration and details can be found here.

You can find out more about the Institute for Diplomacy and International Governance and the postgraduate programmes we offer here.