5.3.4 Health

Health diplomacy has become more and more important in the last decades. Many countries and organisations share the idea of bringing together disciplines like public health, international affairs, management, law, and economics for a common goal for the good of the people. But this is not an easy task. National interests, medical patent rights, intellectual property protection, pharmaceutical industry groups, non-governmental organisations and various other stakeholders each play an important role in the development of global health diplomacy. Health diplomacy is needed for the negotiations that shape and manage the global policy environment for health. The relationship between health, foreign policy and trade is at the cutting edge of global health diplomacy. Health diplomacy and science diplomacy are closely related and have overlapping fields of political and scientific work and interests.

The World Health Organisation (WHO) has a special unit dealing with health diplomacy (cf. WHO 2019). The goals of this unit are:

1. To support the development of a more systematic and pro-active approach to identify and understand key current and future changes impacting global public health
2. To build capacity among Member States to support the necessary collective action to take advantage of opportunities and mitigate the risks for health (WHO 2019)

Many countries express the immediate political will to make a difference for the benefit of all people’s health. In the Oslo Declaration of 2006, for example, the Ministers of Foreign Affairs of Brazil, France, Indonesia, Norway, Senegal, South Africa, and Thailand issued a statement, emphasizing that health is one of the most important, “still broadly neglected, long-term foreign policy issues of our time” (Oslo Declaration 2006). Similarly, many states express the immediate political will to make a difference for the good of all people’s health. Health is described as a global public good (GPG) that needs to be achieved and maintained at a global level. Although there is progress in various fields, there is still a need to agree to the facilitating and the use of the necessary resources on one side and a lack of coordination and management of processes on the other side.

An international platform for the development of health diplomacy and for the enhancement of health as a GPG is helpful. In 2013, the Swiss Academy of Medical Sciences formulated some key points for the establishment of an international platform for health diplomacy. They call it the “5 C’s” (Swiss Academy of Medical Sciences 2013):

1. Common norms and norms for investments
2. Communication mechanisms for information sharing and collaboration
3. Coordination mechanisms so that science and R&D investors have better information
4. Collaborating more efficiently
5. Collective decisions for big issues

Providing the necessary conditions to make these framework conditions possible and to implement an international initiative will certainly require a lot of effort. Nevertheless, there are also initial successes of international health diplomacy. One example is the fight against the Zika virus in a concerted initiative of several American states. The outbreak of Zika in Brazil and Colombia (2015-2016) led to an international epidemiological alert for infection issued by the WHO and the Pan American Health Organization (PAHO). Different institutions, e.g. the U.S. Center of Disease Control (CDC) and the Instituto Nacional de Salud of Colombia (INS), signed a memorandum of understanding to collaborate in an investigation on the long-term effects of Zika virus (CDC 2016). The need for a coordinated approach also became apparent during the COVID-19 crisis: The WHO convened a Global Research and Innovation Forum on the novel coronavirus, attended by more than 450 experts and funders. They came together in February 2020 to assess the level of knowledge, identify gaps and work together to accelerate and fund priority research, with equitable access as a fundamental principle underpinning this work. In summer 2020, the COVAX Facility, a mechanism designed to guarantee rapid, fair and equitable access to COVID-19 vaccines worldwide, secured engagement from more than 150 countries, representing over 60% of the world’s population. (Source: WHO)

Great hope for the longer-term achievement of the goals and sub-goals of SDG 3 currently also lies in the future development of the health-related science, technology, and innovation. Digital technology makes it possible to compensate for the insufficient doctor-patient relationship insofar technology allows us to reach out to people in inaccessible areas. E-health also facilitates the diagnosis, monitoring, and treatment of pandemic diseases. More recent research, in turn, is leading to the production of affordable medicines, including generics. Science will therefore be able to make an important contribution to the development of health diplomacy, as it already has, and help improve the GPG health.

The COVID-19 crisis offers a current example: It shows us how fragile and sensitive our living environments are. “All countries are turning to science. “, is stated in the UNESCO dialogue of 30 March 2020, because political decision-makers everywhere now seem to trust in scientific expertise more than ever. Science Diplomacy is best suited to support the international efforts for a transition towards Open Science:

• to recognise that the creation and transfer of scientific knowledge are critical to building and sustaining socio-economic welfare and integration in the global economy.
• to support the international scientific community to further demonstrate the spirit and principles of solidarity and knowledge sharing.
• to mobilise policy makers, civil society and private sector and patent holders to further collaborate with scientists to share scientific information.

The use of scientific collaborations among nations to address common problems and to build constructive international partnerships is the main definition of science diplomacy. (see 2.2.2 The Royal Society and AAAS’s Conceptual Framework: Science for Diplomacy)

What the experts think

How does the Spanish health system communicate with other national systems to work together on health issues?

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