Global health diplomacy, once a cornerstone of soft power and international cooperation, stands at a crossroads. Recent upheavals – such as the US retreat from the World Health Organization – are challenging its role. Amid geopolitical tensions and biological threats, Lakshmy Ramakrishnan explores why global health diplomacy remains indispensable, and how rising powers like China and India can reshape the landscape
Historically, the US been the largest funder of global health efforts and technical health assistance. It has partnered with other countries and with international organisations, and conducted extensive research. But President Trump’s return to the White House initiated a sudden and unprecedented about-face.
First, the Trump administration alleged a lack of transparency over the origin of Covid-19. It subsequently took steps to formally withdraw from the World Health Organization (WHO). Trump then dismantled the United States Agency for International Aid (USAID), a stalwart of development assistance, voicing concerns that a number of USAID contracts were incompatible with American interests.
Global health may not be a major consideration in current US foreign policy. Yet global health diplomacy is a powerful soft-power instrument, and the Trump administration ignores it at its peril.
Global health diplomacy is a powerful soft-power instrument, and the Trump administration ignores it at its peril
Early examples of potent global soft-power health activities include the US-led medical civic action programme during the Vietnam war, and the medical diplomacy of China and Cuba in 1960s Africa and Latin America.
More recently, the UN embedded health in its sustainable development goals, and the high profile of health at the G7 and G20 reflect how health influences global policy. There is a moral argument for global aid to advance health as a global public good. But there are other advantages to global health diplomacy, including the promotion of national interests and foreign policy goals, and raising a country's international status.
Aside from common health challenges, governments around the world must address novel infectious diseases, bioterrorism, and accidental biological incidents. Tackling such challenges requires concerted global action involving multiple stakeholders, under the aegis of multilateral organisations.
The Covid-19 pandemic highlighted how advancing health policies for the global public good requires coordinated international efforts. For example, collaboration between Oxford University, AstraZeneca, and the Serum Institute of India produced the Covishield vaccine.
COVAX was a novel partnership between the WHO, UNICEF, and the Coalition for Epidemic Preparedness Innovations. The partnership distributed Covid-19 vaccines, under a licensing and technology transfer agreement, to meet global immunisations demands. The sharing of biological information across borders remains critical to global health security, and promotes innovation in medical research and development.
The sharing of biological information across borders remains critical to global health security, and promotes innovation in medical research and development
Despite these notable partnerships, geopolitical rivalry, vaccine nationalism, and the hoarding of medical supplies marred global pandemic management. The crisis damaged public trust in the WHO, weakening its soft power. There were delays in declaring Covid-19 a Public Health Emergency of International Concern (PHEIC), and uncertainty over the pandemic's origin. This demonstrates the urgent need for transparency and enhanced accountability in the WHO, and, ultimately, for its structural reform.
Several WHO member states, most recently the US, are calling for distinct guidelines on when to declare a PHEIC, greater accountability over financing, and measures to ensure the global health workforce is protected.
Negotiations over a pandemic treaty alleviated some of these concerns. Despite the US' absence, the Pandemic Agreement treaty was adopted last month. Yet glaring caveats remain. Negotiations over a Pathogen Access Benefit Sharing (PABS) mechanism, for example, have yet to take place. And any effective agreement will take years to enforce, during which time another pandemic might well occur.
Global health diplomacy remains crucial for navigating the shifting geopolitical landscape. Repercussions from the US' withdrawal from the WHO, the dismantling of USAID, and proposed US funding cuts to GAVI, the Vaccine Alliance, all call for urgent change. A resurgence in military conflicts, and increased military spending by the US, China, Russia, Germany, and India, has reduced global health funding. Finally, global health security remains much weaker without technical assistance and data-sharing with the US.
Any effective agreement will take years to enforce, during which time another pandemic might well occur
To raise their standing on the world stage, China and India continue to influence health activities in Africa, Latin America, and South Asia. India, in particular, is avidly pursuing a permanent seat on the United Nations Security Council.
India is the leading vaccine manufacturer by volume, with vibrant biotechnology and pharmaceutical industries. The country now has a remarkable opportunity to assert its voice in global health. China, meanwhile, has pledged to supplement its mandatory WHO contribution with an additional $500 million over the next five years. Concerns remain, however, over how other countries will be able to interact with China under such multilateral fora.
Global health is undergoing seismic shifts, and biological threats will not diminish. The US departure from health activities leaves a power vacuum, and signals the pressing need for a restructuring of the global health landscape. India and China are poised to address these challenges. Before they can do so, however, both rising powers must address systemic problems that continue to mar global health governance.
