Global Health Diplomacy In The COVID-19 Era – Can Failure Usher In A New Era of Success? 

More than a year into the world’s largest global health emergency, health diplomats have fought hard to ensure that every country across the globe secures access to lifesaving coronavirus health products, including vaccines, treatments, and diagnostics.  

That has not happened yet, given that 80% of countries that are now rolling out vaccines are either high-income or upper middle-income countries. 

Export bans on essential health products in 80 countries, ranging from personal protective equipment to ventilators, have not helped either. And in the absence of clear global guidance, up to 130 countries have imposed an uneven patchwork of travel restrictions in an attempt to keep more contagious variants at bay – mostly to no avail. 

A panel of some two dozen leading diplomats and health policy experts from WHO, government, academia and media pondered the current state of affairs, at the Global Health Centre’s (GHC) launch of a new Guide to Global Health Diplomacy, authored by GHC founder Ilona Kickbusch along with a former Hungerian Health Minister, Haik Nikogosian, former head of the Framework Convention on Tobacco Control, Mihály Kökény; and a preface from WHO’s Director General Dr Tedros Adhanom Ghebreyesus.  

The guide, co-sponsored by the Swiss Confederation, offers a compass to navigate the complexity of global health diplomacy through “practical insights” and “sound wisdom”, said Norway’s leader of the labor party Jonas Gahr Stør at the launch event on Thursday. 

Norway’s Labour Party leader, Jonas Gahr Støre

The event featured some of the bright stars in the world’s global health constellation, including former WHO DG Margaret Chan; Trudi Makhaya, economic advisor to South Africa’s President Cyril Ramaphonsa, Suhasini Haidar, editor of India’s The Hindu Newspaper, Juan Jorge Gómez Camacho, Mexico’s Ambassador to Canada, and Swiss Federal Councillor Alain Berset. The event, moderated by Kickbusch, was co- sponsored by the World Health Organization and the Swiss Federal Council. 

Said Kickbush: “As you can see from the subtitle of this book [better health – improved global solidarity – more equity], the three words, health, so that health moves to the centre of negotiations, solidarity, and equity – those truly are the goals of global health diplomacy.”Better health – improved global solidarity – more equity

Ilona Kickbusch, Founding Director of the Graduate Institute’s Global Health Centre in Geneva.
Crisis Has Shown The Failures of The Current International Health Regulations System For Pandemic Preparedness & Response 
Michel Kazathchkine, former Executive Director of the Global Fund and a member of the Independent Panel for Pandemic Preparedness and Response

The pandemic has uncovered “many flaws” in global preparedness and response, said Michel Kazathckine, former executive director of the Global Fund to fight AIDS, Tuberculosis and Malaria, and currently serving as a member of the Independent Panel for Pandemic Preparedness and Response, mandated by the World Health Assembly in May, to explore how and why the SARS-CoV2 pandemic caught the world so badly off guard.

“The international system we have established for health security did not really work as a system,” he said. “There were clear gaps in preparedness management of the response coordination.”

If there is anything that diplomacy has “certainly” not achieved in the midst of the pandemic, it is “firm and binding commitments” at the international level, added the Global Health Centre’s co-director Suerie Moon. 

Suerie Moon, Co-Director of Global Health Centre at Geneva Graduate Institute
Same Challenges Were Apparent in H5N1 Avian Flu Epidemic 

The challenges are not new. Some 15 years ago after the eruption of the H5N1 Avian Influenza epidemic, Indonesia protested the fact that after low- and middle-income Asian countries had shared samples of the emergent pathogen with research networks around the world,  rich countries then bought up most of the vaccines thus produced  – leaving other countries vulnerable.  

In 2021, the continued lack of clear and binding agreements to ensure equitable access to health products during health emergencies remains largely unresolved, Moon said. 

“We’ve known this for quite some time, but actually we have very weak, frankly, quite non-existent rules and agreements at the international level to make sure that countries get access to vaccines, so this is not a surprise,” she said. “This is not something that is new to the global health community, but it’s something that we have not yet managed to address.”

While some global frameworks do exist to allow LMICs to gain emergency access to lifesaving health products – such as the pre-existing donor-financed vaccine pool for 92 LMICs managed by Gavi, The Vaccine Alliance, or tools like the WTO’s TRIPS agreement (Trade-Related Aspects of Intellectual Property Rights) – the global south still struggles to take advantage of available IP flexibilities, partially due to fear of retaliation from stronger nations and big pharma. And recent negotiations over a South African and Indian proposal for a more far-reaching TRIPS waiver have “not been easy” either, noted Trudi Makhaya, who is economic advisor to South Africa’s President Cyril Ramaphonsa. 

Trudi Makhaya, Economic Advisor to South Africa’s President Cyril Ramaphonsa.

Another alternative, the WHO-backed voluntary licensing pool, has also failed to garner pharma support for now. Still, there is a growing appreciation that technology transfer and the development of more local health product manufacturing capacity is crucial for low- and middle-income countries going forward, said Makhaya. Notably, new World Trade Organization Director General Dr Ngozi Okonjo-Iweala has talked about a “third way” that would encourage big pharma to sign more voluntary deals with countries for local production – without impinging on intellectual property rights.  

However, Makhaya remains wary:  “There is an appreciation that there’s got to be technology transfer [to LMICs], there’s got to be local manufacturing and that current other alternative arrangements to do that, in the absence of the TRIPS [waiver], are going to be very difficult,” she said. 

Economy Among the Myriad Of Global Health Challenges 

But access to vaccines is only one of a myriad challenges facing low- and middle-income countries in the pandemic response. Makhaya also talked about the economic response to COVID : while some “important” ideas have been floated by the international community to bolster fragile economies – such as special IMF drawing rights for low-income countries – fiscal measures have remained stunted in poorer nations, in comparison to advanced countries that have pumped up to 20% of their GDP into local economies for temporary relief to businesses and the unemployed, she said.

“There have been significant calls that there should be resources at the global level that should be injected [into emerging economies],” said Makhaya. “ A key example was special drawing rights at the IMF…[but] it hasn’t found much expression.”

“We have a situation where amongst advanced countries’ central banks there’s cooperation, but none has been extended to many other developing countries.”

Added Juan Jorge Gómez Camacho, Mexico’s Ambassador to Canada: “Health is not just about health itself,” he said.“Health means prosperity, or the lack of. Health means economic growth, or the lack of. “Health means wealth or poverty. Health is everything. In other words, health criss-crosses all the spectrum of human activity – socially, politically, economically.”

Some Successes: COVAX is Unprecedented 
Dr Tedros Adhanom Ghebreyesus speaking at Thursday Global Health Centre event

Even so, some successes have been apparent since the pandemic struck. If the global health community has achieved anything, it is the WHO co-sponsored COVAX global vaccine facility, which has successfully brought together 190 countries “out of thin air” in the aim to provide more equitable distribution of coronavirus vaccines around the world, said Moon. 

“The access to COVID-19 tools accelerator is health diplomacy in action,” added Dr. Tedros. “It is an unprecedented collaboration between countries, international agencies, the private sector, and other partners to ensure vaccines, diagnostics and therapeutics are shared equitably as global public goods. Vaccine equity is a litmus test for solidarity and global health diplomacy.”

Just last Friday, G7 leaders committed an additional $4.3 billion to the ACT Accelerator initiative, which includes COVAX, as well as parallel efforts for tests and treatments and health systems strengthening. That brings the total commitment to ACT for 2021 to $10.3 billion – although global health leaders say that another $22.9 billion is still needed for all arms of the initiative. 

Local Manufacturing Of New Vaccines 
Scaling up generic manufacture of COVID-19 vaccines could help expand supply and stimulate local economies

Meanwhile, some vaccine-makers have made strides in advancing more local production of their vaccines around the world. Russia’s Sputnik V vaccine, for instance, which showed impressive results in the publication of recent Phase 3 results in The Lancet, is already being produced in India, South Korea, Brazil, China. And production is set to begin in Kazakhstan and Belarus, among other countries like Turkey and Iran – although Sputnik has yet to receive formal regulatory approval from a western regulatory agency or the World Health Organization.  

India’s Serum Institute is manufacturing a local version of the Oxford/AstraZeneca, recently approved by the European Medicines Agency. The vaccine, locally branded as Covishield, is set to play a big part in advancing the access agenda through the COVAX facility as well as through bilateral deals. Over the past two weeks, India has exported 23 million doses of the locally-produced “Covishield” vaccine to low- and middle-income countries, said National Editor for The Hindu media outlet Suhasini Haidar, who also spoke at the panel event.

Still, despite the big ambition for COVAX to distribute more than 2 billion vaccines by the end of 2021, it is a rather sobering fact that COVAX-supplied countries will only be able to vaccinate 3% of their population over the first half of this year, said Moon, adding, “frankly, we need to aim far, far, higher than that.”

Meanwhile, countries like Canada have already ordered five times more vaccines than they need, and the EU has ordered twice as many vaccine doses than it needs. That has opened a debate about vaccine sharing of surplus stocks by rich countries to poorer ones – an exchange which WHO would like to encourage through the COVAX facility instead of through uneven bilateral deals and donations.  

Global Solutions Are Important – But Regional Solutions Also Required 
India’s prime minister Narendra Modi as he recently announced a South East Asia regional initiative.

Finally, while global frameworks are crucial in the pandemic response, countries shouldn’t wait for Geneva to take action, added other panelists. 

Notably, the African continent has come together in unprecedented ways through initiatives like the African Response Fund, the African Medical Supplies Platform, or the African Vaccine Acquisition Task Force, among others, said Makhaya.

“Instead of looking at the world as one large area of cooperation, perhaps [we need smaller] building blocks, much more about the regions and then come to some kind of success,” added Haidar. 

“If we only look at the solutions as an all-or-nothing huge global system, I think we’re going to close off,” added Moon. “It’s a very complex multipolar ecosystem with lots of different solutions being figured out by different actors who are not waiting for the answers to come from Geneva.” 

Indeed, as this event was happening, other new regional initiatives were also taking shape – including Europe’s announcement of an emergency biodefense plan and a SouthEast Asia regional initiative for pandemic preparedness and medical emergencies mooted by Indian Prime Minister Narendra Modi. 

This, however, does not mean “we don’t need Geneva”, said Moon. “We absolutely need global frameworks and global agreements, but when we think about how have countries figured out how to solve their problems, it has not always been through massive global agreements and so I think we have to think creatively about how does the entire ecosystem work, including what needs to truly be global versus [regional].” 

One of the newer global frameworks that is now gaining steam is a “Pandemic Treaty”proposed by DG Tedros at the World Health Assembly. The treaty aims to garner stronger political commitment towards pandemic preparedness and response, noted the WHOs regional director for the EMRO region Jaouad Mahjour, also appearing at the panel debate. But until such initiatives are put into force, it “isn’t difficult” to guess who will emerge as a winner in the pandemic response, warned Kazathckine.

 “Health is a political choice that can and must transcend politics,” Dr Tedros said at the Thursday event. “That’s why this book is so important to build the health diplomacy capacity of both diplomats and health experts around the world.”

But as Moon reminded the panel: “At the end of the day, the big challenge will not be what needs to be done, but actually how to do it. 

“And this is the work of diplomats – just how to implement, and how to navigate the politics… reminds us that the work of diplomats is really just beginning and that there’s a huge agenda ahead of us.”

Other Key Points By Panelists 

Juan Jorge Gómez Camacho, Ambassador of Mexico to Canada.“The only way we can address this pandemic is by moving all together. We cannot address [the pandemic] country by country. It is self-defeating not only collectively [but also] individually as a country, if we focus on us instead of focusing on working together. For a diplomat, to understand in this case it is not my own interest versus everybody else’s interests. In fact, everybody else’s interest is in my best interest. 

Joseph Borrell Fontelles, High Representative of the EU for Foreign Affairs and Security Policy Vice-President of the European Commission -“Sharing expertise and information should be at the heard of global health diplomay.”

Dr Tedros, WHO Director General “If we have learned anything, this past year, it’s that none of us can go it alone. We can only thrive when we work together across institutions across borders,” he said. “That’s why it’s truly a pleasure to join you for the launch of the guide to global health diplomacy.”

Margaret Chan, former WHO Director General “Without diplomacy, we cannot begin to negotiate,” she said.“And we cannot begin to [advance] the important policy decisions that impact the health and well being of the world’s population.”

Alain Berset, Federal Councillor of Switzerland “The value of global health diplomacy has probably never been more apparent as it is today,” he said. “In this crisis, we need skilled diplomacy to find good solutions.”

Michel Kazathchkine, member of the Independent Panel for Pandemic Preparedness and Response “The question for us today…is not whether 2020 has been the year of global health diplomacy, but what has global health diplomacy achieved during the crisis, and where has it failed, and looking forward, which are the challenges.”

Global Health Diplomacy Book – Co Published with the WHO and the Swiss Federal Council 

The new book, published in collaboration with the WHO and the Swiss Federal Council, will be translated into Chinese and Portuguese, among other languages, said Kickbush.

Given that health is negotiated across all sectors, the new guide is relevant to a range of stakeholders, including the media, civil society, academia, as well as ministries across various sectors, emphasized the Global Health Centre’s co-director Suerie Moon.

“The book makes it quite clear that you don’t need to be a health specialist and you don’t need to be a former diplomat, and in fact some of the most important global diplomats are economic advisors or are coming from media or coming from civil society and academia and foundations and not necessarily from the traditional ranks of diplomacy. 

“If there’s one lesson we’ve really seen over the past year from COVID it’s that diplomacy is not only the responsibility of ministries of health, but trade, science, technology, intellectual property,  travel, tourism, finance…Every single one of these ministries in government needs to be mobilized to negotiate solutions.”

Read the Global Health Centre’s new guide here


Image Credits: NBC, European Health Forum Gastein, IHEID, Twitter: @WHOAFRO.

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