Global health security and diplomacy in the 21st century
Good politics alongside good public health practice saves lives – and embedding global health as a core component of diplomacy and foreign policy will have a significant impact on global readiness for tackling present and future disease threats
We are living in a time of pandemics. In the last four years, the World Health Organization has declared a public health emergency of international concern on three separate occasions (Ebola in the Democratic Republic of Congo, Covid-19 and Mpox), with Covid-19 alone estimated to have caused the deaths of over 20 million people across the world, including 1 million in the United States. The infectious diseases responsible for a large share of global mortality – HIV, tuberculosis and malaria – remain persistent threats. According to UNAIDS, in 2022 alone there were 1.3 million new HIV infections, and 630,000 AIDS-related deaths.
Disease threats are also becoming more frequent and more severe, due to greater global connectivity, a changing climate, population growth, food insecurity and a host of other factors. Covid-19 showed us that a disease threat in one country is a national security and development threat globally. The US State Department has recognised this fact by taking the unprecedented step of creating the Bureau of Global Health Security and Diplomacy. This new bureau brings together assets from across the State Department to accomplish three main objectives: to lead US diplomatic engagement to strengthen the global health security architecture, to leverage and coordinate US foreign assistance to address health threats, and to elevate and integrate global health security as a core component of US national security policy. The GHSD bureau will have a unique ability to bring together a strong programmatic base through the US President’s Emergency Plan For AIDS Relief – PEPFAR – with the diplomatic power of the State Department to help address current and future disease threats.
Elevating health in diplomacy
Disease threats require a whole-of-government and whole-of-society response. The world learned this lesson during Covid-19, when health departments and ministries were forced to come together with their finance, trade, commerce, education and foreign affairs counterparts to develop a unified response. But this has also been a key lesson in the fight against the HIV/AIDS pandemic. Countries that have been most successful in fighting HIV are the ones that have elevated their HIV/AIDS response to the highest levels of government priority, and have implemented coordinated, multisectoral strategies taking into account the societal and economic dynamics of the disease. The creation of the GHSD bureau provides a tremendous opportunity to re-elevate the HIV/AIDS response as a political priority on a global and regional stage. This is especially critical given the need for partner countries to take on the increased responsibility required to sustain the HIV/AIDS response going forward.
The GHSD bureau will expand upon this effort by other foreign ministries to elevate tackling global health threats as foreign policy and national security priorities, and establish key lines of work that require greater global collaboration such as sharing data, facilitating access to medical countermeasures and countering misinformation. The bureau will take a leadership role in using data and evidence to help shape diplomatic priorities, and showcase the return on investing in preparedness and health security across government, multilateral institutions and other partners.
Leveraging the PEPFAR platform
Over the past 20 years, PEPFAR has been one of the largest investors in the overall public health systems in our partner countries – supporting 3,000 labs, 70,000 facility and community-based clinics, and training over 340,000 healthcare workers. This platform is a vital component of the HIV/AIDS response, and has been effectively leveraged to tackle other disease threats, especially when they pose a risk to the continuity of HIV services. This was demonstrated at a very large scale during Covid-19, when PEPFAR platforms were vital to creating access to diagnostics, supporting vaccination campaigns and conducting surveillance of the threat by building upon PEPFAR-supported data systems. In Tanzania, when the vaccination campaign stagnated in early 2022, PEPFAR supported platforms helped vaccinate 25 million individuals in less than five months. More recently, PEPFAR-platforms have helped to respond to the Ebola outbreak in the DRC, Marburg in Tanzania, and Mpox in several countries in Africa and Latin America. Our partner countries will continue to find ways to build upon the PEPFAR-supported platforms to prevent, detect and respond to future outbreaks.
Developing transformative partnerships
Partnerships have always been central to success in global health – no one entity can drive outcomes through their own funding and efforts. But given the multisectoral challenges that disease threats provide, there is an increasing opportunity to bring in new partners who have aligned interests. This includes global and regional development banks that have the ability to invest in infrastructure relevant to health, and also the private sector, which has distinct expertise that can be engaged across the entire health value chain – from research and development to surveillance to service delivery. A critical example of these partners coming together is in decentralised manufacturing for diagnostics, therapeutics and vaccines. Manufacturing companies in the United States can provide technology and capacity, development financing institutions can provide financing, and global health donors such as PEPFAR, the Global Fund and Gavi alongside countries can provide demand. This can help to catalyse the development of a pharmaceutical manufacturing base in regions of the world where current access to medical countermeasures is limited. This will not only help to create a shorter and more resilient supply chain, but will also serve to build the flexible capacity needed to respond to future health threats. Similar transformative partnership opportunities are possible in a whole range of critical health areas going forward.
Good politics alongside good public health practice saves lives. Embedding global health as a core component of diplomacy and foreign policy will better prepare the world for tackling the disease threats in the present and future.
