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![Health as “Low Politics.”
Adapted from Fidler (2005) [61].](publication/43346228/figure/fig1/AS:342322442194944@1458627438085/Health-as-Low-Politics-Adapted-from-Fidler-2005-61.png)
Health as “Low Politics.” Adapted from Fidler (2005) [61].
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![Figure 1. Health as “Low Politics.”
Adapted from Fidler (2005) [61].](publication/43346228/figure/fig1/AS:342322442194944@1458627438085/Health-as-Low-Politics-Adapted-from-Fidler-2005-61_Q320.jpg)
The public health community has seized upon the concept of health diplomacy to raise the profile of health in the practice of foreign policy. Diverse definitions of health diplomacy represent divergent perspectives on the use and political neutrality of health interventions. Foreign policy priorities often determine political priority and funding f...
Contexts in source publication
Context 1
... each of these scenarios, political priority was placed on a health issue because of its perceived potential impact on one or more national security, economic, or foreign policy interests ( Figure 1). The strength of the relationship between a health issue and the national interests of powerful states may be crudely measured by the amount of funding and political attention the issue receives. ...
Context 2
... foreign policy conceptualization of health diplomacy stands in stark contrast to the idea of health diplomacy held by many global health practitioners. Some global health proponents have argued that the ''political, social and economic impli- cations of health issues'' have collapsed the traditional foreign policy hierarchy of interests (see Figure 1), and that ''domestic and foreign, hard and soft, or high and low-no longer apply'' [8]. This perspec- tive views improving global health as the most important goal of foreign policy in and of itself, and that health diplomacy can ''shape and manage the global policy environment for health'' [italics added] [8]. ...
Citations
... One of the defining features of GHD is its emphasis on collaboration across sectors and borders (Feldbaum & Michaud 2010;Kickbusch et al. 2011). As noted by Kickbusch et al. (2011), GHD involves "the orchestration of the diplomatic and policy efforts of multiple actors to bring about mutually beneficial health outcomes in a globalized world." ...
... Within the Global Health Diplomacy (GHD) discourse, the availability of funds is a crucial factor. Feldbaum and Michaud (2010) note that foreign policy interests play a pivotal role in determining the political priority and funding allocation for various global health issues. ...
... This effort is aligned with conception of GHD that it is involves "the orchestration of the diplomatic and policy efforts of multiple actors to bring about mutually beneficial health outcomes in a globalized world the (Kickbusch et al. 2011) and emphasis on collaboration across sectors and borders (Feldbaum & Michaud 2010). At this point Indonesia government as mentioned by Adams et al. (2008) and also advancing his GHD as a response from emerging various global health issues, such as COVID-19, should be viewed as immediate dangers to vital interests in foreign policy and national security, as well as an acknowledgement of the need to continue addressing global health inequities. ...
In the last three years, during the COVID-19 pandemic shocks, the discussion for economic recovery and global health development agenda prevailed. To date, the discussion has shifted from recovery to more extensive moves such as strengthen the current global health architecture. Specifically, prepare for the next pandemic and reduce potential risks. Countries around the world are interested in this topic and the Group of Twenty (G20), the premier economic forum summit, also focuses on this issue. This kind of “global crisis responder” experience drives the interesting discussion, how did the COVID-19 crisis respond by the G20? Answering this question, during Indonesia's G20 Presidency, the Pandemic Fund was formally introduced in collaboration with the Pandemic Fund secretariat, marked by a significant event during the G20 Joint Finance and Health Ministers’ Meeting. The rationale behind establishing this fund arose from the challenges faced by low and middle-income nations in securing adequate funding for their healthcare systems amidst the COVID-19 pandemic. Depart from that, this significant achievement of the pandemic fund launching raises questions, why Indonesia has an agenda for Pandemic Fund during its presidency? This paper aims to answer this question with the framework of global health diplomacy.
... While there are those who call for health diplomacy in protecting what is seen as a global public good, it is also linked to individual countries' foreign policy aims, as is seen, for instance, in the link between funding for research on infectious diseases and the 198 CHAPTER 10 protection of health security, or the provision of health care as development aid in shaping relations between donor and recipient countries. 8 While the Constitution of the Republic of South Africa, 1996, enshrines basic human rights such as the right to bodily and psychological integrity (Section 12) and access to health care services (Section 27), the country continues to face persistent domestic challenges in redressing past healthrelated injustices. This has been compounded by high rates of HIV/AIDS and tuberculosis (TB), intergenerational poverty, and apartheid urban planning -challenges which are juxtaposed with leading advances in medicines worldwide and leading health care systems in the private sector. ...
... According to Feldbaum and Michaud, health diplomacy is a combination that is used to explain the health negotiation process, the health impact of non-health negotiations, and foreign policy goals to support global health (4). Another view of Kickbusch, Silberschmidt, and Buss is that global health diplomacy aims to capture the multi-level and multi-actor negotiation processes that shape and manage the global policy environment for health (5). ...
Indonesia has continued to carry out vaccine diplomacy since the Covid-19 pandemic emerged in early 2020. Vaccine diplomacy is considered important because vaccines are a crucial tool in dealing with the adverse effects of the Covid-19 pandemic. This study aimed to analyze how Indonesia’s vaccine diplomacy is carried out in the form of bilateral, regional, and multilateral cooperation to overcome the Covid-19 pandemic. In addition, the research also focused on the opportunities and challenges faced by Indonesia in making vaccine diplomacy (health diplomacy) to strengthen health security and national health independence. This research used a qualitative approach. The results showed various efforts made by Indonesia to overcome the COVID-19 pandemic at different levels, namely bilateral, regional, and multilateral. This is done by Indonesia to meet the supply of vaccines in an effort to create health security and national health independence. However, there are challenges in its implementation. Indonesia is still struggling against the COVID-19 pandemic, but also has an interest at the global level to actively participate in global health policies. Therefore, it is important for Indonesia to effectively coordinate with the various collaborations that have been established. In the implementation of Indonesia’s health diplomacy at the bilateral, regional and multilateral levels, it also creates opportunities for Indonesia’s economic recovery, where Indonesia can maximize the production of personal protective equipment. However, it needs to be a concern for Indonesia that in maximizing these commodities, various internal and external aspects must be considered so that effectiveness can be felt not only for Indonesia but also for destination countries. Keywords: vaccine diplomacy, bilateral, regional, multilateral, Covid-19
... The "soft power" approach also can be applied to the GHD as, according to Lee et al. [4] it can help "to obtain an objective through persuasion and collaboration, rather than through economic influence or political domination." However, despite its importance, Feldbaum and Michaud [5] conclude that health issues constitute "low politics" as they are "driven by Foreign Policy Interests,"; and the authors also describe it as "soft power." ...
... Resources are deployed in ways that result in the recipient countries not having full autonomy over malaria policy and resource allocation; therefore, they cannot make decisions on how best to implement malaria prevention, diagnosis, and treatment in their own countries [7]. The existence of multiple players in malaria at the global level also contributes to competition for leadership, influence, and resources at the national level [23]. Country ownership is important, for example, Zambia takes ownership, makes decisions, and provides evidence to the global entity to change policy. ...
The global disruptions brought about by the COVID-19 pandemic as well as the stagnation of progress of global malaria elimination efforts have provided an opportunity to rethink several aspects of the global malaria program, including its governance at all levels, from the community to the nation and to the world. Approaching this issue requires an examination of the critical governance factors that affect malaria elimination as well as lessons that could be learned from the governance of other global health programs. The paper, therefore, first reviews malaria program governance challenges at the global, national, and sub-national levels. We then conducted a literature review of governance factors that affected four major global disease elimination programs; (1) the global smallpox eradication program; (2) polio eradication efforts (focus on Latin America); (3) the onchocerciasis eradication program; and (4) global COVID-19 pandemic control efforts. Based on this review, we identified eight comment governance themes that impact disease elimination programs. These include 1) International support and coordination; 2) Financing; 3) Data use for engagement and decision making, 4) Country ownership; 5) National program structure and management, 6) Community support/engagement; 7) Multisectoral engagement; and 8) Technology and innovation The paper then illustrates how these eight governance themes were factored in the four disease control programs, draws lessons and insights about the role of governance from these programs and outlines the implications for governance of malaria elimination efforts. The paper concludes by making recommendations for improving governance of malaria elimination programs and how the analyses of other global disease control programs can provide new ideas and inspiration for a more robust push towards malaria eradication.
... Fazal (2020) points out that most health diplomacy literature is centred on public health, not political science or international relations, and emphasizes how diplomacy can benefit health rather than global health politics. Scholars such as Drager and Fidler (2007), Katz et al. (2011) and Feldbaum and Michaud (2010), focus on 'health diplomacy' rather than 'global health diplomacy' tend to identify the aims of health diplomacy with the strategic aims of countries engaged in such diplomacy. Lee and Smith (2011) noted a shift from 'traditional' to 'new' diplomacy, and define GHD as 'negotiations on population health issues that require collective action worldwide to address effectively.' ...
The ongoing debate on the conceptual underpinnings of constructivism and global health partnerships (GHPs) in global health studies has a dimension that deserves closer attention. This paper attempts to draw attention to a few aspects of the debate using Finnemore’s constructivist analysis. According to this study, global actors need to rethink their paradoxical notions of pandemic crisis survival in light of the growing demand for mobilizing diverse global health agents and the necessity of constructing complex GHPs to address challenges of international significance. A global response based on solidarity and multilateralism is the only way to effectively combat this pandemic. Against this backdrop, the article analyses this development through an ideational ontological case study of the GAVI, the Vaccine Alliance. This article contributes to the debate by explaining how the GAVI Alliance fostered global collaboration and can serve as a template for future GHPs.
... Autores que se centran en la diplomacia sanitaria tienden a identificar los objetivos de la misma con los objetivos estratégicos de los países comprometido en tal diplomacia(Drager y Filder, 2007), logrando así que la diplomacia sanitaria se constituya en una forma de "ganar corazones y mentes"(Vanderwagen, 2006) y concibiendo las intervenciones de salud como justificadas por el interés nacional(Feldbaum y Michaud, 2010). Las inversiones estadounidenses en salud global, por ejemplo, aseguran percepciones favorables hacia los Estados Unidos(Katz et al., 2011), así como las considerables inversiones de China en materia de salud en el África subsahariana que hacen parte de la política enmarcada bajo la denominada "Iniciativa de la Franja y la Ruta de la República Popular China" o "Belt & Road Initiative" (BRI), las que le generan al gobierno chino réditos tangibles e intangibles.2 ...
En este capítulo se propone responder la siguiente pregunta: ¿qué significa para América Latina la presencia de actores globales extrarregionales (China, Rusia, India e Irán) en la región, en un escenario de incertidumbre acentuado por la pandemia del covid-19? Se propone examinar la influencia actual de esas cuatro potencias no occidentales en la región en torno a tres grandes dimensiones: política, económica y militar. No se usará una metodología estrictamente comparativa ante la inconsistencia y asincronía de los datos, pero se usarán algunas series de tiempo, tablas de indicadores y subtemas de contraste para ponderar en qué países de la región se perciben más esas presencias y cuál puede ser su profundidad.
... Our findings resonate with the literature showing that global health diplomacy entails potentially contradictory "dual goals" of serving foreign policy interests and strengthening global public health [7][8][9]. As Feldbaum and Michaud [10] have argued, "countries are increasingly using health initiatives as a means to improve security, project power and influence, improve their international image, or support other traditional foreign policy objectives" (p1). Yet, we seek to move beyond the state-centric bias in the literature on global health security and diplomacy, which leads to insufficient attention to the role of non-state actors and the interplay between national security, diplomatic and commercial interests [11]. ...
... That wealthy countries adhered so poorly to COVAX's dose-sharing principles also reflects that they used their COVAX donations not only to exercise solidarity, but also as a soft power tool to achieve diplomatic recognition and influence [8,10], so-called "vaccine diplomacy", and domestic political gain. ...
Background
In 2021, donor countries, the pharmaceutical industry, and the COVAX initiative promoted vaccine donation or “dose-sharing” as a main solution to the inequitable global distribution of Covid-19 vaccines. COVAX positioned itself as a global vaccine-sharing hub that promised to share doses “equitably, effectively and transparently,” according to rational criteria overseen by independent scientists. This article provides a critical analysis of the principles and practice of “dose-sharing,” showing how it reveals the politics at play within COVAX.
Results
Donated doses were an important source of COVAX’s vaccine supply in 2021, accounting for 60% of the doses the initiative delivered (543 million out of 910 million). However, donations could not compensate fully for COVAX’s persistent procurement struggles: it delivered less than half of the two billion doses it originally projected for 2021, a fraction of the 9.25 billion doses that were administered globally in 2021. Donor countries and vaccine manufacturers systematically broke COVAX’s principles for maximizing the impact of dose-sharing, delivering doses late, in smaller quantities than promised, and in ad hoc ways that made roll-out in recipient countries difficult. Some donors even earmarked doses for specific recipients, complicating and potentially undermining COVAX’s equitable allocation mechanism.
Conclusions
COVAX’s pivot from global vaccine procurement mechanism to dose-sharing hub can be seen as a “win-win-win” solution for COVAX itself (who could claim success by having access to more doses), for donor countries (who could rebrand themselves as charitable donors rather than “vaccine hoarders”), and for the pharmaceutical industry (maintaining the status quo on intellectual property rights and protecting their commercial interests). Although dose-sharing helped COVAX’s vaccine delivery, its impact was undermined by donors’ and industry’s pursuit of national security, diplomatic and commercial interests, which COVAX largely accommodated. The lack of transparency and accountability mechanisms within COVAX’s overly complex governance structure as a global public-private partnership enabled these practices.
... Health diplomacy, particularly with the growing recognition that health can be an effective 'soft power' tool in policymaking, promoting a better state of the global community while promoting political interests or economic aspects of a country [13]. ...
... The definitions offered by authors of scientific papers, in principle, comply with the WHO's definitions. They refer to such aspects as negotiations (which is similar to the first understanding offered by WHO) and the impact of health issues on nonpolitical aspects (Feldbaum and Michaud 2010). Kickbusch et al. (2007) defined health diplomacy as relating to multi-level and multi-actor negotiations that influence the health areas of global policy, which again corresponds mostly with the WHO's first understanding of health diplomacy. ...
The pandemic of COVID-19 struck the world in early 2020. China, which is regarded as the source of the new disease was also the first one to overcome it. After controlling the outbreak domestically, China started conducting public diplomacy offensive, which we will call ‘coronavirus diplomacy.’ Its main focus is put on assisting other countries that are still struggling with high numbers of infections and many difficulties, such as shortages in medical equipment or medical staff. This article aims to review public diplomacy activities undertaken by China in conjunction with the COVID-19 pandemic in Spring 2020. The goal is to determine what messages the Chinese government has been sending through those activities. The investigation was qualitative and the main research method employed is content analysis. The authors analyzed statements of China’s representatives in search of the messages that were supposed to be communicated.
