Health Diplomacy Spreading, Competent Health Diplomats Needed, Geneva Speakers Say

Global health diplomacy was the subject of a symposium organised by the Geneva-based Graduate Institute this week. The symposium explored the crossing lines between health diplomacy and science diplomacy, in particular how can diplomacy facilitate international scientific cooperation in health. This week was also the one-year anniversary of the World Health Organization protocol against illicit trade in tobacco products.

The 6th High-Level Symposium on Global Health Diplomacy: Health Diplomacy meets Science Diplomacy, organised by the Graduate Institute of International and Development Studies in cooperation with the Swiss Academy of Medical Sciences, was held on 12 November.

The symposium gathered a number of academics and government officials, and was moderated by Michel Kazatchkine, United Nations Secretary General Special Envoy for HIV/AIDS for Eastern Europe and Central Asia.

Ilona Kickbusch, director of the Global Health Programme at the Graduate Institute, said the symposium is held every year and is an opportunity to explore key issues related to global health diplomacy, and new interfaces between global health diplomacy and other areas.

Alexandre Fasel, ambassador and permanent representative of Switzerland to the UN, said science and health diplomacy has long been a tradition in Switzerland. The country, he said, now has 25 science counsellors throughout the world, through its Swissnex network. According to Swissnex’s webpage, science and technology counsellors are based in Swiss embassies around the world. The network “takes an active role in strengthening Switzerland’s leadership as a world-class location for science, education, and innovation,” the site says.

Fasel cited the new Human Brain Project, which proposes fundamental research on the human brain, under the leadership of the École Polytechnique Fédérale de Lausanne as a collaborative enterprise in science. According to its website, it includes over 130 research institutions in Europe and is “a bold international venture to build a working computer model of the human brain by 2023.”

He also cited the European Organization for Nuclear Research (CERN), as other speakers as a model of science diplomacy.

Science is one of the determinants that can contribute to improve global health and possibly access to health, said Anne-Françoise Alliaz, professor at the University Hospital of Geneva and a member of the executive board of the Swiss Academy of Sciences. The Swiss Academy has a longstanding interest in the ethical dimension of research and science, she said.

The necessity for today’s science to be ethically sound represents a challenge in the field of diplomacy, she said, where there are diverse financial and political influences.

Health Diplomacy Spreading

Stephen Marlin, professor at the Institute of Global health Innovation at the Imperial College of London, underlined the importance of the capacity of diplomats and diplomacy institutions to understand scientific and technical knowledge in their decision-making.

Science diplomacy is a concept that is not very well defined globally, but it is a mature field. Health diplomacy, however, is a relatively young field and only emerged in the last decade or so, he said. The speed with which it established itself is “really remarkable,” he noted, citing the World Health Organization’s Framework Convention on Tobacco Control as an example of health diplomacy.

There are four major reasons why health diplomacy is spreading, he said, referring to a WHO bulletin [pdf] of March 2013. The first is that foreign affairs ministries are becoming more involved in health because of its relevance for soft power, security policy, trade agreements, and environmental and development policy. Second, the venues of health diplomacy are expanding and many new actors outside WHO have become “health diplomats.”

The third is that with globalisation, new donor-recipient relationships are evolving, new types of health alliances and the rise of new forms of cooperation between low-and-middle-income countries has heightened the need for health diplomacy. And fourth, there is a need for “competent health diplomats,” he said.

Open knowledge versus private knowledge in science remains a source of tension, he said. Some moves have been made to try to make knowledge more open access, for example to scientific peer-reviewed journals and publications, but two sets of forces have been trying to counter those efforts, he said.

Commercial publishers who made “handsome profits” are reluctant to give up those profits. And important learning societies in some countries, such as in Europe and the United States, have developed a model of existence that is dependent on the income from selling their own publications, and have been resisting open access.

New Mechanism for Diplomacy for Science

For John-Arne Røttingen, acting deputy director general of the Norwegian Institute of Public Health, in the current paradigm, governments invest in basic and precompetitive research, the private sector takes up ideas and produce technologies and drugs, and then governments invest in health services. Although this paradigm works well, he said, large disparities remain between countries – even developed countries – in public health research and development investments.

In this paradigm, some areas do not work, he said, in particular in five areas: rare diseases, the evaluation of non-commercial products/interventions, pandemics/public health emergencies, neglected diseases, and antibiotics/antimicrobials. The main problem in those five areas is the lack of an attractive commercial market, he added.

On antibiotics, he said the world needs new antibiotics in the face of growing antibiotic resistance. Antibiotics are a global collective resource that is diminishing in value, he said, adding that antibiotics need a global regulatory framework on the use of antibiotics. A new business model is needed in that field, he said, but the overuse of antibiotics should be avoided.

As a solution, Røttingen suggested more cooperation in the context of diplomacy for science: Joint funding, joint programming, coordination, information sharing, and norms and goals/targets. A mechanism akin to CERN is needed in other areas of research, he said.

Health Diplomacy in Practice

Ncumisa Ntutela, deputy permanent representative at the South African permanent mission to the UN, said the role of diplomacy in advancing cooperation and opening dialogue towards advancing global health and science is increasingly recognised.

She said South Africa is one of the signatories of the Oslo Ministerial Declaration in which seven countries observed that health was broadly neglected as a foreign policy issue. The seven countries were Brazil, France, Indonesia, Norway, Senegal, South Africa and Thailand.

The Foreign Policy and Global Health (FPGH) Initiative was then launched by the Oslo Ministerial Declaration and the World Health Organization, according to WHO.

One important activity of this group of countries, which concluded in December 2012, “was to raise awareness on the universal health coverage agenda and in so doing, take the agenda at the level of the UN General Assembly to contribute to making health care more accessible and more affordable and enhance social protection systems that prevent citizens from catastrophic spending.”

She said that through diplomatic dialogue, the group was able to attract more than 90 countries to co-sponsor the resolution at the UN General Assembly. “This is in itself rare in diplomacy,” she said.

First Anniversary of Tobacco Protocol

Haik Nikogosian, head of the WHO Framework Convention on Tobacco Control (FCTC), said that the Protocol to Eliminate Illicit Trade in Tobacco Products was signed on 12 November 2012, one year to the date of the symposium.

Illicit trade in tobacco products is a serious threat to public health by making tobacco products more easily accessible and more affordable. It also undermines public health efforts put into place by countries, and deprive those countries of tax revenues that could be used for prevention actions, he said, adding that the tobacco industry itself participated in illicit trade.

It is estimated that about 10 percent of tobacco products comes from illicit trade, and goes as high as 50 percent in developing countries, he said.

The protocol is a new international treaty in its own right, he said, adding that in a way the protocol is the second global health treaty, following the FCTC. It underlines the growing power of public health, he said.

Some 37 countries have signed the protocol and none have ratified it though some are in the process of doing so, he said. The protocol will enter into force after 40 ratifications. The protocol is open for signature at the UN headquarters in New York until 9 January 2014, according to WHO.

Powerpoint presentations of the speakers and a recorded webcast of the session will be available on the Graduate Institute website.