Medical Diplomacy to Face The Global Health Challenges: A Case Study of COVID 19

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Photo Credit- Science and Diplomacy & Journal du Cameroun

Medical Diplomacy in the Context:

Medical diplomacy (MD) has gained more credence and foreign relations weigh over the last two decades in nation’s policies. According to Oslo Ministerial Declaration – global health- as a pressing foreign policy issue of our time, published by the Lancet in 2007 “As Ministers Foreign Affairs, we will work to increase awareness for our common vulnerability in the face of health threat by bringing health issues more strongly into the arenas of foreign policy discussions in order to strengthen our commitment to concerted action at the global level; build bilateral, regional and multilateral  cooperation for global health security”.


By Dr. Mory Sumaworo, (Ph.D.)


The Former Director-General of the World Health Organization (WHO), Mrs. Margaret Chan said in recognition of neediness of MD as useful contemporary foreign policy tool in her opening addressing, to the Executive Board of WHO at its 132nd session ‘Health Diplomacy works’. It helps in addressing global medical and health crises both real and potential.

Having said that, the Covid-19 has set itself as the greatest threat to the world. It can be metaphorically considered as the WW3. Although there are neither Allies nor Axis Powers as they were in the WW2, but both are fighting against the common enemy, coronavirus. Considering this nature of the pandemic, and its rapidly spread all over the world, especially in the highly sophisticated health systems in Europe, Asia and the United States of America. It presents the never before neediness of the health and MD to control the situation that is now threating not only the poor countries as usual contagious disease outbreaks do. Nevertheless, the fatality of the Covid-19 cannot be de-emphasized in China, the second largest economies in the world, Japan the cradle of technology, Singapore, the spot of innovation and hygiene, the US the largest  economy and the world’s most powerful nation on earth, Saudi Arabia, one the wealthiest nations on the in the world, the United Kingdom with its reliable and excellent healthcare system, and the EU with all it has achieved medically, economically and developmentally.

Worrisomely, the pandemic has penetrated the fragile medical systems in some parts of Asia and Africa. The aid-providers are the aid-solicitor now, not necessarily to build their infrastructures or create economic prosperity as the aid normally does, but to use MD in combating the Covid-19 that is controllably spreading. So, what is the aid that is urgently needed by all? What are the roles of every country in the comity of nation towards this common whipper (Covid19)?

sThe answer is to accentuate and effectively use health and medical diplomacy among the nations. It is, however, means in this context, medical, clinical with their related collaboration and sharing information to uproot and deracinate the virus from the World. Medical diplomacy or MD is the concept, which persuades the members of the comity of nations to support the efforts of their counterparts and international organizations like WHO to defeat disease; Covid-19. Besides, Global Health Diplomacy (GHD) as it is at times acronymized as the international and foreign relations practice through which the governments along with Non-State actors medically coordinate to address global health issues such as Ebola, HIV-AIDS and Coronavirus.

Academically, its nomenclature may suggest that it solely falls under Political Science and International Relations. However, in practice, it is a multi-disciplinary subject that brings several areas of studies together including, Medicine, Law, Politics, Management, Sociology, Economics, Trade Policy and others. This is why, in order for a nation to institute an effective medical diplomacy, it should not only focus on conventional diplomats or medical doctors or healthcare professionals. It may need a conglomerate of different specialists from other related disciplines to actualize its objectives.

It is worth mentioning that many foreign missions do focus on conventional political concerns, education, culture and trade. Embassies and foreign mentions have a special attaché for these interests. However, it hardly heard about the medical attaché at foreign representations in the host nations.  

Medical Diplomacy (MD) can sometimes be applied even by political rivals who might not be on the same political boat. For instance, when Hurricane Katrina hit New Orleans of the United States of America on August 29, 2005, Cuba took several steps to strengthen and apply its relations with the US through medical diplomacy. The moment the information reached Dr. Juan Carrizo, a Cuban famous medical doctor, academic and former Dean of the Latin American Medical School reacted within a military precision as it is rightly put by Andrew Jack in Financial Time article: ‘Cuba’s Medical Diplomacy’ Dr. Carrizo mobilized 1100 medical doctors and nurses to be sent to assist addressing medical needs resulted from Hurricane Katrina. This was the first step taken by Cuba.

The Second step was the political statement by Fidel Castro, then the President of Cuba, when he stated “Our country was closest to the area hit by the hurricane and was in the position to send over human and material aid in a matter of hours. It was as if a big American cruise ship with thousands of passengers aboard were sinking in waters close to our coast. We could not remain indifferent” It is immaterial whether the US should have accepted the offer or not, that is not the central of this discussion.

What really matters here is, Cuba’s approach to uphold medical diplomacy when it was needed either by the US or for the best interest of Havana and Cuban People in general. It can be extrapolated from Fidel’ speech that medical diplomacy can be urgently needed and stringently required when there is a global or regional threat such as Ebola and Covid19. Notwithstanding the Cuban intended medical assistance was not accepted by the United States, but it set a great precedent for usefulness and usage of medical diplomacy even between the two political rivals.

Importance of Medical Diplomacy:

It is noteworthy to state that medical diplomacy (MD) is very paramount in today’s international relations and politics due to its never before globalized nature of goods and services that leads to never before the movement of the people. A medical crisis in the Far East may easily affect the West, Africa and the rest of the world in no time. For example, 2014 Ebola outbreaks in the West African countries; Liberia, Guinea and Sierra Leon affected the United States and many other African nations in a very short period of time. Equally so, the Covid19 that emerged in Wuhan had affected more than 160 countries in less than six months. International trades and transportation had been seriously wounded by the outbreak. Paradoxically, allies are restricting the movement of their friends in fear of the pandemic.

The United States’ President J. Donald Trump suspended all fights from Europe excluding the United Kingdom and later on, it had been included in the suspension. This is very strange in the US-EU or Europe relations. However, the decision was made by Washington because of the gravity and rapid spread of the virus with its advert impacts on peace, security, trade and economies, basic human rights and civil liberties, it might even be considered as the WW3 thought there are neither Allies nor Axis powers. But the common enemy is the Covid 19, which medical diplomacy being played to defeat. Based on the above, the medical diplomacy is significant for contemporary foreign relations for several reasons. Some are as follows:

  1. Since the early 1990s, when Harvard University’s pundit, Joseph Nye, Jr., introduced the cotemporary concept of soft power in his popularized book “Bound to Lead:  The Changing Nature of American Power as opposed to hard power, medical diplomacy has been playing a major role in addressing many burning international political issues in lieu of radical diplomatic business. It shows the goodwill of the giver to the receiver. According to Marrogi and Al-Dulaimi in their article – Medical Diplomacy in Achieving US. Global Strategic Objectives- published by Join Force Quarterly (2014) “Although the concept of soft power is not universally embraced, using economic, cultural, scientific and healthcare resources can create a dominant soft power, when carefully applied, might generate favorable behavior from other nations and their leaders and build enduring partnerships to promote regional and global security’.
  2. It solidifies and strengthens the national, regional and continental efforts to address medical and health crises such as Ebola, HIV-AIDS and Coronavirus.
  3. It may help to reduce and de-escalate political tensions between/ among the nations.
  4. It is more selfless tool within the realm of politics to serve the humanity. Unlike trades and politics between/among the nations, which are mainly based on interests with disregarding some social and humanitarian concerns such as pollution and political crises because of the interest of politically heavy-weight nations.
  5. It indirectly helps to destress local healthcare and medical infrastructures.
  6. It leads to sustainable development growth. A healthy world is a wealthy globe, and a wealthy globe is bound for sustainable development and shared happiness and prosperity.
  7. It helps to secure the future of globalization. Covid 19 has clearly illustrated that pandemic is the biggest threat to globalization even between and among friends and allies. Donal Trump’s pronouncement to suspend all flights from Europe including the United Kingdom serves a great lesson for magnitude of healthcare crisis against internationalization and globalization.
  8. It has been pointed out by Suleman, Ali and Kerr in their article ‘ Health diplomacy : a new approaches to Muslim World’ published by Globalization and Health,  that the nicest field of health diplomacy provides a political framework which aims to deliver the dual goals of improved health in target populations and enhanced governmental relations between collaborating countries.

 ILLUSTRATIONS OF MEDICAL DIPLOMACY DURING EBOLA AND CORONAVIRUS:

Firstly, the United States of America has a diverse group of healthcare industries accounting $2.8 trillion, 17.8 percent of its GDP. Through this, the US delivers healthcare assistance through hospitals and support medical research institutions. As a result, these activities play a pivotal role in U.S asymmetric response to unpredictable challenges overseas both directly through the care of patients and more generally in the economic benefit (Marrogi & Al-Dulaimi, 2014). The US foreign aid package normally includes billions of dollars in support of healthcare system around the World. For instance, the largest government-owned referral hospital in Liberia, JFK medical centre was built by the US. The Center was constructed at the request of Liberia’s former President William V.S Tubman when he visited the States in 1965 and met with President John F Kennedy. The USAID funded the project with $ 6.8 million loan and $ 9.2 million in grants from USAID and a $ 1 million contribution from the Liberian Government. The center was opened in 1971. 

Secondly, when Ebola hit the West African region in 2014, Cuba provided nearly half a million medical professionals, according to Vijay Chattu in an article “Politics of Ebola and the Critical role of global healthcare diplomacy for the CARICOM, published by Journal of Family Medicine and Primary Care (2017). 165 were sent to Sierra Leone, 83 doctors arrived in Liberia and Guinea. This initiative took by Cuba led the United States to say that it had made an impressive effort in the anti-Ebola campaign. In the same direction, Havana International Conference on Ebola was called and some senior medical professional from the USA attended the event from the Center for Disease Control and Prevention. Despite the historical and political rivalry between the countries, medical diplomacy was able to shorten the distance between them to have professional discussions on global health issues;- In a highly unusual break with procedure between the two nations, which do not have normal diplomatic relations, Raul Castro said pointedly ‘ Cuba is willing to work side by side with all nations including the USA in the fight against Ebola” ( Chattu, 2017).

Thirdly, the Kingdom of Saudi Arabia during the Ebola Crisis in the West African Region as well played its card in medical diplomacy. The Financial Afrik published that Saud’s former King, King Abdallah gave $ 35 million grant to the West African badly affected Ebola countries; Liberia, Guinea- Conakry and Sierra Leon. The package included; providing schools with thermal sensors and medical examination equipment designed to diagnose the disease, thereby facilitating its treatment. Providing thermal sensors and medical examination equipment at airports and bus satiations. And establishment specialized treatment center in each of the three endemic countries including Mali. For the Covid-19, the Kingdom also gave $ 10 million as part of its contributions to a total 675 million packages in funds that the Strategic Preparedness and response Plan (SPRP) has called for, of which 61.5 million for WHO’s urgent preparedness and response activities for the period of February to April 2020. According to Taleen Davies, in Healthcare IT news, the Saudi’s $ 10 million is mainly allocated to the Research and Development to create better understanding of Covid-19 and fast track the development of vaccines, diagnostic and therapeutic. 

Fourthly, China has presented herself over the last five decades as frontrunner of soft power through economic and medical diplomacies mainly to the poorly managed countries in Africa and Asia. But during the rapid spread of Covid-19, she has opened a new channel of MD to advanced countries in Europe. According to Financial Times March 18 article ‘China ramps up coronavirus help to Europe’ the capital of the European Union, Brussels has thanked China for offering to provide more than 2 million medical masks and 50000 coronavirus testing kits. Urshula Von der Leyen, European Commission president, said she spoke to Li Keqiang, China premier, and agreed with him that the two powers should support each other in times of need. This China’s deal with the European Union came as reciprocity of what did to her as Mrs Leyen pointed that ‘Today we are the center of the coronavirus pandemic and we need protective equipment ourselves as China needed it when it was the centre of the virus outbreak and European Union helped.   

INTRA-AFRICAN MEDICAL DIPLOMACY:

Africa is lagged behind in terms of fostering Intra-African health medical diplomacy. The continent still heavily depends on the external medical aid in during the crises. It is however, imperative for the African Union and its sub-regional organizations consolidate their efforts and cordially coordinate medically and financially to address pandemic and medical crises on the Continent. This does not only serve the health sector, rather it plays a vital role in the African integration, trades, socio-political solidarity, self-reliance and more importantly swift response to health problems before the global engagement that requires in most often lots bureaucratic processes. Intra-African diplomacy is very paramount for the Continent, it helps to contain pandemics. 

CHALLENGES AND PROSPECT OF MEDICAL DIPLOMACY:

The prospect medical diplomacy is brighter and more promising as it concerns the entire World, especially after the devastating socioeconomic and trade impacts the Covid-19. It is a hope and anticipation that it will be the central of regional and global networks to coordinate and collaborate to prevent and fight pandemics and other dangerous diseases together in order to halt their spread to other countries and regions. The global economic performance is every nation’s concern. Therefore, not giving political weight to health and medical diplomacy will badly affect the global economy. For instance, PwC conducted a survey on the impact of Covid-19 financially and economically, it concluded that 80 percent of participant concerned that the Covid-19 global health emergency will lead to a global economic recession. According to the UN News, Covid-19 likely to cost economy $ 1 trillion during 2020 based on the estimate of the UN’s Tade and Development Agency (UNITAD). Such a size of economic loss must grasp the attention of the comity of nations to strengthen bilateral and multilateral medical diplomacy to prevent its reoccurrence. With this, there is a prospect for the World’s leaders to start reconsidering their foreign policies toward medical and healthcare diplomacy. 

On the other hand, the medical diplomacy also faces some challenges. For instance, interference of political interests as a barricade to MD. The case study of Cuba’s initiative to send 1100 health professional to the United States of America during 2005 Hurricane Katrina, is a typical example. The offer was not received and accepted the US government based on its political differences with Havana. Another obstacle that is confronted by MD is sustainability of its efforts. In some countries, other advanced nations may supply and support them with medical infrastructures like hospitals, clinics and clinical materials, but they software component – trained medical doctors and healthcare professionals – is absent durability of efforts will be the great challenge.  

CONCLUSION:

Health crises pose fundamental challenges to international relations and have been a major focal point of contests for global influence as pointed by Emma Anderson in African heath diplomacy published by the Journal of International Relations. Therefore, it is very paramount for the comity of nations to reconsider their bilateral and multilateral cooperation to excessively and exceedingly include medical diplomacy in the package. It will be of a great relevance to keep the World safe and prevent a global economy from recession due to global health crises as it is being witnessed by Covid-19, which is estimated by the UN’s Trade and Development Agency (UNITAD) to cost the global trade $1 trillion. Finally, medical and healthcare diplomacy leads to three different deliverables; political interest, commitment to protecting universal human rights and direct and indirect economic gains. A direct economic gain through some conditionalities of medical diplomacy between/ among the collaborating nations. An indirect economic gain through saving the global economy from recession due to an unthwarted pandemics in the world such as Covid-19   

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