On January 26, 2024, the Global South in the World Order network discussed major challenges in global health diplomacy and ways for improving equity.
Progress has been achieved in the representation of Global South countries in multilateral health institutions such as the World Bank’s Pandemic Fund and the World Health Organization (WHO). Yet, Global South countries continue to face challenges in getting their input included in these institutions’ endeavors, efficiently partaking in international negotiations, and implementing necessary policies domestically. These challenges notably stem from the domination on the international scene of Western knowledge paradigms that do not factor in Global South countries’ contexts and expertise, as well as these countries’ limited financial and human resources, among other issues.
As the international community strives to collectively build a system to prevent and address health emergencies, now it is more critical than ever to move beyond mere representation in multilateral institutions and actively support the inclusion of Global South countries’ expertise to formulate effective solutions. To that end, international fora should pursue innovative solutions to support poorer states during negotiations and other working meetings. Although regionalism and South-South diplomatic partnerships and networks have their own challenges, these avenues can also be explored by disadvantaged governments seeking to pool their resources and counterbalance Western power dynamics.
Equally important, while acknowledging the limits of fragile states, more impetus is needed to reframe health as both a national security and soft power issue in order to boost domestic investment in this sector.
Regional Global Health Initiatives: More Important Now Than Ever
Carolina Inés Andrada, Research Associate, Global Health Policy Center, Center for Strategic and International Studies, @ciandrada
Motivated by the devastation of the COVID-19 pandemic, the member states of the WHO have been negotiating a revision to the 2005 International Health Regulations and working to create a “Pandemic Accord,” an international instrument to manage pandemic prevention, preparedness, and response. Despite persistent Global South advocacy for the inclusion of key principles such as equity and access into these documents, neither negotiating body has reached a consensus on how and to what extent these ideas should be incorporated into international agreements. Yet, those agreements are not the only avenues for creating global change. Governments of the Global South should make further investments in regional health initiatives to increase their power in international arenas and strengthen their health systems against threats.
In the Americas, the Pan American Health Organization (PAHO) is central to regional health and a source of relative equality in decision-making, despite the United States’ asymmetrical weight in the region and its status as a founding and a key member of the organization. The PAHO Regional Revolving Funds have exemplified the Global South’s calls for access to medicines and therapeutics. The Funds use pooled procurement mechanisms to supply vaccines, medicines, and medical supplies to participating countries at competitive costs while providing technical support, quality assurance, and capital extensions as needed. By consolidating regional demand for particular items, PAHO is able to negotiate more affordable prices for critical public health products, increasing the region’s access to these lifesaving medical technologies.
In Africa, similar initiatives have sought to strengthen regional public health and establish better regional ownership of health governance. In 2017, the African Union launched its own public health agency, the African Centres for Disease Control (Africa CDC). The Africa CDC played an early and important role in the region’s COVID-19 response and is investing in building a strong regional laboratory network through initiatives such as the Regional Integrated Surveillance and Laboratory Network. These initiatives empower African public health leaders and governments to make decisions that align with their priorities and increase access to key public health resources such as vaccine technologies and laboratory surveillance.
These and similar initiatives are critical because they provide an alternative avenue, at the regional level, for pursuing some of these key principles being advocated for by Global South delegates in international negotiations. In addition, the success stories of these regional initiatives can serve as proof of the necessity, utility, and achievability of these key principles; regional unity and South-South cooperation can provide leverage to push for the inclusion of these initiatives in international agreements.
From Better Representation to Actual Inclusion
Jackline Kiarie, Regional Program Manager, Amref Health Africa, @jaqjerry
In the fast-paced arena of global health diplomacy, critical discussions and negotiations are shaping the future of pandemic prevention and response, as evidenced by the drafting of key amendments to the International Health Regulations and negotiations over an international treaty on Pandemic Prevention, Preparedness, and Response.
These platforms have made progress in terms of ensuring representation for both developed and developing nations. For instance, the World Bank Pandemic Fund‘s 21-member Board exhibits an equitable representation of “Sovereign Contributors” (donors) and “Sovereign Co-Investors” (funding recipients), with one seat each allocated for Global South and North civil society organization representatives, and one seat for philanthropic organizations. However, the apparent optimal membership structure is marred by glaring deficiencies in contributions, particularly from co-investor nations. This issue is compounded by several factors, including inadequate financial and human resources to effectively negotiate and ensure meaningful participation in global dialogues and decision-making processes. Owing to a scarcity of technocrats in many developing countries, the same representatives from the Global South are often burdened with representing their nations across multiple global and regional platforms without adequate support from the UN Secretariat, leaving them ill prepared to meaningfully contribute to negotiations. Furthermore, these representatives, despite being subject matter experts, often lack expertise in health diplomacy — i.e., negotiations — leading to imbalanced negotiations and input in global discussions.
It is imperative to incorporate expertise from the Global South in these international conversations to inform the global health security agenda. Therefore, global and regional health diplomacy platforms should allocate resources for support from the UN Secretariat for these states’ representatives. Moreover, regionalism could counterbalance existing inequity in international negotiations with Western powers’ representatives. Therefore, the Global South representatives in negotiation platforms should explore and engage in regional partnerships that promote a unified voice and stance on global issues within regional platforms. This collective approach enhances the effectiveness of advocacy efforts and strengthens the inclusion of developing nations’ interests in global health discourse. Different regional groupings can also support each other in negotiations by forging alliances.
Limited domestic resources in many developing countries pose challenges in expanding the participation of technocrats in such discussions. It is also important to acknowledge the inherent limitations governments face, such as translating global commitments into actionable strategies at the country level, often hindered by high external debt and donor conditionality, constrained fiscal space, and subsequent limited allocation of resources to health. Although development assistance has been suggested as a solution to this resource constraint, it typically constitutes only about 0.5% to 20% of the current 5-6% fiscal allocation to health in developing countries, rendering it an unsustainable option for translating global commitments to support effective health strategies into action. It is, therefore, imperative that the international community advance cross-sectoral solutions for Global South countries to expand their economies sustainably through, for example, fair trade practices and promoting self-reliance through local production of health commodities and supplies.
Only through such measures can Global South countries anticipate receiving a larger share of international health organizations’ economic pie, resulting in increased allocations toward health programming and therefore a translation of global commitments to support effective national policies and strategies on health issues. That said, increased resourcing will require greater accountability mechanisms. These include, for instance, policy monitoring by civil society groups because these organizations can influence governments to implement people-centered health programming that is equitable and effective in its delivery, thereby improving health outcomes for all.
Resilience is Feminist: Global Health in the Post-COVID-19 World
Dalya Salinas Pérez, Mexican Diplomat writing in her personal capacity
After the COVID-19 outbreak, the international community focused on improving the global health system. But framing the disruptions caused by the pandemic only in terms of global health neglects other aspects that are making the world more vulnerable than before to the next global emergency.
More than a biological hazardous event, COVID-19 was a large-scale disaster, that was a major disruption to the world order resulting from the interaction of the hazardous event — the pandemic — with three other elements: exposure, vulnerability, and capacity. In 2016, the international community adopted the Bangkok Principles to reduce the risk of health emergencies “such as pandemics that have the potential for huge social and economic impact,” as stated by the United Nations Office for Disaster Risk Reduction (UNDRR). Regrettably, these recommendations were rarely integrated into international policy discussions and negotiations; today, as in 2020, the world remains unprepared to understand and reduce disaster risk, let alone to accept the radical transformation needed to achieve global resilience and sustainability for our species.
What went wrong? According to a paper by the Brookings Institution, people living in G-7 countries “were 77 times more likely to be offered a vaccine than those living in the world’s poorest countries,” and as Erfani and others point out, “by late June of 2021, “46% of people in high-income countries had received at least one dose of the COVID-19 vaccine, compared to 20% in middle-income countries and only 0.9% in low-income countries.” But unequal access to vaccines is just the tip of the absurdity iceberg. Despite their critical role as “essential workers,” service workers were — and still are — grappling with low-wages. Moreover, women suffered disproportionately from the worst effects of the pandemic — including the exponential increase in gender-based violence, despite representing 70% of healthcare workers, 70% of unpaid care workers, and the vast majority of care labor.
According to UNDRR, building resilience means that “the most vulnerable must drive change, rather than be the recipients of it.” This Copernican Revolution points directly to feminism — movements that promote policy approaches that rely on equality, inclusion, and structural change to bring prosperity to all. Just like the Bangkok Principles, feminist-based strategies and policies are marginalized in dominant conventional policy discussions, despite women’s meaningful proposals in leadership, economics, science, patents, and many other areas. For instance, regarding the polarizing issues of patents, UN Women and various feminist organizations dedicated to equal access to vaccines have proposed to enhance South-South cooperation for knowledge and technology sharing. Illustratively, a 2023 Feminists for a People’s Vaccine report calls for the reform of the World Trade Organization and the Agreement on Trade-Related Aspects of Intellectual Property Rights to promote equitable access to medicines such as vaccines. For its part, the UN’s Women’s Feminist Plan advocates for a community-based approach to policy innovation “to make service delivery more effective and adaptable to the changing realities of women on the ground.”
The recent trend of countries adopting feminist foreign policies suggests that the time is ripe for building back better. It is more critical now than ever to foster conversations and raise awareness about how feminist approaches to global challenges can support innovative solutions to address vulnerabilities and inequitable power relations and promote inclusion in every policy area, including in global health.
Global Health Diplomacy and Paths Toward Equity
Global South Experts Turn the Tables
By Aude Darnal Lead Author • Carolina Inés Andrada • Jackline Kiarie • Dalya Salinas Pérez • Mir Mohiuddin
Grand Strategy
Every month, the Global South in the World Order Project convenes a meeting of experts from across the Global South to discuss international relations from their perspectives, challenge conventional thinking, and inject non-Western viewpoints into prominent policy circles in Washington. This publication is part of the Global South Experts Turn-the-Tables series, which highlights insights from select participants in these discussions.
On January 26, 2024, the Global South in the World Order network discussed major challenges in global health diplomacy and ways for improving equity.
Progress has been achieved in the representation of Global South countries in multilateral health institutions such as the World Bank’s Pandemic Fund and the World Health Organization (WHO). Yet, Global South countries continue to face challenges in getting their input included in these institutions’ endeavors, efficiently partaking in international negotiations, and implementing necessary policies domestically. These challenges notably stem from the domination on the international scene of Western knowledge paradigms that do not factor in Global South countries’ contexts and expertise, as well as these countries’ limited financial and human resources, among other issues.
As the international community strives to collectively build a system to prevent and address health emergencies, now it is more critical than ever to move beyond mere representation in multilateral institutions and actively support the inclusion of Global South countries’ expertise to formulate effective solutions. To that end, international fora should pursue innovative solutions to support poorer states during negotiations and other working meetings. Although regionalism and South-South diplomatic partnerships and networks have their own challenges, these avenues can also be explored by disadvantaged governments seeking to pool their resources and counterbalance Western power dynamics.
Equally important, while acknowledging the limits of fragile states, more impetus is needed to reframe health as both a national security and soft power issue in order to boost domestic investment in this sector.
Regional Global Health Initiatives: More Important Now Than Ever
Carolina Inés Andrada, Research Associate, Global Health Policy Center, Center for Strategic and International Studies, @ciandrada
Motivated by the devastation of the COVID-19 pandemic, the member states of the WHO have been negotiating a revision to the 2005 International Health Regulations and working to create a “Pandemic Accord,” an international instrument to manage pandemic prevention, preparedness, and response. Despite persistent Global South advocacy for the inclusion of key principles such as equity and access into these documents, neither negotiating body has reached a consensus on how and to what extent these ideas should be incorporated into international agreements. Yet, those agreements are not the only avenues for creating global change. Governments of the Global South should make further investments in regional health initiatives to increase their power in international arenas and strengthen their health systems against threats.
In the Americas, the Pan American Health Organization (PAHO) is central to regional health and a source of relative equality in decision-making, despite the United States’ asymmetrical weight in the region and its status as a founding and a key member of the organization. The PAHO Regional Revolving Funds have exemplified the Global South’s calls for access to medicines and therapeutics. The Funds use pooled procurement mechanisms to supply vaccines, medicines, and medical supplies to participating countries at competitive costs while providing technical support, quality assurance, and capital extensions as needed. By consolidating regional demand for particular items, PAHO is able to negotiate more affordable prices for critical public health products, increasing the region’s access to these lifesaving medical technologies.
In Africa, similar initiatives have sought to strengthen regional public health and establish better regional ownership of health governance. In 2017, the African Union launched its own public health agency, the African Centres for Disease Control (Africa CDC). The Africa CDC played an early and important role in the region’s COVID-19 response and is investing in building a strong regional laboratory network through initiatives such as the Regional Integrated Surveillance and Laboratory Network. These initiatives empower African public health leaders and governments to make decisions that align with their priorities and increase access to key public health resources such as vaccine technologies and laboratory surveillance.
These and similar initiatives are critical because they provide an alternative avenue, at the regional level, for pursuing some of these key principles being advocated for by Global South delegates in international negotiations. In addition, the success stories of these regional initiatives can serve as proof of the necessity, utility, and achievability of these key principles; regional unity and South-South cooperation can provide leverage to push for the inclusion of these initiatives in international agreements.
From Better Representation to Actual Inclusion
Jackline Kiarie, Regional Program Manager, Amref Health Africa, @jaqjerry
In the fast-paced arena of global health diplomacy, critical discussions and negotiations are shaping the future of pandemic prevention and response, as evidenced by the drafting of key amendments to the International Health Regulations and negotiations over an international treaty on Pandemic Prevention, Preparedness, and Response.
These platforms have made progress in terms of ensuring representation for both developed and developing nations. For instance, the World Bank Pandemic Fund‘s 21-member Board exhibits an equitable representation of “Sovereign Contributors” (donors) and “Sovereign Co-Investors” (funding recipients), with one seat each allocated for Global South and North civil society organization representatives, and one seat for philanthropic organizations. However, the apparent optimal membership structure is marred by glaring deficiencies in contributions, particularly from co-investor nations. This issue is compounded by several factors, including inadequate financial and human resources to effectively negotiate and ensure meaningful participation in global dialogues and decision-making processes. Owing to a scarcity of technocrats in many developing countries, the same representatives from the Global South are often burdened with representing their nations across multiple global and regional platforms without adequate support from the UN Secretariat, leaving them ill prepared to meaningfully contribute to negotiations. Furthermore, these representatives, despite being subject matter experts, often lack expertise in health diplomacy — i.e., negotiations — leading to imbalanced negotiations and input in global discussions.
It is imperative to incorporate expertise from the Global South in these international conversations to inform the global health security agenda. Therefore, global and regional health diplomacy platforms should allocate resources for support from the UN Secretariat for these states’ representatives. Moreover, regionalism could counterbalance existing inequity in international negotiations with Western powers’ representatives. Therefore, the Global South representatives in negotiation platforms should explore and engage in regional partnerships that promote a unified voice and stance on global issues within regional platforms. This collective approach enhances the effectiveness of advocacy efforts and strengthens the inclusion of developing nations’ interests in global health discourse. Different regional groupings can also support each other in negotiations by forging alliances.
Limited domestic resources in many developing countries pose challenges in expanding the participation of technocrats in such discussions. It is also important to acknowledge the inherent limitations governments face, such as translating global commitments into actionable strategies at the country level, often hindered by high external debt and donor conditionality, constrained fiscal space, and subsequent limited allocation of resources to health. Although development assistance has been suggested as a solution to this resource constraint, it typically constitutes only about 0.5% to 20% of the current 5-6% fiscal allocation to health in developing countries, rendering it an unsustainable option for translating global commitments to support effective health strategies into action. It is, therefore, imperative that the international community advance cross-sectoral solutions for Global South countries to expand their economies sustainably through, for example, fair trade practices and promoting self-reliance through local production of health commodities and supplies.
Only through such measures can Global South countries anticipate receiving a larger share of international health organizations’ economic pie, resulting in increased allocations toward health programming and therefore a translation of global commitments to support effective national policies and strategies on health issues. That said, increased resourcing will require greater accountability mechanisms. These include, for instance, policy monitoring by civil society groups because these organizations can influence governments to implement people-centered health programming that is equitable and effective in its delivery, thereby improving health outcomes for all.
Resilience is Feminist: Global Health in the Post-COVID-19 World
Dalya Salinas Pérez, Mexican Diplomat writing in her personal capacity
After the COVID-19 outbreak, the international community focused on improving the global health system. But framing the disruptions caused by the pandemic only in terms of global health neglects other aspects that are making the world more vulnerable than before to the next global emergency.
More than a biological hazardous event, COVID-19 was a large-scale disaster, that was a major disruption to the world order resulting from the interaction of the hazardous event — the pandemic — with three other elements: exposure, vulnerability, and capacity. In 2016, the international community adopted the Bangkok Principles to reduce the risk of health emergencies “such as pandemics that have the potential for huge social and economic impact,” as stated by the United Nations Office for Disaster Risk Reduction (UNDRR). Regrettably, these recommendations were rarely integrated into international policy discussions and negotiations; today, as in 2020, the world remains unprepared to understand and reduce disaster risk, let alone to accept the radical transformation needed to achieve global resilience and sustainability for our species.
What went wrong? According to a paper by the Brookings Institution, people living in G-7 countries “were 77 times more likely to be offered a vaccine than those living in the world’s poorest countries,” and as Erfani and others point out, “by late June of 2021, “46% of people in high-income countries had received at least one dose of the COVID-19 vaccine, compared to 20% in middle-income countries and only 0.9% in low-income countries.” But unequal access to vaccines is just the tip of the absurdity iceberg. Despite their critical role as “essential workers,” service workers were — and still are — grappling with low-wages. Moreover, women suffered disproportionately from the worst effects of the pandemic — including the exponential increase in gender-based violence, despite representing 70% of healthcare workers, 70% of unpaid care workers, and the vast majority of care labor.
According to UNDRR, building resilience means that “the most vulnerable must drive change, rather than be the recipients of it.” This Copernican Revolution points directly to feminism — movements that promote policy approaches that rely on equality, inclusion, and structural change to bring prosperity to all. Just like the Bangkok Principles, feminist-based strategies and policies are marginalized in dominant conventional policy discussions, despite women’s meaningful proposals in leadership, economics, science, patents, and many other areas. For instance, regarding the polarizing issues of patents, UN Women and various feminist organizations dedicated to equal access to vaccines have proposed to enhance South-South cooperation for knowledge and technology sharing. Illustratively, a 2023 Feminists for a People’s Vaccine report calls for the reform of the World Trade Organization and the Agreement on Trade-Related Aspects of Intellectual Property Rights to promote equitable access to medicines such as vaccines. For its part, the UN’s Women’s Feminist Plan advocates for a community-based approach to policy innovation “to make service delivery more effective and adaptable to the changing realities of women on the ground.”
The recent trend of countries adopting feminist foreign policies suggests that the time is ripe for building back better. It is more critical now than ever to foster conversations and raise awareness about how feminist approaches to global challenges can support innovative solutions to address vulnerabilities and inequitable power relations and promote inclusion in every policy area, including in global health.
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