An argument for U.S. health diplomacy

An argument for U.S. health diplomacy
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A lethal pathogen is on the loose. The U.S. Secretary of State convenes an international conference in Washington to establish regulations to “protect the health of our respective countries against the incursion of disease” recognizing “the conflict between permanent free and open intercourse of trade…with this particular and pressing emergency of public health.”  

That was not Secretary of State Mike PompeoMike PompeoPompeo on CIA recruitment: We can't risk national security to appease 'liberal, woke agenda' DNC gathers opposition research on over 20 potential GOP presidential candidates Dozens of scientists call for deeper investigation into origins of COVID-19, including the lab theory MORE confronting COVID-19 during the current pandemic; it was Secretary of State William M. Evarts, who assembled an international sanitary conference in Washington in 1881 against yellow fever.

U.S. diplomatic leadership on global health was needed over a century ago and is only more urgently required in the age of COVID-19.


Health diplomacy is essential because we need the cooperation of other countries for early warning of infectious diseases and to marshal an effective response. Diplomacy not only protects the health of the American people, as Evarts understood, it protects our prosperity and security. Here is how:

Early Warning of Health Emergencies: Diplomatic muscle must press sovereign states to share information about pathogens within their borders. In 1851, the first international sanitary conferences targeted cholera and other deadly diseases to protect health and commerce. In total, there were 14 conferences between 1851 and 1938, which served as a foundation for what would later become the World Health Organization (WHO), established in 1948. 

This process grew into a 2005 treaty — the International Health Regulations (IHR) — which commits parties to notify the World Health Organization within 24 hours of all events that may threaten or lead to a public health emergency of international concern, including “adequate and sufficiently detailed public health information” on disease outbreaks. 

IHR has the right goals, but the coronavirus pandemic highlights weaknesses, principally that sovereign states may not share information or samples in a timely way and that the WHO itself may be subject to political influence. To help avoid this lapse in coordination, we need to strengthen IHR’s reporting requirements and ensure the independence of international decisions about public health emergencies. Careful and sustained diplomatic engagement can build the coalitions and consensus to achieve these reforms.

Coordinated Response: Countries need both the will and the means to respond to health threats. The U.S.-led Global Health Security Agenda (GHSA) is a partnership of 67 nations, international organizations and NGOs that helps countries develop capacity to prevent, detect and respond to disease outbreaks. GHSA supports practical steps to strengthen disease response.  


The U.S. makes unique contributions through our leading technical institutions like the Centers for Disease Control and Prevention, our research universities and our private health industry.

American diplomacy built the GHSA coalition and it ensures others help carry the burden, too. For example, faced with avian influenza, our embassy in Cambodia worked to improve Cambodia’s disease surveillance capability in partnership with the French Institut Pasteur. The coordinated effort enabled researchers to get to the bottom of why the rate of people infected with the avian flu in Cambodia was 10-fold higher than elsewhere in 2012.

While the United States leads in the fight against HIV/AIDS, through the development of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the U.S. helped ensure others would match a significant part of U.S. expenditures. The most recent Global Fund financial report lists donors, showing that the U.S. pledged $4.68 billion for the 2020-2022 biennium out of total pledges of $14.2 billion. 

Our embassies constantly press even poor countries to pay more to support the health of their own people, as we successfully did in Zambia by boosting local funding for antiretroviral drugs. 

While the U.S. provides significant bilateral assistance, its contributions to international health organizations are often matched by others: U.S. funding for the World Health Organization is about 16 percent of WHO’s total revenue — well below America’s 24 percent proportion of world GDP, as reported by the World Bank.

Broader U.S. Interests: American health diplomacy serves broader American interests, too. China sees COVID-19 as an opening to expand its influence. American withdrawal only magnifies China’s opportunities at our expense. 

American generosity, abundantly displayed through the President’s Emergency Program for AIDS Relief (PEPFAR), saved millions of lives especially in Africa. American leadership in health diplomacy coupled with our significant health assistance programs wins friends and stabilizes regions. By ensuring equity in access to vaccines and treatment, U.S. health diplomacy can continue a tradition of enlightened self-interest of which the American people are rightly proud. Congress recognizes the value of these programs and funds them generously. 

U.S. diplomacy draws on unique strengths. Our interagency teams in Washington have unparalleled technical skills. We built networks of like-minded professionals through our medical schools and institutions like the Epidemic Intelligence Service, which trained the best epidemiologists around the world.  

Our embassies call on capable health attachés and environment, science, technology and health (ESTH) diplomats who serve as our eyes and ears. USAID’s health system strengthening programs give us unequalled insight into health challenges around the world.  No other country can match our advantages.

Events since 1881 and today’s COVID-19 crisis make abundantly clear that American health diplomacy is essential to protect the American people. In the face of COVID-19, the U.S. declined to participate in a global vaccine conference and has announced its intention to defund and withdraw from the World Health Organization.   

These actions run directly counter to the interests of the American people.

The U.S. should play to its strengths. Health diplomacy is one of them. This is no time to withdraw from international engagement on health. It is time to lean in.

Mark C. Storella is a foreign service officer and he is retiring to join the Faculty of Boston University as a professor of the Practice of Diplomacy in the Frederick S. Pardee School of Global Studies; the opinions expressed in this article are the author's own and do not necessarily reflect the views of the U.S. Department of State or the U.S. Government.