W e are living in a time of pandemics. In the last four years, the World Health Organization has declared a public health emergency of international concern on three separate occasions (Ebola in the Democratic Republic of Congo, Covid-19 and Mpox), with Covid-19 alone estimated to have caused the deaths of over 20 million people across the world, including 1 million in the United States. The infectious diseases responsible for a large share of global mortality – HIV, tuberculosis and malaria – remain persistent threats. According to UNAIDS, in 2022 alone there were 1.3 million new HIV infections, and 630,000 AIDS-related deaths. Disease threats are also becoming more frequent and more severe, due to greater global connectivity, a changing climate, population growth, food insecurity and a host of other factors. Covid-19 showed us that a disease threat in one country is a national security and development threat globally. The US State Department has recognised this fact by taking the unprecedented step of creating the Bureau of Global Health Security and Diplomacy. This new bureau brings together assets from across the State Department to accomplish three main objectives: to lead US diplomatic engagement to strengthen the global health security architecture, to leverage and coordinate US foreign assistance to address health threats, and to elevate and integrate global health security as a core component of US national security policy. The GHSD bureau will have a unique ability to bring together a strong programmatic base through the US President’s Emergency Plan For AIDS Relief – PEPFAR – with the diplomatic power of the State Department to help address current and future disease threats. ELEVATING HEALTH IN DIPLOMACY Disease threats require a whole-of-government and whole-of-society response. The world learned this lesson during Covid-19, when health departments and ministries were forced to come together with their finance, trade, commerce, education and foreign affairs counterparts to develop a unified response. But this has also been a key lesson in the fight against the HIV/AIDS pandemic. Countries that have been most successful in fighting HIV are the ones that have elevated their HIV/AIDS response to the highest levels of government priority, and have implemented coordinated, multisectoral strategies taking into account the societal and economic dynamics of the disease. The creation of the GHSD bureau provides a tremendous opportunity to re-elevate the HIV/ AIDS response as a political priority on a global
Global health security and diplomacy in the 21st century Good politics alongside good public health practice saves lives – and embedding global health as a core component of diplomacy and foreign policy will have a significant impact on global readiness for tackling present and future disease threats
By John Nkengasong, US global AIDS coordinator and senior bureau official for the Global Health Security and Diplomacy Bureau
22
Health: A Political Choice – From Fragmentation to Integration
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