Center for Strategic Communication


By Colin Geraghty, adjunct junior fellow, American Security Project, and co-founder and vice president, Next Generation Foreign Policy Network (NextGen FPN).

Health diplomacy is transforming rapidly, and transforming the way actors tackle global health challenges, fostering new relationships and achieving new levels of coordination. To learn more about these exciting issues, the Next Generation Foreign Policy Network is organizing a discussion on Tuesday, March 25, 2014, with leading representatives from NGOs, the US government and academia. For more information, including how to register, please visit

–       Health issues are now an increasingly active arena for international engagement, particularly in the wake of several outbreaks of infectious diseases in recent years

–       They can bring nations together, as infectious diseases do not stop at borders

–       NGOs foster positive relationships abroad, sometimes achieving results intergovernmental cooperation could not

–       The role of the US Navy in delivering medical aid underscores how conducting medical diplomacy is an application of effective smart power

Picture 1On February 13, 2014, the Obama administration joined with representatives from over 25 countries and multiple UN agencies to launch a new Global Health Security Agenda to tackle pandemic threats and promote a coordinated, international response. The GHS Agenda brings together the United States with 26 nations, and includes support from various UN agencies such as the World Health Organization (WHO) and others, to help nations deal with infectious diseases, by strengthening their ability to prevent, detect, and respond to outbreaks.

Picture 2“The GHS Agenda marks an important and promising turning point in U.S. policy” according to J. Stephen Morrison, senior vice president and director of the Global Health Policy Center at CSIS. Indeed, it is the culmination of efforts in recent years to bring global health security into the interagency process, in light of outbreaks of infectious diseases that have caused significant loss of life around the world and incurred economic costs in the billions of dollars.. The Department of Defense and Center for Disease Control (CDC) are already working together, with a budget of $40 million on global health issues. The Department of Health and Human Services is now deploying Health Attachés in embassies Secretary of State John Kerry and Secretary Sebelius co-signed an op-ed on with Lisa Monaco, assistant to the President for homeland security and counterterrorism, in which they called the Severe Acute Respiratory Syndrome (SARS) outbreak of 2003 a “wake-up call” that affected 8,000 people, caused 775 fatalities and resulted in $30 billion in damages. Other diseases, including the H1N1 flu that killed over 250,000 people in 2009, led the Obama administration to elevate global health issues. Yet, as Laura Holgate, senior director for weapons of mass destruction, terrorism and threat reduction (WMDs include biological weapons, hence the WMD advisor’s involvement in global health issues) at the National Security Council noted, “[In 2012 the U.S.] looked around the world and said, ‘This is not something the United States can do alone.’”

Indeed, health is not only recognized as an international issue (Secretary of Health and Human Services Kathleen Sebelius remarked that “germs do not recognize or stop at national borders”), but one that is increasingly tackled through international engagement, in a variety of ways. Since 1963, Cuba has had a very active medical diplomacy, sending thousands of doctors abroad each year to offer medical services to nations around the world. This program promotes a positive image of Cuba, and can also serve the national interest in very direct manner: “what began as a strategy for exporting revolution has in more recent years turned into a means of ensuring the government’s survival.” Cuba now sends 31,000 medical personnel to Venezuela in exchange for close to 100,000 barrels of oil per day, a program known as “oil for doctors.”

Picture 3From a security perspective, global health requires intergovernmental cooperation and coordination. For instance, sharing information about outbreaks is essential for other countries to put into place remedial measures to contain the spread of a disease and adequately treat those infected. China has now become a leader in transparency, sharing information with other governments, as evidenced by its handling of the H7N9 outbreak. Yet other countries remain unwilling to share information out of fear of the impact any quarantine measures might have on their economy, which often results in a much deadlier outbreak due to lack of early warning. Increased intergovernmental cooperation is crucial here, as “the WHO is still limited in how it can intervene when a country does not report. No entity, including the WHO, can verify the character of an outbreak until a sufficient body of evidence is amassed, and wrongly accusing a country of not reporting has political consequences.” Thus, Saudi Arabia’s delay in sharing information about the Middle East Respiratory Syndrome coronavirus (MERS) virus in 2013 was criticized as hampering efforts to understand the disease and implement proper measures. In their op-ed, Secretaries Kerry and Sebelius and Lisa Monaco called for “a safe, secure, globally linked, inter-operable system to prevent disease threats, detect outbreaks in real time, and share information and expertise to respond effectively.”

Picture 4Beyond intergovernmental cooperation, NGOs play a crucial role in global health. Project HOPE, established in 1958, began by operating the iconic SS Hope, the first peacetime hospital ship, to send medical personnel (doctors, nurses, and technical staff) to developing nations from then-South Vietnam to Tunisia to Colombia, in order to provide care as well as training. In doing so, NGOs such as Project HOPE provide immediate relief while improving health conditions over the long term through the training they conduct. NGOs can also foster partnerships that may be more difficult to achieve at the intergovernmental level: since 1983, Project HOPE has partnered with the Chinese government to provide training and education on medical issues. This partnership includes opening the groundbreaking Shanghai Children’s Medical Center, one of the world’s premier children’s heart centers. Through its actions, Project HOPE offers a positive image of U.S. presence and capabilities to countries in which it operates, and can help establish productive relationships with local actors in such nations.


Picture 5When a disaster strikes, nations offer humanitarian aid, and the military often plays a crucial role in delivering relief capabilities, alongside foreign aid agencies and NGOs. The US Navy has repeatedly conducted Humanitarian Assistance/Disaster Response (HADR) operations in the past few years, as well as other forms of medical diplomacy. Rear Admiral Michael Smith expands on the Navy’s role in “proactive” and “reactive” humanitarian assistance. Reactive assistance refers to crisis response and disaster relief, such as the aid provided by the US Navy in Haiti or after the tsunamis of 2004 and 2013. “Proactive humanitarian assistance is a form of our larger cooperation and stability mission that incorporates Navy skillsets in theater security, partner capacity-building, and mutual training. These planned events allow the U.S. Navy to share skills and build partnerships with our international counterparts, other U.S. Government organizations, and relief organizations. The U.S. Navy’s role can thus provide immediate relief as well as long-term support by strengthening capabilities and coordination, enabling enhanced cooperation while projecting while projecting a positive image of US naval presence abroad.

Retired Admiral James Stavridis wrote that if “we subscribe to the understanding that “public health” plays a vitally important role in maintaining long-term stability, then we can restate our strategic objectives more along the lines of removing and/or reducing health issues as a potential factor to increased likelihood of conflict. Thus, our continuing commitment to engaging in what some have termed “medical diplomacy” becomes inherently synchronized with our previously stated strategic goals to promote security, enhance stability, and allow for economic prosperity.” In other terms, conducting medical diplomacy is an application of smart power.

Picture 6Health partnerships are thus playing an increasingly active role in fostering or strengthening international interactions. Moving forward, closer coordination with the private sector appears crucial, whether to develop and disseminate vaccines or learn from the private sector to implement more efficient ways to deliver medical aid. At USAID, a recently established Center for Accelerating Impact and Innovation seeks to do just that. Health diplomacy is transforming rapidly, and transforming the way actors tackle global health challenges, fostering new relationships and achieving new levels of coordination.


To learn more about these exciting issues, the Next Generation Foreign Policy Network is organizing a discussion on Tuesday, March 25, 2014, with leading representatives from NGOs, the US government and academia. For more information, including how to register, please visit 



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