Health Diplomacy: lessons for global health from PEPFAR

Abstract

Health diplomacy has become an increasingly important strategy for the US in the less developed world. PEPFAR (President’s Emergency Plan for AIDS Relief) provides lessons for future global health initiatives. Technical leadership, accountability, and the future of the US global diplomacy work force are discussed. In a world of increased global health risks, economic disparities between nations and profound challenges to national security, global health programs have become an important part of the diplomacy. President’s Emergency Plan for AIDS Relief (PEPFAR) is a US health diplomacy effort, perhaps the largest ever undertaken -with well documented successes and limitations -provides lessons for future global health initiatives. 1 Other global investments in HIV/AIDS have failed due to weak or inexperienced bureaucracies. 2 Building on PEPFAR, the Obama administration has proposed to increase the US investment in global health to $63 billion. 3 A role of health diplomacy has been recommended in the fight against radical Islamasists. 4 While political influence on foreign assistance have often been cited as a cause for failures, divorcing the global health action of national from diplomacy is rarely possible. 5 There are three rationales for health diplomacy which were part of the original conceptualization for PEPFAR which worked to bridge the differences between diplomatic and health efforts. 6 Morbidity and mortality are inequitably distributed across the globe and principles of beneficence and justice mandate humanitarian action. Second we must protect ourselves from diseases arising in other countries, which include prevention, and treatment of illness as well as efforts to build infrastructure abroad necessary to contain outbreaks. Finally, there is the growing recognition that poor health and inadequate health care in populations lead to destabilization which make our world more dangerous, setting back advancement of our national security and other priorities. These perspectives were reaffirmed by the Institute of Medicine in a recent report on global health. 7 Box 1 The President’s Emergency Program for AIDS Relief, commonly known as PEPFAR, was created by an act of the US Congress in 2003 supporting by US$15 billion.