Responding to the public health consequences of the Ukraine crisis: an opportunity for global health diplomacy.

Tim K Mackey,Steffanie A Strathdee

doi:10.7448/ias.18.1.19410

Abstract

IntroductionPeace and stability in Eastern Europe is now at a crossroads with the rapidly deteriorating foreign policy crisis continuing to unfold in the Ukraine. However, largely overlooked in the context of other foreign policy and diplomatic priorities are the serious public health consequences for the region following the annexation of Crimea and the subsequent decision to ban opioid substitution therapy in the disputed territory.DiscussionOn 1 May 2014, the Republic of Crimea officially announced it would end access to opioid substitution therapy, an essential harm reduction tool recognized by international organizations and virtually all other European countries. The policy development marks a critical reversal in the region’s fight against its growing HIV epidemic and also threatens years of public health gains aimed at providing evidence-based and integrated treatment approaches to combat drug dependence and HIV. Beyond these risks, the Ukrainian conflict could also negatively impact control of other infectious diseases that are converging with HIV and injection drug use, such as multidrug-resistant tuberculosis and hepatitis C virus. The continuing conflict is also likely to have a significant negative impact on Ukraine’s fragile public health system leading to even worse population health outcomes than currently experienced by the country.ConclusionsIn response to this crisis, the application of global health diplomacy principles represents a possible route of advocacy to ensure that HIV prevention, humane treatment of substance using populations, and improving public health outcomes in the region are pursued among concerned international stakeholders. In order to be effective, global health diplomacy efforts must be coordinated and advocated in all forms of diplomatic engagement, including at the core, multistakeholder and informal levels and through existing channels such as the different human rights bodies of the United Nations as well as amongst other actors. Hence, the Ukraine crisis represents a critical moment for the practice and advancement of global health diplomacy in order to ensure global public health priorities are given their rightful place in foreign policy making to hopefully help in bringing resolution to the current conflict.

Highlights

Peace and stability in Eastern Europe is at a crossroads with the rapidly deteriorating foreign policy crisis continuing to unfold in the Ukraine
This includes the potential application of an emerging form of diplomatic statecraft known as ‘‘global health diplomacy’’ (GHD), generally defined as diplomatic activities focused on issues of global health importance and prioritization of global health issues in the foreign policy context [5,6]
The real threat of losing the fight against HIV in Eastern Europe, the possible growth and spread of multidrug-resistant tuberculosis (MDR-TB) and hepatitis C virus (HCV) converging with HIV among people who inject drugs (PWID), and the need for the international community to coalesce around supporting evidencebased harm reduction practices and Ukraine’s struggling public health system provide a critical moment for GHD to come to action

Summary

Introduction

In a recent piece in the BMJ, Michel Kazatchkine, the UN Secretary General’s Special Envoy for HIV in Eastern Europe and Central Asia, brings needed attention to the negative public health consequences arising from the current regional conflict in the Ukraine [1]. Kazatchkine highlights how the rapidly deteriorating political and foreign policy crisis in the Ukraine, Russia and disputed annexed territory of Crimea could have long-term consequences for scientifically based public health interventions aimed at addressing the epidemic of injection drug use and HIV in Eastern Europe [1] Beyond these concerns raised by Kazatchkine’s article, ongoing destabilization has the potential for broader regional public health implications. The challenge posed by this ongoing regional conflict marks a crucial opportunity to prioritize public health concerns in ongoing foreign policy and diplomatic efforts by concerned nation states This includes the potential application of an emerging form of diplomatic statecraft known as ‘‘global health diplomacy’’ (GHD), generally defined as diplomatic activities focused on issues of global health importance and prioritization of global health issues in the foreign policy context [5,6]. We expand on the Kazatchkine’s discussion by exploring the unique public health threats associated with the current UkraineÁRussia conflict and how the practice and application of GHD could lead to benefits for public health, regional political stability and shared global health security

Findings

Discussion

Conclusions