The lack of consensus around definitions of global health security and global health diplomacy (GHD) has fostered a duality of preferences insofar as conduct of health diplomacy is concerned. The global North has tended to privilege bilateral interactions around health, chiefly driven by fear of the effects of global pandemics; conversely the global South has been inclined towards multilateralism entailing regional cooperation and South-South coalitions underpinned by suspicions about motives of health securitization by powerful stakeholders. The array of global responses to the Ebola virus outbreak in West Africa is testament to this dichotomy with countries like the US and UK deploying military troops to assist with training, logistics and engineering while countries like China and Cuba have been at the forefront of dispatching medical experts and supplies to Guinea, Liberia and Sierra Leone.
The distrust of a militarised approach to the Ebola crisis also trickles down to the locals evident when clashes erupted in Westpoint, Liberia when Liberian troops attempted to forcefully quarantine residents. The legacy of mistrust has deep roots in colonial experiences coupled with fears of sovereignty being encroached upon by powerful actors with vested interests. Thus for African countries, navigating the precarious terrain of GHD will mean finding a middle ground between suspicion-based perspectives and commitment to public health priorities at national and regional levels.
The African Union Support to Ebola Outbreak in West Africa (ASEOWA) was established in August 2014 comprising of medical experts and volunteers to assist with the fight against the epidemic and is funded by the US ($10 million), the EU ($5 million) and China ($2 million) 2014). In comparison with contributions from other members of the international community, the AU’s effort may be deemed Lilliputian but AU Commission Chairperson Dlamini-Zuma has maintained that the mission is all about African unity and showing solidarity with affected countries. On its part, the AU has been engaged in combating diseases for over a decade. Article 4 of the AU Constitutive Act established a Specialized Technical Committee on Health, Labour and Social Affairs tasked with supervision, coordination, follow-up and harmonization of health programmes on the African continent.
Moreover, the AU adopted a nine-year Africa Health Strategy (2007-2015) to ‘build an effective, African driven response to reduce the burden of disease and disability, through strengthened health systems, scaled-up health interventions, inter-sectoral action and empowered communities.’ Initiatives such as the AU Africa Health Strategy, though often upstaged by a focus on economic and political agendas, are a positive indication of African engagement on health security discourse. However, sustained and effective participation in health diplomacy will require greater policy coherence and institutional transformation from the national level; reordering of health diplomacy priorities at the regional level and the active engagement in modes of South-South cooperation on health security issues in multilateral fora.
Nevertheless, bigger questions emerge around lessons to be learned from the Ebola crisis and how countries can prepare for Ebola-type crises in the future. For instance, in 2000, Uganda successfully contained an Ebola outbreak through control measures such as social mobilization, case management, active surveillance, resource mobilization and improved communication. Additionally, post-outbreak measures included infrastructure development and the enhancement of surveillance for early warning and infection control measures. The outbreak lasted for four months with 224 reported deaths. Recurrences of Ebola outbreaks in 2007 and 2012 killed only 37 and 17 people respectively, owing to the institutional memory from tackling the 2000 outbreak.
Valuable lessons can also be gleaned from China’s experience with the 2002-2004 Severe Acute Respiratory Syndrome (SARS) outbreak which saw the Asia Pacific Economic Cooperation (APEC) and the Association of East Asian Nations (ASEAN) take up the lead in collective combating of the epidemic. In 2003, APEC formulated an Action Plan on SARS which outlined common set of guiding principles for health screening procedures for travellers, promotion of a feasible strategy for SARS and other infectious diseases and information-sharing among member states. The SARS experience brought out the centrality of good lines of communication in national and regional contexts as well as the obligation of states to ensure that their national policies are not a detriment to regional stability including undertaking timely actions to prevent spread of disease.
If Africa’s health diplomacy is to move away from the crisis-driven, self-interested and elastic attention accorded to it by foreign policy, there is need for African states to re-examine the paradigms through which health security is viewed. Not only is it imperative to understand how health-specific MDGs are imbued with development strategies of foreign policy, but it is also crucial to interrogate health diplomacy from an inter-sectoral perspective engaging a diversity of actors and employing strategies of issue-linkage in integrating health into foreign policy. A case in point of viewing foreign policy through the health lens is Brazil, which has integrated health diplomacy into its foreign policy matrix by building alliances with developing nations and promoting South-South cooperation in the universal fight against HIV/AIDS and access to ARVs as a platform to gain political leverage for its agenda within the UN around issues such as Security Council reform. The status of health in foreign policy will not be elevated without input from policy entrepreneurs from within and without government. These policy entrepreneurs, including both public health professionals and diplomats, play an integral role in promoting intra- and inter- state cooperation and by strategically utilising attention generated by high-impact occurrences such as disease outbreaks to build sustainable institutions.
Faith Mabera is a Researcher at the Institute for Global Dialogue associated with UNISA