Health is but one of a litany of global challenges. Any response requires State – national – action:
The policy authority for tackling global problems still belongs to the states, while the sources of the problems and potential solutions are situated at transnational, regional or global level.
It is at the state level that the answers to the questions – Who identifies which global problems constitute priorities? Who decides which priorities are translated into a response? And how? – are formulated.
This is because, although health issues can be raised at the global level, binding decisions on their response are located at the national and inter-national level. this highlights the fact that global is not the same as inter-national. This is why diplomacy plays a particular role. ‘International health diplomacy’ refers to traditional, State-based diplomacy. In international health diplomacy, States and a limited number of others advocate for and, critically, are responsible for implementing, mutually beneficial health regulations. The International Sanitary Regulations (ISRs) initially, and the International Health Regulations (IHRs) contemporarily epitomise these efforts. That these operate under the auspices of the World Health Organization (WHO), constituted by Member States, further underscores the international nature of this arrangement.
International health diplomacy can also be differentiated from ‘global health diplomacy.’ At the global level of analysis, three dimensions come into play that are relevant here: diplomacy of or for health, as well as health science for diplomacy. These can be delineated into the three levels of: diplomacy of health; diplomacy for health; and health (science) for diplomacy).
First, diplomacy of health includes the elevation of health to an issue of international, notably security, concern. This is best revealed by the bringing of first HIV (2000) and then Ebola Virus Disease (EVD) (2014) to the attention of the United Nation’s Security Council (UNSC). Never before had health made it to this epicentre of international diplomatic agenda-setting.
Second, diplomacy for health is broader, and includes diplomatic efforts on the parts of States to increase awareness not only of health crises but of (their proffered) solutions. These include diplomatic efforts by state and non-state actors to facilitate access to anti-retroviral (ARV) medications to fight HIV and AIDS, as done by Brazil and India, with regard to HIV and AIDS; and in a different vein, by Indonesia in its invocation of ‘viral sovereignty’ (2007) in a contest over access to an anti-influenza vaccine. Health (science) for diplomacy in turn includes research and innovation enabling the development and production of, among other health interventions, ARVs, for example. It also encompasses that of biological and chemical weapons as well as of anticipatory and exploratory research on emerging infectious diseases (EIDs) and concomitant and co-morbid health complications, most notable with regard to HIV and tuberculosis (TB).
Third, health (science) for diplomacy highlights an important related point: that health diplomacy and health security are not one and the same. A host of definitions places the focus of ‘global health diplomacy’ on the State – as in ‘global health as foreign policy’. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) falls under this description, wherein the emphasis lies on the ‘strategic use of global health interventions’ in developing States to achieve foreign policy goals, notably for the giving as opposed to the receiving State. Similarly, health security refers to the security from especially infectious diseases – such as HIV and EVD – primarily for the benefit of protecting developed States from the import of such infections. Health (science) for diplomacy can promote health for security in both developing and developed states, especially when it emerges from developing country contexts and is communicated with developed states.
In other words, health diplomacy, in both of its guises, can contribute to health security.
Just as global and international health diplomacy are differentiable, so too is international health security from global health security. Whereas the former emphasises the security of States, the latter prioritises the heath of people (in or between) any State.
Given that States and state-based actors, informed by many NSAs and scientists, remain the final arbiter of many policy responses, the possibility and the routes of knowledge exchange of, for and to health diplomacy and health security are of vital interest to any effective response to global health challenges. What knowledge transfers occur? This very idea of transfers necessarily presupposes that one ‘has knowledge’ to be transferred, and infers that the other sides lacks this knowledge (Benetar, 7 April 2017). In order to overcome such bias, tracing knowledge exchange can reveal political, policy and private industry practice and cultural context through which informed heath priorities and responses can be imparted to assure any success.
Taking both State and human security into account offers a new lens through which to analyse the implications of health crises for health diplomacy for health security. While policy remains national, health challenges are increasingly global. While they may differ in their orders of magnitude – HIV and (XDR)-TB higher in southern Africa, NCDs currently still higher in Europe – the luxury of treating each disease in a silo is waning. Co-morbidities are on the rise. Concurrent crises, exacerbated by cross-border migration of disease and populations, are shifting from being the exception to becoming the rule. It is high time for a new conceptualisation of health diplomacy for health security.
Critically, multi-faceted health (security) challengesare not fundamentally different between the EU and South Africa but rather of divergent orders of magnitude. The vulnerabilities are the same. Each can therefore benefit from the other’s coping strategies through diplomatic cooperation. Admitting that existent policies are not equal to performance / implementation is a crucial component of identifying health problems and potential niches for diplomatic response.
 Thakur, Ramesh and Luk Van Langenhove, 2006, ‘Enhancing Global Governance through Regional Integration,’ Global Governance Vol. 12, No. 3: p. 233.
 See, e.g. Feldbaum, 2010; Kickbusch et al., 2007; McInnes & Lee, 2006; Novotny & Adams, 2007; Kickbusch & Buss, 2011.