The Foreign Service Journal, July-August 2020

THE FOREIGN SERVICE JOURNAL | JULY-AUGUST 2020 37 leadership on global health. Access to the vaccine for the new coronavirus will be the most consequential global health chal- lenge of our lifetimes. Will the G-7, NATO allies, Latin America and the Caribbean, African beneficiaries of the President’s Emergency Plan for AIDS Relief, and Mideast and Asian security partners need to go elsewhere for countermeasures, information and solutions to meet the needs of their own populations? What are the consequences for U.S. public diplomacy and “soft power” standing in the world? Toward a Solution: Practical Recommendations The World Health Organization, the International Health Regulations, the U.S.-led Global Health Security Agenda and the global standing and leadership of our USAID, NIH, Centers for Disease Control and Prevention and FDA can be the basis for improved global health governance. Here are six recommendations I think we should consider— and implement: First, the WHO Health Emergency program should have a separate governing authority (a strengthened Independent Oversight and Advisory Committee, for instance) that reports to the WHO director general, not directly to the World Health Assembly of member states. WHE should also have a budget that is independent of WHO’s biennial program budget and thus not competing with other mandated programs for annual share. Further, WHE should have the ability to raise money from emergency appeals to philanthropies and private indi- viduals, as, for instance, UNICEF and the Red Cross do with considerable success. Second, WHO should convene a review conference to update and improve the International Health Regulations , giving WHO representatives “on-demand inspection” authority (based on International Atomic Energy Association precedent) and clarifying both the concept of a public health emergency of international concern and what border and trade controls might be appropriate at different levels of threat. Third, WHO’s assessed contributions should be tripled and the assessment shares by country updated every two years to reflect the economic growth of emerging economies. The United States should pay its assessments, which are nearly two years in arrears. Fourth, the U.N. Secretary General should appoint a per- manent senior Global Health Security Adviser , who would also have the responsibility to inform and support the Security Council to take a more active role in dealing with global health emergencies. The Japanese government has in the past offered to pay for this position. Whoever is appointed should be a well-respected global figure. One role this UNSG Global Health Security Adviser could have is to convene a Coordinated Health Products and Equity Forum , which would bring together WHO, the World Trade Organization and other U.N. agencies, the G-7 and other governments, multilaterals such as GAVI–the Vaccine Alli- ance, and The Global Fund to Fight AIDS, Tuberculosis and Malaria, private-sector R&D and philanthropies, such as the Gates Foundation, for the purpose of sharing information and aligning research and development of vaccines, treatments and essential supplies for novel or severe outbreaks, and assuring that distribution adheres to equitable principles that respect both market incentives and public health exigencies. Fifth, the U.S. government should reestablish a senior directorate within the National Security Council to coor- dinate an all-of-government approach to health security and revitalize and adequately fund the Global Health Security Agenda. Sixth, the State Department should, likewise, appoint a full-time assistant secretary–level “Ambassador for Global Health Security and Diplomacy” to supervise the existing global health and biosecurity and global health diplomacy staffs. Health diplomacy requires skills and perspective beyond biomedical knowledge and health as a development issue. The United States needs to engage diplomatically at a senior level in global health governance, decision-making and emergency response. Lapses in U.S. leadership, the United Nations system, WHO and institutions of global health governance all proved costly to preventing, responding to and controlling COVID-19 around the world. But pretending these institutions are not necessary, or trying to start over with a replacement for the World Health Organization, is delusional. We have governance building blocks in place for global health security. Let’s find a way to make them work better. n Even more than in other sectors, a large number of countries have looked to the United States for technical and operational leadership on global health.