The Foreign Service Journal, December 2004

myelodysplasia, that ended her life a year later. Following her death, he embarked on a personal mis- sion of medical diplomacy, establishing a memorial fund to help globalize pathbreaking research on the causes and cure for MDS. Indeed, one of the most striking elements in the med- ical diplomacy equation is the existence of private philan- thropy and powerful NGOs as a major force on the inter- national health scene, with the Bill and Melinda Gates Foundation only the largest and most prominent. The French organization, Médecins Sans Frontières/Doctors Without Borders, founded by a small group of French doctors in 1971, was the first NGO to both provide emer- gency medical assistance and publicly bear witness to the plight of the populations they served. Now MSF has affiliates in 18 countries, and is just one among many NGOs active around the world. Public-private partnerships have become decisive in meeting the needs of developing countries in an envi- ronment of slashed government aid budgets. This is as true in the health field as anywhere else, where consor- tiums including governments, bodies such as the World Health Organization and the World Bank, NGOs, foun- dations and private corporations are active in everything from promoting hand-washing with soap in Central America to rolling back malaria around the world. The Global Alliance for Vaccines and Immunization, launched in 2000 to improve access to both existing and priority new vaccines in low-income countries, is a good example. GAVI partners include UNICEF, WHO, the World Bank, governments, foundations, vaccine manu- facturers and public health and research institutions. Recently, the biotechnology industry joined forces with the Rockefeller Foundation and the Bill and Melinda Gates Foundation to create the nonprofit group BIO Ventures for Global Health to get new medical tech- nologies to the world’s poorest people. At the same time, the expanding global commerce in health goods and services, the proliferation of multi- lateral and bilateral trade agreements, and the debate over how to balance the need to protect U.S. markets without endangering “global public goods” — encom- passing such topics as drug pricing policies, intellectu- al property rights, expansion of the U.S. health insur- ance industry abroad, and the hot, new boom industry of “medical tourism” (see Cybernotes, p. 12), among others — are certain to command increasing attention. The Theory and Practice of Medical Diplomacy We do not pretend to a comprehensive presentation of medical diplomacy here. Our package begins with what for policy-makers is the key: the recognition that public health is a global security issue. The threat of bioterrorism, while especially alarming, is only one aspect of it. Diseases such as HIV/AIDS can devastate economies, thereby creating the kind of “failed states” that are breeding grounds for terrorism. Randy Cheek, a former FSI instructor and now a senior fellow and Africa analyst at the National Defense University, makes this case comprehensively in “Public Health as a Global Security Issue” (see p. 22). In some respects, practice is already ahead of policy when it comes to medical diplomacy. Even the U.S. military has quietly extended its role beyond protecting the health of its personnel abroad to getting involved in rebuilding health systems. For example, the dialogue with American physicians to help revive modern medi- cine in post-Saddam Iraq was initiated by the U.S. Army Medical Brigade. Consultant and former med- ical society executive director Lousanne Lofgren tells the story in “Medicine As a Currency of Peace in Iraq” (see p. 30). The Bush administration’s five-year, $15-billion emergency effort to fight AIDS abroad, launched in May 2003 as a priority program in 15 nations, was the largest single up-front emergency commitment in history for an international public health effort. But well before that initiative, USAID’s health mission had expanded to programs addressing child and maternal health and combating infectious diseases, including HIV/AIDS. FSO Jeffrey Ashley gives us a first-hand look inside the agency’s initiative in the high-risk HIV/AIDS corridor in Ethiopia & Djibouti in “An Excursion of Hope: Fighting HIV/AIDS” (see p. 37). Finally, we present a case study in medical diploma- cy from the 1950s, “Medical Diplomacy at Work in 1950s Nepal.” The pioneering medical work of Dr. George Moore and his colleagues in Nepal, following the country’s opening to outsiders after 100 years, was based on their ability to establish a relationship of trust with the Nepalese and attests to the value of medical diplomacy as a bridge between people from disparate cultures (see p. 41). F O C U S D E C E M B E R 2 0 0 4 / F O R E I G N S E R V I C E J O U R N A L 21