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This is the third in a Series of three papers about political science and health
IntroductionThe importance of global health diplomacy has been made clear during the COVID-19 pandemic. As always, the relevance of global health diplomacy comes to the fore in crisis situations. The response to the COVID-19 pandemic has put diplomacy centre stage in international organisations and high-level political gatherings, by engaging in crisis diplomacy and negotiating a joined-up response between countries who otherwise have strained relationships. As the Director-General of WHO, Tedros Adhanom Ghebreyesus, said: “no one is safe until everyone is safe”.1
The intensified negotiation efforts—mainly under the backing of WHO—to ensure a collective response to the biggest pandemic since the 1918 influenza pandemic were initially stalled because of geopolitics, nationalism, and weak institutions. First and foremost, the diplomatic stand-off between the USA and China blocked agreements at WHO,2 the UN Security Council,3 the Group of Twenty (G20),4 and the Group of Seven (G7).5
The unique multilateral agreement on health security (the International Health Regulations [IHRs] adopted in 2005) showed its fragility and was disregarded as many countries neglected to fulfil their obligations, closed borders, and blocked the export of critical medical supplies.6 WHO's lack of authority and resources hampered advancement at the speed required, causing delays to their confirmation of human-to-human transmission of the COVID-19 virus and to the declaration of a public health emergency of international concern.7,8
While international organisations were rapidly crafting a new governance mechanism—the Access to COVID-19 Tools (ACT) accelerator—to speed up the development, production, and equitable access to COVID-19 tests, treatments, and vaccines across the globe, high-income countries (HICs) in particular embarked on a wave of vaccine nationalism, investing large sums of money to secure exclusive access to vaccines for their populations.9 In the face of supply constraints during the early roll-out of COVID-19 vaccines and as COVAX, the vaccines pillar of the ACT accelerator, distributed doses on the basis of the principle of equitable access and fair allocation, some key countries engaged in geopolitical vaccine diplomacy by sending doses to their friendly allies.10 During the COVID-19 pandemic, countries practised two types of health diplomacy: one with the aim to establish solidarity and equity,...