Pandemics,health diplomacy,and peacebuilding 1

As COVID-19 has caused serious human and social crises around the world, global health issues have become increasingly preeminent in the evolving global diplomacy agenda. Given the increasing need to mobilize disparate global health stakeholders coupled with the need to design public health partnerships to tackle the coronavirus and its associated issues, effective and timely cooperation among nation states is critical. Such cooperation includes dissemination of information on the virus and its diagnosis, the supply of medical equipment and testing devices, and economic and financial support for the people and societies hit hard by the pandemic.

Moreover, as health has become an integral part of economic, geopolitical, security, and social justice agendas, the strategic relevance of health has changed. Since 2015, the international community has made great progress toward the UN Sustainable Development Goals (SDG) including global health, SDG 3. Unfortunately, many of those gains appear to be at risk of being reversed by the COVID-19 pandemic. Three aspects of the SDG agendas are essential: achieving peaceful societies, building just and accountable organizations, and fostering international cooperation. These three aspects are a small part of the overall SDG agendas, but they also constitute a crucial foundation for all the other goals. Indeed, SDG 16 (justice and peace) has come to be seen as “the enabler” of almost all the other goals. A fundamental consequence of war and armed conflict is a precipitous decline in health (Gates et al., 2012). Peace is critical.

The special issue is designed to explore pandemics, health diplomacy, and their influence on peace building around the world. Health diplomacy is a budding field, bridging the priorities of global health and foreign affairs. Health diplomacy is defined as the practice of conducting negotiations between states or groups on global policy issues that shape and influence the global environment for health. Global health diplomacy covers broad issues such as fighting epidemics or pandemics, addressing the lack of medical supplies and vaccines, and tackling the health problems of migrants and refugees. This special issue features such critical questions as: How do states approach global health issues? How have they utilized health diplomacy and for what purposes? What are the principal challenges? How do pandemics affect conflict, and vice versa? Has health diplomacy effectively addressed global health concerns particularly in conflict-torn societies?

Given the many interesting questions on global health issues and health diplomacy, this special issue aims to achieve two main goals. First, it explores how pandemics and conflict interact with each other. In the places where political violence and conflict such as maritime crime and civil or interstate wars are present, the detrimental impact of pandemics on public health and well-being are enormous. Armed conflict and political violence affect both the supply and the demand for health services. The demand for health services is increased through the direct and indirect effects of fighting. Simultaneously, demand is decreased through the destruction of health facilities and infrastructure, the deliberate targeting of health workers, and the limiting and re-prioritization of government resources away from health and other public services toward the security sector. Conflict and contention take place in contexts where public health is already severely constrained. In turn, the same conflict can put these fragile institutions under unbearable stress. Meanwhile, conflict can also negatively affect the flow of health aid and assistance between states. By disrupting supply chains of vaccine or other health assistance, conflict can worsen global health problems. This special issue assesses the link between pandemics and conflict and examines associated conditions that affect the link.

Second, it examines how health aid and diplomacy have been exercised by donor states. As the literature on foreign aid reports, states’ benevolent behavior tends to draw policy cooperation from the recipients. Some states may view health assistance as an opportunity to promote its image and reputation regionally and internationally. Others may utilize it as a tool to promote national economic interests such as easy access to local trade or financial markets. And, for others, health diplomacy can be used to build or consolidate alliance ties with the recipient of health-related assistance. Although speculation on the link between health diplomacy and various national interests is abundant, few systemic and empirical research and studies exist in this field. In this regard, two articles in this special issue offer novel insights on health diplomacy, its history, and how it has been played by donor states.

In sum, this special issue brings together scholars who are specialized in conflict, health aid, and diplomacy to closely examine the link between global health issues and conflict, health diplomacy, and challenges associated with health diplomacy.

Composition of the issue

The special issue consists of five articles. Phayal, Gold, and Prins offer an assessment of the consequences of the COVID-19 Pandemic on maritime crime. They examine the effects of COVID-19 on maritime pirate attacks in Nigeria, located in the Gulf of Guinea, and Indonesia, located in the Indo-Pacific. By employing monthly and quarterly data on government measures to prevent infection, economic conditions, and sea-piracy incidents, they show that deteriorating economic conditions heightened by the pandemic and government stringency measures have increased sea-piracy incidents in Nigeria. The findings imply that the prospect of peace significantly declines unless proper health aid and assistance are provided to states that are hit hard by the pandemic and associated economic and social crises. In this regard, bilateral or multilateral cooperation between states on health issues is critical to reduce further conflicts.

The outbreak of COVID-19 pandemic has made vaccine diplomacy more relevant than ever. Caruso and Balestra examine the flow of vaccines and how armed conflict affects world supply of vaccines. By presenting a theoretical model which combines elements of Hirshleifer-style economic analysis of conflict and microeconomic modeling of oligopolistic markets, they suggest that a large world supply of vaccines and the existence of armed conflict are incompatible. This means that vaccine producers cannot credibly commit to global health cooperation if they are experiencing serious armed conflict. They show that world supply of vaccines is negatively affected by the existence of armed conflict in a producer country. Since the world price of vaccines increases as the vaccine supply declines, armed conflicts in vaccine producing states generate a detrimental impact on global efforts to address health challenges.

The COVID-19 also has devastating effects on the prospect of democracy and peace in some countries. Myanmar is one of them. Due to the rise of public health problems caused by the pandemic, internal and external efforts to deal with the Myanmar democratic crisis triggered by a military coup in 2021 largely have failed. In Wicaksana, Nauvarian, and Pramudia's article, the authors explore how the pandemic affects the Myanmar democratic crisis. They report that the pandemic is abused by the ruling elites and military to create a situation in which individual liberties are easily taken away and political institutions in support of democracy are severely undermined. Highlighting the important role of ASEAN during the pandemic and the democratic crisis, the authors explain how and why ASEAN confines its responsibility to resolve the Myanmar crisis only by facilitating dialogue among the conflicting parties and not mediating or deeply intervening in the crisis. The article focuses on diplomatic culture and institutional legitimacy of ASEN as the key factors that account for ASEAN and its limit in coping with the critical juncture moments of the COVID-19 and the Myanmar crisis.

The arguments and findings in these three articles suggest that pandemics and conflict or democratic crisis have a vicious cycle of negative influence. One way to break the vicious cycle is to promote health aid and diplomacy among states. Since many states that suffer from pandemics, conflict, or both often lack resources to deal with the issues, international cooperation via health aid and diplomacy is critical to stop or reverse the negative cycle. Despite the importance of health aid and diplomacy in global health and peace, however, we do not know much about how states allocate health aid and implement health diplomacy. In this regard, two articles in the special issue focus on health aid allocation policy and explore factors that drive it.

Hwang and Hwang's article provides an important assessment of how donors allocate their health aid to others and whether donor-interest based factors as well as need-based factors matter in accounting for health aid flows. By highlighting the differences between health aid and other types of foreign aid in terms of their nature and political costs and effects, the authors explain that health aid can be an effective policy tool for donors to improve their relations with recipients that have divergent foreign policy preferences from donors. In the analysis of 24 donors and their recipients of health aid from 1990 to 2017, the article shows that health aid flows frequently between a donor and a recipient that maintain very divergent foreign policy preferences, claiming that, along with need-based factors such as the number of deaths caused by health problems and economic conditions in a recipient state, donors may seriously consider their political relations with recipients. Interestingly, their arguments and findings suggest that health problems caused by pandemics or epidemics can create an opportunity for donor states to ameliorate historically trouble relationships with recipient states.

One of the countries that has actively engaged in health diplomacy during the COVID-19 crisis is South Korea. In Kim, Lee, and Cho's article, the authors provide an excellent assessment of South Korea's health aid strategy as a representative case of health diplomacy. By initiating Agenda for Building Resilience against COVID-19 through Development Cooperation (ABC) program in 2020, South Korea has provided COVID-19 test kits, medical equipment and health-related capacity for building and development projects to states in need of help. Like Hwang and Hwang's article, the authors report that South Korea consider its own national interests as well as recipients’ necessities in its health aid program. Specifically, they show that South Korea provides health aid to recipients with whom South Korea has maintained close economic ties or to whom it has provided a high volume of other types of foreign aid in the past. This implies that realistic aspects of health aid and its short-term effects on their relations with a recipient are important factors for middle power donors like South Korea in their health diplomacy. Noting that there is a large gap among G-20 countries in their awareness and capacity to address global health and security issues, the article suggests that even a middle power like South Korea can play a pivotal role in strengthening global efforts to combat COVID-19 and other infectious diseases.

Overall, this special issue contributes to our understanding of pandemics, health diplomacy, and peace. By highlighting issues associated with responses to global health issues and health diplomacy, this issue offers novel perspectives to analyze the prospect of global health and security.