Global health diplomacy
Interaction between speakers and participants during the global health diplomacy and disaster diplomacy session at the 2020 AAAS-TWAS Summer Course on Science Diplomacy held virtually from September 21-24, 2020. Credit: AAAS.

COVID-19 as a Revelation: Challenges in Global Health Diplomacy & Disaster Diplomacy

COVID-19 PEPFAR global health Disaster diplomacy Americas East Asia Europe South and Central Asia Sub-Saharan Africa

The year 2020 will be remembered as a pivotal year of the 21st century in which the whole world focused on health diplomacy to address the COVID-19 pandemic. Continuing a partnership that began in 2014, the American Association for the Advancement of Science (AAAS) and The World Academy of Sciences (TWAS) held its annual Science Diplomacy course virtually from September 21–24, 2020.1 The topic of finding new vaccines and mitigation strategies in coping with this worldwide emergency was front and center for the 75 students coming from every continent. The speakers included distinguished scientists and diplomats who are practitioners of science diplomacy. With international scientific engagement, they use their expertise and knowledge of science and technology to help achieve diplomatic goals and their expertise and knowledge of diplomacy to help achieve scientific goals.

One of the most interesting and insightful sessions of the 2020 course directly addressed “COVID-19 as a Revelation: Challenges in Global Health Diplomacy & Disaster Diplomacy.” Although the comments of the four expert speakers were made over six months ago, their perspectives addressing what we have learned from this pandemic, from confronting other major challenges such as HIV/AIDS in Africa and natural and human-caused disasters to trying to cope with inequities, are as relevant and insightful today as they were then. For that reason, Science & Diplomacy is pleased to provide their presentations of September 23 (with minor updates) in written form and commend them to our readers.

COVID-19 from a Global Citizen’s Perspective

Dr. Michaela Told is co-founder of HumanImpact5 (HI5) and Visiting Lecturer at the Global Studies Institute in University of Geneva. She has worked more than 25 years on global health, gender, and development/migration, both at the operational and policy level. She holds three master’s degrees in development economics, social work, and women & development respectively, as well as a Ph.D. in Cultural Studies.

Is COVID-19 a revelation? How did it change our lives, our society, and the world? These are questions we may have asked ourselves as the pandemic has unfolded, exploring answers from different perspectives. I want to take here a global citizen’s perspective:

COVID-19 has confirmed what we have learned from earlier outbreaks, but we never acted sufficiently upon. We knew…

… that strong health system can absorb the impacts of the pandemic better,

… that collaboration across private and public entities is crucial,

… that we need to listen to science,

… that communication plays a pivotal role,

… that health impacts all sectors,

… that there is a differential impact on women and men and other gender identities,

… that we require collective solutions,

… that we live in an interconnected world,

… that in crisis, health inequities widen,

… that marginalized communities and poor segments of society are often the most affected, and

… that health and politics are intertwined.

We knew all of the above and yet, a few dimensions have been re-enforced through COVID-19 and will be outlined below:

First, COVID-19 has affected the whole world in an unprecedented way.

Second, this global dimension has added a level of uncertainty that we have never before experienced. COVID-19 has provoked much economic and social uncertainty. We have also encountered political uncertainty, and we are confronted with scientific uncertainty. This scientific uncertainty has penetrated our personal lives in many different ways: We do not know whether we will face a second or third wave,2 we do not know what the best measures are to take to prevent the spread of COVID-19, we do not know when the first vaccine will be on the market,3 and we do not know how virus mutations will prolong the crisis. Much is unknown and uncertain, but the knowledge and science on COVID-19 is continuously adapted, revised, and evolving. We need to find ways to deal with this uncertainty and we need to be aware of how this uncertainty influences diplomacy.

Third, COVID-19 has added an unprecedented level of urgency to the work of the political and scientific community. Never before in history has data on the genome of a virus been shared so quickly after its discovery with scientists around the world.4 This sense of urgency has triggered concerted action at the global level.

Fourth, this level of urgency has also triggered an unprecedented sense of shared responsibility. The Sustainable Development Goals (SDGs) highlight the importance of shared responsibility among countries.5 The notion of shared responsibility among different stakeholders is also strongly embedded in  Universal Health Coverage (UHC).6 In addition, the West African Ebola crisis evoked health security not only as an important concept and moved it up the political agenda, but also stressed the importance of solidarity and shared responsibility in outbreak response.7 And yet, this urgency and re-emerging sense of shared responsibility regarding COVID-19 are of a different nature due to their scope, their worldwide occurrence, and their impact on science. They resulted in the opportunity of improved and strengthened collaboration.

Therefore, fifth, the sense of urgency and shared responsibility linked to COVID-19 has led to the realization that we need action. Thanks to cooperation between public and private sectors and among researchers, open science has been promoted and cross-country collaborations have been fostered much more than ever before.8 At the same time, we can also observe the dramatic consequences of non-action in times of crisis.

The required collective action takes place at different levels, both at the national and the global level. It can be linked to diplomacy at these different levels and entails governance. Governance matters. Governance means the management of interdependence9 and entails political processes and balancing competing interests and demands.10 It also means decision-making in a political environment.11 The importance of governance and political decision-making is not a revelation and health as a political outcome was stressed long before COVID-19.12 Yet, COVID-19 has brought “health as a political choice” to our front doors. It showed us how much health is political, how politics affects decision-making, and how political decision-making is involved in managing a crisis—any crisis, be it a pandemic or any other crisis. We face these political choices for health every day and COVID-19 has brought these decisions into our personal lives. We can also observe diplomacy related to political choices both at national and global level on a daily basis. In all our countries, political decisions have been taken to prevent the spread of the disease—reaching from strict measures to hardly any. At the global level, political decisions were taken collectively across the different institutions. For example,

  • the UN Security Council has passed resolutions related to COVID-19, the latest on 26 February 2021,13
  • the UN General Assembly has passed resolutions14 and held a Special Session on COVID-19,15
  • both G716 and G2017 leaders have released statements on COVID-19, as well as respective sub-groups,
  • WHO has delivered regular briefings, even daily briefings, on the pandemic,18 and
  • several public-private partnerships have emerged to find common solutions, among them the ACT Accelerator19 with its four pillars of work (diagnostics, treatment, vaccines, and health system strengthening), the COVID-19 PPP Rapid Response Umbrella Program by the World Bank,20 and the COVID Action Platform by the World Economic Forum.21

All international organizations and political and economic alliances have also issued statements on COVID-19. The scope, urgency, and impact of the pandemic has forced all sectors to integrate health considerations in their work and the ILO has issued a series of briefs on different sectors.22

In such an extraordinary situation, the role that science plays in decision-making processes is indispensable. Science is needed, for example, to develop a vaccine, respond appropriately to the pandemic and take adequate measures. Science should shape and influence decision-making processes. The pre-requisite is that decision-makers listen to scientists and scientists themselves understand the decision-makers’ information needs.23 We need science and we should rely on science to develop evidence. This evidence should then inform decision-making processes.24 Decisions, however, remain political, as they are always embedded in a political reality and involve political choices.

Hence, decisions are rarely entirely based on evidence, but remain at most evidence-informed. COVID-19 has demonstrated that—despite the need for science to play a predominant role—decisions are political processes. COVID-19 has fostered and increased our understanding of these political processes. We need to apply a sense of realpolitik and find ways to address situations where science is not appropriately considered in the decision-making process.

One question emerging from this, then, is how do we address such situations and how can we transform an understanding of political decision-making into political action? What does this entail, especially in times of crisis? We need political action, and we need it within an appropriate timeframe. This is not a new revelation but a renewed realization. Some questions, however, have a particular urgency now:

How do we deliver vaccines to the population? Should vaccination be considered a public good? Vaccine diplomacy is at the center of this question. Concerns regarding research and development have gained less importance because, as of September 3, 2020, 321 vaccine candidates are in development and 33 are in clinical trials.25 So, there will be vaccines available in due time. With this knowledge, our concern should shift towards the equitable, affordable, and fair delivery of the vaccine. Several initiatives have been taken at the global level, with the COVAX Facility,26 within the ACT Accelerator, among the most important here. This is not only because it was launched in April 2020, but also because, through COVAX Advance Market Commitment (AMC), it wants to deliver vaccines to 92 lower-middle and low-income economies and, through its Country Readiness and Deliver (CRD) workstream, wants to support the practical implementation of the vaccines in these countries. The significance of this facility is also in the diplomacy involved, the early steps taken to ensure concrete collective action and the equitable and affordable delivery to the global population.

The need for affordable, fair, and equitable political action also leads to the question of how to counter vaccine nationalism. It is not only a question of human rights27 and the policy and political responses, but it is also a question that we need to ask ourselves. If we want to trigger political action, we need to do so at different levels, including the individual level. It concerns all of us. We need to be engaged as citizens and transform the political dimensions of health revealed by COVID-19 into political action.

How do we trigger political action as citizens? What is our contribution in triggering political action? What is our contribution in demanding accountability and transparency from decision-makers in governments? What are our rights and how do we stand up for them? In times of crisis—even in democracies—decision-making processes change at the local, national, and global level.28 Our own democratic rights are affected but even more so, we see the rights of marginalized and minority populations infringed. What is our reaction to this vaccine nationalism? We want to see responses at the political level but, for this to happen, we need to act ourselves, as responsible citizens. Outrage over vaccine nationalism and decisions taken at the political level need to be reflected in our political action in terms of our citizens’ rights. We need to transform this outrage into our own voting power. Even though decision-making in times of crisis is largely delegated to policymakers, we ourselves have the responsibility to hold these decision-makers accountable. Through our voting power, we need to make sure that these decisions are equitable, fair, and affordable. We ourselves must act as responsible citizens and seize any opportunity in this regard, claim our rights, and insist on them.

COVID-19 and PEPFAR: The U.S. Government’s Preparedness and Response

Dr. Mamadi Yilla is Deputy Coordinator for Multi-Sector Relations in the U.S. Department of State’s Office of the Global AIDS Coordinator and Health Diplomacy, which provides oversight for the PEPFAR program. Prior to joining PEPFAR, Dr. Yilla served at the U.S. Centers for Disease Control and Prevention as a research fellow in immunology, improving diagnostic tools for vaccine-preventable childhood diseases, and publishing CDC studies on the SARS-CoV outbreak of 2003. Dr. Yilla completed undergraduate and graduate training at the State University of New York at Buffalo, and post doctorate training at MIT in Cambridge, MA.

The U.S. government has shown it is deeply committed to controlling and ending the HIV/AIDS pandemic at home and around the world through the President’s Emergency Plan for AIDS Relief (PEPFAR). Over the past 17 years, through PEPFAR and our substantial contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the United States has invested over $85 billion in the global AIDS response.

Each recent administration—those of Bush, Obama, Trump, and now Biden—has focused on a different critical phase of the U.S. government’s response to the HIV/AIDS pandemic.29 In Phase I, the focus was on emergency response, to save lives. In Phase II, our goal was to ensure an AIDS-free generation. Now, under Phase III, PEPFAR is focused on accelerating core interventions to achieve epidemic control.

PEPFAR programs have supported countries to save over 20 million lives. We have helped train nearly 300,000 health care workers in the last decade, helping to revolutionize the global AIDS response and the health infrastructure to manage new health threats.

We have invested almost a billion dollars annually in health systems strengthening, including support for 3,000 laboratories. These efforts have strengthened the platform for global health security and improved the ability of countries with sizable HIV/AIDS burdens to swiftly address other outbreaks, such as Ebola, avian flu, cholera, and, most recently, COVID-19.

We are proud of all that has been accomplished under the PEPFAR Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020). We know from our site-level data, which anyone can review on PEPFAR Panorama Spotlight,30 that we are closer than ever to controlling and ultimately ending the HIV epidemic. Additionally, PEPFAR-funded population-based HIV impact assessment surveys show remarkable country progress toward achieving the UN Sustainable Development Goal 90-90-90 targets for 2020, as evidenced by the rate of community viral load suppression.

Before the COVID-19 pandemic, we already knew strong public health policies and political will matter in saving and improving lives. PEPFAR has long leveraged its financial investments and robust global U.S. embassy support to engage with heads of state, prime ministers (PM), and ministers of health (MOH) and finance (MOF), across PEPFAR-supported countries. Such work helps ensure World Health Organization policies are rapidly adopted and implemented at local in-country sites where clients access health care.

These diplomatic engagement efforts have helped move countries to treat all their people living with HIV (PLHIV)—addressing patient concerns over the cost of drugs—and adopt a multisector approach, including not only civil society organizations (CSOs), faith-based organizations, multilateral organizations, and the U.S. government, but also bilateral discussions across MOH, MOF, and PMs.

For example, throughout 2019, the government of Malawi (GoM) agreed to adopt a policy on annual viral load suppression testing for all patients and to start dispensing six-month antiretroviral therapy (ART) for stable patients on dolutegravir-based regimens. The GoM also approved the implementation of recency, insight into the timeline of an individual’s HIV infection and self-testing.

And, in Zambia, the government has agreed to revise its HIV testing policy, institutionalizing the use of screening tools to prioritize the highest-risk individuals and reducing and/or removing user fees for health services.

In response to COVID-19, PEPFAR also rapidly scaled up its policy on multi-month dispensing (MMD) of ART prescriptions. This adaption not only improved adherence to ART and retention in care, but also improved decongestion of clinics to prevent patient exposure to COVID-19. To date, 27 of 51 PEPFAR-supported countries with care and treatment programs have increased their MMD coverage.

We are strengthening our engagement with trusted community leaders. These individuals are vital to our success as they live in the most affected communities, understand who and where the social networks of men, women, and youth are, and appreciate what they need to help us find and treat the undiagnosed. Specifically, in the context of COVID-19, these leaders have a unique ability to provide decentralized services, such as highly targeted distribution of HIV self-tests, along with access and linkage to treatment, an important contributor to retention.

Civil society organizations (CSOs) and communities are essential to this effort; community-led monitoring (CLM) and the client perspective is the missing piece to help us assure quality implementation of our program, ensure minimum program requirements and site standards, and hear directly from communities about how we are doing and what is needed. We are funding CLM in all countries and expect these activities to support local and independent CSOs. To sustain our hard-won success and common objectives, we have made the continuity of care and lifelong continuous treatment a key PEPFAR priority, especially given that most clients who fall out of ART continuity are relatively young, well, and in the early stages of treatment.

Programs must design services and interventions that remove all barriers to continuous client-centered ART care, including stigma and discrimination, and maximize convenience and responsiveness to client needs and preferences.

COVID-19 has affected and continues to affect PEPFAR programs. To ensure the continued success of our programs, we have adapted our strategies to emphasize convenient, client-centered care to protect PEPFAR’s HIV gains. Challenges for PLHIV globally have been exacerbated during COVID-19.

PEPFAR is doing everything it can to mitigate these impacts on clients and communities by focusing on the following key areas of concern:

  • The COVID-19 pandemic has devastated economies and impacted health systems, including the global HIV response.
  • UNAIDS estimated a six-month disruption in treatment could result in more than 500,000 additional deaths from HIV in sub-Saharan Africa over the coming year
  • An Imperial College study suggests that deaths due to HIV, TB, and malaria could increase by 10, 20, and 36 percent, respectively, because of COVID-19.31

Because we understand the linkages between global health and other U.S. foreign policy objectives in increasing economic prosperity and promoting peace and security, PEPFAR’s global health diplomacy efforts extend beyond our work on HIV/AIDS.

PEPFAR’s investments to strengthen global health security and health care systems delivery have helped lay the groundwork for the U.S. government’s support to the COVID-19 response around the world.

Now, PEPFAR is advocating for a more rapid adoption of client-centered services to mitigate the risk for COVID-19. Despite COVID-19’s negative effects, we are seizing this moment to advance these critical pieces.

The Dimensions of Sustainable Health Equity

Dr. Juan Garay is Head of Cooperation at the European Union’s Mission in Cuba, professor of Global Health at the National School of Public Health in Spain, and co-founder of the Sustainable Health Equity Movement. He is a medical doctor from Spain, specialized in internal medicine, infectious diseases, and public health.

Health, possibly the most common aspiration across time and cultures, is the state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity (WHO, 1948). Equity is the fair and impartial distribution of a good. Health equity therefore is the fair distribution of health, which relates to a common goal across all nations, summarized by the constitutional goal of the World Health Organization (1945): to achieve the best feasible level of health for all peoples. Health equity should also be sustainable, since the rate of use of natural resources above nature’s recycling capacity undermines the next generation’s health, causing intergenerational inequity. When a shared objective is feasible to achieve and conforms to the accepted standards of conduct, it can become an ethical principle.

What is the ethical principle of sustainable health equity within and among countries? History, philosophy, religion, and politics engender individual and social values (empathy, solidarity, responsibility), which influence the dynamics of equity at community, local, national, and global levels. Societies strive for their individual and collective well-being by generating, distributing, and regulating knowledge, economic means, and natural resources (environment). The way knowledge, economic means and natural resources are generated (equitable contribution), distributed (equitable access), and regulated (legal frameworks, governance, universal human-natural rights against discrimination by gender, age, race/ethnicity, nationality, or any other attribute), conditions basic daily life needs (nutrition, water, shelter, minimum income), security (rule of law and protection against all kinds of violence, social protection, public health, safe environments, healthcare) and opportunities (education, communication, creativity, meaningful work). These factors in turn determine the distribution of individual and collective wellbeing. Health equity is possibly the best “barometer” of equity at local, national, and global levels. Figure 1 describes the relationship among the main dimensions: knowledge, economy, and environment; the dynamics (contribution, distribution, sustainability); and the legal frameworks, defining daily life conditions which then translate into sustainable health equity. This framework of Sustainable Health Equity is adapted from epidemiologist Sir Michael Marmot’s ground-breaking work on the social determinants of health.

Figure 1

Figure 1

Diagram on sustainable health equity, created by Juan Garay.

Sustainable Health Equity: health (physical and psychosocial wellbeing) depends on the satisfaction of basic needs (water, nutrition, shelter, minimum income), protection from risks and threats (rule of law, public health, preventive, and curative health care services), and the satisfaction of self-actualization needs (education, communication, creativity, meaningful work). These needs can be met if the following dimensions (knowledge, economy, environment) are geared through rights-based frameworks and contribution/distribution towards equity. Basic needs are currently not met by all people, even in a world with more than enough economic resources to guarantee those needs. Risks are increasing through toxicity (in air, water, and food), epidemics, pandemics, wars, and climate change, while access to safe environments and health services are skewed against those in greatest need. Self-actualization needs are often unmet by lack of lifelong education and space for self-fulfillment, creativity, and innovation. As a result, the burden of health inequity (or gap from best feasible level of health) is high and while there has been progress in narrowing the inequalities in child mortality and others, the excess mortality from feasible and sustainable models has not decreased significantly. The WHO Commission on Social Determinants of Health and its related World Health Assembly Resolution has called for more attention to be given to all the root causes of health inequity and to measure their levels, distributions, and trends. The only international legally binding framework related to health equity is the International Covenant on Economic, Social and Cultural Rights (ICESCR), signed by 170 countries and ratified by 160. However, the attention to equity under the ICESCR is indirect, limited, and not monitored.

Sustainable health equity is, as mentioned above, based on the equity dynamics (contribution, distribution, and sustainability) in the following three dimensions and how their global and national legal frameworks guarantee universal and equal human rights (eliminating all forms of discrimination based on gender, sexuality, race and ethnicity, disability, age group, national origin/migration):

  1. Equity and knowledge: humankind generates massive knowledge every day. It thrives on challenges, lifelong education, imagination, collaboration, technological means, and resources. When applied to national or (progressively a larger share) global challenges, knowledge contributes to shared aspirations and, if accessible for all, it becomes a national or a global public good. While there is growing trend in global sharing, global markets often drive knowledge, especially in relation to health products, through patent monopolies, which contribute to the profits of some and the burden of inequity. As a result, much global knowledge does not meet global public challenges and when it does, it often benefits only a few who can pay and not those who need it the most. The COVID-19 pandemic reveals the weaknesses of the present global framework where global human knowledge may translate, in major profits for a few and access for those able to pay and, as in the first two decades in the AIDS pandemic, rather than universal access prioritizing those in greatest need. To achieve equity in knowledge, it is crucial to develop an international binding framework promoting and protecting the main principles of global public goods and set more ambitious targets for health equity under SDG 17.
  2. Equity and the economy: knowledge transforms natural resources in technology, products, and services. This is done through labor, which is often subject to uneven power relations, with high gains by those who own the means of production and insufficient wages for the workforce. The access to those means has been organized through the conventional value of currency; the local, national, and gradually dominating global markets; as well as through financial derivatives and speculation over those transactions. Economic growth, measured in GDP (monetary transactions), has become the driver of all economies, regardless of income levels, causing stress on the environment. Inequalities have been growing as economic power (assets and income) is concentrated in fewer individuals (excess accumulation), while most of the world’s population is deprived of minimum living conditions for wellbeing. Such unfair distribution of resources, or economic inequity, is growing both within and among countries. To achieve economic equity, there is a need to prevent financial speculation and excess economic accumulation; guarantee a minimum universal income; establish global, regional and national frameworks of fiscal and territorial equity; and establish more ambitious targets for health equity under SDG 10.
  3. Equity and the environment: we survive and thrive by using natural resources for our vital needs, wellbeing, technology, and the advancement of knowledge. The way we are using natural resources, driven by constant economic growth, global-scale production, trade, and urban consumption and lifestyles, has upset the balance in nature. This has been conceptualized in the literature on planetary boundaries, which concludes that carbon emissions, freshwater depletion, and the loss of biodiversity are already beyond nature’s regeneration capacity. The overuse of natural resources has caused global warming and is having a direct effect on the health of people and the environment, with a detrimental impact not only for the current generation but for generations to come, determining intergenerational inequity. Climate change has been and continues to be caused by the people who are more insulated from its consequences, encapsulating all inequities, with higher risk and higher burdens among those who contribute the least to climate change. Life expectancy of the generation born in this century is forecasted to be, for the first time in recorded data, lower than the previous one, due to the social and economic transgressions of the last two centuries. Since the Kyoto agreement, the world has only managed to reduce the rate of growth of carbon emissions, but we are far from the levels which would prevent the “point of no return” of 1.5°C above pre-industrial levels (SDG 13.1), and the dramatic decreases in the wellbeing of generations to come. To achieve environmental equity, it is critical to guarantee the respect of planetary boundaries at individual, national, and global levels; chart the transition to a post-oil era; and work together towards more ambitious targets for health equity under SDG 13.

Integrated and human rights–based approach:

In working towards an integrated and rights-based approach to equity, we call for an update to the ICESCR to include the right to a life with dignity for all, based on collective equity, linked to the dimensions of knowledge, economy, and environment as described above, and centered on the goal and indicator of sustainable health equity. This should also be reflected in the ongoing discussions around the United Nations Declaration on the Right to Development. The Covenant on Economic, Social, and Cultural Rights should have an independent commission (Sustainable Equity Commission/Council) and a Rapporteur to monitor progress, report to the UN Secretary-General, and issue recommendations at the country level.

Disaster Management and Reconstruction from a University Perspective

Dr. Glenn Fernandez is an associate professor at the Institute for Disaster Risk Management and Reconstruction, a joint institute of Sichuan University and Hong Kong Polytechnic University. He has conducted disaster risk reduction research as principal investigator and as collaborator in China, Indonesia, Japan, Myanmar, Nepal, Philippines, Thailand, and Vietnam. He is an alumni from the 2019 AAAS-TWAS Train the Trainers Course on Science Diplomacy.

The Institute for Disaster Management and Reconstruction (IDMR) is a joint institute of Sichuan University and Hong Kong Polytechnic University. IDMR was established shortly after the massive 2008 Wenchuan earthquake, which killed approximately 80,000 people in southwest China. IDMR is the first institute in China focusing mainly on disaster risk reduction (DRR). IDMR is also one of the most international institutes in China. Its dean is American and it has faculty members from China, Germany, Iran, Japan, Nepal, the Philippines, Uganda, and the United States. It continuously recruits scientists from around the world.

During the COVID-19 pandemic, IDMR has been actively supporting four international initiatives that promote global health and disaster diplomacy. The first initiative is the High-level Experts and Leaders Panel on Water and Disasters (HELP). The Dean of IDMR is one of the advisers and IDMR staff provide secretariat support to the panel.

HELP is currently chaired by Dr. Han Seung-soo, a former Prime Minister of South Korea. The high-level panel is composed of 21 members, sixteen advisors, and two coordinators. The main mission of HELP is to raise awareness of the importance of water and disasters at the top level. HELP provides global recommendations to galvanize the actions of various stakeholders. For example, to assist in addressing the COVID-19 pandemic, HELP consulted with different groups of stakeholders and came up with ten principles to address water-related disaster risk reduction under the pandemic. The principles were presented during the International Online Conference to Address Water-Related DRR under COVID-19, held on August 20, 2020. The Emperor and Empress of Japan together with 300 participants from 40 countries attended the virtual event.

The second initiative supported by IDMR is the Alliance of Alliances for Research and Education on Water and Disasters. In the field of DRR, numerous networks or consortia are working independently of each other. The vision of the Alliance of Alliances is to avoid the duplication of efforts among these networks. The Alliance of Alliances would like to coordinate the various networks to increase efficiency and coverage while reducing wastage of efforts and funds. IDMR is aware of the problem of duplication of research efforts because it is itself a member of several networks such as the Global Alliance of Disaster Research Institutes (GADRI), which is based in Kyoto University in Japan, and the Himalayan University Consortium (HUC), which is based in the International Center for Integrated Mountain Development (ICIMOD) in Nepal.

The third initiative is the Alliance of International Science Organizations on Disaster Risk Reduction (ANSO-DRR). ANSO-DRR was jointly initiated by IDMR and the Institute of Mountain Hazards and Environment of the Chinese Academy of Sciences. ANSO-DRR aims to construct an international platform for global scientists and engineers to jointly conduct research projects, exchange knowledge and technology, and enhance capacity-building. ANSO-DRR is cognizant of the many existing networks and alliances that are making excellent contributions to DRR, especially those in Belt and Road Initiative (BRI) countries. ANSO-DRR hopes to add value to those efforts by helping to bridge gaps that are currently insufficiently addressed. The first gap is between the natural and social science communities, on the one hand, and the efforts of the broader engineering community, including engineering academies, professional societies, and industry, on the other. The second main bridging goal is to make better links between the outstanding communities of disaster and emergency health sciences and the engineering and natural and social sciences communities. It is through the creation of more effective collaborations among all these communities that the most effective new approaches to DRR can be found.

And the fourth initiative is the U-INSPIRE Alliance. U-INSPIRE Alliance is an alliance of youth, young scientists, and young professionals working in science, engineering, technology, and innovation (SETI) to support disaster risk reduction and resilience-building, in line with the Sustainable Development Goals (SDGs) and the Sendai Framework for DRR. This alliance has been facilitated and nurtured by UNESCO, together with IDMR, United Nations Office for Disaster Risk Reduction (UNDRR), UN Major Group for Children and Youth (UNMGCY), Integrated Research on Disaster Risk Programme (IRDR), universities, and other DRR-related stakeholders. The origins of the U-INSPIRE Alliance can be traced back to 2018 in Indonesia. To date, there are twelve country chapters throughout Asia. This alliance is positioning itself as an active network for collaboration, where mutual learning is encouraged in order to address transboundary issues. IDMR recognizes the importance of engaging young scientists and acknowledging their potential for innovation, their capability to bridge the intergenerational gap, their capability to engage at the grassroots level in their communities, and many others. U-INSPIRE members are already engaged at the national and international levels and contributing policy inputs.

Common to the four initiatives that IDMR is supporting is the challenge of working with non-academic partners under the pandemic. Disaster risk management is inherently transdisciplinary. IDMR works with communities, local governments, policy makers, and DRR practitioners. All of these non-academic partners are currently preoccupied with responding to the pandemic. IDMR has halted almost all of its research projects because it does not want to distract its partners from their more important work of helping people who are suffering from the pandemic.

In the meantime, while the pandemic is raging, lectures at IDMR have continued online. In the 2020 autumn semester, IDMR launched a new elective master’s course titled “Science Diplomacy for Disaster Risk Reduction.” This course is co-taught by professors from eight countries. It is hoped that the course will attract more students interested in science diplomacy in the coming years, as a tool for addressing shared or cross-boundary risks.


  1. Sean Tracy, “Amid pandemic, science diplomacy goes virtual,” The World Academy of Sciences (TWAS) News, October 23, 2020,
  2. Note that this text is based on a public discussion held on September 23, 2020, and thus entails information which may appear obsolete at this point of time.
  3. The Pfizer/BioNTech vaccine was the first COVID-19 vaccine validated by WHO for emergency use, on December 31, 2020; see
  4. Ian Le Guillou, “COVID-19: How unprecedented data sharing has led to faster-than-ever outbreak research,” Horizon (March 23, 2020), and Roujian Lu et al., “Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding,” The Lancet 395 (2020): 565–574,
  5. Sylvia Karlsson-Vinkhuyzen, Arthur Dahl, Åsa Persson, “The emerging accountability regimes for the Sustainable Development Goals and policy integration: Friend or foe?” Environment and Planning C: Politics and Space 36, no. 8 (2018): 1371–1390,
  6. See World Health Organization, “Anchoring Universal Health Coverage in the Right to Health” (Geneva: World Health Organization),
  7. World Health Organization, “WHO leadership statement on the Ebola response and WHO reforms,” April 16, 2015,
  8. SPARC Europe, “Open Science in the Era of the Coronavirus,” 2020,
  9. Miles Kahler, “Complex governance and the new interdependence approach (NIA),” Review of International Political Economy 23, no. 5 (2016): 825–839,
  10. Peter S. Hill, “Understanding global health governance as a complex adaptive system,” Global Public Health 6, no. 6 (2011): 593–605,
  11. Tom Christensen, “Decision-making in the political environment,” in Project Governance, eds. Terry Williams and Knut Samset, (London: Palgrave Macmillan, 2012), 256–276.
  12. Ilona Kickbusch, “Health is a political choice – but health for whom?” BMJ Opinion, 2017,; Tedros Adhanom Ghebreyesus, “Health is a political choice,” BMJ Opinion, 2019,; John Kirton and Ilona Kickbusch (eds.) Health: A Political Choice (London: GT Media, 2019),
  13. See, for example, Resolution S/RES/2565 (2021), February 26, 2021,
  14. See, for example, Resolution A/RES/74/270 (2020), “Global Solidarity to Fight the Coronavirus Disease 2019 (COVID-19),” April 2, 2020,
  15. Special Session of the General Assembly in Response to the Coronavirus Disease (COVID-19) Pandemic, December 3–4, 2020,
  16. G7 Leaders’ Statement on COVID-19, March 16, 2020,; Joint Statement of G7 Leaders, February 19, 2021,
  17. Extraordinary G20 Leaders’ Summit – Statement on COVID-19, March 26, 2020,
  18. See the WHO website dedicated to COVID-19 with recordings of the press briefings,
  19. Access to COVID-19 Tools (ACT) Accelerator,
  20. COVID-19 PPP Rapid Response Umbrella Programme,
  21. COVID Action Platform,
  22. International Labour Organization (ILO), “COVID-19 and the World of Work,”
  23. Detlof von Winterfeldt, “Bridging the gap between science and decision making,” PNAS - Proceedings of the National Academy of Sciences 110, supplement 3 (2013): 14055–14061,
  24. Anthony J. Culyer and Jonathan Lomas, “Deliberative processes and evidence-informed decision making in healthcare: do they work and how might we know?” Evidence & Policy: A Journal of Research, Debate and Practice 2, no. 3 (2006): 357–371(15),
  25. Tung Thanh Le, Jakob P. Cramer, Robert Chen, & Stephen Mayhew, “Evolution of the COVID-19 vaccine development landscape,” Nature Reviews: Drug Discovery 19 (2020): 667–668,
  26. COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator,
  27. See also the dedicated website on COVID-19 and its human rights dimensions on the OHCHR website,
  28. This opinion piece does not explicitly address the impact of COVID-19 on political systems.
  29. The session where the original remarks were made was held on September 23, 2020. This contribution has been edited and acknowledges the Biden administration.
  30. PEPFAR Panorama Spotlight,
  31. Hayley Dunning and Dr Sabine L. van Elsland, “COVID-19 pandemic could significantly increase HIV, TB and malaria cases, Imperial News, Imperial College London,” July 13 2020,
Health Diplomacy Spring 2021