Policy processes sans frontières: interactions in transnational governance of global health

Global health diplomacy-reconstructing power and governance

Over the past two decades, global health diplomacy, foreign policy for health, and global health policy have changed substantially. Diplomacy is a constitutive part of the system of global health governance. COVID-19 hit the world when multilateral cooperation was subject to major challenges, and global health has since become integral to geopolitics. The importance of global health diplomacy, especially at WHO, in keeping countries jointly committed to improving health for everyone, has once again been shown. Through a systematic review, this Series paper explores how international relations concepts and theories have been applied to better understand the role of power in shaping positions, negotiations, and outcomes in global health diplomacy. We apply an international relations perspective to reflect on the effect that those concepts and theories have had on global health diplomacy over the past two decades. This Series paper argues that a more central role of international relations concepts and theories in analysing global health diplomacy would help develop a more nuanced understanding of global health policy making. However, the world has changed to an extent that was not envisioned in academic discourse. This shift calls for new international relations concepts and theories to inform global health diplomacy.

Governance for global health: the role of Nordic countries

Purpose

Global health challenges and threats could be confronted by collaborative efforts of international community. Governance for global health is a set of formal and informal processes, operating beyond state boundaries, and refers to institutions and mechanisms established at the national, regional and international levels. Nordic countries demonstrated a long-standing commitment to development assistance for health (DAH), and more recently to governance for global health. Governance for global health tools could be used effectively to achieve collective solutions for the maintenance and promotion of health as a common good, could ensure accountability and transparency, and reconcile the interests of different actors on the international and national levels. The aim of this paper is to provide an overview of tools and approaches in support of eight sub-functions of governance for global health applied by the Nordic countries. This will help international audience to compare those mechanisms with similar mechanisms that are available or planned in their countries and regions, and may benefit policy scholars and practitioners.

Design/methodology/approach

This study uses qualitative review of research literature, policy documents and information available from institutional websites related to the governance of global health in four Nordic countries. In total, 50 selected publications were analyzed using framework synthesis, mapping all findings to 8 dimensions (sub-functions) of governance for global health and related tools.

Findings

Review reveals which tools are available, how they have been applied by the Nordic countries and influenced all domains (sub-functions) of governance for global health at different levels: national governments, agencies and networks; bilateral and multilateral partnerships; inter-governmental institutions and international health-related organizations. Common trends and approaches in governance for global health have been formulated.

Originality/value

This study is unique in relation to the prior literature as it looks at the role of Nordic countries in the governance for global health system through the lens of tools applied in support to its sub-functions.

An initiative of cooperation in Zika virus research: the experience of the ZIKABRA study in Brazil

BACKGROUND

The Zika virus outbreak has triggered a set of local and global actions for a rapid, effective, and timely public health response. A World Health Organization (WHO) initiative, supported by the Department of Chronic Condition Diseases and Sexually Transmitted Infections (DCCI) of the Health Surveillance Secretariat (SVS), Brazil Ministry of Health (MoH) and other public health funders, resulted in the start of the "Study on the persistence of Zika virus in body fluids of patients with ZIKV infection in Brazil - ZIKABRA study". The ZIKABRA study was designed to increase understanding of how long ZIKV persists in bodily fluids and informing best measures to prevent its transmission. Data collection began in July 2017 and the last follow up visit occurred in 06/26/2020.

METHODS

A framework for the ZIKABRA Cooperation initiative is provided through a description and analysis of the mechanisms, strategies and the ethos that have guided the models of international governance and technical cooperation in health for scientific exchange in the context of a public health emergency. Among the methodological strategies, we included a review of the legal documents that supported the ZIKABRA Cooperation; weekly documents produced in the meetings and working sessions; technical reports; memorandum of understanding and the research protocol.

CONCLUSION

We highlight the importance of working in cooperation between different institutional actors to achieve more significant results than that obtained by each group working in isolation. In addition, we point out the advantages of training activities, ongoing supervision, the construction of local installed research capacity, training academic and non-academic human resources, improvement of laboratory equipment, knowledge transfer and the availability of the ZIKABRA study protocol for development of similar studies, favoring the collective construction of knowledge to provide public health emergency responses. Strategy harmonization; human resources and health services; timing and recruiting particularities and processing institutional clearance in the different sites can be mentioned as challenges in this type of initiative.

The interface of multisectoral and multilateral dimensions of public health policy: what's new in the 21st century?

The article examines key developments unfolding in the 21st century in the intersection of multisectoral and multilateral dimensions of public health policy. Several processes and mechanisms, relatively new or rapidly evolving, are fuelling this dynamic interface. They include, in particular, expansion of the spectrum of sectors involved in the health domain, the upsurge of trans-border and commercial determinants of health, growing presence of health issues in multilateral instruments and processes that are outside of the health sector, and strengthening the legal base of intersectoral relations and responsibilities for health. They also encompass and reflect important transformations in health diplomacy and governance for health, some of the fundamentals of contemporary public and global health. The article argues that overall, multisectoral and multilateral dimensions tend to interact, inform and reinforce each other, and that such interaction would be one of important drivers of 21st century intersectoral policy-and international cooperation-for health.

How Will COVID-19 Impact on the Governance of Global Health in the 2030 Agenda Framework? The Opinion of Experts

In 2015, the 2030 Agenda was formally adopted by the United Nations, establishing a set of 17 Sustainable Development Goals (SDGs). SDG 3 seeks to promote Global Health and the quality of public health systems in developing countries. The achievement of these goals requires the commitment of all signing countries, but the COVID-19 crisis is changing the behavior of the main stakeholders in the international arena. What do the experts think about these changes? Could these changes threaten the 2030 Agenda and Global Health? To answer these questions, we conduct a content analysis of 152 documents written by experts from the 15 main think tanks on international development policy. The results point out that the new scenario brought about by the pandemic is hindering the necessary cooperation between countries to achieve global health goals and to guarantee public health coverage in developing countries. To deal with these challenges, more delegation of powers to international organizations and a reform of the international cooperation system are needed. With this analysis, we launch a warning about potential weaknesses of the institutional design of the 2030 Agenda in order for it to survive in a post-COVID-19 world and remain a valid instrument to promote health worldwide.