The COVID-19 pandemic has highlighted the need for public health diplomacy, even as public health remains an underrated focus of U.S. foreign policy. A lack of dedicated personnel to address international public health concerns—both domestically and at overseas posts—has led to the marginalization of public health, despite its status as a unique diplomatic priority and portfolio. This leaves the United States vulnerable to future pandemics and with limited capacity to collect public health information, assess in-country disease control capabilities, ensure effective use of foreign assistance, and combat the potential risks of chemical and biological weapons. Within the Department of State, public health is typically subsumed as part of the environment, science, technology, & health section (ESTH) at some larger posts and often relegated to the margins of broader political-economic sections at most smaller posts. Domestically, only the United States’ global AIDS coordinator holds the rank of ambassador-at-large and assistant secretary, while other domestic policy offices regarding public health at State do not exceed the director level.
To address this critical information gap and better coordinate global health diplomatic initiatives, the Department of State should establish a new public health officer cone within the foreign service, as well as a consolidated public health diplomacy bureau under an assistant secretary of state. These measures will ensure public health diplomacy priorities are regularly elevated to the secretary of state and other top policymakers, and will better develop U.S. global public health strategy.
Foreign service officers are currently assigned to one of five different career tracks or cones: political, economic, consular, management, and public diplomacy. Diplomatic engagement related to science, technology, and environmental issues (including public health) largely falls within the economic officer portfolio. Responsibilities for public health are poorly divided within overseas diplomatic posts. In a handful of posts, health attachés from the Department of Health and Human Services (HHS) assume this role. In large embassies, an economic officer supervising an ESTH section assumes the duty of coordinating diplomatic activities related to public health. In developing countries, U.S. Agency for International Development (USAID) population, health, and nutrition officers supervise development assistance on public health.
This haphazard distribution of responsibility for public health often means it is, in practice, a neglected priority; this is especially true for small posts where ESTH responsibilities fall under a small political-economic section. While an expansion of HHS health attachés would be an improvement, this could risk eroding the Department of State’s authority to conduct diplomacy related to public health, and potentially provoke interagency “turf war,” particularly over which agency should take charge of leading public health diplomacy.
Disease control has become one of the foremost challenges of modern foreign policy.
A better approach would be to create a separate cone of public health officers within the Foreign Service. Public health officers would be tasked with monitoring and analyzing public health developments and negotiating diplomatic agreements related to public health and global health security. Furthermore, alongside their USAID partners, they would identify needs and coordinate and evaluate foreign assistance related to public health. Larger structural reforms within the Department of State, particularly the creation of a Bureau for Public Health Diplomacy, would enhance this new cone and ensure its success.
Responsibilities for public health remain divided within the Department of State. Public health and biosecurity policy is compartmentalized within the Office of International Health and Biodefense, which is part of the broader Bureau of Oceans and International Environmental and Scientific Affairs. Meanwhile, responsibility for policy to combat the spread of HIV/AIDS falls within the Office of the U.S. Global AIDS Coordinator and Health Diplomacy. A consolidated bureau under an assistant secretary of state for public health diplomacy would far better complement this new reinvigorated global health strategy. A new bureau could include separate regional desk offices, as well as specialized functional offices for specific policy interests and programs, such as advancing America’s interests within the World Health Organization; coordinating COVID-19 response policy; combating HIV/AIDS, malaria, and tuberculosis; monitoring and protecting against the threat of chemical and biological weapons; as well as, most importantly, a 24/7 watch center to monitor emerging biosecurity threats.
An entry-level public health officer could meet with in-country health and environmental ministry contacts, visit and report on local hospital conditions, and meet with civil society actors to discuss local public health challenges and concerns. Mid-level officers could work with health ministry officials to coordinate disease control contingency plans, negotiate research agreements, and supervise disease information-sharing. They could also work in conjunction with counterparts, both within the State Department and the intelligence community, to monitor biological and chemical weapons proliferation. Finally, senior-level officers could advise policymakers on drafting and implementing biosecurity strategy.
Public health officers would not replace HHS health attachés. Instead, HHS health attachés should serve in a support role to provide technical advice as trained epidemiologists and public health specialists to better assist public health officers in conducting public health diplomacy. In doing so, this would establish a clear delineation of responsibilities with health attachés responsible for advising on the technical and scientific aspects of public health diplomacy. At the same time, public health officers would remain responsible for policy formulation and diplomatic negotiations. The presence of health attachés should also be significantly expanded, thus enabling both agencies to complement the other’s strengths, and ensure more effective coordination on public health diplomacy.
Public health officers may also face fewer diplomatic restrictions from host country governments, compared to their political and economic officer counterparts. Public health officers could potentially be perceived as more neutral and objective as they would be independent from the political-economic section. This would be advantageous to the United States in better understanding local health security concerns and engaging with host country medical research communities.
Disease control has become one of the foremost challenges of modern foreign policy. Creating a public health cone and a Bureau of Public Health Diplomacy within the State Department would enable the United States to collect needed information on global health security concerns, raise “early alarm” to contain disease outbreaks, ensure successful domestic coordination of public health diplomacy, and enable public health diplomats to elevate both warnings and solutions to top policymakers.
About the Author
Jake Brooke is an MA candidate in international relations at the Johns Hopkins University School of Advanced International Studies. Prior to beginning his graduate studies, Brooke worked as a contractor within the State Department’s Bureau of Democracy, Human Rights, and Labor, Office of East Asian and Pacific Affairs, where he focused on policy related to China and Myanmar. Brooke also serves as an Ordnance Officer within the Army National Guard and is a native and resident of Virginia. The views expressed in this article are his personal views and do not reflect the views or policy of the Department of State or the Department of Defense.
A special thank you to Dania Torres for informing me of and inspiring me to take part in the Pitch. I am also grateful to Carrie Cordero for constructive feedback regarding the publication of this article. Thank you also to Carisa Nietsche, Nathalie Grogan and the Pitch team for their role in organizing the Pitch and preparing my idea for publication. Finally, thank you to the Center for a New American Security for providing a platform for young national security and foreign policy professionals to make their voices heard.