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Study group led by IOP Fellow Howard A. Zucker, former assistant director-general and representative of the director general, World Health Organization; former deputy assistant secretary of health, U.S. Department of Health and Human Services

Thursdays
Time: 4:00 - 5:30 PM
Location: FDR

In a world that can send wireless signals across continents, over oceans, and even millions of miles away to space probes on the planet Mars, surely it should be possible to improve the health of individuals in villages and towns in any nation, no matter how large, small, rich or poor. America has always been viewed as a country where the principles and freedoms we hold dear to our nation are reflected in our actions overseas. However, the events subsequent to September 11th have tarnished our image abroad. 

Developing a sustainable solution to border crises, military conflicts, or human tragedies are just a few of the issues that will challenge the leadership of the Obama Administration. A component to our new foreign policy must include health assistance to troubled nations as a key diplomatic tool in re-engaging as a leader on the international stage. Our nation’s talent in the arenas of technology, pharmaceuticals, medicine, public health, and disaster response, must be channeled into a public policy that demonstrates, by action, that our government is passionate about working with other countries to improve global health. This must become a cornerstone of our foreign policy footing.

Transmitting the knowledge, the resources, and the shear commitment of individuals for the betterment of all will go far in healing the open wounds that presently exists in our international reputation. No greater example exists of how a government’s concern for humanity touches at the hearts of all than the remarkable success of John F. Kennedy’s vision and implementation of a Peace Corps.

The objective of this study group is to examine mechanisms by which our nation can use medical diplomacy as an instrumental component of our new foreign policy. Looking at better ways to engage with international organizations, understanding the developing world’s view of consensus-building in health delivery, and examining successes and failures in U.S. assistance in disaster response, will help lay the foundation for an improved American presence on the world stage. We must not forget that where there are challenges there are opportunities.

We will examine what is the most effective role for the private sector, philanthrocapitalists, international organizations, academia, amongst others in partnering with government. Moreover, we will explore the role that United States Ambassadors should play in assisting nations with health care issues as well as the role that American citizens who serve as Goodwill Ambassadors overseas should present. Throughout the semester we will look at how the U.S. government can demonstrate leadership in issues of access to medicines, sharing of scarce resources during a pandemic, wireless technologies to transmit health information, global biosecurity, health literacy, and economic models to create new philanthropists, to name but a few. Critical to a successful U.S. foreign policy involving health requires a new strategy for working with international organizations including the World Health Organization, World Trade Organization, The World Bank, and others. Furthermore, we will examine how a disciplined and rigorous process should be applied for sound policymaking in health and the dangers of biases that favor individual philosophical or commercial interests.

Through lively debate, this study group will challenge all participants to question conventional wisdom on how a superpower should approach foreign policy. We will look beyond the policy page and take a glimpse into the reality of the politics of health at the international level. Our study group will demonstrate that the Obama Administration must use medical diplomacy as part of its toolbox towards achieving an improved American image abroad in the 21st Century.


Session 1: Time Zones are Arbitrary Concepts: Working with all Nations Across the Globe:
(Feb. 19)     

This introductory session will provide a background on the health challenges facing all continents across the globe. The world’s population is projected to increase from the present 6 billion to over 9 billion within the next 40 years.  Increased disparities and escalating lack of resources will become a harbinger of disease with worldwide implications. The inequities in health in many countries are due to a lack of health care infrastructure including poor or non-existent delivery systems, too few skilled staff, costs and corruption.

This first discussion will examine issues from a 30,000 foot level regarding the challenges brewing. With one eye on the successes and failures of American policies we will figuratively fly around the world glancing down into regions troubled by health care challenges. Identifying the key dilemmas across the globe we will collect and place them into our global health Pandora’s box and be prepared to grapple with each issue in the sessions to follow. Throughout our discussion it will become evident that the main thread woven into all these issues is that politics is an instrumental player - even in global health!


Session 2:  Responding to Natural & Non-natural Disasters: Charity Begins at Home:
(Feb. 26)    

In difficult global economic times, the President of the United States must lead by example showing the world that nations help each other out in times of crisis. We must not forget that the winds of nature can easily blow upon our own shores causing health calamities of astronomical proportions. Discussion will focus on the efforts made by the United States in assisting other countries during and after calamities and conflicts. We will examine our nation’s humanitarian responses during the crisis in the Balkans to our response to the tsunami in Southeast Asia. How did America get it right and achieve international respect during a global catastrophe? In contrast, what role did our poor response to Hurricane Katrina have on our international reputation as a country compassionate of the plight of others? Do we need to develop more ships of the caliber of the U.S.S. Comfort in order to respond to disasters across the globe? Can a model such as the government-initiated, volunteer-run U.S. Medical Reserve Corps be duplicated on an international level?  The unsettling turmoil in the Middle East, in Darfur, in Pakistan and elsewhere may offer the United States another opportunity to demonstrate to the world that it is reinventing its foreign policy using medical assistance as a diplomatic tool. The health and welfare of people must transcend all political differences.

Guests: The Honorable Ambassador Daniel Spiegel, Senior of Counsel, Covington & Burling, formerly US Permanent Representative to the European Office of the UN and Special Assistant to the Secretary of State,
Rear Admiral Craig Vanderwagen, Assistant Secretary of Public Health and Emergency Preparedness, formerly Director: Indian Health Service


Session 3:  Role of the Non-Governmental Organization as a Partner with the United States Government:
(March 5)   

Within the past decade there has been an exponential increase in the resources provided to global health. The commitment of the Bill and Melinda Gates Foundation, William J. Clinton Foundation, Medicines for Malaria Venture, Global Fund for AIDS/TB/Malaria, International AIDS Vaccine Initiative, Global Alliance for Vaccine Initiative, to name just a few, are all playing a key role in shaping global health policy. In addition, novel approaches to financing have been set forth through collaborations between governments and organizations. From UNITAID, IFFim, and Advanced Market Commitments, clever minds are working to find solutions to complex problems.

Whereas once it was simply the role of diplomats to address public policy, this has changed. From Afghanistan to Zambia, foundations are playing a greater role in global health solutions. How best can organizations work with the U.S. government as we identify a foreign policy that incorporates medical care as one key diplomatic component? We will consider whether the politics of foundations impact policy. Are there ways to improve efficiency within a government bureaucracy so that foundations choose to further partnerships with the U.S. federal agencies rather than bypass it? Should, and if so can, the U.S. government encourage other nations to develop economic incentives for their wealthy citizens thereby fostering the establishment of foundations directed at global health?

Guests: Beth Collins, William J. Clinton Foundation,  Former Country Director (Rwanda) for the Clinton Foundation, former Senior VP of Miramax Films.


Session 4: The Private Sector’s Place in Public Service and Global Health:
(March 12)

Challenges facing the United States federal government’s efforts to move forward on global health initiatives are, in part, a result of strong lobbying from selected industries, including pharmaceuticals and technology. Nevertheless, great achievements in the biosciences are the result of our dominance in research and development. What influence should the private sector have on shaping U.S. foreign policy when the issue relates to the health of millions of people in nations where over 20% of the children die before reaching the age of five? Perhaps greater good can come from competing industries working together, in partnership, with the U.S. government to provide pharmaceuticals and/or technologies to nations in need. Pharmaceutical companies invest billions of dollars in the hopes of developing a blockbuster medication with the potential for a high yield return. However, we mustn’t forget that neglected tropical diseases are killing or maiming millions across developing nations. What efforts are being made by the corporate sector to address this problem?

Often success is achieved when multiple sectors of an industry come together for the betterment of all. But are antitrust laws inhibiting the ability for the private sector to join together in delivering the necessary resources to the less fortunate in Africa, Asia and South America? What incentives should the U.S. government provide to industries that channel resources towards finding a diagnostic test, a pharmaceutical, vaccine, or other health related technology that specifically targets the developing world? Or should there be incentives at all? Are there successes in public-private partnerships that are cost-effective and demonstratively improve the lives of millions in war-torn nations? In this session we will also address whether, and if so how, a free-enterprise system can still prosper in technology while working towards solving developing world problems.

Guests: Dr. Jeff Sturchio, Chairman, Corporate Council on Africa, Former Vice President for Corporate Responsibility at Merck & Co., and former President, The Merck Company Foundation)


Session 5: The Developing World’s Chair at the Decision-making Table: 
(March 19)   

To achieve success in improving global health the United States must enter negotiations by figuratively wearing the shoes, or sandals, of the patient whose own steps may be numbered by disease. Whereas developing nations were once satisfied simply by receiving charity from more affluent societies the situation has transitioned in the past decade. With the advent of the internet, rising efforts of civil society groups, and health issues on the agenda of hi-level meetings including the G-8, the World Economic Forum, and other prominent gatherings; the leaders in developing countries are no longer content to be a silent voice (nor should they be) at the receiving end of assistance.

How can the U.S. work more collegially with nations challenged by disease, pestilence, and famine? The issues of intellectual property rights and pharmaceuticals, trade negotiations, and research into neglected diseases, are just several of the issues where American interests have not always dovetailed with those of other countries.  How should the U.S. work with a health minister of one nation that speaks on behalf of forty or fifty other nations? Is there a win-win between nations in need of health assistance by addressing other deliverables that they can offer in negotiations? Does America always have to sit at the head of the table or would it be more productive for our image if we took a seat elsewhere, on occasion? We will discuss the way in which America is perceived from abroad and the fact that politics remains a constant within the global health equation.

Guests: Richard Wilder, Esq. Asosciate General Counsel, Microsoft Corporation, Former Advisor to the Bill & Melinda Gates Foundation
Thomas Burke, MD, Director, Division of Global Health & Human Rights, Massachusetts General Hospital, Harvard Medical School.
Khama Rogo, MD, Advisor for Population and Reproductive Health, The World Bank


Session 6: Working outside Silos: The Marriage between the Department of State and the Department of Health & Human Services:
(April 2)      

All too often individual Executive Branch departments become protective of their specific projects. Not only can this lead to inefficiencies within the system it inhibits the collaboration of diverse talent across the government. Moreover, there are critical issues involving HHS agency responsibilities (i.e. NIH, FDA, and CDC) that have implications on the international stage. By example, the dangers of counterfeit medicines as well as poorly regulated manufacturing plants supplying “molecules” to the U.S. drug industry have an impact here at home.

This session will discuss examples of crises within the world that required teamwork between the Department of State, the Department of Health & Human Services and The White House. Examples include; SARS, risks of pandemic influenza, President’s Emergency Plan for AIDS Relief, and reconstruction efforts in Iraq and Afghanistan. Collaboration between agencies can foster our foreign policy, as applied to health, and demonstrate to the world that America is passionate about the diplomacy of global public health.

Guests: Thomas Novotny, MD, MPH, Professor, Graduate School of Public Health, San Diego State University, Former Deputy Assistant Secretary for International and Refugee Health, Co-Founder of the Academic Consortium on Health Diplomacy.


April 9:  No Study group


Session 7:  Working with International Organizations – The Politics of Health Security, Legal Frameworks and other Thorny Issues:
(April 15)  

(Please note: This study session is on Wednesday April 15th at 4:00-5:30 PM)
America’s success in advancing any mission in health diplomacy requires successful efforts in international negotiations. In recent years the U.S. has often led a small minority of nations during such deliberations involving controversial global health topics. Efforts to find consensus during World Health Organization, World Trade Organization, and World Intellectual Property Organization Intergovernmental Working Groups on intellectual property rights, innovation, and public health negotiations have been fraught with challenges. Similarly, controversy has centered on the sharing of the “bird flu” virus. Despite the criticisms that have been raised, the United Nations remains the most notable venue for discussion on international collaborative efforts. Therefore, it is in America’s best interest to establish favorable partnerships between nations when negotiating multinational resolutions and/or treatises. Sharing our skills, knowledge, resources, and personal energy in the areas of health care with other countries fosters a new image for America.

Our discussion will focus on how best to achieve resolution on controversial health topics where the U.S. position is non-negotiable but the concern of other nations must be recognized. We will examine specific arenas including the issue of the destruction of the smallpox virus, viral sovereignty, Framework Convention on Tobacco Control, International Health Regulations, the Convention on Biologic Diversity, and patent protection in pharmaceutical research and development. We will discuss the politics of international agreements and what it really means when a Minister signs his name to a negotiated resolution. Is there a role for our Judicial Branch to play by demonstrating legal precedent on health law that can be tailored for other nations? And should U.S. political ideologies affect global health initiatives when negotiating international agreements?

Guests: Kenneth Bernard, MD, RADM (Ret.), former positions: Special Assistant to the President for Homeland Security, Former Special Advisor for International Health Affairs, National Security Council,  Senior Advisor to the Director-General of the WHO and Medical Director of the Peace Corps,
Steve Solomon, Senior Legal Counsel, World Health Organization, Former Deputy Legal Counsel to the US Mission to the United Nations in Geneva


Session 8: Today’s Dreams, Tomorrow’s Reality:
(April 23)

Our closing session will provide an opportunity for all participants to imagine the impossible and then discuss how best to make it feasible. Recognizing that politics matters we will build upon the highlights of our past discussions. As a backdrop to the interactive dialogue will be examples in history when one individual questioned the status quo and demonstrated to their nation’s leadership that changes for the better was possible. We will brainstorm about new ideas that should become part of our government’s strategy for 2009 forward. By way of example it could include information technology in developed nations with village workers in developing nations using cell phone text messaging. Perhaps it involves private companies establishing novel partnership programs in accordance with corporate social responsibility programs to assist government led efforts on improving global health delivery, new venues on the international stage whereby countries in need of medicines can receive them through novel financing schemes which foster a sense of empowerment. Maybe American health professionals-in-training receive tuition credit from the government for working in the developing world for a semester? Or could exchange programs forged between the U.S. and other nations regarding health in line with the Fulbright model be supported by philanthrocapitalists? Finally, as we bid adieu to our study group sessions, which student’s daydream during one of the previous seven gatherings is apt to become the answer for improving America’s foreign policy through global health diplomacy? Have the open wounds started to heal?