The influenza threat gave an impetus to the international negotiation process Pandemic Influenza Preparedness (PIP) under the auspices of the WHO. This process provides a good illustration of how health overlaps with other areas of international politics, and what health diplomacy really means.
In 2009, it was not only the distribution of vaccines that posed a problem. The negotiations started in 2007, when Indonesia refused to share an influenza virus with a WHO-based network of laboratories. The network is intended to ensure an optimal sharing of information that can lead to development of vaccines. But, as argued by Indonesia, if the pharmaceutical industry patents vaccines developed on the basis of an Indonesian virus, what will Indonesia receive in return?
As the PIP negotiations progressed, it became increasingly clear that what appeared to be a matter of medical science, concerning the use of a virus with a potential for causing an influenza pandemic, also included a number of topics in which countries from many regions have very differing interests, political ambitions and requirements. The issue of whether manufacturers should be granted patents for vaccines against pandemic influenza had repercussions far beyond the negotiations within the framework of the WHO, reaching into negotiations in the World Trade Organization (WTO) and the World Intellectual Property Organization (WIPO).
It was of decisive importance for a solution that the negotiations were raised from the «technocrats», i.e. the health experts, to the level of ambassadors, i.e. persons who have access to politicians in key positions. Even though the core issue was that of disease and vaccines, the representative delegates could not negotiate in isolation from actors in civil society or business interests, and political concerns therefore assumed a material importance. During the final year, the negotiations were directed by the Norwegian and Mexican ambassadors to the UN in Geneva, where both enjoyed widespread trust across countries and regions. Here, the path was laid for a final agreement and signature in April 2011.
Health diplomacy requires joint problem-solving. Negotiators from the foreign ministries are trained diplomats, and are knowledgeable in many and diverse fields. The technical-scientific health experts, or those who work with development assistance, are not always in agreement. Often, the ministries of justice and trade may be involved. The cases and processes take their course over several years, while the diplomats move around. Therefore, agreement must be established not only between the delegations from various countries, but also internally within the delegations and across national ministries.