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Global leadership and collaborative health diplomacy as the antidote to “unhealthy”

Published onJul 06, 2021
Global leadership and collaborative health diplomacy as the antidote to “unhealthy”

East-West rivalry is one of the defining features of global politics. It spans several areas including military, economics, social, political, ideology and even culture. The Cold War, which featured problems such as the arms race and the constant threat of a nuclear war had the developing world as the theatre for superpower rivalries. Today, the rivalry is especially apparent in US-China relations which is usually referred to as the ‘new Cold War’, even if it has a more geopolitical flavour compared to the US-Soviet rivalry1. That rivalry also finds expression in the developing world where they compete for influence. However, today, the world faces several transnational problems that call for these key actors in global politics to look beyond their narrow self-interests and their propensity to engage in rivalries. Indeed, the failure of the international society to stop COVID-19 from turning into a pandemic and its failure to act in a coordinated manner once it reached the pandemic stage confirm the need for both East and West to re-think the competitive ideas underpinning their relationship.

While containing several instances of rivalries, the COVID-19 context also comes with an opportunity to rethink the ways that countries interact with each other as well as the way that the whole international leadership infrastructure is organised. We argue that two closely related factors that are deepening East-West competition also have the potential to facilitate cooperation in the handling of threats to global health: the state of the global leadership infrastructure and the politicisation of health diplomacy in the developing world. In essence, the pandemic carries the seeds of a salutary shock that can improve the international leadership infrastructure surrounding global health and at the same time compel great powers to mellow their competitive drive.

Leadership infrastructure has two key components: the hardware and the software2. The hardware is the tangible aspect of the infrastructure which can include the buildings, laws that confer power to those institutions and even the personnel. It symbolises the existence of those institutions and provides the necessary channels for exercising leadership. While these symbols can exercise strong influence because they project an image of power and possibly sophistication, it is the way that the power conferred is exercised that determines their continued relevance.3 This is the software element of leadership which is perhaps more important than the hardware. It includes the way that power is organised and exercised as well as the kind of relationship that it builds with the broader society or target communities over time.

This infrastructure, especially its hardware, is easily deciphered at the national level because the hierarchical nature of the domestic political system means that the roles and powers of institutions are more clearly defined. By contrast, the anarchical nature of the global level leads to leadership infrastructure that is much more decentralised and convoluted. Nonetheless, it is important not to draw a clear-cut distinction between national and international leadership infrastructure because a robust national leadership infrastructure provides a country with the hardware to exercise influence internationally.

The State of the Global Leadership Infrastructure

The quality of domestic responses to COVID-19 pandemic to a large extent depended on leadership infrastructure, especially its software element. In fact, it is not the nature of a country’s political system or the size of its economy that has determined success in responding to the outbreak of the pandemic. Rather, it is how power was exercised that determined the outcomes. The US, for example, despite the widely uncontested quality of its institutions failed to contain the spread of COVID-19 while New Zealand modelled a nearly flawless leadership infrastructure.4 China is considered a success story in dealing with COVID-19 (following criticism of its initial handling of the virus) even if its centralised leadership infrastructure differs from that of New Zealand.5 China was able to capitalise on its successful management of the virus to expand its influence in developing regions of the world, first through (direct and indirect) distribution of select PPE and so called “palliatives” to poorer countries, and now extended through vaccine diplomacy as discussed later. 6

What constitutes an effective leadership infrastructure at the global level needs a more nuanced understanding if it is to be exploited for East West Cooperation. How, for example, can United Nations Security Council (UNSC) or the World Health Organisation, which visibly exude the symbolism of the hardware of the global leadership infrastructure, strengthen their influence through the software dimensions of leadership? Both institutions offer a space for interaction between East, particularly China, and the West.

In the face of the pandemic, the UNSC was inactive and unable to bring the collaborative potential of its members to bear to mobilise a global response. It was ground nearly to a halt by the trade war between the US and China. The World Health Organisation (WHO) tried to lead the world in responding to COVID-19 but was unable to provide effective leadership. The leadership hardware is evident in an International Health Regulation that set out several legally binding duties for both states and the WHO7. Under that system, the WHO has the legitimate power to decide when a situation constitutes a Public Health Emergency of International Concern (PHEIC)- ‘the loudest alarm that can be sounded by the WHO Director-General’8. The system clearly has flaws as already highlighted in at least 11 high-level panels and commissions set up to recommend measures to improve responses to future crises9. In essence, fundamental changes are required in the hardware aspect of the WHO’s leadership infrastructure. Even so, it is clear that the existing framework was not properly used during the COVID-19 crisis owing to the way that power was exercised.

In fact, the WHO delayed the classification of COVID-19 situation as a PHEIC until the end of January 202010. Even then, its call for actions like testing and social distancing were ignored by states,11 which shows that there are fundamental problems with its interactions with the society of states. It showed that the organisation’s legitimate and expert power were not enough to trigger national and an international mobilisation against the spread of the virus. Getting countries to pay attention to its warning has been a key issue at the WHO.12 One of the main problems was the failure of the organisation to define the situation using familiar terms understood by the international society at large and consequently failed to create the necessary sense of urgency to act13. It was only on 11 March 2020 that it reframed the health crisis using the more familiar terms- ‘global pandemic’.14 Furthermore, there is a lack of transparency in the way the organisation is run not least the process for declaring a PHEIC15. Therefore, the WHO also needs a well-defined and accompanying leadership software if it is to be more effective at societal mobilisation.

The same leadership software problem arises beyond the formal realm of the IHR, interactions between WHO and member states are also influenced by factors like funding and politically motivated praising. In that regard, it is interesting to look at the exchange of reward power that took place during the pandemic which eventually led the WHO to lose some of its referent and legitimate power. The Director-General of the WHO praised China for the handling of the pandemic and even went to the extent of congratulating China for its ‘openness to sharing information’16 and describing Chinese ‘commitment to transparency [as] “very impressive, and beyond words”’17- something that was deemed unwarranted by many states and even staff of the WHO18. It seems that the WHO was only using praise (reward power) as a means to ensure that China continues cooperating with the WHO on dealing with the disease19.

The overall effect is probably a loss of referent power and legitimate power as the organisation is perceived to lack impartiality. The US’s withdrawal from the organisation during the pandemic can to some extent be interpreted as a reaction to this perceived partiality. Similarly, the organisation lost support among international NGOs with Human Rights Watch even characterising WHO’s handling of China as ‘institutional complicity’.20 At the same time, there are also people who believed that WHO did not have much choice because taking a hard stance on China would probably have led to a total lack of cooperation and sharing of information.21 Overall, one is left wondering whether in its exercise of leadership, the WHO failed to strike a right balance between the carrot and the stick in its dealings with China.

However, within this political maze, there is broad agreement between the East and the West that WHO needs reform.22 At the global level in particular, the leadership infrastructure designed to tackle world problems has remained depressingly stuck in the post-WWII world characterised by western dominance. Reforming the WHO while at the same time considering the new multipolar state of the world will mean pressing the reset button on the current frozen leadership infrastructure. This in turn creates the potential for constructing inclusive institutions equipped with a high degree of legitimate power to tackle pandemics and other pressing global health issues. This question is both pertinent and urgent because experts are already ringing the alarm bell on potential future pandemics.23 However, reconfiguring only the hardware aspect would not be sufficient if the organisation is to successfully handle global health issues. In other words, it is important to pay attention to the existence of an interactive leadership process that builds mutuality with all parts of the international society and not a select few. This determines whether the WHO is in line with the needs of the international society.

Politicisation of health diplomacy in the developing world

China and other BRICS countries have a growing influence in global health even if they also face formidable domestic public health issues.24 These countries, have made significant progress in acquiring vaccine technology and supplying low cost medicine more generally.25 These emergent leadership infrastructures not only enable them to play a greater role in health cooperation but also constitute opportunities for fostering south-south cooperation. The implication of this is that these countries present themselves as development partners rather than just donors26. They can also serve as ‘role models’ for each other and for the broader developing world.27 This also enhances China’s growing status as a global leader.

The developing world, particularly Africa, is the theatre of expanding East-West competition. In the COVID-19 context, China initially scored points with provision of palliates to African countries in lockdown. Chinese billionaire Jack Ma provided African countries and the broader developing world with masks and ventilators at the height of the pandemic.28 The Africa Centres for Disease Control and Prevention (Africa CDC) received several rounds of those equipment which also included temperature guns, swabs and test kits, gloves among others.29 Far from mere philanthropy, Jack Ma’s ‘gifts’ are usually seen as forming part of China’s deployment of soft power.30 Similarly, the US also contributed to African responses to the pandemic by providing some $270 million dollars by mid-2020 to help in risk communication, for instance.31 However, Ma’s donation (usually called mask diplomacy) seems more striking because it was in a context where the world (including the West) was competing for key medical supplies including masks and ventilators.32

Similarly, China has gained an advantage over its Western competitors when it comes to vaccine diplomacy as the latter wanted to vaccinate their own populations first and foremost before donating vaccines to the developing world33. As one observer puts it: ‘…with the help of pictures of African leaders receiving the Chinese vaccine, China is owning the narrative of vaccine diplomacy by getting headlines “on the cheap”’34. Its vaccines – Sinovac and Sinopharm – are available in more than twenty African countries. In at least ten of those countries these vaccines are the only ones that have been donated (even in the relatively small numbers) to the population. In addition, China is helping Egypt to acquire the necessary capacity to manufacture Sinovac vaccines with production set to begin at the end of June 202135. Similarly, Russia has been involved in its own vaccine diplomacy. The country is not donating its Sputnik (which is not competitively priced in Africa), but its manufacturer (Gamaleya) made its technology available and this is potentially of longer-term benefit to the region. It is in this space that China and Russia appear to act alone and outside the global response coordinated by WHO.

However, even in the provision of vaccines to the developing world there are opportunities for cooperation between East and West. The WHO is working with non-state actors like the GAVI – the Vaccine Alliance which itself encompasses civil society, industry, philanthropists and even the vaccine industry. In that regards, WHO has been a major actor in the launching of the COVID-19 Vaccines Global Access Facility (COVAX Facility) which has so far supplied 80 million vaccines to 129 participant countries.36 Even if access to COVID-19 vaccines remains a major problem in the developing world, there are clear signs that COVAX is also a platform that is bringing together East and West into the common cause of making vaccines accessible to the developing world. In February Chinese companies proposed to donate some 10 million vaccines to the initiative37. More recently, both the US and UK have also made pledges to contribute to the COVAX initiative.38 Using potential collaborative spaces such as COVAX to develop some ground rules for engaging with the developing world will contribute to managing East-West competition. There is need for responsible global leadership in parts of the world that are easily caught in great power rivalry, potentially leading to their exploitation.

Concluding remarks

In this paper, using the concept of leadership infrastructure, we have argued that the COVID-19 pandemic can also provide the impetus for more cooperation between East and West. The pandemic has created the socio-political conditions conducive to a restructuring of the global health leadership infrastructure to reflect the decentralisation of power. A new structure can foster cooperation between both East and West, especially if it not only focusses on the material element of the leadership infrastructure but also on the way that that element is used in leadership processes, which are essentially about influence and relationship building. Similarly, when it comes to vaccines, while China engages in vaccine diplomacy as a way to acquire referent power, the scale of the G7 commitment to COVAX will likely render China’s donations pale in comparison and encourage it to maintain its contributions within the COVAX initiative that includes the Western world. Finding such collaborative channels for collective health diplomacy with the developing world is one way that East-West competition can be managed for the good of the world.


Professor 'Funmi Olonisakin is Vice-President and Vice-Principal International and Professor of Security, Leadership & development at King’s College London and founded the African Leadership centre (ALC). She was Director of the Conflict, Security and Development Group (CSDG) at King’s College London from 2003 to 2013. Prior to this, she worked in the Office of the United Nations Special Representative of the Secretary-General on Children and Armed Conflict. 

Olonisakin has positioned her work to serve as a bridge between academia and the worlds of policy and practice. Her most recent research has focused on “Reframing narratives of Peace and State Building in Africa” and on “Future Peace, Society and the State in Africa”. In January 2015, Professor Olonisakin was appointed by the United Nations Secretary-General, Ban Ki Moon, as one of seven members of the Advisory Group of Experts (AGE) on the Review of the UN Peacebuilding Architecture. She was also appointed in 2016 as a member of the Advisory Group of Experts for the UN Progress Study on Youth, Peace and Security. She serves on the board of the Centre for Humanitarian Dialogue and Chairs the Africa Regional Advisory Committee of the Open Society Foundation.


Reference List

Burki, Talha (2020), ‘China’s Successful Control of COVID-19’, The Lancet, 08 October available at https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30800-8/fulltext (Accessed 14/05/21)

Jalalpour, Ahmad (2020), ‘Iran Is Nearing Collapse Under the Strain of Covid-19’, The Nation, 21 December available at https://www.thenation.com/article/world/iran-coronavirus-us-sanctions/ (Accessed 18/05/21)

Maxmen Amy (2021), ‘Why Did the World’s Pandemic Warning System Fail When COVID Hit?’, Nature, 23 January available at https://www.nature.com/articles/d41586-021-00162-4 (Accessed 17/05/21)

McClure, Tess (2021), ‘How New Zealand’s Covid Success Made It A Laboratory For the World’, The Guardian,03 April available at https://www.theguardian.com/global/2021/apr/04/how-new-zealands-covid-success-made-it-a-laboratory-for-the-world (Accessed 17/05/21)

Olonisakin, ‘Funmi (2020), Framing Paper for ALC COVID- 19 Research: Leadership in Crisis: Markers of Sustained Influence for Societal Mobilisation in Response to COVID-19, April

Paz, Christian (2020), ‘All the President’s Lies About the Coronavirus’ , The Atlantic, 02 November available at https://www.theatlantic.com/politics/archive/2020/11/trumps-lies-about-coronavirus/608647/ (Accessed 18/05/21)

The Independent Panel for Pandemic Preparedness and Response (2021), COVID-19: Make It The Last Pandemic, available at https://theindependentpanel.org/wp-content/uploads/2021/05/COVID-19-Make-it-the-Last-Pandemic_final.pdf (Accessed 14/05/21)

UNDP (2002), Human Development Report 2002: Deepening Democracy in a Fragmented World, (New York: Oxford University Press)

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