Health diplomacy is the use of health-related activities to build relationships between countries, negotiate international agreements, and advance both public health goals and foreign policy interests. It covers everything from formal treaty negotiations at the World Health Organization to a government shipping vaccines to another country during a crisis. The term has entered mainstream use, but it carries many different meanings depending on who is using it and in what context.
Three Forms of Health Diplomacy
Health diplomacy generally falls into three categories. The first is core diplomacy: formal negotiations between nations that produce binding agreements, like international treaties on disease surveillance or tobacco control. The second is multistakeholder diplomacy, where governments negotiate alongside other actors like nonprofit organizations, pharmaceutical companies, or philanthropic foundations. These discussions don’t always produce binding agreements but shape global health norms and funding priorities. The third is informal diplomacy: the day-to-day interactions between international health workers and their counterparts in other countries, including local government officials, NGOs, and communities on the ground.
These three layers work simultaneously. A country might be negotiating pandemic preparedness rules at the WHO while its aid agency runs immunization programs in a dozen nations and its health attachés build working relationships with foreign ministries abroad. The formal and informal feed into each other. Relationships built through fieldwork often shape what’s politically possible at the negotiating table.
Health as a Foreign Policy Tool
Countries use health programs strategically to build political reputation, strengthen alliances, and extend influence. Many international relations scholars describe this through the lens of “soft power,” the idea that a country gains influence not through military force but through generosity and expertise that earn goodwill.
The most prominent example is the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Between 2004 and 2018, the U.S. committed roughly $70 billion to fight HIV/AIDS in low- and middle-income countries. The program’s impact has been substantial: across 90 recipient countries, all-cause death rates dropped by 10 to 21 percent during that period, with the largest reductions (17 to 27 percent) in countries receiving the most funding per person. One study estimated that between 2004 and 2013 alone, 2.9 million HIV infections were averted, 11.6 million life-years were gained, and 9 million children were spared from becoming orphans. PEPFAR simultaneously served as one of the most effective public health interventions in history and as a powerful instrument of American foreign policy, building deep ties with African and Asian governments.
Cuba offers another long-running example, deploying tens of thousands of doctors to countries across Latin America, Africa, and Asia. China has similarly invested in medical diplomacy, providing health infrastructure and personnel to partner nations. These programs address real health needs while building political alliances and international prestige for the sending country.
Vaccine Diplomacy During COVID-19
The COVID-19 pandemic made health diplomacy visible to the general public in a way few previous crises had. Countries raced not only to develop vaccines but to distribute them internationally as a tool of influence. China took an early lead, launching its first overseas vaccine trial in Brazil in July 2020 and signing supply deals with dozens of lower- and middle-income countries by November of that year. By March 2021, Beijing had provided free doses to 69 countries and commercial exports to 28 more. India, Russia, and the United States all followed with their own distribution campaigns.
The pandemic also exposed the darker side of health diplomacy. High-income countries pre-purchased enormous quantities of vaccines from manufacturers, hoarding supply to vaccinate their own populations as quickly as possible. This practice, widely called vaccine nationalism, left developing countries struggling to access doses at all. The financial incentives were stark: pharmaceutical companies competed not to deliver vaccines at minimum cost but to secure the strongest commercial position. While prioritizing one’s own population is understandable on its face, the scale of stockpiling raised serious ethical questions about equity when a virus respects no borders.
The pandemic revealed two competing impulses in health diplomacy: solidarity and self-interest. Some countries used vaccine distribution to build bridges, while others treated vaccines as a scarce commodity to be leveraged for geopolitical advantage.
The Legal Architecture Behind It
Health diplomacy operates within a framework of international law. The most important instrument is the International Health Regulations (IHR), a legally binding agreement covering 196 countries. The IHR require every participating country to maintain core capacities for disease surveillance and response, designate responsible authorities, and report public health risks with potential international implications to the WHO, regardless of where those risks originate. Countries must be able to detect acute health threats in a timely manner, assess their severity, and respond effectively. The regulations were last updated in 2024.
Alongside the IHR, the Global Health Security Agenda (GHSA) brings together countries working to build capacity in nine technical areas: antimicrobial resistance, biosecurity and biosafety, immunization, laboratory systems, legal preparedness, surveillance, sustainable financing, workforce development, and zoonotic disease. So far, 58 countries have strengthened their capabilities to a level of “demonstrated capacity” in at least five of these areas.
The New Pandemic Agreement
In May 2025, the World Health Assembly adopted the first-ever WHO Pandemic Agreement, a milestone that followed three years of intense negotiations launched in direct response to the failures and inequities of the COVID-19 response. The agreement was approved by 124 member states, with no objections and 11 abstentions.
The agreement aims to strengthen international coordination for pandemic prevention, preparedness, and response, with particular emphasis on equitable access to vaccines, treatments, and diagnostics. It explicitly addresses the inequities that left poorer countries waiting months or years for tools that wealthier nations had from the start. Critically, the agreement also includes clear language protecting national sovereignty: it gives the WHO no authority to direct, order, or impose specific actions on any country, including vaccination mandates, travel bans, or lockdowns.
The next major step is negotiating a Pathogen Access and Benefit-Sharing system, which would govern how biological samples and genomic data are shared internationally and how the benefits of resulting products (like vaccines) are distributed. Once that annex is finalized, the agreement opens for signature and ratification. It will enter into force after 60 countries ratify it.
Why It Matters Beyond Pandemics
Health diplomacy is no longer considered “low politics,” the kind of technical, humanitarian issue that sits below trade, defense, and security on a government’s priority list. The COVID-19 pandemic demonstrated that health crises can destabilize economies, reshape elections, and alter the global balance of power. Health concerns now enter foreign policy conversations when they intersect with trade, national security, or economic stability.
The field also highlights persistent power imbalances. Governments with large budgets and pharmaceutical industries set the agenda, while smaller nations and NGOs rely on lobbying, advocacy, and coalition-building to influence outcomes. In practice, health priorities often take a back seat to trade or security interests in shaping a country’s diplomatic positions. Civil society organizations work to counterbalance this by networking with academic institutions and think tanks to push health concerns higher on the agenda.
Health diplomacy, at its core, is the recognition that diseases, environmental hazards, and health inequities do not stop at borders. Addressing them requires countries to negotiate, cooperate, and sometimes compromise in ways that blend public health expertise with the realities of international politics.