Historical context and lessons learned

Historically, global health initiatives, driven by robust, government-led political leadership, have demonstrated significant success. Governmental convening and support were pivotal in the eradication of smallpox, the Framework Convention on Tobacco Control, the Pandemic Influenza Preparedness Framework and the Political Declaration of the High-Level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases, illustrating how concerted global action can significantly reduce major public health threats.3 The global response to the HIV/AIDS epidemic, catalysed by the establishment of global health entities such as UNAIDS; the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria; PEPFAR; and Unitaid, transformed a once dire prognosis into significantly improved conditions for millions. Similarly, Gavi, the Vaccine Alliance, has drastically improved vaccine accessibility in lower income countries, directly impacting child mortality rates worldwide. These lessons are further underscored by the COVID-19 pandemic, which highlighted the global threat of infectious diseases and the critical need for collaboration in preparedness and response, reinforcing that no nation is immune to pandemics. Ultimately, the reality of these examples accentuates the importance of effective political leadership in elevating health issues on the international agenda, resulting in concrete enhancements to public health.

Current challenges

Today, the context in which these successes were achieved has changed. The contemporary political environment—characterised by a mix of emerging and enduring powers, shifting geopolitical landscape and extreme polarisation of publics and politics both within and between nations—presents novel challenges for global health diplomacy.4 The advent of digital transformation, while offering innovative solutions, also brings new complexities in terms of data privacy, equitable access, disinformation, mental health and digital health literacy.5 The COVID-19 pandemic revealed systemic weaknesses in global health governance and inequities in resource distribution, highlighting the inadequacy and fragmentation of existing accountability and governance mechanisms in the face of a global health crisis.6

Reports and calls highlighting the need for a robust global surveillance system, equitable access to health technologies, better preparedness and response financing and high-level political engagement have emerged.7 Yet, the gap between recommendations and their implementation reflects a dissonance between acknowledged needs and political action. This disconnect underscores the necessity not only to understand but also to engage with the political realities of health, as relying on public health evidence and arguments alone is insufficient.⁷ Health leaders not only need to understand politicians, the private sector, activists and academic and multilateral institutions but also to be able to communicate and engage constructively with them.

Evolving leadership in global health diplomacy

Effective global health diplomacy today demands a new generation of leaders who combine traditional skills in international relations and public health with a multidimensional perspective, political lens and renewed sense of collective accountability to tackle this metacrisis. Politically astute leaders can leverage diplomacy to build coalitions, share knowledge and negotiate agreements that advance global health objectives.8 Modern health diplomats blend knowledge from a wide range of disciplines and fields beyond their traditional domains of public health or medicine—for example, politics, economics, history, law, business, ethics, the environmental sciences and many other fields—adapting to the multidisciplinary and interconnected nature of global health challenges.9 Their roles extend beyond forging alliances and sharing information to include negotiating agreements with a balanced view of national interests and global needs and benefits. This comprehensive, multidimensional approach is critical for successfully navigating complex global health issues and advancing global health objectives.

Strategic future directions

Developing future health leaders at global and regional levels, therefore, requires cultivating skills in negotiation, political analysis, communication, public and private engagement and cross-cultural understanding. A nuanced approach, employing tools such as political economy analysis, is required to navigate this complex terrain.

The conference on ‘International Politics, Leadership and Diplomacy for Health’ also emphasised the need for programmes that blend health expertise with political acumen, preparing leaders to address future health challenges. Such learning opportunities could be offered by a range of institutions, from schools of public health or medicine to those focusing on public policy, business, law, governance or the social sciences, from tailor-made training programmes to informal sessions at conferences. Therefore, to advance global public health in this complex scenario, we propose the following strategies:

1. Articulate health as a political choice: positioning health as a strategic and political opportunity is vital. Global and regional public and private sector leaders must recognise that investing in health is not merely a moral imperative but a pragmatic, strategic decision with far-reaching benefits; this requires speaking a common language that can resonate across sectors.10

2. Move beyond traditional public health models: merging public health evidence with insights into other disciplines can provide the right tools and competencies for health diplomacy. This multidisciplinary approach, encompassing the language and priorities of politicians and the public, is key to navigating the complex political landscape and aligning health initiatives with broader political and social objectives.

3. Leverage emerging global dynamics: the increased engagement and empowerment of low-income and middle-income countries and under-represented populations, in addition to the emergence of private sector and regional blocs like the African Union and Association of Southeast Asian Nations and private sector in global health discussions, present novel prospects for innovative forms of enhancing cohesion and strengthening leadership. Engaging with these emerging powers can create more balanced and effective global health governance structures when combating global health challenges.11

4. Cultivate a new generation of global public health leaders: there is an urgent need to provide learning opportunities for global public health professionals who can adeptly navigate the current political realities.12 These leaders should emerge from diverse regions and sectors, including civil society, government, academia and the private sector, to foster a multifaceted approach to global health challenges.