“Vaccine Diplomacy”: Historical perspectives and future directions

Introduction: Origins and Definitions

International cooperation for purposes of infectious and tropical disease control goes back to at least the 14th century, when early concepts of quarantine were introduced in Dubrovnik on the Adriatic Coast of Croatia [1], [2], and to the later date of 1851, when Europe held its first International Sanitary Conference for multilateral cooperation to prevent the spread of cholera and, subsequently, plague and yellow fever [3]. Such efforts led to a series of international sanitary treaties and conventions and ultimately to the formation of the Pan American Health Organization and the later establishment of the World Health Organization (WHO) [3], [4].

Some scholars trace our current framework for global health diplomacy to the writings of Dr. Peter G. Bourne in his role as special assistant for health issues to US President Jimmy Carter [5] and later (during the first years of the 21st century) to the launch of the Millennium Development Goals (MDGs) and the release of the “Report of the Commission for Macroeconomics and Health”, when global health was placed squarely in the international diplomacy arena [6]. Among the driving forces for these activities was an urgent need for diplomatic collaboration to combat pandemics caused by HIV/AIDS and seasonal and avian influenza, which came with the revelation that such diseases are threats to economic development and both national security and foreign policy interests [7]. There were also practical considerations concerning potential bioterrorist threats and situations that required international diplomacy, such as when Indonesia balked at sharing its time-sensitive avian influenza data or when Nigeria and Pakistan halted polio and other immunization initiatives because of religious tensions [7]–[11].