Promoting health diplomacy in the fight against COVID-19: the case of Vietnam

Abstract

The global but uneven course of the Covid-19 pandemic highlights the importance of international cooperation and negotiation on such matters as financial assistance, medical equipment provision, vaccine development and distribution, and other pandemic response measures. This article will present a theoretical overview of “health diplomacy” and analyze the case of Vietnam within this framework, showing how the country’s political response to the pandemic demonstrates an increasingly proactive engagement in health diplomacy. The article argues that health diplomacy will become more relevant for international relations in the time to come and that the case of Vietnam might yield valuable lessons.

Covid-19; health diplomacy; international relations; multilateralism; Vietnam; realism; functionalism

Introduction

When Covid-19 struck the world in 2020, the daunting memories of previous pandemics came back. However, it helps to accentuate the important role of public health, including its international dimensions, of which diplomacy is a critical tool. Pandemics, in all cases, are trans-border by nature. It thus naturally requires international cooperation and enhanced interactions between states and relevant regional and global regimes. The reality is less promising. There have been encouraging efforts to step up international cooperation during health crises, but expectations are yet to be met. In the field of international relations, the pandemic has directed renewed attention onto debates surrounding the concept of “health diplomacy”, and even “global health diplomacy.” In order to add clarity to this picture, this paper attempts to: (i) reexamine the concept of health diplomacy in a proposed theoretical framework and in the current context of Covid-19; (ii) prove the relevancy of health diplomacy, using Vietnam as a case study, given its successful responses to Covid-19 and proactivism in health diplomacy. The aim of this paper is twofold, adding analysis to the scholarly literature on health diplomacy and creating another source of reference for policy makers at times of health crises.

Health diplomacy: theory and definition

How should we understand health diplomacy? Efforts to define health diplomacy or global health diplomacy have noted how the pairing of “diplomacy” and “health” suggests both an opening of new subject for the practice of international negotiations and a new method for achieving improvement in medicine and healthcare around the world (Kickbusch et al. 2007). Recognizing the close correlation between politics and healthcare, some scholars distinguish health-related international political initiatives based on whether they have the improvement of health or the advancement of foreign policy agendas as the ultimate goal. Thus, Fazal (2020, E78) proposes that health diplomacy could be understood alternatively as “international aid or cooperation meant to promote health or that uses health programming to promote non-health-related foreign aims.”

These two types of normative aims have tended to make up much of the literature on global health diplomacy (Lee & Smith 2011). However, Lee and Smith also note that scholars have advanced a third perspective in examining how the toolkit of diplomatic activities can be used to facilitate policy negotiations on health (2011, 6–7), thus moving the analysis beyond an exclusive focus on ultimate goals. In the same spirit, other scholars propose a more expansive definition of health diplomacy, in which the relationship between health and politics is not strictly instrumental in the sense that one only serves to achieve the other. Thus, for Novotny et al. (2013):

Health Diplomacy is the chosen method of interaction between stakeholders engaged in public health and politics for the purpose of representation, cooperation, resolving disputes, improving health systems, and securing the right to health for vulnerable populations.

In this definition, health diplomacy is understood as a “method of interaction” that serves a variety of goals, encompassing both health and non-health matters.

Recognizing the complexity of health challenges on a global scale, scholars have theorized the practice of “global health diplomacy” (GHD), which might imply different normative and analytical concerns from “health diplomacy.” Theorists of GHD tend to stress the complex goals of global health engagements and the need to involve multiple actors in them. GHD is considered by Adams et al. (2008) as “a political change activity that meets the dual goals of improving global health while maintaining and strengthening international relations abroad, particularly in conflict areas and resources-poor environments.”

As an approach to improving health, its purported scale is the global population as a whole (Lee & Smith 2011). Beyond health, GHD can serve multiple purposes and is commonly assessed in seven dimensions, which include the building and maintaining of relationships, the gathering of information, the establishment of goodwill and the use of health as “soft power” (Kickbusch et al. 2021). Other scholars have characterized GHD as involving “multi-level, multi-actor negotiation processes that shape and manage the global policy environment for health” (Kickbusch et al. 2007). This is consistent with an understanding of health diplomacy as part of the “new,” as opposed to traditional diplomacy, which involves “engagement with diverse actors” and “elevation of ‘soft power’ in foreign policy” (Lee & Smith 2011, 2).

Theorists of health diplomacy, however, tend to center the state as the primary actor in international health-related initiatives even as they recognize the need for states to engage in multilateral processes (Fazal 2020). This has been evident since early conceptions. For example, when Peter Bourne, an advisor to President Jimmy Carter, introduced the concept of “medical diplomacy” in 1978, he argued that:

the role of health and medicine as a means for bettering international relations has not been fully explored by the United States. Certain humanitarian issues, especially health, can be the basis for establishing a dialogue and bridging diplomatic barriers because they transcend traditional and more volatile and emotional concerns (Bourne 1978).

While advocating a move toward less “traditional” and less contentious means to improve the world, Bourne still saw the United States as the main enactor of medical diplomacy, which can help the United States win the “hearts and minds of people in poor countries by exporting medical care, expertise and personnel to help those who need it most” (Fauci 2007, 1171).

Identifying the actors of health diplomacy is a salient issue, as the Covid-19 pandemic places the role of international organizations such as the WHO in doubt, while heightening scrutiny of the policies of major countries. At the recent launch of the Guide to Global Health Diplomacy (2021), published by the Graduate Institute in Geneva, the incumbent WHO Director-General asserted that “[p]erhaps the most outstanding example of health diplomacy was when the Soviet Union and the USA worked together at the height of the Cold War to eradicate smallpox, which had killed an estimated 300 million people during the 20th century” (Ghebreyesus 2021). Making the Cold War the fulcrum of modern health diplomacy demonstrates the hope that cooperation on global health issues would transcend geopolitical competition. However, the statement also implicitly makes concession and appeals to the crucial roles of great powers in addressing global health challenges.

Thus far, we can discern some basic elements of health diplomacy. These include: (i) the combination of public health, security and politics; (ii) the cooperation of multiple actors taking place at multiple levels; and (iii) the goals of elevating health cooperation and increasing influence abroad. This approach asks for a marriage between realism with the focus on the security aspect and role of state and functionalism with the emphasis on common interests between multiple stakeholders (Donnelly 2000; Imber 2007). Health diplomacy can be bilateral or multilateral, involve states or non-state actors, and have a variety of goals, including but not limited to improving population health and advancing foreign policy and security agendas. However, this theoretical overview and current events also show that the relative weights of these actors, processes, and objectives cannot be taken for granted and must be evaluated in situation-specific manners.

Covid-19 and the health diplomacy of Vietnam in global perspective

The Covid-19 crisis prompted significant changes to how health diplomacy is practiced globally. Until recently, health diplomacy was conducted in both bilateral and multilateral forms, through international institutions, during previous epidemics such as SARS, MERS, Ebola, witnessing the active role of great nations as well as the WHO in effectively controlling the diseases and limiting their infection sphere. However, the reemergence of health diplomacy during Covid-19 is characterized mainly by bilateral health diplomacy among countries via donation, the stagnant reaction of international regimes, and the increasing role of regional regimes, a process also called “fragmentation” (Fazal 2020, E90). In this context, Vietnam increasingly emerges as a considerable player in a number of bilateral, as well as multilateral initiatives.

The contribution by middle powers such as Vietnam could be understood better with the juxtaposition of other key players in this realm of health diplomacy. In this connection, the roles of relevant multilateral institutions are essential, though many of them face formidable challenges, such as lack of funding and great power competition.

Most notably, despite doubts and the US threat of withdrawal, the WHO keeps its global role by launching the Access to Tools (ACT) Accelerator, designed to aid development, production and access to Covid-19 tests and treatments. This also ensures equal access to vaccines for all countries, mainly developing and middle-income ones, via the COVAX distribution program, which aims to offer 2 billion doses by 2021 (World Health Organization 2021). Several countries have expressed their support for the initiative, including China, the US and the EU (Bochkov 2021). However, it should be noted that the WHO can only function effectively with the support of its member countries.

In the Indo-Pacific, multilateral mechanisms also raise their voices and take actions. The Quadrilateral Security Dialogue (QUAD), comprising the US, Japan, Australia and India released a joint statement, “The Spirit of the QUAD,” in its first senior meeting, calling for collaboration among member countries to support vaccine rollouts in Southeast Asia (Green 2021). Similarly, the Association of Southeast Asian Nations (ASEAN) has been quick on activating pandemic preparedness protocols for travel, tourism and borders, sharing of information and best practices, and strengthening response capacity. Soon a Covid-19 ASEAN Response Fund was established during the Special Summit on Covid-19, with high consensus among all member leaders (Tan 2020). Again, multilateralism only works desirably with the appropriate mandate from member countries. In this regard, it is noteworthy that middle powers, such as members of QUAD and ASEAN, have demonstrated their strong commitment to the fight against Covid-19. They also support related global efforts by G20, of which they are members (“G20 commits to ‘full financing’ of WHO scheme to buy COVID vaccines, drugs – draft” 2021).

The role of middle powers in health diplomacy could be further proven by looking at the deficit in global governance due to either the lack of great powers’ engagement or issues created by that engagement (Jones 2020). An analysis of China’s current approach to the global fight against Covid-19 can testify to this deficit. Remarkable for its conspicuousness, China has obviously turned crisis into an opportunity to play the role of a global leader through its massive donations and shipments of masks, personal protective equipment (PPE), other medical resources, and even doctors to various countries. Within 2 weeks in March 2020, for instance, China sent more than 26 million face masks, 2.3 million testing kits and other supplies to 89 countries, according to a review of state media reports and government and company statements. Its government claimed to offer help to 120 countries (Pancevski 2020). China also sent testing kits to Cambodia, planeloads of ventilators and masks to hard-hit nations like Italy and France, and experts to Iran and Iraq, and pledged to help many other nations (Kuo 2020).

China’s activism in health diplomacy became more prominent given the waning role of many other traditional stakeholders. For example, while “Chinese bilateral health aid has been marked in its presence, […] US bilateral health aid has been marked in its absence” (Fazal 2020, E92). The same could be said of Western powers more generally, and the problem of vaccine demonstrates this most clearly. As countries race to find an effective vaccine for Covid-19, the development, manufacture, and distribution of vaccines have come to occupy the center of global health diplomacy. As the world leader in this race, the US has adopted vaccine nationalism, prioritizing their domestic needs at the expense of other countries by stockpiling more than 1 billion doses, more than enough to inoculate the entire American population (Launch and Scale Speedometer 2021). Similarly, the UK and the EU have also joined the ranks of vaccine nationalism as they all pre-ordered vaccines for their citizens, with the stockpile of around 475 million and 1,8 billion respectively (Launch and Scale Speedometer 2021). They are now engaged in a battle over who is more entitled to 100 millions of AstraZeneca doses. Worse, bans on vaccine exports have been announced by some EU members (Cendrowicz 2021).

Yet, China does not go without competition in the developing world. Most notably, India has also jumped on the diplomatic train despite its domestic conditions concerning Covid-19, having sent testing kits, PPE, respirators and medicines to other countries in the fight against Covid-19. Now, India is releasing its vaccine diplomacy with its “Neighborhood First,” providing vaccines to its immediate neighbors in South Asia, including Bangladesh, Bhutan, Maldives, Myanmar, and Nepal, and to key Indian Ocean partners, Mauritius and Seychelles (“India Sends Covishield Vaccines to Mauritus, Seychelles, Myanmar” 2021). As observers allege that the vaccine has been politicized as a tool to boost Chinese soft power and buy influence in strategically important regions (Vuk Vuksanovic 2021), India’s vaccine diplomacy can be seen to serve as a soft power tool to counter China’s influence, “a follow-up effort to win hearts, minds and influence” in regions of developing countries, especially in South Asia (Ramachandran 2021).

Furthermore, the type of health diplomacy promoted by China has faced certain backlash and criticisms. In several recipient countries, concerns over the accuracy of Chinese-made test kits have led governments to renounce their use (Loh 2020). Meanwhile, the term “mask diplomacy” has come to have derisive connotations, in which China’s aids serve to divert attention from illegal geopolitical advances or come with coercive strings attached. For instance, China’s activism in health diplomacy has been seen as a way to mask China’s continued construction, deployment of military ships and planes, and extraction of natural resources in the South China Sea (Hornung 2020).

Against the backdrop of global reconfigurations of health diplomacy laid out above, Vietnam’s remarkably high performance (ranked #2) in containing the pandemic enables it to engage in health diplomacy in significant ways, to the extent that foreign policy is the continuation of domestic policy (Ozkececi-Taner 2017). Obviously, Vietnam’s health capabilities and priorities at home have resulted in a number of foreign policy initiatives, including supplying medical equipment, conducting vaccine research and production, and promoting multilateral initiatives. In March 2020, two months after the outbreak, Vietnam stepped up and provided face masks and medical supplies to Europe, South East Asia and the US, with 550,000 face masks to France, Germany, Italy, Spain and Britain, 390,000 to Cambodia and 340,000 to Laos, and 450,000 protective suits for the US (“Vietnam Challenges China’s Monopoly on Coronavirus Diplomacy” 2020). The Vietnamese government enacted Resolution No.20/NQ-CP to license the export of fabric face masks in response to high demand from markets such as the US, the EU, and Canada. In 10 months, the number has reached around 1,4 billion medical masks shipped abroad. Other medical products such as testing kits, gloves, gowns and ventilators are also on the list (Nguyen 2021). Furthermore, the implementation of bilateral free trade agreements (FTAs) such as the Comprehensive and Progressive Agreement for Trans Pacific Partnership (CPTPP), European Union-Vietnam Free Trade Agreement (EVFTA), and United Kingdom-Vietnam Free Trade Agreement (UKVFTA) will remove further barriers and create more chances for economic cooperation and investment in medical industry (Nguyen 2021).

Arguably, the ability of countries to engage in health diplomacy in both bilateral and multilateral venues partly depends on how well they manage the fallout of the pandemic within their own territories. In that case, Vietnam’s domestic performance prepares it well for foreign engagements. A recent study by the Lowy Institute (where 98 countries were evaluated in the 36 weeks following their hundredth confirmed case, using 6 indicators, namely (i) confirmed cases; (ii) confirmed deaths; (iii) confirmed cases per million people; (iv) confirmed deaths per million people; (v) confirmed cases as a proportion of tests; (vi) tests per thousand people) reveals the top ten countries in Covid performance:

Vietnam also attempted to research and produce local Covid-19 vaccines early on, which will likely enable the country to engage in more forms of health diplomacy. Vietnam numbers among the 81 pioneering Covid-19 vaccine candidates entering the clinical trial phase (GAVI 2021) with three locally made vaccines: NanoCovax, COVIVAC, and Vabiotech (Ministry of Health 2021). After just five months of research and lab experiments, this success indicates the scientific potential of the country (“JICA Helps Vietnamese Hospitals Improve Infection Control Capability” 2021). As an indication of progress, Vietnam’s NanoCovax is planned to be rolled out in the second half of 2021 (Onishi 2020). Vietnam’s vaccines are expected to provide enough not only for local use but for export purposes as well (Ministry of Health 2021).

From the functionalist point of view, as an emerging middle power, Vietnam proactively engages in and supports multilateral initiatives in battling Covid-19. In the role of ASEAN Chairman 2020, Vietnam successfully called for the participation of the “entire community” to contain the Covid-19 pandemic, releasing the ASEAN Comprehensive Recovery Framework and its implementation plan, the ASEAN Declaration on the Travel Corridor, and the Strategic Framework for Public Health Emergencies. The Regional Reserve of Medical Supplies, the ASEAN Covid-19 Response Fund, and the ASEAN Regional Centre on Public Health Emergencies and Emerging Diseases were also established during the 37th ASEAN Summit (ASEAN Vietnam 2020). Vietnam announced intentions to donate healthcare equipment worth US$5 million to the regional medical supply reserve and contribute $100,000 to ASEAN’s COVID-19 Response Fund (“Viêt Nam Donates Medical Supplies Worth $5 Million to Regional Reserve” 2020). Finally, against the backdrop of the Covid-19 pandemic and the urgent need for more resilient and robust health systems, Vietnam also proposed an International Day of Epidemic Preparedness, which the UN has recently approved (United Nations 2020). If, according to an author, the varying and sometimes dreary international responses to the pandemic can be boiled down to (i) the decreasing number of participants in resolving tough problems and (ii) the effects of the US-China rivalry (Fazal 2020), Vietnam’s health diplomacy shows the potential for small and mid-range countries to contribute to solving global health challenges through multi-level efforts.

Explaining Vietnam’s active engagement in health diplomacy

Why does Vietnam engage in extensive health diplomacy, and which among current theoretical approaches in international relations should be the analytical framework for this question? For one, realism would privilege the state as the main actor in health diplomacy. By stressing the lack or inefficacy of a global governing institutions and focusing on national self-interest as an explanatory factor, realism could explain why countries engage in such practices as “vaccine nationalism” in order to ensure their security. Moreover, in the realist scheme, health diplomacy would appear to be less benevolent gestures than self-interested attempts by states, especially great powers, to enhance power and influence and guard against non-traditional security threats such as diseases. Realism’s emphasis on national interest, defined in security terms, also invites considerations of domestic politics.

Functionalism, on the other hand, is closer to the global health diplomacy approach that directs attention to multi-level processes, diverse actors, and multiple goals. The pandemic is everyone’s business. Functionalism emphasizes the role of institutions of global and regional governance in coordinating responses to health emergencies. Actors might be engaged in sincere efforts to address both diseases and socio-economic problems caused by them rather than only guard off security threats. As Katherine Bond (2008, 384) observes, “the terms ‘health diplomacy’ or ‘medical diplomacy’ offer alternatives to ‘health security’ that make more explicit possibilities for the cultivation of trust and negotiation of mutual benefit in the context of global health goals.” A functionalist approach would take the diplomatic, mutual, and collective dimensions of health diplomacy more seriously.

This article argues that analyzing Vietnam’s assertive engagement in health diplomacy calls for a balanced integration of realism and functionalism. To understand the case of Vietnam, domestic priorities, foreign policies, and national capability all have to be taken into consideration. The transnational nature of infectious diseases represents a threat to Vietnam’s domestic agenda. Vietnam’s focus on local and global health addresses the need to stave off threats and build national capacity as a basis for economic development. However, while it accords with domestic priorities, health diplomacy abroad is not limited to the basic realistic motive of ensuring security. Vietnam’s active engagement in bilateral and multilateral arrangements reflects a foreign policy orientation that takes international cooperation seriously and harmonizes it with national interest.

Domestic priorities: A robust preventive healthcare system

Vietnam’s pandemic response follows the adage of “prevention is better than cure” (Le 2020a), a philosophy informed by realistic assessments of local and global health trends. Southeast Asia is the hub for new viruses, especially viruses originated from animals. Vietnam is also “a breeding ground for new diseases” due to large populations of domestic animals, which increases the potential contact with humans (Silberner 2015). Vietnam’s population is reaching approximately 98 million people (Worldometers 2021). The country also has a vast network of connections with the world. This makes it more prone to health crises in the future, especially infectious ones, and increases the need for human security and safety priorities (“Chuyên gia Pháp: Viêt Nam có nguy cơ cao lây bệnh truyền nhiễm từ động vật” 2021). From a realist perspective, the increasing significance of health security in the state’s domestic and foreign policy reflects the role of health in securing national interests, since threats to public health would hamstring a country’s ability to address issues in international politics (Fidler 2003; 2009).

The great social and economic impacts on Vietnam exerted by Covid-19 heighten the urgency of health security:

According to the General Statistical Office (GSO), GDP for the first six months of 2020 grew by only 1.81 percent compared to 6.77 percent in the same period last year. This is the slowest rate GDP growth rate since the mid-1980s, and far below the average for the 2011-2020 period of 5.44 percent” (United Nations 2020).

Vietnam’s GDP growth in 2020 reached its lowest point at only 2,91% (General Statistics Office 2020). No doubt as a consequence of the slump in tourism and hospitality industry due to quarantine and social distancing measures, Vietnam’s service sector suffered the heaviest loss from Covid-19, with a growth rate of 2,34%, which is only a third of previous years (2011-2019) (General Statistics Office 2020). Unemployment rate has increased from 1,22% to 2,03%, not to mention decreasing labor productivity. This might result in further consequences in terms of social equality and welfare (Dangcongsan 2020).

However, despite economic difficulties, Vietnam has demonstrated ample capacity to contain the pandemic, ranking 2nd in controlling the Covid-19 pandemic, according to Lowy Institute Covid-19 Performance Index (Table 1), thanks to quick actions in setting up quarantine measures and contact tracing (Lowy Institute 2021). Indeed, without the financial and technological resources of wealthy countries such as South Korea or New Zealand, Vietnam could not choose the economy over the people’s health and safety but, on the contrary, had to develop cost-effective measures to tackle pressing health issues (Le 2020a). Being the first country to contained SARS back in 2003 (Marshall et al. 2003), Vietnam also benefited from a wealth of experience in dealing with infectious diseases, significant investment in preventive medicine, and creditable medical corps (Le 2020a). As health becomes increasingly important for national security and national comprehensive power, Vietnam’s high performance and attention to healthcare is bound to boost its standing among Asian powers (Table 2; Lowy Institute 2020). Vietnam’s timely and resolute actions in response to the pandemic not only puts its economy on an early recovery path but also opens up the possibility for it to engage in effective diplomatic activities, among which health diplomacy has been increasingly prominent.

Table 1
Covid Performance Index, Top Ten

Rank	Country/Territory
1	New Zealand
2	Vietnam
3	Taiwan
4	Thailand
5	Cyprus
6	Rwanda
7	Iceland
8	Australia
9	Latvia
10	Sri Lanka

• Source: Lowy Institute Covid Performance Index 2021 (Lowy Institute 2021)

Table 2
Asia Power Index, Sorted by Covid-19 Response Ranking

Ranking	Country/ Territory	Ranking	Country/ Territory
1	Taiwan	14	Myanmar
2	New Zealand	15	Brunei
3	Vietnam	16	Papua New Guinea
4	South Korea	17	Nepal
5	Australia	18	China
6	Singapore	19	Bangladesh
7	Japan	20	Philippines
8	Thailand	21	Pakistan
9	Mongolia	22	Indonesia
10	Sri Lanka	23	India
11	Laos	24	North Korea
12	Malaysia	25	Russia
13	Cambodia	26	United States

• Source: Lowy Institute Asia Power Index 2020 (Lowy Institute 2020)

Foreign Policy Orientation: Focusing on common interests

While a realistic evaluation of health as both a domestic and foreign policy problem is important, it is not enough to explain why Vietnam proactively promotes health diplomacy abroad. To understand this, it is necessary to see how Vietnam’s extensive engagement in multi-level health diplomacy is consistent with and informed by its foreign policy principles. In line with Vietnam’s goal of elevating multilateralization and increasing integration to the world as decreed in Directive 25 issued by the Secretariat of the Communist Party of Vietnam, the guiding principle in Vietnam’s foreign policy is to be a “responsible member of the international community” (Le 2020a). This orientation is borne out by Vietnams’ commitments to international regimes such as the UN, the WHO as well as regional bodies like ASEAN.

Despite difficulties during the pandemic, functionalism suggests that, in order to promote common interests, diplomacy is supposed to thrive, turn challenges into opportunities, uphold the principles of responsibility and multilateralization, and demonstrate national capability. Internationally, Vietnam successfully played the dual role as a non-permanent member of UNSC and the ASEAN Chairman 2020, hosting virtual meetings and conferences and proactively promoting cooperation in the battle against the pandemic, economic recovery for regional and international prosperity, peace and development. Displaying technological prowess and capability in an age of digital transformation, Vietnam performed 34 phone talks and virtual meetings with senior leaders and collaborated with regional partners during its ASEAN Chairmanship to successfully hold the 36th and 37th ASEAN Summits on virtual platforms. Remarkably, Vietnam plays an important role in promoting parties to sign the RCEP during its chairmanship of ASEAN in 2020 and fostered the ratification of more than 80 documents at ASEAN senior meetings (Pham Binh Minh 2021). Vietnam diplomacy also witnessed successes in international economic cooperation, with signed and approved FTAs such as EVFTA, EVIPA coming into effect in August 2020 and UKVFTA in December 2020 (Pham Binh Minh 2021).

Domestic diplomacy is also positively impacted, as Vietnam’s international Covid-19 response provides the state with the chance for nation branding and confidence building toward its own population. Pictures of diplomats in their efforts to rescue citizens from infected areas abroad on chartered flights or travelling warnings have been posted on social platforms for universal outreach (Manor 2020). Vietnam has impressed the world and its people with its citizen protection work, offering help and sending nearly 80,000 Vietnamese people from 59 countries safely back to their motherland on 280 charter flights (Pham Binh Minh 2021). Vietnam has received lauds from WHO representatives for its quick response to the pandemic (Le 2020a). On Twitter, Vietnam’s efforts have been well received with the hashtag #VietNamLeavesNoOneBehind¹. Information regarding the pandemic is published and instantly updated for Vietnamese on government-run social media accounts on Facebook, mobile apps like Zalo and text messages (Le Lena 2020).

These favorable developments on both foreign and domestic diplomatic fronts allow Vietnam diplomacy to claim an increasingly prominent presence on the new front of health diplomacy. Health diplomacy is a logical next step, showing Vietnam’s international responsibility and commitment to regional and global regimes of governance in a time of retrenchment, disengagement, and cynical manipulation by great powers. It also helps raise the image of Vietnam in its citizens’ eyes and shore up their support for international and domestic endeavors.

Further discussion and outlook for Vietnam health diplomacy

Beyond the pandemic, health diplomacy is likely to grow in importance in Vietnam’s foreign policy and strategy. Vietnam’s foreign policy is based on a synergy between domestic and international concerns, and the pandemic has shown that health is a perfect issue connecting the agendas of domestic development and international integration. Health diplomacy will become a significant aspect of Vietnam’s effort to build a modern, well-rounded diplomacy, a prediction with basis in existing circumstances, opportunities, and priorities.

Recent occurrences of global pandemics and predictions on crisis possibilities in the future underscore the importance of international cooperation and preparation. Over the past two decades, the world has been through several epidemics, such as SARS, H1N1, H5N1, MERS, Zika, Ebola (Huong Le Thu 2021). The outbreaks of these epidemics have indicated that (i) all countries, regardless of their economic capabilities, are vulnerable to diseases; (ii) diseases can come from all animals; (iii) diseases can become a threat to global security (World Health Organization 2015). “Pandemics as a whole are increasing in frequency,” warned Peter Daszak. Up to 70% of diseases are zoonotic origins and 1,7 million undiscovered viruses may still exist in wildlife (Brulliard 2020). WHO also warns that Covid-19 may only be a “wake-up call” and “this is not necessarily a big one” (Davey 2020). As a mid-level income country with a rapidly growing population, vulnerable climate, and modest financial and technological resources, Vietnam will need to engage in international arrangements in order to build capacity for normal times as well as future crises.

Such opportunities for Vietnam to engage in health cooperation abound. At the level of multilateral institutions, Vietnam can tap into the roles of ASEAN, WHO, and the UN in promoting universal healthcare in order to strengthen its own healthcare system while fulfilling international obligations. For instance, the UN is progressively implementing the Sustainable Development Goals (SDGs) with Health as the third priority to “Ensure healthy lives and promote well-being for all at all ages” (United Nations 2015). This is further reiterated by other 13 goals regarding the WHO’s work promoting global health (World Health Organization n.d.). Also, the UN initiated the Global Action Plan for Healthy Lives and Well-being for All. Vietnam has issued action plans and related resolutions to promote universal health care and access to the health system, ranking at high levels when compared to other countries in the Western Pacific Region, with 73 per-cent of the population of Vietnam having access to essential health services in 2017 (United Nations 2018). As it becomes deeply integrated to the international system, Vietnam, as purported by functionalism, needs to collaborate with the outside world, and in many cases, this can be understood as a philosophy of “giving is taking.” Emerging from the Covid-19 pandemic, Vietnam will continue to benefit from its credential in promoting multilateralism in these international forums, in order to engage in further undertakings in global health diplomacy.

Bilaterally, major countries, such as the US, the UK, and Japan also want to promote health diplomacy for and with Vietnam. The proactive approach adopted by Vietnam with respect to health diplomacy has borne fruits. For instance, Vietnam is likely to become a focus of US health diplomacy in the region, as US aid aims at certain nations of strategic significance in US-China rivalry in Asia and its traditional allies (Williams 2020). In Vietnam, the US provided $4.5 million worth of assistance to its partners, working in collaboration with the Government of Vietnam for technical support, training, supplies for COVID-19 surveillance and case management; public health screening at points of entry; laboratory diagnostic capacity; community education and engagement; and infection prevention in health care settings (USAID 2020). The US and other partners are working in collaboration to promote One Health Partnership with Vietnam. Recently, Vietnam has signed the Partnership Framework of Vietnam One Health Partnership for Zoonoses from 2021-2025²

The UK and Vietnam have also accelerated cooperation in digital healthcare transformation, as “Vietnam was at an important stage in the development of its healthcare system, with increasing demand for affordable and high-quality healthcare” (“Great Potential Seen for Vietnam-UK Cooperation in Digitalized Healthcare” 2021). Collaboration was fostered between Oxford University Clinical Research Unit and the Ministry of Health for clinical trial to treat and prevent COVID-19, or the University of Bristol collaborated with the Company for Vaccine and Biological Production No.1 (VABIOTECH) under the Vietnamese Ministry of Health to develop a vaccine based on virus vector technology. As the UK Ambassador in Vietnam remarks, “health is also an important area in the Strategic Partnership between the UK and Vietnam” (“Vietnam Steps up Health Co-Operation with the UK” 2020). The two sides signed a MoU on facilitating the implementation of Better Health Programme in Vietnam, which is a part of the UK’s Prosperity Fund (“Vietnam Steps up Health Co-Operation with the UK” 2020). The UK is likely to become an important partner in providing Vietnam with technological assistance for disease prevention and research.

In Asia, Japan has long been a partner of Vietnam in healthcare cooperation. Japan researchers have played a great role in collaborating with Vietnam in scientific output (Nguyen et al. 2017). JICA (Japan International Cooperation Agency) has engaged in proliferating Vietnam’s health system in order to improve universal health coverage and universal health insurance with a 2-year plan (Ministry of Health 2017). During Covid-19, JICA has decided to continue implementing aid packages worth JPY60 million (roughly US$551,503) for Cho Ray Hospital and worth JPY20 million (US$183,842) for the provincial Centres for Disease Control and Prevention (CDCs) in Nam Dinh, Ha Giang, Bac Giang, Vinh Phuc, Kien Giang and Tra Vinh (“JICA Helps Vietnamese Hospitals Improve Infection Control Capability” 2020). According to Japanese Ambassador to Vietnam Yamada Takio, the government of Japan since the start of the pandemic has financed about US$19 million in non-refundable aid, while JICA has provided technical support, test kits, personal protection equipment, face masks, shields, among others, worth US$1.6 million to Vietnam (“JICA Intensifies Assistance to Vietnam in Fight against Covid-19” 2020).

Vietnam’s diplomatic activities during the Covid-19 pandemic and the foregoing prospective assessment show that there will be plenty of room for Vietnam as a middle power to contribute to global health initiatives. Whether bilateral or multilateral, health diplomacy can help Vietnam build national capability at home and strengthen its standing abroad. Shifting more emphasis onto health diplomacy will both further Vietnam’s mission of building modern diplomacy and better prepare it for novel challenges (Le 2020b).

Vietnam’s active role in health diplomacy can contribute to the contemporary discussion on Vietnam as an emerging middle power which has recently attracted the attention of many scholars of international relations. For instance, from a realist perspective, Barbara Kratiuk (2014) considers Vietnam a middle power by examining its capabilities and relations with regional countries. Similarly, Ralf Emmers and Sarah Teo (2014, 185) chose Vietnam as a case study in an oft-cited article on middle powers in the Asia Pacific, in which the authors use “the functional and behavioral approaches of middle power diplomacy.” As mentioned above, the Lowy Institute, in its Asia Power Index 2020, put Vietnam in the middle power group. Middle powers are widely understood as actors that actively contribute to the common goods of the international community (Jordaan 2003; Brattberg 2021). With an increasingly proactive approach to global health diplomacy, Vietnam is moving in that direction of middlepowership (Le & Vu 2021).

Conclusion

When Vietnam’s domestic priorities, foreign policies and national capability are taken into consideration, one can see that Vietnam’s goal in engaging in health diplomacy takes both security and diplomatic concerns into account. While conceptualizing diseases as one of the rising non-traditional security threats, Vietnam also recognizes the benefits and reputations it will gain, both abroad and at home, as a result of participating broadly in international cooperation and partnerships on health. The Vietnamese state makes use of both bilateral and multilateral arrangements and is increasingly active in both regional and global regimes of governance. Importantly, there is a synergy between the domestic and foreign policies of Vietnam, a process involving multiple stakeholders and cross-cutting issues. Vietnam takes international cooperation seriously and sees it as compatible with national interests because the nature of non-traditional security challenges is transnational.

Covid-19 will not be the only major health crisis the world will witness in the next decades. The prevalent threats of infectious diseases demand that countries be prepared and cooperate on pandemic prevention. At the same time, the suspicion of how great powers have conducted their pandemic response and health diplomacy will open up new possibilities for small and mid-range countries to contribute to both bilateral and multilateral global health initiatives. Health diplomacy will become not only relevant to these countries, but, as the case of Vietnam demonstrates, middle powers can engage deeper in this field and become credible partners to the international community.

Acknowledgments

We thank Khanh Linh, research intern at the Institute for Foreign Policy and Strategic Studies, Diplomatic Academy of Vietnam, for her diligent proofreading and technical assistance. This research is funded by Vietnam National Foundation for Science and Technology Development (NAFOSTED) under grant number 506.01-2019.300.

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• 1
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Publication Dates

• Publication in this collection
  25 Mar 2022
• Date of issue
  2022

History

• Received
  31 Mar 2021
• Accepted
  06 Sept 2021