Improved Health Diplomacy is Necessary for Resilience after COVID-19

Since the World Health Organization’s (WHO’s) country office in the People’s Republic of China first flagged a media statement describing cases of “viral pneumonia” (December 2019), the number of people infected with SARS-CoV-2 has surpassed 191 million, and the number of deaths surpassed 4.1 million and is still climbing (Adhanom 2020a, b; Dong and Gardner 2020). COVID-19 (SARS-CoV-2) has claimed a place of infamy on the list of the most lethal modern viral pandemics, which includes the 1918 “Spanish flu” (Influenza A virus subtype H1N1), the 1957–1958 “Asian flu” (Influenza A virus subtype H2N2), the 1968–1970 “Hong Kong flu” (Influenza A virus subtype H3N2), and the ongoing AIDS epidemic (HIV).

Not only has COVID-19 contributed to widespread morbidity and mortality, but the consequences of COVID-19 include a reversal of decades of hard-fought gains to eliminate poverty through the United Nations Millennium Development Goals (UN MDGs), and backsliding due to COVID-19 threatens to derail the achievement of the UN Sustainable Development Goals (UN SDGs) by 2030 (Ceschia 2020). In the face of such a significant setback, this article raises the question, “How should healthcare professionals—including engineers and nurses—pick up the pieces and once again move forward to meet the ‘grandest challenge of all,’ namely achieving sustainability” in the world’s low and middle income countries (LMICs) (Mihelcic et al. 2017). To answer this question, two issues come to mind, namely, (1) how will this be done as COVID-19 continues, and (2) how will we ensure a transdisciplinary approach, for example, engineers and nursing working together and learning from each other?

As described previously in a series of editorials in the Journal of Environmental Engineering, engineers can learn from and learn with nurses (i.e., Oerther and Watson 2020; Oerther and Shattell 2020; Oerther and McCormack 2021). For example, the importance of governments employing clear, concise, and consistent risk communication is one lesson we (engineers and nurses) can learn from COVID-19 (Oerther and Watson 2020). This fact is highlighted in the unfortunate politicization of the use of face coverings (Oerther and Shattell 2020), as well as in the ongoing debates—pro and con—regarding vaccinations for COVID-19 (Ward et al. 2020).

At least one aspect of the difficulty in addressing risk communication arises from a lack of us (engineers) often failing to consider person-centeredness in typical public health approaches (Oerther and McCormack 2021). While nursing practice often recognizes that individuals (i.e., patients) are autonomous, have an unalienable right to self-determination, and make decisions based in the values each individual holds dear, the public health approaches typically employed by engineering practice often emphasize aggregate measures of people (i.e., the public). Scaling up from the individual and beginning to consider a holistic view of the friends, family, and community of the individual, it is vital that health-care professionals—including engineers and nurses—use appropriate tools to integrate these complex human-to-human relationships.

Health diplomacy, an important component of the emerging concept of science diplomacy, is one tool that engineers should consider as they address human-to-human relationships at the largest public health level of sovereign states—entities possessing a permanent population, defined territory, government, and capacity to enter into relations with other sovereign states (League of Nations 1936). As famously explained by the American journalist Edward R. Murrow (1963), “It has always seemed to me the real art in this business [foreign policy and diplomacy] is not so much moving information or guidance or policy five or ten-thousand miles. That is an electronic problem. The real art is to move it the last three feet in face to face conversation.”

In 2010, a joint conference of members of the Royal Society in the United Kingdom and the American Association for the Advancement of Science (AAAS) produced a report entitled New Frontiers in Science Diplomacy (Royal Society 2010). Science diplomacy was characterized in three dimensions. The first dimension, science-in-diplomacy, includes professional diplomats with formal training in science [i.e., engineers serving as diplomats to negotiate international agreements such as the development of the Caribbean Ocean and Aquaculture Sustainability Facility (COAST)] (Oerther 2020). The second dimension, diplomacy-for-science, includes multi-national-scale scientific cooperation, such as the WHO, and campaigns promoting cooperation such as the International Year of the Nurse and Midwife: 2020 (WHO 2020). And the third dimension, science-for-diplomacy, includes interpersonal-scale scientific cooperation such as study abroad and short-term exchange including the Fulbright program, ERASMUS+, and the Turing Scheme (Oerther and Oerther 2021a).

The COVID-19 global pandemic created a significant setback to the world’s efforts to achieve sustainable development by 2030. One way that engineers can build back better with an improved approach is to learn from and leverage efforts in health diplomacy as exemplified by the profession of nursing to ensure resilience in individuals, organizations, and systems. As engineers engage in ongoing professional development, and as academic institutions train future engineers, it is important to consider the value of learning how to navigate complex human-to-human relationships, including the three dimensions of science diplomacy (Oerther 2017a). Concrete recommendations for those who are training and educating environmental engineers include (1) adapt theories from nursing to guide engineering best practice, such as Florence Nightingale’s Environmental Theory—health is the normal state of humanity, and the purpose of the health-care professional is to modify the environment to restore health and promote wellness (Oerther 2017b); (2) adapt workforce enhancement programs from nursing (i.e., Getting Nurses on Boards campaign) to improve the engineering workforce (i.e., Changing the Conversation campaign) (Oerther 2018a); (3) teach science diplomacy to engineers as part of preconference workshops (Oerther 2021b) and in the classroom and laboratory (Oerther 2017a, 2018b, 2021a); (4) promote joint educational opportunities among engineers and nurses (Oerther et al. 2020); and (5) develop new, convergent educational and best practice models that merge traits of engineers and traits of nurses into new V-shaped professionals (Oerther and Oerther 2021c). Beyond training and education, in our practice, research, and service, engineers must mobilize the global diplomatic community to prioritize engineering as part of the global response to achieving sustainable development—including health as a human right, coordinating monitoring and response, and supporting poverty eradication—through an intentional effort to leverage the success of engineering in science-for-diplomacy (i.e., EWB) to achieve recognition in diplomacy-for-science (i.e., the International Year of the Nurse and Midwife: 2020).