Where have all the health attachés gone?

An influential article of 2014 noted that health attachés were appointed shortly after the Second World War and were thereafter assigned by ‘a growing number of countries […] to work in embassies in countries of strategic importance’. Is this true? If not, why not? And does it matter anyway?

Because of the sparsity of published diplomatic service lists in recent years, it is not at all easy to make even a rough guess at the number of health attachés extant. Making the task more difficult is the fact that (capital city) diplomatic lists, which are more readily available online, are not always on one page. Old-style, one-page lists, like the Swedish Diplomatic List, require only one search for ‘health’, but others provide separate pages for each state’s mission staff, as in the case of New Zealand, and these demand a search of every individual mission’s staff. Nevertheless, a random search of the position of a few states where some evidence is easily available at least enables an impression to be formed of the current position, which is not good.

In the first decade of the new millennium there was a growing fear in medical circles that pandemics were likely to grow in number and intensity; this was due, among other things, to increased global travel. The SARS pandemic of 2003 had sounded a particular alarm. But despite the fact that this was followed by a flu pandemic in 2009, two years later only four countries with missions in the United States of America had diplomatic officers with full-time health responsibilities (two attachés and two counsellors); and in 2014 (the year of the Ebola epidemic), the USA itself had only eight full-time health attachés posted abroad – five by the Department of Health and Human Services (HHS), two by the Pentagon, and one by USAID. Moreover, none had embassy sections of their own, but found themselves part of others, typically economic/commercial, science and technology – or even political sections. On its current website page on health attachés, last updated six months before the 2016 US presidential election, HHS reported that by then it had six: in Brazil, China, India, Mexico, South Africa, and at the US Mission to the UN in Geneva. As for the UK, it probably has no health attachés at all, because while a search of its website brings up 235 hits for ‘defence attaché’, it brings up only one result for ‘health attaché’, and not a British one. As for embassies in London, according to its old-style diplomatic list for May 2020, only those of Canada, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates currently have health or ‘medical’ attachés. Furthermore, most of these are probably only concerned with ministering to the personal health needs of their citizens resident in, or visiting the UK, than with global health diplomacy. This is certainly the case of Qatar, and it is something of a giveaway that the office of the UAE’s medical attaché is in Harley Street, famous for its high class, private specialist clinics. The Swedish diplomatic list reveals no health attachés posted in Stockholm at the moment; likewise the Czech list à propos Prague. By way of a footnote to this paragraph, I can find no reference to Morris B Sanders, the ‘Public Health Attaché’ said to have been appointed to Brussels, Paris, and The Hague in or around 1948 in any US Foreign Service List between 1945 and 1950.

There are practical reasons for the scarcity of genuine health attachés in the world’s embassies. Chief among these, it seems, is the absence of a clear career pathway, which makes the position unattractive to many of those otherwise well qualified – and in high demand elsewhere, especially during a pandemic like the present one. It seems likely, however, that their scarcity is also a result of the complacency of too many governments – especially of the populist variety – towards the threat of pandemics, their preoccupation with nationalist agendas, and their tendency to discount diplomacy in general.

If it is indeed true that health attachés are very thin on the ground, does it matter? Embassies got some bad headlines during the first weeks of the COVID-19 pandemic, chiefly for the mixed response of their consular sections and satellite consulates to the huge numbers of citizens abroad desperate to get home. But health attachés would presumably have been of little use in such circumstances. However, they are surely a valuable conduit for advice to an embassy’s economic and/or commercial section urgently seeking a reliable source of medical equipment; and there were lamentable failures in such searches during the first, panicky weeks of the COVID-19 crisis. And in the critical matter of discovering viable anti-virals, and above all, a vaccine for COVID-19, health attachés provide embassies with the ability to promote co-operation on the part of medical scientists and public health experts in relationships where international professional networks are weaker and more fragile. They are also needed to oversee any local health project sponsored by a sending state, support the negotiation and monitoring of bilateral health accords (as in the case of the first Sino-US memorandum), report on local health conditions, and so on. It is significant that in the case of the USA, at any rate, its embassies are repeatedly asking for more health attachés than Washington can provide.

The weak response of many embassies to the demands made on them during the first weeks of the COVID-19 crisis are readily explained by the health precautions required of embassy staff and the impediments to their work caused by local lockdowns and curfews. But a less obvious contributing factor might well have been that health attachés in embassy ranks have almost certainly not grown significantly in numbers since the late 1940s and remain far too few. Some serious research on this subject needs to be done urgently.

This post first appeared on the personal blog of Prof. GR Berridge and is republished here with permission.