Overview of the relationship between science diplomacy and pandemics
Science diplomacy is the collaborative efforts by local and global entities to solve global issues using science and technology as a base. In science diplomacy, collaboration takes place to advance science but science can also be used to facilitate diplomatic relations. This allows even conflicting nations to come together through science to find solutions to global issues. Global organizations, researchers, public health officials, countries, government officials, and clinicians have previously worked together to create effective measures of infection control and subsequent treatment. They continue to do so through sharing of resources, research data, ideas, and by putting into effect laws and regulations that can further advance scientific research. Without the collaborative efforts of such entities, the world would not have the vaccines and treatments we now possess for diseases that were once considered deadly such as tuberculosis, tetanus, polio, influenza, etc. Historically, science diplomacy has proved successful in diseases such as SARS, Ebola, Zika and continues to be relevant during the COVID-19 pandemic today.
Plague, yellow fever, and cholera.
Following the Congress of Vienna in 1815, a new era of international trade and cooperation began in Europe. The Habsburg Empire, the United Kingdom, Russia, and Prussia, as the victors, used their power to enforce quarantines. They met weekly in Paris and prevented the spread of plague and yellow fever in Europe.
Outbreaks of plague and cholera in the Ottoman Empire led to the creation of the Constantinople Council of Health, which included European members. Plague was endemic to the Ottoman Empire at this point, so the Austrian Empire had a border zone with the Ottoman Empire and did not allow passage except at places where quarantine was possible. The Ottoman Empire used European knowledge to decrease the spread of disease.
While quarantine became a common practice by the mid-fifteenth century, it was frequently used to further political ends. Even though it was unclear whether quarantine was effective, it was still used by European states during an outbreak of cholera in European Russia in 1830. Quarantine measures were highly impacted by commercial interests, however.
The government of Louis Phillipe in France suggested international guidelines for quarantine to prevent their use for political gain. M. de Segur Dupeyron, as part of this government, studied quarantine and found that outbreaks of plague were directly tied to commerce. As such, quarantines were effective, but their unsystematic nature made them unduly oppressive. He suggested banning arbitrary increases in quarantines.
The French government took heed and spent many years attempting to arrange an international meeting. The first International Sanitary Conference occurred in 1851. It lasted six months. However, different nations had different goals: England and France wanted a decrease in quarantines to promote their commercial and colonial interests while Mediterranean countries wanted to maintain quarantines for their recognized public benefit. Much of the convention was spent debating whether cholera was contagious and whether quarantines were effective against cholera. The convention was signed by only France, Portugal, and Sardinia.
There were a total of nine International Sanitary Conferences that focused on cholera, occurring from 1851 to 1894. Eventually, the International Sanitary Conferences led to the formation of the World Health Organization in 1948.
1918 Influenza Pandemic (Spanish Flu).
The 1918 influenza pandemic, also termed the Spanish flu, constituted the most severe infectious viral outbreak in modern history, prior to the spread of COVID-19. Emerging in March 1918, in the final months of World War I, the Spanish flu proliferated as global efforts to contain the virus fell short to wartime antagonism. Despite its name, the virus was first recorded in Kansas, U.S., and rapidly spread amongst American soldiers located at Camp Funston. Close quarters of the barracks made for a perfect environment for the virus to spread, and soon the virus began appearing in other parts of the nation as soldiers were assigned across the nation. As America was mobilizing to enter fighting in World War I, infected soldiers were sent to France, facilitating the spread of the illness across Europe, with trenches making for perfect incubators for the virus. Despite guidelines set by the U.S. government for using face masks and quarantining, and exchange of information between Allied governments about the virus, censorship and suppression of information allowed for the virus to devastate Europe. In an era uniquely fraught with international hostility and belligerence, science diplomacy experienced limitations in its ability to facilitate information sharing and coordinate responses to the outbreak, yet it also enabled international collaborations among scientists and public health officials to mitigate the effects of the pandemic.
Pandemic Disinformation and Censorship.
As the war continued to enable the spread of the influenza throughout Europe, European powers underplayed the severity of the outbreaks. Governments strove to preserve military morale and prevent mass panic, and they often encouraged the press to publicize false information, or outright prohibited publicity regarding the Spanish flu. During the first major wave of the flu, British newspapers and public officials dismissed the virus as a threat and deemed it unpatriotic to be concerned with the flu rather than the war. In Italy, Corriere della Sera, an Italian newspaper, was prohibited from publishing death tolls. During the second wave of the Spanish flu, Great Britain continued to suppress information about the spread of the disease. For example, the British press suppressed news that the prime minister had caught the disease.3 In addition to maintaining patriotism, countries did not want to appear weak or vulnerable to their enemies. General Erick Ludendorff, a German military general, failed to report that there had been a major outbreak within his troop. The same was true for the United States. Though the U.S. Army's medical department recognized the severity of the pandemic and encouraged public health precautions such as quarantines, other higher-up officials, including the president, prevented these measures from being taken. The pandemic was also leveraged to promote hateful rhetoric towards enemy nations. Rumors spread that the Germans were behind the flu. Governments across the world, including that of the United States, spread disinformation, censored data publication, and refused to implement precautionary measures until it was too late. This shortcoming in science diplomacy allowed the Spanish flu to claim more lives than it should have.
Interplay between the 1918 Pandemic and World War I.
The complex interplay of the pandemic and the war makes it hard to claim one was more significant than the other. On one side, the spread of the virus resulted in more casualties and decreased morale amongst the soldiers, but on the other, the movement of troops and wartime censorship allowed for easier spread of the virus. To a large extent, the outcome of the pandemic and the war would not be the same if the other factor was missing.
The flu is believed to have first emerged in the United States, where military men trained and awaited their deployments. Once shipped off to Europe to join the fighting, many of the men unknowingly carried the influenza virus with them and facilitated its spread. While both the Allied and Axis powers were damaged by the spread of influenza, the American military more effectively treated and isolated its sick soldiers as compared to German military. The lack of medication and knowledge regarding the virus, along with the German troops' waning strength and comparatively inferior organization skills, all contributed to the forceful and damaging effects of the pandemic on the Axis powers. Scientists and historians agree that the 1918 influenza pandemic definitively weakened the German ranks and helped lead to their eventual defeat.
During the war, medical innovation and discovery was stalled due to the need for healthcare workers to serve as medics and nurses and to support the Army. Additionally, laws prohibited information exchange regarding the pandemic or war efforts. This meant that scientists between nations on opposing sides of the war could not communicate with one another and share details about the virus. This further delayed research regarding the flu, including its epidemiology and treatment methods, as no country had a complete understanding of the pandemic and science diplomacy was effectively hindered.
Public Health and Scientific Advancements.
Etiological knowledge and scientific information regarding the Spanish flu was limited, and a shortage in pharmaceutical and preventive interventions, including immunizations, antiviral medications, or antibiotics for targeting secondary bacterial infections, impeded efforts to contain the virus. Many international and federal health agencies did not monitor the disease, and, in the United States, for instance, there was no requirement for medical officials to report cases of the flu. Consequently, the spread of the pandemic largely outpaced the development of effective international, national and local policies.
Nevertheless, previous scientific advances in germ theory and microbiology informed public health policy to some extent. Oceanic islands imposed quarantines, and Australia remained largely sheltered from the pandemic during its first wave in 1918. Face masks were enforced across nations including Japan and the United States, though not without public opposition. Across the U.S., social distancing measures were introduced. However, there was no international enactment of a coordinated pandemic response, and collaborative exchange of scientific and pandemic-related knowledge remained restricted. Thus, implementation of public health policy was inconsistent across the globe, and different nations suffered from the pandemic to varying degrees.
Despite wartime polarization, scientists and public health officials managed to mobilize science to assist with the pandemic response across geopolitical boundaries. The British Medical Research Council brought together international scientists to study the epidemiological and virological basis of the Spanish flu. In subsequent years, these cooperative efforts contributed to the development of experimental vaccinations for “influenzal pneumonia,” a bacterial infection secondary to the Spanish flu. Global efforts to develop an influenza vaccine continued into the decades following the 1918 pandemic and were bolstered by alliances between North American and European research scientists. While science diplomacy was not yet formally established as a discipline, its principles were exemplified in the coordinated efforts between international scientists and public health policy officials to respond to the 1918 Influenza outbreak.
The tragic consequences of the Spanish flu pandemic imparted valuable lessons on the need to integrate science and policy for addressing issues in international affairs. The League of Nations, developed in 1920 for the promotion of world peace following World War I, was accompanied by the establishment of a specialized body that would encourage global cooperation to prevent the spread of infectious diseases, such as the Spanish flu, and respond to public health crises. Formally titled the Health Organization of the League of Nations, this agency mobilized scientists, researchers, public health officials, policy makers, and legislators, to coordinate international efforts that ultimately laid the foundation for the modern World Health Organization.
Severe acute respiratory syndrome (SARS).
The 2003 severe acute respiratory syndrome (SARS) pandemic is often labeled the first pandemic of the 21st century. It initially appeared in China at the end of 2002 and quickly spread to more than two dozen countries in North America, South America, Europe, and Asia. The virus that causes SARS is known as SARS-associated Coronavirus (SARS-CoV) and is highly contagious, producing sometimes fatal respiratory illnesses. It can easily spread through close person-to-person contact. In 2003, the World Health Organization (WHO) reported a total of 8098 infections and 774 deaths. Only 8 tested positive for SARS-CoV in the United States at the time. The collaborative efforts by organizations, countries, researchers and public health officials all over the world led to containment of the virus within about 5–6 months. WHO first announced a global alert for a severe pneumonia-like disease on March 12. Measures taken by WHO ensured that consistent reports regarding countries most affected by the outbreak were received. WHO's collaboration with other organizations such as media outlets, UN agencies, and Global Outbreak Alert and Response Network (GOARN) allowed for identification of locations with new SARS cases. WHO also utilized the Global Public Health Intelligence Network (GPHIN), developed for WHO by Health Canada, to improve the speed of outbreak detection and advance the response time.
Immediate action was taken to implement proper containment measures when outbreak locations were identified. WHO also partnered with GOARN to dispatch teams of experts into areas heavily impacted by SARS such as China, Hong Kong, Singapore, and Vietnam. These experts represented around 20 different organizations and 15 different nationalities and worked in several sectors to contain the virus. Epidemiologists of varied backgrounds also worked together to review the measures to control the spread of the virus