Life-Saving Exchanges: Tuberculosis and the Need for U.S.-Russian Cooperation

Tuberculosis (TB) is an airborne, infectious disease that infected 8.6 million people and killed approximately 1.3 million worldwide in 2012. UNAIDS has summed up this situation by concluding “TB anywhere is a threat everywhere.”

Although TB is curable, the challenges of controlling the epidemic include the emergence of multidrug-resistant strains, HIV-TB co-infection, and a lack of an effective vaccine. Identifying solutions to these daunting challenges will require international partnerships in which experienced health professionals and scientists work together to identify innovative solutions. Despite the frosty relationship between the governments of the Russian Federation and the United States, Russian scientists, public health officials, and clinicians have unparalleled expertise in TB control, particularly treatment for MDR-TB, that would be helpful to international initiatives. Recent political tensions, combined with a new law that makes it difficult – possibly even dangerous –  for Russian non-governmental organizations to receive financial support from international donors, have caused many potential partners in the U.S. and Europe to hesitate to work with experts based in Russia. 

A new report published by the Center for Strategic & International Studies (CSIS), U.S.-Russia Health Engagement: Still on the Agenda, argues that such collaboration remains both “feasible and valuable.”(1) Writing in The Practice of Public Diplomacy, Elise S. Crane offered a similar argument stating that “it would be a mistake to overlook a region still plagued by authoritarianism.” She asserted that outreach to “Russia’s populace must be a priority.”(2) Dr. Judyth Twigg, the author of the CSIS report, points out that even during the darkest days of the Cold War, the U.S. and the Soviet Union found reasons to cooperate on public health initiatives such as the campaign to eradicate smallpox and the development of the polio vaccine. According to Dr. Twigg, Russia has provided significant support to U.S. global health priorities and has the potential carry out global health-related work in areas where the U.S. is not as effective, such as in parts of the Islamic World. 

Rather than reducing the number or scope of collaborative initiatives, Dr. Twigg believes that now is the time to strengthen relationships with Russian NGOs through global health-focused professional exchanges.(3) Exchanges have long been the public diplomacy tool of choice for achieving progress on health issues. For example, HealthRight International organized an exchange for Vietnamese health professionals and government officials to visit and learn about successful HIV treatment and prevention models in St. Petersburg, Russia in 2008. The lessons learned in St. Petersburg were then used to develop similar programs in Vietnam. More recently, a delegation of Russian medical researchers participated in a professional exchange with immunology and epidemiology experts while visiting Children’s National Medical Center, the National Institutes of Health, and the National Institute of Allergy and Infectious Diseases through the 2013 Open World program. Vera DeBuchananne, Program Manager at the Open World Leadership Center, has seen how both visitors and hosts benefit from the exchange of information and ideas.  According to DeBuchananne , professional exchanges introduce all participants “to new lab procedures, best practices, and…ways of consulting and assisting each other in their research projects.”(4)

Diplomacy experts have also referred to exchanges as “the most successful element of public diplomacy.”(5) In their systematic review of public diplomacy recommendations made to U.S. policymakers between 1999 and 2005, Susan B. Epstein and Lisa Mages found that the majority recommended expanding U.S. exchange programs.(6) Unfortunately, Carol Bellamy and Adam Weinberg concluded that exchanges “tend to be grossly underestimated in terms of the scalability of their impact.”(7) According Giles Scott-Smith, the myriad of global social contacts obscures the value of exchanges so much that their worth is often questioned.(8) As a result, public diplomacy practitioners are now required to demonstrate the quantitative and measurable impact of their proposed exchanges (9), which is difficult since such types of evaluation often involve measuring performance against a pre-determined goal.(5) For exchanges to succeed, however, they must be independent and devoid of political intent.(5) 

While the true impact of most exchanges can only be seen over a long-term period and their value is not always captured through quantitative evaluation, professional exchanges seeking to reduce the global burden of disease can yield measurable outputs. Moreover, reducing the threat of epidemic diseases like TB requires the collaboration of medical professionals and changes in social attitudes and behaviors that only professional exchanges implemented via civil society participation can achieve.(10)  

In conclusion, effective interventions for TB must include a wide range of perspectives and professional exchanges, which are a useful tool that can facilitate international collaboration. The urgent need to include the expertise of Russian professionals in international efforts to control the global TB epidemic must override U.S. and European reservations about partnering with colleagues based in the Russian Federation. Eight million lives depend on it. 

References

(1)    Twigg, Judyth. U.S.-Russia Health Engagement: Still on the Agenda. Center for Strategic and International Studies: Washington; 2014. 

(2)    Crane, Elise S. “Finding the Right Media Formula – from the Soviet Union to Russia” in The Practice of Public Diplomacy: Confronting Challenges Abroad ed. Rugh, William A. Palgrave: New York; 2011. P. 200

(3)    Interview with the author.

(4)    Interview with the author. 

(5)    Scott-Smith, Giles. “Mapping the Undefinable: Some Thoughts on the Relevance of Exchange Programs within International Relations Theory” in Public Diplomacy in Changing World.  American Academy of Political and Social Sciences: Philadelphia; 2008. P. 173-195. 

(6)     Epstein, Susan B. and Mages, Lisa. “Public Diplomacy: A Review of Past Recommendations.” CRS Report for Congress. September 2, 2005.    

(7)    Bellamy, Carol and Weinberg, Adam. “Educational and Cultural Exchanges to Restore America’s Image.” The Washington Quarterly 31: 3 (2008). P. 55-68.    

(8)    Scott-Smith, Giles. “Exchange Programs and Public Diplomacy” in Routledge Handbook of Public Diplomacy ed. Snow, Nancy and Taylor, Philip M. Routledge: New York; 2009. P. 51

(9)    Snow, Nancy. “International Exchanges and the U.S. Image” in Public Diplomacy in Changing World.  American Academy of Political and Social Sciences: Philadelphia; 2008. P. 214.  

(10)    Riordan, Shaun. “Dialogue-based Public Diplomacy: A New Foreign Policy Paradigm?” in The New Public Diplomacy: Soft Power in International Relations ed. Melissen, Jan. Palgrave: New York; 2005. P. 187.

****Image created by Julia Nagel. © 2011 by the Center for Strategic and International Studies (CSIS).