Think7 Policy recommendations on global health

The Covid-19 pandemic has increased the pressure on our health systems, clearly revealing how much investment in resources and planning is still needed to develop health systems that are resilient, equitable, efficient, and sustainable. The pandemic highlights the necessity to allocate funds towards prevention, training, and communication activities: greater public attention towards health risks can help promote virtuous changes, including sharing contents and information that act as a guide for the population. This policy brief identifies five pillars on which governments should invest to increase the preparedness and sustainability of health systems. It describes actions that the G7 should take to support countries and ensure harmonized policies, coordination, and exchange of information to avoid repeating previous mistakes with future health threats.

The COVID-19 pandemic has clearly demonstrated the importance of surveillance data in detecting and responding to an infectious disease event. Disease surveillance data is currently a mélange of types and sources, of differing validity and usefulness. Today, the primary source of surveillance data are healthcare providers, laboratories, and local health departments. However, relying on these sources alone can miss events in populations that may not be able to access quality healthcare. There are myriad proposals for using new technologies, but few that integrate critical humans who can interpret data and find the signal in the noise that requires action. There is no comprehensive structure for rapidly and equitably collecting and analyzing data needed to extract actionable insights that will inform decision-making to mount a robust response.  But even more critical are many disincentives – economic and political – that prevent transparent sharing of essential data from traditional and nontraditional sources.  It is vital that emerging and re-emerging infectious diseases with outbreak and pandemic potential can be identified faster. Time matters. Delays lead to loss of lives as well as economical and societal disruption.

Vaccine inequity has devastated millions of lives globally. It has not only impacted citizens of poorer countries who are unable to access vaccines but also people in more industrialised nations as access became stratified across race, income level and geographic location. Ultimately, the uneven rollout has affected the entire international community as variants continue to proliferate and raise the possibility of reduced vaccine efficacy against COVID-19. This inequity is a symptom of the larger malaise of uneven and skewed health systems, affecting economic development and, social stability. Thus, this moment is critical for both financial and moral reasons, providing the G7 with the opportunity to rethink and to act on equitable vaccine access and health priorities. This issue paper is set in the context that the worst effects of the COVID-19 pandemic may be waning (Murray, 2022) but there are stark warnings of increased occurrence and severity of pandemics in the future due to rapid and chaotic urbanisation, climate change and deforestation (Thoradeniya & Jayasinghe, 2021). It is therefore crucial that the next pandemic does not catch us unprepared as this one did, and we avert the tremendous toll on lives, livelihoods and societies. A vaccine delayed is a vaccine denied. The present injustice and vague promises should be replaced by genuine action to save lives—all lives. The c urrent course of action will not contain transmission of the virus and we need continued joint collaborations and initiatives if we are to progress towards an equitable world.

Building resilient health systems starts with human resources for health. The demand for health workers is rapidly growing with increased income, the increasing pace of medical advances and with the urgent need to correct severe imbalances between and within countries in the availability of health care workforce. Yet, supply does not match demand in an increasingly globalized health labour market. The global shortage fuels the global mobility of health professionals. The G7 and the international community must address the challenges of expanding labor supply as well as financing and regulating health labor markets.

All world leaders are committed to the goal of Universal Health Coverage (UHC) – whereby everyone should receive the health services they need without suffering financial hardship – yet the COVID-19 pandemic has undermined progress towards UHC in almost all countries. COVID has exposed insufficient investments in public health and key population groups have been left behind in many national responses. While global scientific solidarity and collaboration to tackle the pandemic has been impressive, the task of ensuring sufficient production and equitable allocation of the resulting technologies has clearly failed. At its 2021 summit, the G7 failed to address vaccine inequity, resulting in some experts calling for the summit to be its last. It is vital that in 2022 the G7 put global health at the top of its agenda and act across a number of priorities to ensure it fulfils its universal health commitments.

The unchecked growth of drug-resistant infections – which are increasingly hard to treat – is a silent pandemic with long-term consequences for global public health and the global economy. According to recently released data published in the Lancet, at least 1.27 million people died of drug resistant infections in 2019. Antimicrobial resistance (AMR) also threatens the viability of surgical and curative medical interventions, such as chemotherapy. It is no longer a threat with future consequences, but a complex existential emergency of infections by multiple microbes. Many countries lack access to existing antibiotics, while in other countries rising rates of resistance require new treatments that have not yet been developed. Drug-resistant infections are a long-term challenge for which governments, including through G7 leadership, as well as the private sector, and civil society, must construct a durable infrastructure to prepare and respond. One pressing concern is for this infrastructure to ensure sustained research and development of novel antibiotics that address priority infections, and responsible access to novel and existing antibiotics to save lives and assure the long-term viability of such critical countermeasures.

COVID-19 produced a health crisis and exacerbated a democracy crisis. Members of the Group of 7 and other democracies were unprepared for the pandemic, and many responded poorly to it. Nearly twenty years of G7 global health leadership did not prevent G7 members from contributing to multilateralism’s failure during COVID-19. The pandemic also made the global decline in democracy worse. COVID-19 has raised questions about the relationship between democracy and health with which the G7 has not grappled. The G7 must do so now because democracy’s credibility on global health is badly damaged. The way forward includes fulfilling existing COVID-19 commitments made by G7 members, critically evaluating the COVID-19 responses of G7 nations, creating G7 ministerial and engagement groups on democracy, and identifying how to use development assistance for health to defend and advance democracy.

COVID-19 exposed the disparities in basic healthcare coverage and a human’s ability to thrive. While it affects everyone on the planet, the disparity across countries is stark due to access to vaccines, basic health systems, and increasingly, data. In fact, the Lancet FT Commission recognized digital technology as “a social determinant of health”. Examining social determinants of health makes apparent that the uneven distribution of and access to technology and data can make a significant difference to health outcomes. Government’s’ ability to implement a whole of society approach when designing digital infrastructures, systems, and services, protecting and using the data from those systems to make health decisions will be a key factor in addressing global inequity. Building on the G7 Patient Access to Health Records and the G20 Ministers Declaration on the role of Digital Health in the Pandemic Response, to address the key challenges facing health and society, we must make the necessary investment in reusable digital infrastructure and services. We must do it in a way that builds the local capabilities to ensure technology tools empower people, strengthen systems, and minimise potential harms.

Covid-19 has put the lives of millions of people at risk, creating uncertainties and heightening existing fragilities, particularly where social inequities and inequalities are most pronounced. Global health requires equitable, inclusive responses, informed by research, data and evidence. Existing global health research infrastructure is afflicted by weak institutional mechanisms and perpetuation of evidence hierarchies and silos and excludes and devalues different knowledges and lived experience. Major challenges include unevenness of financial support to global health research, evidence generation, and learning, policy engagement with too narrow a range of evidence; and insufficient investment in infrastructure for promoting international learning and exchange of health-related knowledge, evidence and data. Recommendations for action by G7 members to address these challenges include: (1) a jointly negotiated quota of 0.5% of G7 members’ national GDP for R&D funds administered through multilateral channels; (2) establishing a centralized health research clearing-house with joint governance for communication and action; (3) establishment of Pandemic Centres of Excellence  in all world regions providing collaborative, regional mechanisms for medical research, social science research relevant to health, and vaccine production, distribution and delivery; (4) support to collaborative research networks that represent different forms of knowledge and experience, and use a diversity of research approaches and methodologies; and (5) investment in adaptive, agile national and regional systems for monitoring, early warning, and crisis preparedness, underpinned by open data and digital utilities. The paper also offers practical suggestions for implementing these recommendations in the short, mid and longer term, including G7 members working jointly with the UN, G20 and other international actors to join a global call for a 2023-2032 UN Decade for Health Research.

We are at a tipping point: the health of the world’s people and the health of the planet’s natural resources on which all life depends are facing unprecedented threats. The human led drivers of economic development, industry and globalisation are causing climate change, pollution of air, soil and water, and biodiversity loss year after year, and these in turn are destroying the animal and human health gains of the last century. In the Anthropocene where humankind have made the world an insecure and precarious place to live, planetary health provides a framework to take rapid, globally-connected action, setting  a system in place which can steer the individual investments towards universal health coverage, pandemic preparedness, climate neutrality, clean air, and the reduction of poverty and inequality. The common goal of healthy people flourishing on a healthy planet, which is the vision of the Sustainable Development Goals, is a necessary pursuit.  To achieve this we suggest that the G7 utilises planetary health to create a global framework expanding on One Health initiatives. Such a framework can be supported by the G7 in the form of i) better coordination between health and environmental agencies, ii) the development of standards and indicators for planetary health, iii) the better alignment of new global health monitoring initiatives and iv) the prioritization of planetary health in the new pandemic treaty.

As new variants keep the Covid-19 pandemic raging in many countries, the worldwide race between vaccinations and mutations may yet be lost: with more uncontrolled infections, further mutations are more likely to emerge, especially when unvaccinated hosts with weak immune systems allow infections to last longer. Transmission to vaccinated hosts can then facilitate the selection of mutations that “escape” the vaccine-induced immune response. To win that race, the worldwide campaign for vaccinations must be redesigned to exploit economies of scale more efficiently. But popular calls for patent waivers are misguided; they risk damaging the incentives for continued vaccine innovation efforts on which the world depends in fighting against SARS-CoV-2, other existing epidemics and future pandemics. Instead, the G7 should help convert the existing Covid-19 Vaccines Global Access initiative (COVAX) into a more generously endowed global fund that instead of – as it was de facto forced to do, against initial intentions – merely acquiring rich countries’ surplus vaccines and relying heavily on unpredictable donations, acquires the most promising vaccine patents in what is known as a patent buyout, aiming to offer free production licenses to all technically qualified vaccine and generic drug manufacturers around the world. This Policy Brief spells out detailed steps the G7 must take, and the funding for COVAX they must provide, to achieve this turnaround in the worldwide fight against the pandemic. It also argues the proposed patent buyouts would be more efficient than the draft compromise on patent waivers that India, South Africa, the EU and the US have recently negotiated and that is now waiting for approval by their respective governments and EU member countries and thereafter by all member countries of the World Trade Organization (WTO).