A global health agenda for G-20

The objectives of the group are to achieve global economic stability and growth to prevent future financial crises through risk-reducing regulation, and create a new financial architecture. While global health is not explicitly a part of this mandate, it is very clear that financial stability and growth can only be assured if the health of populations is protected and promoted. Otherwise, national and global economies will keep slipping on the banana skins of public health failure. 

While G-20 represents countries with large economies, it is also clear that the contemporary design of global development intricately connects the health of all countries in an inter-dependent manner. If this was not adequately recognised before, the Covid-19 pandemic has made it abundantly clear. The flip side of globalisation is the breakdown of supply chains in a pandemic situation. Clampdown on mobility within countries cramps production while exports are shackled by transport restrictions. Demand for goods and services too goes down due to job and income losses. Economic slowdown, too, becomes a global contagion.

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The pandemic also brought us another reality check. Despite proclamations of global solidarity and emphatic affirmations that ‘no country is safe till every country is safe’, many high-income countries were reluctant to share vaccines equitably. They opposed moves to waive patent rights on vaccines, drugs, and diagnostics needed to combat the pandemic and imposed trade restrictions on the supply of needed raw materials that could be used by vaccine-producing countries like India for large-scale manufacture of effective vaccines for global supply. 

Vaccine inequity cost the vaccine-rich, high-income countries too. Highly transmissible and prior immunity-evading variants emerged from under-vaccinated populations, to sneak back into the countries which had taken multiple boosters and trigger fresh waves. Even when vaccines were supplied as aid, they were often too close to the expiry date and beyond the capacity of understaffed health systems to deliver them on time, as observed in several African locations.

As G-20 meets under India’s presidency, these lessons must translate into the earnest affirmation of the need to protect global health as a common commitment, with appropriate financial investments for strengthening health systems everywhere and assurance of access to needed health technologies to all populations without undue delays and unsurmountable price barriers. This calls for a well-distributed network of global production facilities, so that supply chain constraints can be eased and distribution, too, is managed efficiently with knowledge of national health-system capacity and local community profiles.

Countries can no longer afford to treat health security and health systems as separate and siloed issues on the global health agenda. The World Health Organization defines health security as “activities required to minimise the danger and impact of acute public health events that endanger people’s health across geographical regions and international boundaries.” This is an inadequate definition since non-acute conditions—such as climate change, air pollution, food insecurity, anti-microbial resistance, and chronic non-communicable diseases (which as co-morbidities contributed most to severe disease and death even in Covid-19)—also pose a danger to health security. Absence of efficient and equitable health systems that provide assured universal health coverage (UHC) is a major cause of health insecurity, which cuts across acute and chronic health conditions.

Under India’s presidency, G-20 is prioritising several of these areas. Health emergencies are being examined under the lens of international cooperation in pandemic prevention, preparedness, and response. One Health surveillance of microbial migration across wildlife, veterinary populations, and human communities is being accorded high priority to reduce the risk of future zoonotic outbreaks that can acquire pandemic potential. Laboratory capacity for genomic testing needs to be scaled up, and data sharing speeded up. Anti-microbial resistance, a mounting threat even in non-pandemic times, gets aggravated due to increased antibiotic misuse when viral infections surge. This, too, is on the G-20 agenda. 

Easy access to, and affordability of, essential vaccines, therapeutics, and diagnostics (VTD) will be a priority for G-20. These have to be effective, safe and quality assured. Support for the development of scientific and technological capability across the world calls for knowledge sharing and financial co-investment by high-income countries to enable the abundance of intellect and enterprise in low- and middle-income countries to blossom to their full potential. The establishment of widely distributed production facilities for VTDs will be a good beginning. With a robust domestic pharmaceutical sector, India can be a role model and technical resource.

Unless the capability of health systems is enhanced across all countries, neither pandemic threats nor regular health needs of the population can be effectively met, to confer health security. This calls for co-investments in building a multi-layered, multi-skilled health workforce that can serve the whole world, instead of rich countries poaching trained professionals from others.

Opportunities provided by innovative digital technologies for advancing primary-care-led UHC must be optimally utilised. Point of care diagnostics, clinical decision support systems on handheld devices, telehealth services, electronic health records, real-time microbial and disease surveillance, development and clinical trials of new treatments, health workforce assessment, and supply chain monitoring can be greatly enabled by digital health technologies. With growing expertise in this area, India can lead this agenda in the G-20. The G-7 gave impetus to global health from a sense of shared vulnerability. The G-20 must give it momentum through shared values of global solidarity and health equity.

Author is cardiologist, epidemiologist, and distinguished professor of public health, PHFI

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