G20 and Global Health Architecture
Our management of health issues should get the maximum benefit from this world-class big event. Health problems that are in sight and become a daily burden need to be prioritized for treatment.
One of the outcomes of the 2022 Group of 20 Indonesia presidency is the launch of the Pandemic Fund, created in order to strengthen global health architecture. The Pandemic Fund is expected to address the global pandemic financing gap in the future.
The G20 is an international forum that focuses on policy coordination in the economic and development fields. The G20 represents the world's economic and political power, with the composition of its members covering 80 percent of the world's gross domestic product (GDP), 75 percent of global exports and 60 percent of the world's population. The G20 members consist of 19 countries and one region, the European Union.
The Indonesian presidency focuses on three priority sectors that are considered to be the key to a strong and sustainable recovery.
Indonesia holds the G20 presidency for one year (1 December 2021-late November 2022). Many activities have been carried out this year and the highlight of the activities of the Indonesian G20 Presidency is the Bali Summit which will take place on 15-16 November 2022.
As president of the G20, Indonesia carries the spirit of recovery with the theme "Recover Together, Recover Stronger". This theme was chosen considering that the world is still under pressure due to the Covid-19 pandemic, so it requires a joint and inclusive effort to find a way out or a solution for world recovery. The Indonesian presidency focuses on three priority sectors that are considered to be the key to a strong and sustainable recovery, namely strengthening global health architecture, digital transformation and energy transition.
Three reasons
On the official website of the Ministry of Foreign Affairs, it is stated that in the light of the current pandemic, global health architecture must be strengthened.
This is not only to cope with the current pandemic, but also to prepare the world to have better responsiveness and capacity in dealing with other health crises in the future. Actually, there are at least three important things related to the urgency of improving the whole world health architecture.
First, we know that the pandemic before Covid-19 was the 2009 H1N1 pandemic, which started on 11 June 2009 and ended on 10 August 2010.
After the H1N1 pandemic ended, in 2020 the World Health Organization (WHO) established the International Health Regulations (IHR) Review Committee. I am one of its members, along with 24 other world experts. Our team analyzed in-depth what happened with the 2009 H1N1 pandemic, how the world and countries anticipated it and what impact it had on human life. In conclusion: the world was ill-prepared for the H1N1 pandemic at that time.
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> Pandemic Fund Helps Overcome Disparity
From there, the world is then trying to improve in the face of the possibility of the next pandemic, by using the parameters contained in the IHR, an international regulation that was agreed upon in 2005. One of the efforts is to assess the health readiness of countries in the form of a Joint External Evaluation (JEE) which combines in-country assessments and international assessments.
The goal is to obtain objective data on the country's readiness to face a possible pandemic or major health problem. After this assessment, countries know the situation, and then make improvements so that they feel sufficiently prepared for possible health hazards.
However, in reality, when the world was hit by Covid-19, practically all countries turned out to be very overwhelmed and almost devastated. This means that various improvements made in the 10 years since the end of the H1N1 pandemic in 2010 have failed miserably. In fact, The Independent Panel for Pandemic Preparedness and Response team formed by WHO in 2020 came to conclusion that the world was "not prepared" to face the Covid-19 pandemic.
So, in 2010 the world was ill-prepared, and 10 years later in 2020, again, the world was not prepared. This means that if there is no improvement in the global health architecture, in 2030, or at some other time when a pandemic comes, the world will still not be prepared and we do not know what term or phrases will be used to describe "unpreparedness". Strictly speaking, this experience shows that the global health architecture clearly has to change.
The second reason why the health architecture must change is the situation during the Covid-19 pandemic itself. There are at least four incidents that show the urgent need for a stronger global health architecture, namely (1) an incident that was previously only in Wuhan, China, turned out to be unstoppable and hit practically all countries in the world.
Then, (2) various countries experience a lack of medical equipment. We remember when there was no oxygen, all the ventilators were used, and so on. This is happening in many countries without any quick mechanism to deal with it. As a result, it cost life.
Furthermore, (3) once the vaccine became available, it was clear that there were injustices and inequalities in distribution. Developed countries producing vaccines can get them easily and use them, even in a somewhat excessive manner, for their people. Meanwhile, developing and poor countries have to fight hard to get it.
In late 2020 and early 2021, the world is faced with the problem of discrimination and the politicization of vaccines. In fact, because this is a pandemic, all countries must be able to protect their people. If there are still any -- let alone many -- countries that have not succeeded in overcoming the pandemic, the pandemic will not end. "No one is safe until everyone is safe".
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> Continuous Commitment Needed for Pandemic Fund’s Success
> Management of Pandemic Fund Urged to be Inclusive
Then, (4) various variants and sub-variants of Covid-19 continue to emerge and quickly spread to various other countries. For example, the XBB and BQ1 subvariants are now attacking us and causing an increase in cases and deaths. It is not impossible that in the future there will also be other variants or sub-variants that the world needs to deal with together.
The third reason for the need for a new global health architecture is the threat of the future, both in the form of epidemics and pandemics. In 2022 alone, WHO has declared monkeypox as a "Public Health Emergency of International Concern (PHEIC)". In a situation where when the author was the director general of the Ministry of Health, the term "Public Health Emergency That Troubled the World (KKMMD)" was used.
Fortunately, so far, monkeypox does not seem to be too widespread and we can hope that the PHEIC status can be revoked and it does not become a pandemic. It can only be predicted that in the future there will still be PHEIC/KKMMD for other diseases.
In addition, what is more important is that we know for sure that there will be another pandemic in the future; however, we do not know when, nor what disease it will be. Experts predict at least three possible diseases as forerunner of the upcoming pandemic, namely (1) influenza -- remember, the big pandemic at the beginning of this century was influenza. Then, (2) zoonotic diseases related to animals – however, we do not know which animal will be the culprit, and (3) disease X, which we do not know yet.
New architecture
For these three reasons, it is clear that a new global health architecture is needed to address this. There have been efforts at various levels to strengthen world health. One aspect is that the world currently adheres to the IHR that has existed since 2005, which from the experience of Covid-19 does not seem to function optimally, so this regulation needs to be strengthened.
At the world level, on 1 December 2021, the World Health Assembly (WHA) world health meeting agreed to launch a world-historical process in preventing, preparing for and responding to pandemics. To that end, a negotiation forum was formed, namely the Intergovernmental Negotiating Body (INB).
It is hoped that by 2024 we will have some kind of new -- or updated -- international rule that will certainly strengthen the global health architecture.
The INB will discuss draft conventions, treaties or other forms of WHO international instruments in the field of pandemic prevention, preparedness and response. The INB has held meetings in March and August 2022; then, it will continue various negotiations. The results are targeted to be reported to the WHA in 2023, with the final results targeted for 2024.
If all goes well, it is hoped that by 2024 we will have some kind of new -- or updated -- international rule that will certainly strengthen the global health architecture.
Meanwhile, The Independent Panel for Pandemic Preparedness and Response team formed by WHO to review the Covid-19 pandemic has also analyzed in-depth and submitted seven recommendations to make the world's health architecture better and ready to face pandemics and other big health problems.
A very complete and comprehensive recommendation. First, increase leadership to the highest level to be able to respond to health threats, be accountable and involve related multi-sectors. From the experience of Covid-19, we know that the pandemic is not only a health problem, but also affects almost all aspects of life.
Second, the need for a fully independent WHO organizational authority with adequate funding support. Third, the need for investment so that all functions in preparation for facing health hazards run well, at the national, regional or global level.
Fourth, establishing a new international-surveillance system that can quickly and accurately detect developments or spikes in public-health problems anywhere in the world, especially those with the potential to spread internationally.
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Fifth, the availability from the start of a system (pre-negotiated platform) that guarantees the availability of the necessary medical equipment and supplies in the event of a supply shortage, as we experienced during the Covid-19 pandemic.
Sixth, growing the provision of a new financial system to anticipate the needs of the upcoming pandemic. This sixth recommendation was, among other things, answered in the G20 presidency of Indonesia by establishing a Pandemic Fund or Financial Intermediary Fund (FIF). Seventh, so that all countries can form a national coordination system at the highest administrative/authority level to be able to exercise their best rights in preparation for and response to a pandemic.
G20 Bali Summit Results
In terms of this global health architecture, the G20 health meeting of the Indonesian presidency presents five areas of activity, some of which are more or less in line with the recommendations of the international independent panel above. So far, it seems that the results in the health sector are still in the form of a Chair Summary, not in the form of a communiqué.
The first thing in Indonesia's G20 presidency in the health sector is strengthening support for the establishment of FIF. Second, there is a structured mechanism to mobilize essential health resources. Third, strengthening genomic surveillance, as well as using a collaborative platform for sharing pathogenic data for better pandemic preparedness and management.
Fourth, strengthening support for a common platform in connecting various digital systems of health-document certification, including vaccines and diagnostic results, to facilitate the movement of people and goods.
Health problems that are in sight and become a daily burden need to be prioritized for treatment, for the sake of the health of the nation's citizens.
Fifth, expand the network of global research and manufacturing centers. It is hoped that this expansion will enable countries, particularly lower-middle income countries, to have better access to vaccination, treatment and diagnostics.
From the results of the discussion of the G20 health architecture in the Indonesian presidency, we have at least three hopes. First, the results can actually touch the main basic elements needed by the world so that the earth's population can live healthier and more prosperous lives, according to the third goal of the Sustainable Development Goals (SDGs) for the achievement of "health and well-being", not just health in a narrow sense.
Second, if it is in line with the needs of the whole world, these results must really be implemented in the field. At the end of November 2022, Indonesia’s G20 presidency will end. Therefore, from the outset it must be designed, and there is also a clear roadmap on how to implement and monitor it in the future so that in the years to come it will really benefit world health.
Third, it is hoped that the important outcomes of the G20 and on the world level, especially regarding health issues, will also have an impact on our country. Our management of health issues should get the maximum benefit from this world-class big event. Health problems that are in sight and become a daily burden need to be prioritized for treatment, for the sake of the health of the nation's citizens.
Tjandra Yoga Aditama
Tjandra Yoga Aditama, Director of Postgraduate Yarsi University/Professor of FKUI; Former Director of WHO Southeast Asia; Former Director General of P2P and Head of BalitbangkesThis article was translated by Kurniawan Siswo.
