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The World Health Summit 2022: Taking Global Health to the next level?

The World Health Summit 2022: Taking Global Health to the next level?

By Kristof Decoster
on October 20, 2022

Frankly, it was good to be back in Berlin for the World Health Summit 2022, the ‘multistakeholder governance platform I love to hate”, especially after the gloomy Zoom years of Covid. The autumn colours of the city provided a nice backdrop for global health discussions, even if I personally didn’t enjoy the (mandatory) FFP2 masks much. While I understand the logic behind them (well, not during the lunchbreaks obviously, when they were eagerly dropped 🙂 ), they aren’t exactly good for my (already fairly limited) schmoozing skills. When I have ‘that thing’ up, I just don’t feel like talking much in the first place.

Unlike in 2019, in those happy pre-Covid times, when Bratwurst and cakes were ‘all around’, the food was a bit (too) politically correct to my taste this time. The coffee sucked as usual, and yes, it was once again raining ‘Gamechangers’ at various sessions, even if the mood was a bit gloomy in most discussions, in line with our grim times. More on that below. To stay a bit sane (both physically and mentally), I had to alternate between the small (often cramped and hot) rooms (room Asia!) and the more spacious and cool Virchow plenary room. Anyway, so much for the backdrop, let’s get to the global health business now.

As already mentioned by others, the joint organization with  WHO (while not being good for my overall Bratwurst & cake uptake), meant progress over previous years. I had, less than usual, a “Davos feeling” (even if it hadn’t totally disappeared), Big Pharma CEOs weren’t present anymore in the opening plenary (even if some of their powerful GHI ‘friends’ were still very much around, and guess what, Thomas Cueni, of all people, also still seems part of the ‘scientific committee’).  (quick suggestion for the organizers: then you might as well include me in that‘scientific committee’ 😊 ).

While the various themes of this World Health Summit  (Investment for Health and Well-Being, Climate Change and Planetary Health, Architecture for Pandemic Preparedness, Digital Transformation for Health, and Global Health for Peace) all got their share of attention and sessions, I still had the feeling that Pandemic preparedness & response (plus related global health governance questions) got most of the limelight. Not entirely avoidable, I guess, as we – frantically – try to “leave the Covid pandemic behind” (even if Covid itself won’t cooperate much, unfortunately (hence the FFP2 masks, among others), and the global health emergency architecture is being reshaped (including a FIF, an (upcoming?) pandemic treaty, ….). But yes, it might also have to do something with my own selection of sessions. In which Ilona Kickbusch was fairly “omnipresent” I have to say, in spite of her relatively advanced age (“good genes” I’ve been told 😊). Unlike mine, it appears. I celebrated my 50th anniversary while in Berlin, and as the conference progressed, I certainly felt like it : ).

A few personal highlights & common themes

Some personal highlights then, and themes perceived during the summit.

Many WHS participants were more aware than before of their privilege of being at such event. With ‘privilege’ comes responsibility & accountability, though (as both Mike Ryan & Jocalyn Clark put it, albeit in different terms). Mike Ryan mentioned, among others, that the WHS *has* to be more than just “speed-dating for consultants”, while Jocalyn Clark admitted, during a session on ‘healthy societies and populations’ (see also below) that it felt quite painful for her to be at such a posh event, when all around the world millions of people are suffering, and women in particular (referring also to the brave women in Iran now, who are risking their lives while going on the streets, at this very moment).

As already mentioned, the mood was a bit grim in some sessions (not unlike the current state of the world). Mike Ryan mentioned we’re “now in a permanent stress response”, and so health emergencies will continue in his opinion.  Karl Lauterbach (the German Minister of Health) reckoned that the likelihood of us ‘spiraling down’, due to these cascading and intersecting crises, is higher for the time being than ‘spiraling up’.   I can’t say I disagree with that dire assessment, unfortunately.

In another session, Peter Sands argued UHC is actually spelled as ‘T.A.X’ – not wrong either. Sands (and many at the WHS) seem to think that UHC is a national question, and thus mainly a (domestic) political decision.  Global institutions can only nudge a bit, no more. (Perhaps this is also one of the underlying reasons why the health systems pillar got so little money in the ACT-A PPP?)

Nevertheless, all these global health bigwigs (many of them the ‘usual suspects’) said, with a view on PPR but also in general, lofty things about the need for UHC, resilient health systems (esp the importance of PHC), health workers in the frontline (the real ‘heroes’ they kept saying)… but in the end, when the funding flows, the same patterns as with ACT-A (pillars) seem likely again, unfortunately, in the years to come (although Germany does seem to focus a bit more on HSS, in its new Global Health strategy).

Most European leaders & technocrats I saw and listened to ( like Sandra Gallina, “not my cup of tea”, I have to admit, pretty much like Ursula von der Leyen, whom she seemed to replace here; or Charles ‘One Ealth’ Michel ) kept emphasizing all the good things the EU is doing now, or will do in the near future (including support for regional manufacturing, we’ve clearly “all seen the light now”), the many blessings of Team Europe, and the lofty values and principles they want to see included in the pandemic treaty (and in the upcoming European Global Health Strategy). They kept rather silent, however, about the blatant European selfishness shown in the pandemic (hoarding vaccines, and obstruction on TRIPS waiver etc; by the way, apparently now they seem to be going for a re-run of these “stonewalling tactics” on  diagnostics & therapeutics  ). In short, it amounted to a silly attempt to ‘rewrite history’, so to speak. I doubt Africans will be impressed (and neither will they forget what “really” happened during the pandemic).  But true, it wasn’t just the EU, obviously.

Related to this, I found it quite striking to see how Mike Ryan forcefully defended ACT-A (& COVAX), at least when it came to its design.  He said there wasn’t much wrong with the design of these mechanisms, and put the blame squarely on selfishness of rich countries and the greed of Big pharma. While we obviously agree with the latter, some would argue the design of ACT-A (and COVAX) also had (major?) flaws.

As always, I also got impressed by charisma of certain leaders & role models (whom you get to see for real at these sorts of high-level dialogues, instead of via media). I already mentioned a few above (Jocalyn Clark, Mike Ryan), but Tedros was of course effective as always on stage ( PS: I personally also enjoyed his Kofi Annan/ “Morgan Freeman” anecdote), the humble John Nkengasong (who won the first Virchow prize), who certainly more than deserves to be called a ‘brother’ by Tedros ( who should, in general, perhaps be a bit more stingy with using this term), …. And there are many others.   Conversely, others got a bit carried away by their own egos sometimes (but I will stay (global health) diplomatic here, and so not name people :) ).

Meaningful engagement with civil society and youth was also a key theme. On the former, Tedros said a new Civil Society Commission is currently being set up at global level, but he also argued this meaningful engagement should take place at the three WHO levels – globally, regionally but certainly also, at national level. Easier said than done, as we all know.

The Financial Intermediary Fund (FIF) was mentioned heaps of times (the money isn’t following so far, though …). By the way, everybody agrees we need to find another name for that thing (with ‘Pandemic Fund’ perhaps a simple and neat option); and also the ACT-A transition and more in general, the post-Covid global health architecture, got their share of attention in the sessions I attended.

As for ACT-A, I tend to agree with Helen Clark & Kazatchkine’s assessment (well, at least I think it was Kazatchkine), who mentioned in the ‘Ports to Arms Approach to Access: Supercharging ACT-A for Future Pandemics’ session that ACT-A hasn’t delivered equitable access – or at least not enough. Arguing we thus need something else to prepare for the next pandemic (while keeping ACT-A perhaps in place till then). Basically saying, in other words: we shouldn’t ‘supercharge ACT-A’, we need another model.

As for the (somewhat notorious) FIFA-WHO relationship, in a session on Sunday, only the pros were mentioned, not the cons. But hey, I got to see Didier Drogba, as well as a very inspiring testimony from a Paralympic athlete. The discussion on whether the obvious advantages of capitalizing on sports stars (via FIFA) for ‘getting all of us to move’ outweigh the disadvantages for WHO of working with an organization that has a certain ‘reputation’, to put it mildly (as well as with sports stars being paid indecent amounts of money while the global precariat is struggling or worse), will be for some other time, I guess.

A key theme, though perhaps still not prominent enough, was also the importance of the ‘pivot’ towards prevention and social determinants. Tedros sees this himself as part of his three-pronged approach towards ‘taking global health to the next level’, and it was also front and center during an evening session on healthy populations & societies.  In a session chaired by Robert Marten that had to compete with alcohol (the reception had just started 😊), panelists argued how important this change and necessary paradigm shift really is. Let’s hope next year it’ll indeed be prominently part of the main stage, at the opening plenary. As I agree:  such a paradigm shift is absolutely essential, also with a view on creating a positive narrative (and some much needed hope) for this “polycrisis” age. Indeed, I doubt the young will be inspired by ‘ever more resilience’ (which seems to be the preferred option of the many big shots) to deal with the intersecting and cascading crises that characterize our age….  Somehow, we have to find a way “to spiral up”. And  hope  and a positive narrative are indispensable for this, otherwise we might as well all already book our cozy ‘spot under the ground’.

The – very impactful – intervention by the Scientist Rebellion at the opening  plenary shows perhaps part of the way.   As others said, you will need the raw energy of civil society (like in the HIV battle) to actually make real progress in the years ahead. In this day and age, that certainly includes the likes of Extinction Rebellion et al. We have to refuse to think these –  i.e. healthy populations and healthy societies – are just utopian ideas. In fact, the paradigm shift is crucial to tackle all these crises, otherwise dystopian scenarios most certainly await us.  Or as many others say, ‘Health for All’ now requires Planetary & One Health thinking, if not we can forget about it.  By the way, it was good to see also dr Tedros now talking about the ‘existential threat of climate change’ (something he didn’t do much in his first term). On a side note: while I agree with his closing plenary message of John Lennon’s “Imagine”, we do need a cooler song – certainly for the new generations.

Some final thoughts and remarks

Some final thoughts, then, in no particular order.

My own feeling about this so called ‘World Health Summit’ is that it should either rotate (continents), as Ngozi Erondu first argued on Twitter ( the main event, I would argue, not the regional branching off), or else drop its claim of being a ‘World Health Summit’ altogether, and instead use the term ‘Regional Health Summit’. For planetary health reasons, I tend to think it’s better most participants join either via train (and so best come from Europe), and zoom. But that only makes sense if the WHS drops its current claim of being a ‘World Health Summit’. (Yes, I hear you think, ‘won’t happen’ 😊)  By the way, if you do rotate, let’s also just do this once every two years, not every year (also for planetary health reasons, and as many of the discussions aren’t that ‘new’, if held every year, even if the world is changing fast).

On another note, some influential global health people mentioned there’s a time for polarizing and also one for building up, claiming that now it’s probably time for the latter (on ACT-A, for example). To be honest, I doubt that’s the case already. I’m afraid far more revolution & activism are needed, given the huge ‘political economy’ behind our unhealthy societies & populations (in the words of the World Bank’s Pablo Uribe). “We need to be more aggressive, disruptive, provocative”, he said.  I would add, paraphrasing Tedros, in order “to really manage to take global health to the next level”.  

Yet, as Ilona Kickbusch mentioned, among others in the closing plenary, in times of geopolitical divides, it’s even more difficult now to find a global health governance that more or less functions…. During an earlier session, Björn Kummel (also with multifocal glasses, I suspect, being from my generation 😊 ?) already noted that everybody seems to agree on the values (equity, resilience, accountability, inclusiveness…. you name it), but it’s not yet clear how all these different elements and initiatives in the global health (emergency but also broader) architecture can be made more coherent, and find synergies. (PS: Mike Ryan preferred the term ‘ecosystem’ over ‘architecture’, among others as it feels more ‘dynamic’ as a term)  In another session, M Ryan also stressed that in times like these (with cascading crises, and many new stakeholders (including Big Tech)), WHO needs “to take more risks” than in past decades.

Germany’s new chancellor, Olaf Scholz, wasn’t very impressive ( among others, he kept banging on about the difference between Neanderthals  & Sapiens in his opening address for reasons not entirely clear to me). In his own troubleshooting intervention, trying to restore order (with the  activists from Scientist Rebellion making a hell of a noise outside), he didn’t “feel” (like Bill Clinton would have), “the pain” of the young activists outside. Quite the opposite actually.

And yes, The Wellcome Trust, Gates Foundation are still way too influential in fora like these (see the opening plenary, and during the Polio pledge). It was a bit weird to see all these global health people in the room clapping when the Gates Foundation announced its new pledge of over a billion to the polio eradication effort.  Whether you like it or not, this is still ‘Billionaire’s charity’, it’s not sustainable (and worse, the fact that a billionaire seems to be able to decide over lives, makes a lot of people really angry nowadays).  The Gates Foundation’s CEO, Mark Suzman, claimed in his address also that ‘we’re off track on the SDGs due to Covid pandemic, and so we need acceleration of partnerships… to accelerate the pace’ (duh, or is it huh).

One of the awkward Pharma “highlights” – though I wasn’t in the room myself – was probably when a Pfizer representative talked about all the nice things Pfizer did, in a so called ‘health equity & resilience session’. Guess Albert ‘Moonshot/Equity is our North Star’ Bourla would have been proud of her. By the way, they also love to talk about “partnerships to reach the ‘last mile’ ”, these pharma types.

But the ‘last mile’ is also stressed by others, sometimes for good reason. I actually agree with GAVI’s “zero dose agenda” (to reach the last ten % of children for routine vaccination), for example, and also Mike Ryan argued, correctly, “The last mile of delivery is the first mile of health security”.

On a side note, as Ryan said, the most resilient people are actually over there, in places like  Afghanistan, South Sudan refugee camps, ….– we will also have to learn from them, now that even (formerly more or less stable) parts of the world, like Western Europe, seem to move towards ever more  instability and crisis.

Covid, ‘the learning machine’ in the words of some, got plenty of attention, obviously – as the pandemic isn’t over (the WHO just said quite the same: “still an international emergency”   ), and we global health people just “love”  ‘to learn lessons’ : )

In a session on global health communication, Kai Kupferschmidt (a Science journalist I greatly admire, and apparently also a Twitter addict, though a far more effective one ) – admitted that scientific health communication has become more difficult in this time. Due to social media of course (polarizing, “shouting spaces” rather than communicating places (Ryan)) but there’s also the hunt for always new headlines by mainstream media (Ryan), the many personalizing attacks on public health people…   Pretty neat session, that one, expertly moderated by Gabby Stern (WHO).

Elsewhere, the Wellcome Trust’s Jeremy Farrar mentioned it’s more difficult than ever for our policy makers (24-hour news cycle, lots of crises, ….), in short, it’s a very challenging political environment. That is true, to some extent, but it’s also partly of our own (neoliberal) making in recent decades, the current (political) mess.   (by the way, happy not to be a UK Citizen these days, Jeremy 😊)

Everybody agreed, having learned a vital lesson in this pandemic, that ‘trust’ is essential – but how do we get to more trusting societies and polities? That seemed less clear. The Global Health Security indexes have certainly failed miserably in the pandemic, and so at the very least, updated indexes will have to incorporate ‘trust’ somehow.  

I also found the mRNA hub update session quite insightful, and there was some great moderation by MP Kieny  (whom I suspect might also do reasonably well as a stand-up comedian 😊).

As already flagged, this WHS was also characterized by three incidents. The environmental activists’  catchy action at the opening plenary, the treatment of the acting director of African CDC at Frankfurt airport (somewhat strangely (mis?) ‘managed’ also in WHS official statements), and the “Me Too case” during the reception. In the last two cases, I had the feeling that WHO (Gabby Stern, but also Tedros himself) communicated and acted more decisively than WHS organizers.

A last word perhaps on the ‘framing front’. The frame of “we need to reverse the SDG roll back’ is gaining momentum, it seems, but sadly, the ‘C’ word still doesn’t fall much in settings like these. The World Health Summit doesn’t seem quite ready to embrace post-capitalism, in spite of the (numerous) planetary health sessions here.  If “health is a political choice”, I would argue part of that political choice is to go ‘full speed ahead’ for a post-capitalist world. But maybe that’s just me.

By the way, now that pandemic security  is increasingly becoming part of national security in some rich countries (Germany, US, …) it seems only logical to get some of the required money from defense budgets then.   More in general, the “funding via ODA frame” needs to be replaced, as the frame and (shrinking) money are clearly not fit for purpose anymore in the polycrisis world of the 21st century.  Many suggestions are being offered, from taking big bucks from defense budgets, over a Global Public Investment approach, to Oxfam’s recently floated suggestion to impose windfall taxes on energy companies, for a loss & damage fund for LMICs hit by climate change….  and also the case made by some at the WHS to involve (and fund) multilateral and regional development banks much more in the SDG financing/Financing of GPGs agenda.  All of these would already go a long way in terms of solving the current grave ‘multilateral trust deficit’, I guess. (PS: I also listened in to a session from some investment bankers (as well as Gordon Brown), who still seem to believe in a more benign capitalism, where the trillions would increasingly flow and be directed to environmental, social, health and other public goods purposesfairy tale stuff, I’m afraid, certainly in a world on fire).

I personally don’t believe in a benign capitalism, or ‘rescuing capitalism from itself’. To take global health to the next level, we have to ditch it. Full stop.  

But that won’t happen at settings like the World Health Summit, it’s a fight we need to have all over the world, and in our daily lives.   

“Taking Global Health to the next level” will require no less.

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