“Let’s remember that trust is restored when ordinary people feel the tangible benefits of policies designed to protect their lives and livelihoods.” Hans Kluge, WHO
The theme of this year’s World Health Summit (WHS), which took place from the 15th to 17th October, 2023 in Berlin, could not have been more appropriate for our (dire) times: “A defining year of Global Health Action”
As a first-time “WHS-er,” it could not have been better timing either.
Organized annually under the patronage of the German Chancellor, the French President, the President of the European Commission, and the Director General of the World Health Organization (WHO co-organized the summit for the second time), the WHS brings together politicians, diplomats, multilateral organizations, clinicians, scientists, the private sector, and civil society organizations. This year, 3500 attended the WHS in person, and over 12000 virtually.
The 370 speakers across 63 sessions – enriched the discussions around the polycrisis we’re currently experiencing. A defining moment- perhaps, though one which makes us wonder where to begin. “No one is safe until everyone is safe,” was a phrase echoed through the proceedings of the three days, but who is the “everyone” who counts? The mantra remains apt – though in the pandemic, it was more a rhetoric fig leaf, as you might recall. A much-needed reminder in our times was from Dr. Jeremy Youde, Dean at the University of Minnesota, who said, “health is inherently political… when we forget about politics and policy, we fail to understand how health and science get translated into action”. Even if Axel R. Pries, President of the WHS, admitted, “Here at the World Health Summit, we cannot solve political problems.” But he did call on all delegates to work towards ensuring health for all, in their various capacities.
Takeaways from the summit
Sessions at the summit covered a wide spectrum of topics with implications on health for all – climate change, equity, pandemic prevention, preparedness and response, universal health coverage, tuberculosis, digital health technologies, noncommunicable diseases, private-public partnerships, and antimicrobial resistance. In some ways, it was a three-day opportunity and experience to catch up with discussions on topics on the agenda. My interests converged around sessions on the pandemic accord, financing, tuberculosis, and antimicrobial resistance that I now use to summarize my personal five takeaways.
1. The world has never been more divided. Debates on issues affecting global Health, such as conflict, racism, climate change, and ongoing negotiations on the Pandemic Accord are more often than not perceived from a pre-determined narrow and tribal lens. Revelations and frustrations among delegates were palpable. The call for action became ever more urgent. Expectations for shared humility and humanity, even after the experience during the COVID-19 pandemic, felt far-fetched. The need for better preparedness and response to the next health emergency was expressed. And whilst this was agreeable to the majority, the urgency towards an agreeable PPR strategy felt lost among the other competing acute ongoing crises.
Discussions on the ongoing negotiations for the pandemic accord, reminded us that national sovereignty and self-interest still seem to come first (see the disagreements on intellectual property). Perhaps, as reflected by Hans Kluge, RD WHO EURO – the world has lost trust in each other – or even the benefits we could reap if we rebuilt trust. Christian Drosten, Director of Institute of Virology, The Charité, one of the co-organizers of the summit, noted misinformation and disinformation were always the first epidemic during an epidemic/pandemic. It was much needed advice (for the leaders) to deal with misinformation collectively – just if we can agree to what misinformation is.
2. Funding continues to be inadequate, inequitable, unpredictable, and inflexible- expecting the desired impact would be a stretch. Starting off with WHO funding.As you might recall, the “investment round” intends to broaden the funding base for WHO to include all donors, including non-state actors. There is indeed a case for sustained and flexible funding to empower WHO to respond to global health needs with greater autonomy, particularly in an increasingly polarized and crisis-prone world. However, the participants cautioned about potential conflicts of interest (you might want to look at the history of regulators and big pharma). WHO’s confidence that “investors will abide by its values” will no doubt be assessed at subsequent summits in Berlin.
Funding constraints and their impact on global health and disease eradication (such as those on eradicating polio and TB) were also discussed. Speakers were resolute about the need to increase funding to strengthen the health systems towards more resilient health systems. Community engagement, participation and the role of community health workers was highlighted, for example, towards strengthening polio eradication efforts in Pakistan. The UN High-Level Meeting on Tuberculosis arguably came up with some commitments, but the general feeling was nevertheless that 2030 will come too soon.
Even the private sector expressed the need for funding, especially in less-lucrative research and drug development areas for novel antibiotics. It was chilling to learn that 80% of the industries involved in the research and development of newer generations of anti-microbials are small and medium industries and struggle to stay afloat. As the world is faced with increasing antimicrobial resistance, there is a clear case for countries and non-state actors to invest! On the plus side, $455 million was fundraised for the Global Financing Facility (GFF) to continue improving the health and rights of youths, women, and children towards achieving Universal Health Coverage. A call for greater domestic financing on health was expressed, but in general, fiscal space in many LMICs remains dire, in the aftermath of the pandemic. An urgent solution to the debt crisis in many LMICs is vital.
3. Climate change and One Health. Within the context of new and emerging diseases (and pandemics), and facing increasing AMR, taking a One Health approach was argued for. Climate change and its impact on health and diseases was also discussed in many sessions. For example, malaria – it’s changing patterns due to climate change, growing resistance to existing therapeutics emerged. The discussions at the WHS provided a clear linkage between climate and Health – following on the just concluded World Bank/IMF annual meetings in Morocco, 9th to 15th October 2023, and preceding the COP 28 (in the UAE), 30 Nov – 12th December 2023. There was a general sense that failure to build resilience in the face of climate change would inequitably affect the vulnerable. However, options like debt interest restructuring are yet to be adopted, and so despite the fact that more African countries performed better than the big polluters on the clean air scorecard, the situation remains bleak for most of the continent.
4. The pandemic agreement is critical, but does everyone agree? Discussions on the ongoing Pandemic Accord negotiations highlighted an obvious need for a binding agreement, but only if it was a good one. The issue of intellectual property was repeatedly raised. Karl Lauterbach, German Health Minister, said, “without intellectual property protection, there will be no accord” – which sounded like a less than thinly veiled veto. The new draft text – shared earlier this week – manages to upset all sides– maybe that will be the beginning of coming to a compromise from all in the next phase?
5. The Global Health community sounded upbeat about the role and participation of the youth and women in the Global Health agenda: the WHS presented a lineup of remarkable young activists across the different sessions. I am optimistic about the overtures toward the youth. Dr. Alakija said, “Young people will save the world,” – dramatic, but the point was clear. The summit continued with the new tradition of recent conferences like the Global Adolescent Forum to engage youth leaders on the global challenges and provide a greater role for them in policymaking spaces. An inspiration to the youth came from Inger Ashing, CEO, Save the Children, who started as a youth activist at age 12. Women also played a key role at the WHS, among others with 52 % of the speakers. And the Equity 2030 Alliance was launched – a global effort to reshape gender equity in science, technology, and financing.
Conclusion
The WHS was an opportunity to build momentum from the UN High-Level Meetings – three major ones which were held in September 2023. True, for the time being, it’s not clear what sort of “momentum” can be spotted from the UN High-level meetings, and so it’s far from obvious how 2023 can be ‘defining’. And that’s not even taking account of the harrowing conflicts and disasters now becoming all too familiar in news bulletins. Yet, we have no choice but to try make the planet “livable” (borrowing from the World Bank boss) again, not the least for our children and grand children.
So yes, it is worth every shot to make this a “defining” year.