Concerns over disease outbreaks — and the threat they pose to international security — will for the first time feature prominently on the agenda of the upcoming Group of 20 summit. A coalition of development and relief agencies is using the opportunity to push global leaders for stronger commitments to improve health systems in some of the world’s poorest countries.
The annual summit, which was first convened in 2008 and includes governments of 19 countries along with the European Union, traditionally focuses on finance and economics. But the German government, which is organizing the July 2017 meeting in Hamburg, has found plenty of room for global health on its agenda. In addition to appearing among German Chancellor Angela Merkel’s priority issues, there will also be a pre-summit meeting of health ministers — the first of its kind for the G-20.
Previous G-20 summits have addressed individual epidemics, but public health professionals and advocates are urging the forum to widen its lens to include health systems, which form the first line of defense in emergencies. They hope the effort might ultimately help advance universal health coverage, which campaigners argue would provide the best guard against future epidemics.
“The problem isn’t the outbreak, which is an inevitability that will happen,” said Frank Smith, who heads the No More Epidemics campaign. “The problem is the capacity of the system to identify the threat as a threat and to respond effectively.”
Global health advocates say it is no surprise health has finally risen to the summit level. They point to the recent outbreaks of Ebola and the Zika and the looming threat of antimicrobial resistance — the emergence of viruses, diseases and other microbes that are resistant to first-line treatment. Beyond the immediate danger to human life, states increasingly understand that an outbreak in even the most remote location has the ability to disrupt economies and undermine security in countries across the globe.
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Scientists have said, for example, that Asia only narrowly avoided a catastrophic yellow fever epidemic when an already devastating outbreak that began in Angola in December 2015 spread earlier this year to China — a country where virtually no one has been immunized against the disease.
“These public health emergencies of international concern help elevate the issues on the G20 agenda,” said Dr. Yanzhong Huang, the senior fellow for global health at the Council on Foreign Relations. “For health ministers, you could always make the argument that health affects economic development, economic growth. But they have got to convince financial ministers, government leaders on the importance of health.”
It is increasingly clear that they have made their case. The 2014 meeting in Brisbane, Australia, took on the Ebola outbreak and last year’s summit in Hangzhou, China, included a discussion about AMR.
Global health advocates want the G-20 leaders to broaden those discussions.
“They are still focusing on the extreme case, rather than getting ahead of the issue,” Smith told Devex. His No More Epidemics campaign launched in 2015 with a coalition of aid and development agencies — Management Sciences for Health, Save the Children, International Medical Corps and the African Field Epidemiology Network — aiming to increase outbreak prevention efforts, especially in poorer countries where health systems are traditionally weaker.
That was the case in southern Guinea in late 2013 and early 2014, as the Ebola virus spread undetected for months. After failing to contain the early cases, the virus moved into neighboring Liberia and Sierra Leone and other regional countries, before eventually reaching Europe and the United States.
No More Epidemics has launched a global advocacy campaign to highlight the importance of better health systems in epidemic prevention. The G-20 has become an early and important target.
Specifically, the coalition hopes to see commitments to improve existing mechanisms for assessing global health security risks and improving individual country reporting capacity. Those analyses will help identify some of the immediate gaps, even as advocates leverage the political support to find funding for more systematic improvements to health systems around the world.
“We need upstream investments to prevent outbreaks from becoming epidemics,” Smith said. Through the approaches they champion and the resolutions they adopt, the G-20 leaders can “create conditions for the possibility for technical solutions to move forward. We want to get the right set of commitments at the highest level.”
Ultimately, campaigners hope to bring the G-20 in line with existing international health targets, including the Sustainable Development Goals. They argue that achieving the ambitious health-related targets laid out in the SDGs, which include access to quality healthcare and to affordable treatment and vaccines, would significantly reduce the risk of future, unchecked disease outbreaks.
Early indications from the July summit are promising. Detailing her list of priorities for discussion earlier this month, Merkel wrote that an assessment of efforts to improve health systems is “a fundamental prerequisite for safeguarding against outbreaks of diseases with pandemic potential.”
A German health ministry spokesperson declined a request to discuss what officials specifically hope to accomplish during the ministerial meeting. But Health Minister Hermann Gröhe pledged ahead of the summit, “A global health policy is going to be a hallmark of our country’s international responsibility. Only if we cooperate can we really prepare the world for future health crises.”
Katri Bertram, the head of advocacy and policy for Save the Children Germany, attended a two-day discussion earlier this month to help set the agenda for the health ministerial meeting and the subsequent summit. She said the emerging interest in health has been “wonderful to see,” though she worries the agenda remains “too narrow” and too focused on responding to individual outbreaks.
Betram said she is hopeful that sustained lobbying throughout the summit from No More Epidemics will ultimately pave the way for G-20 countries to push for stronger health systems and, eventually, universal health coverage.
“There is a lot of openness from the government’s side to communicate on [global health] in a slightly broader way,” she said. “We’ll have to see in the language of the communiqué.”
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