Opinion: The end of global health advocacy as we know it

The COVID-19 pandemic is a health crisis of unprecedented proportions that has brought countries to their knees. It is a lived nightmare, during which we witness daily death tallies, individual financial ruin, and national economic collapse. Health advocates and practitioners are rightly focused immediately on doing everything in their power to mitigate the impact of the virus and save as many lives as possible. But in the few moments of pause we can find, we are also asking ourselves an important question: What is our responsibility to channel the current global attention on health toward building a brighter and healthier future?

A number of health champions and scholars have offered their ideas in recent weeks, issuing challenges for how we approach the crisis at hand and foster cooperation across international health investments and programs overall.

Recommendations range from statements of principles to an outright rejection of the existing global health architecture. The question now is how those of us pushing political leaders for policy change make sure our demands are heard and heeded to make a difference both now and for the long term. What are the proposals and parameters we put in front of them to take action that best serves those most in need of critical resources and support around the world?

Firstly, we need to renew and further build on a systemic approach to achieving healthy lives and well-being for all.

The COVID-19 pandemic is a systems crisis. All around the world, health systems have been pushed to, and in many cases beyond, breaking point. Not only does this limit a nation’s ability to treat those infected, but the disruption to other essential health services inevitably leads to further — and potentially more severe — loss of life. While every country can, and should, strengthen their preventative measures, there is only one defense measure against future epidemics: strong, resilient health systems everywhere.

This isn’t new to the global health community. In recent years, and in line with the establishment of the Sustainable Development Goals, the politics of health advocacy has shifted from a disease-specific focus to calls for sustainable, systemic change.

Last September, the United Nations High-Level Meeting on Universal Health Coverage marked this shift, but failed to galvanize the substantial funding needed to ensure everyone has access to the essential health services that they require. Still, that meeting highlighted the potential to unite health advocates across silos towards a common aim.

COVID-19 offers us two avenues from here: reversing this trend or strengthening our unity and resolve to respond and recover on a systemic scale. We choose the latter.

Secondly, in order to deliver this ambitious aim, we have to reexamine the make-up and governance of the current global health architecture.

This isn’t to say things were all wrong in the first place. Global commitments to international health initiatives such as polio eradication have been noble and essential, achieving gains hardly imagined possible in a matter of decades. We can and should very much build on that progress and what has clearly worked. Still, it needn’t be perceived as mutually exclusive from a transformation agenda that rethinks some of our critical assumptions of foreign assistance and priority needs.

There have been recent discussions at the Global Health Council about how health stakeholders should better coordinate and what role each of the different global health institutions can and should play in dealing with international health emergencies such as COVID-19 and for achieving longer term health goals.

As special initiatives emerge to address the pandemic leveraging existing mechanisms, the key question for each institution will be how it responds to the quickly changing world while not losing focus on its core mission, and whether there is room among them for a new model that can work beyond whatever limitations persist.

Meanwhile, it is critical that every institution engages meaningfully with civil society and affected communities, to ensure a relentless focus on the poorest and most marginalized.

Thirdly, we also recognize the need to extend our focus beyond the health architecture and connect beyond our own communities.

While advocates battled for health for all in one U.N. room last September, in neighboring halls, climate advocates were demanding global action. COVID-19 provides the strongest incentive yet to break down the divide between these spaces and engage meaningfully across both movements.

Surely, no one can reasonably deny the obvious linkages between global health security and climate change, a connection long emphasized but often ignored. The challenges to such an integrated approach might range from political to logistical, but that doesn’t mean we shouldn’t be pursuing a more collaborative mission and message akin to what the 2030 Sustainable Development Agenda demands of us.

Over the past year, we have been building on such new partnerships. We’ve been seeking opportunities to sync messages, align objectives, and integrate our agendas in a mutually supportive way. We’ve extended our horizons beyond the World Health Assembly and other health fora to the U.N. Climate Change Conference, or COP26. In light of COVID-19, now more than ever, we need to redouble these efforts and work together toward a truly sustainable and shared vision for healthy people and planet.

Lastly, these new approaches and priorities demand that we also refresh our narrative, in order to inspire a broader set of champions for our cause.

In recent years, global health has experienced waning political support and public apathy. But, now, COVID-19 has defined the meaning of “global health” to millions around the world in a very personal way, experienced both locally and globally. Not only do many crave a sense of safety but also equity and solidarity on which we could capitalize.

How then, with a world that is listening, do we ensure that we sustain and direct this political and public attention for long-term change?

We need a participatory and mutually beneficial approach to communication across our own communities, practicing the maxim “nothing about us without us.” Earlier this year, Action for Global Health set out to do just that, convening U.K.-based advocates and global colleagues to jointly forge a new narrative to engage the U.K. public on global health.

We sought to inform U.K. perspectives with those of health advocates from around the world, particularly in low- and middle-income countries, to identify the foundation concepts that can unite us all, in order to build a strong global health movement. At the dawn of a new age, we have to work together to drive understanding and support of health for all and leave no one behind.

It is also time to move beyond the moral imperative or socioeconomic value of global health investments to a new framework and narrative emphasizing shared leadership, collaboration, and local ownership.

This approach will better reflect today’s realities and opportunities for meaningful, collective action grounded in each country’s respective needs. Furthermore, acknowledging widespread inequities across settings and the application of international principles or programs in a domestic context could motivate even more influential actors to champion our efforts.

In thinking about how we “build back better” from the COVID-19 pandemic, we are focusing on several broad opportunities for evolution that we propose will set us on the right path.

We believe that the way we unite to defeat COVID-19 now will frame our mutual understanding of what is possible for the future. We hope you will join us in making this transformation a reality.