Why we agree to disagree on global health crises

Healthcare: we all want it, we all say everyone else should have it too, but my goodness we disagree on how that can be achieved, writes Imogen Foulkes.

The fact that our health systems are not as good as they should be is reflected in the fact that the United Nations has embedded improvements in its sustainable development goals; SDG 3 aims to “ensure healthy lives and promote well-being for all at all ages”.

A noble ambition, which the UN believes can only be achieved by ensuring “universal health coverage and access to quality health care. No one must be left behind”.

But the fact is, health is a commodity, access to which tends to depend on how much money you have, and where you live. The United States is an economic superpower, yet millions of its citizens cannot afford health insurance. In low income countries, young women still die in childbirth because they have no access to basic antenatal care. In Europe, it is common now for the elderly to spend their entire savings ensuring just the most basic care during their last few years of life.

Healthcare was fraught with problems, inequities, and political dilemmas even before Covid 19, but the pandemic has thrown all those problems into even sharper relief, it has revealed systemic flaws from top to bottom. When you see that the best funded health services on the planet, the ones that can perform heart and liver transplants, buckle when faced with an infectious disease outbreak, you know something is very badly wrong.

Pandemic lessons

When the 194 member states of the World Health Organisation meet for the annual World Health Assembly from May 24, top of the agenda will be learning lessons from the pandemic, or as Suerie Moon of Geneva’s Global Health Centre puts it: “What do we need to do to fix a broken system? That Covid has shown over and over again is not functioning?”

Suerie joins me for our latest Inside Geneva podcast, together with Maria Guevara of Medecins sans Frontieres and Thomas Cueni of the International Federation of Pharmaceutical Manufacturers, to talk about what options the member states have in front of them.

We discuss the surprise US backing for intellectual property waivers for vaccines. Cueni explains why in his opinion it won’t provide a “single dose” more for low income countries desperate for supplies. Moon counters that IP waivers could, and probably should, be the foundation for a new “social contract” during global health crises, especially when, as with Covid 19, governments (taxpayers) have shouldered the financial risk of developing the vaccines.

Guevara warns that Covid 19 shows that we had become not only “complacent” but we are facing “a crisis of humanity” in which we do not respect one other, or one other’s equal right to health.

WHO’s future

The assembly is certain to discuss the World Health Organisation itself, amid calls for its reform. We already know the independent panel (IPPPR), set up to look at how we handled the pandemic, has recommended more powers for the WHO, giving it a global health threats council with the power to hold member states accountable, and a disease surveillance system which can publish information without the approval of the country concerned.

But will member states agree to this? The one thing governments really unite over is reluctance to give a UN body more power to criticize them. Moon recalls that, post Ebola, they were given the chance to make the WHO more independent from the countries funding it but chose not to.. 

And what of the pandemic treaty? At least 25 countries have backed it, calling for “greatly enhancing international co-operation to improve, for example, alert systems, data-sharing, research and local, regional and global production and distribution of medical and public health counter-measures such as vaccines, medicines, diagnostics and personal protective equipment”.

WHO chief Tedros backs such a treaty, probably calculating it will strengthen his hand if (or as most epidemiologists tell us, when) the next pandemic comes along. But big powers like the United States and China haven’t committed to a treaty yet, and Cueni of IFPMA cautions against rushing into the kind of binding international agreement that normally takes months if not years to negotiate.

Clearly, there are huge challenges ahead, still MSF’s Guevara argues that “Covid is an opportunity” that we must seize, above all to recognise that “our security depends on our solidarity”. And, since no one wants another year like the last one, with all the loss, grief, and hardship that has come with it, change and reform are really the only option, or as Maria puts it “we have no choice”.