The global health architecture is increasingly under strain, to a large extent due to ensuing global health crises such as the Ebola and Zika outbreaks. The Ebola crisis in particular revealed serious flaws in the ability of the system to prevent and respond to global health crises. As the links between health, development, and security challenges become ever clearer, and the World Health Organization (WHO) is increasingly the object of criticism, the multilateral system anchored in the United Nations must address these issues with renewed focus.
On 8-9 February 2016, The Independent Commission on Multilateralism (ICM) convened a retreat on “Global Pandemics and Global Public Health” in collaboration with the Graduate Institute in Geneva (Read more about the work of the ICM and the sixteen issue areas that are the focus of its work here). The retreat took a holistic look at the global public health architecture. Participants identified and analyzed the main challenges —particularly in relation to global pandemics—and brainstormed on concrete recommendations as to how the multilateral system anchored in the UN can be adjusted to better respond to these challenges. Dr. Ilona Kickbusch, Director of the Global Health Programme at the Graduate Institute, delivered the keynote address for this event, which will be accessible on the ICM’s website. A brief summary of some of the issues discussed and recommendations made during this two-day retreat follows below.
A central point raised in the discussion was the issue of institutional silos as an impediment to sound and holistic policy-making, smooth implementation, and operational capacity. The siloed approach has effectively created an international system that is insufficiently prepared for – and reacts too slowly when – an outbreak escalates to a global health security threat. Further, the lack of adequate funding, including the lack of assessed contributions for WHO, hampers the international health system and in particular WHO’s ability to meet demands. Moreover, as the report of the High-Level Panel on Global Response to Health Crises, published the day before the retreat and a central topic of discussion, highlights: there is a need to improve the operational capacity of as well as accountability within and towards the WHO. It was argued that the lack of accountability is putting global health at risk as it is not possible to create strong multilateral frameworks for health without effective feedback loops. The High-Level Panel recommends the establishment of a High-Level Council to strengthen the accountability of health actors in WHO. Participants considered the idea of a new global health summit – perhaps in 2018 – as a forum to focus on the issues of finance and accountability. Towards this purpose, there are mechanisms of accountability on the domestic level that the multilateral system could support through bringing local community voices to the global response. A meeting of Ministers of Health and Ministers of Foreign Affairs could also be an opportunity to examine not only the Panel’s specific recommendations, but also the issue of state compliance with the International Health Regulations.
Similarly, the multilateral system’s role in capacity building for local and national health systems was highlighted as an important issue as many national health systems and first responders at the local level lack the necessary response capacities and infrastructure to cope with health crises. The discussion brought out a number of areas where the multilateral system could contribute to building robust health systems, such as investment in human capital; political commitment; community engagement; technology development; and international solidarity. It was also argued that, on the national level, there is a need to implement comprehensive public health policies, as many of the challenges transcend the health sector. The multilateral system should support the development of these inclusive and inter-sectoral national health policies and systems, as well as assist states in their implementation of the International Health Regulations.
In building robust national health systems, the importance of considering the intersection between emergency response and longer-term development work was also stressed. Here, a two-track response was argued as being central – development and emergency response must move forward at the same time and not be in competition. New pandemics should not take the focus – and funds – away from existing development projects for public health. It should not be forgotten that international and national investment in health goes beyond preparing for and responding to outbreak emergencies, but is largely about infrastructure and capacity building of comprehensive public health services that also can cope better when an emergency does break out.
A number of participants were critical of some of the findings of the High-Level Panel’s report. In particular, the fact that the report does not address the issue of health services in conflict areas was considered by some as a glaring omission as conflict zones are often characterized as “breeding grounds” for disease outbreaks. The possible need for a specific framework to deal with the specific challenges of delivering health care in conflict zones was raised.
The possible necessity for a Framework Convention for Global Health was also discussed and the idea seemed to gain quite some traction.
A key message that came out of the discussions is that WHO remains the right organisation to coordinate international policies and action in the area of global public health, but that the organisation’s operational capacity needs to be strengthened and complemented with existing and new partnerships, including regional organisations and the private sector. Increased funding will be required and the Panel’s recommendation for a 10% increase in assessed contributions to WHO from member states met the approval of several participants. However, the notion of partnerships was stressed as equally important. Other actors in public health, including regional organisations, NGOs, and the private sector are geared towards creating innovative solutions, and establishing stronger relationships with them would likely enhance the ability of local-, national- and global-level health systems to respond to outbreaks. For example, there is a role for pharmaceutical companies to partner in detection, treatment, research, and development Such partnerships have worked in the past because they attract more resources, are often more flexible and result-oriented . However, it is important to guard the global public health agenda from being driven by the private sector. Many participants warned that because national and multilateral health budgets are under strain, there is a chronic reliance on private capital, philanthropies and NGOs, which is not a sustainable option to ensure adequate investments in global public health. While many recognized that the use of military assets can be of great value during pandemic outbreaks, this came with a strong caveat about the use of military assets in conflict areas.
Although there seemed to be a general consensus that WHO must remain the epicenter of the global public health architecture, the retreat’s discussions confirmed that there are multiple areas that urgently need to be effectively addressed and adapted in order to improve that architecture and its capability to prevent and respond to health crises.
The discussions at the retreat will feed into further work by the Commission on this topic. A discussion paper will be published here for comments; as well, a webcast Public Consultation will subsequently be held in the coming months. The paper and the feedback from these consultations will then feed into the Commission’s final report.
Written by Anette Ringnes for the GHP newsletter
Research Assistant, International Peace Institute
Photo: Suzie Hoisington, Oldendesigns.etsy.com