Global health reform or revolution?
(MENAFN – Daily Outlook Afghanistan) The governing body of health ministers of the World Health Organization has answered the call from dozens of world leaders for a new international treaty for preparedness and response to pandemics, and will hold a special session in November devoted to such a treaty. This is a positive step. But the global response to COVID-19 and adequate preparation for future pandemics requires much more.
As the COVID-19 crisis has shown, the current global health infrastructure is simply not up to the task of managing – let alone preventing – a pandemic. But the pandemic has also shown that we must not just focus on epidemics of infectious diseases. We must also respond to the pandemic of inequity that the crisis has highlighted.
Each year, more than 16 million people in low- and middle-income countries die from preventable causes. The vast majority are relatively poor, have limited access to education, are marginalized or live in low-income countries. In other words, as the WHO Commission on Social Determinants of Health pointed out over a dozen years ago, “social injustice kills people on a massive scale”.
The only vaccine against this pandemic is a global health infrastructure based on the principles of equality and human rights. Beyond dramatically reducing preventable deaths, such an approach would vitally complement the proposed treaty to strengthen global pandemic preparedness and response. This is why we are advocating for the Framework Convention on Global Health (FCGH), another proposed treaty, based on the right to health. The right to health goes beyond responding to emergencies like the coronavirus epidemic to embrace the responsibility of ensuring universal access to the underlying determinants of health, such as nutritious food and preventive care . As long as these factors are ignored, poor and marginalized populations will continue to suffer disproportionately from diseases like diabetes and hypertension, which increase the risk of complications and death from other diseases, like COVID-19. The right to health also demands accountability, including independent monitoring, redress for violations, and political solutions to prevent recurrence. This would reduce corruption and lead to stronger health systems that protect health workers and the public, use funds efficiently, and allocate services and resources equitably. This last point is crucial. Marginalized populations, such as migrants, are likely to depend on public health systems. Yet the health facilities that are accessible to these communities are often irresponsible or under-resourced. In a system based on the right to health, resources would be allocated on the basis of need, rather than wealth or relationships, leading to more equitable health outcomes. Fairness and accountability are essential to public trust, which in turn is vital to reducing vaccine reluctance and ensuring broad compliance with public health measures, such as mask wearing and social distancing, during epidemics. Participatory decision-making and a sense of public ownership of health systems would also promote confidence. The FCGH would support the creation of such health systems by setting clear and meaningful standards, such as the full inclusion of marginalized populations. It would also provide countries with useful tools and guidance, including comprehensive roadmaps, national action programs and impact assessments. And it would include concrete commitments for countries to make progress in building health systems based on the right to health. These commitments would also take into account the commitment of the private sector. For example, the FCGH could oblige governments to include in contracts with private entities provisions guaranteeing universal access to the medical technologies (such as vaccines) they develop. This can be achieved through affordable prices, sharing of technology and know-how, openness of data and licensing. A national and international funding framework, adapted to national contexts through participatory processes, would help ensure sufficient resources. Such a treaty would be reinforced by a comprehensive accountability regime, including independent monitoring and reporting, strategies to overcome implementation gaps, and creative incentives, such as favoring top-performing country nationals for leadership positions. in global health. Realistic sanctions – including the diversion of international health aid from governments to NGOs responding to areas of non-compliance – would also be needed. A treaty specifically focused on pandemic preparedness and response could certainly improve global health security and even equity in, for example, access to vaccines. It is therefore good news that the international community is moving in this direction. But the COVID-19 crisis has revealed more than our lack of pandemic preparedness; He also exposed the extent of systemic inequalities in health and how these inequalities can exacerbate a public health crisis, putting everyone at risk. By enhancing cooperation, accountability and fairness, the FCGH would improve global health security, including helping to prevent new threats to public health from gaining traction. This is why world leaders urgently need to initiate a process to establish the FCGH.
As Tedros Adhanom Ghebreyesus pointed out in March, a pandemic treaty would strengthen the international health infrastructure. But the FCGH was going to transform it.
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