Building resilience and trust in global health governance

These two intertwined factors account heavily in how every health system functions. Global institutions have various critical contributions to make in establishing both

Resilience and trust are critical components of global health governance, especially amid the escalating crises of our times. Resilience means quickly recovering from shocks or setbacks and having recuperative power. Trust is a firm belief in the reliability or truth or strength of a statement, person or system, but also the obligation or responsibility of people for those entrusted to their care.

Resilience gives global health governance, systems and people the ability to continue functioning when disaster strikes and to adapt when new pandemics or diseases arise, to add to the burdens on those whose resources already struggle to meet existing needs. Trust allows people to follow the advice of their healthcare providers, the latest evidence of their scientists, and the guidance of their political leaders who are ultimately responsible to protect and promote the health and well-being of all. Governments and their taxpayers must trust that the new resources they provide to national, regional and global health institutions will be spent in the most effective, transparent and accountable ways, to deliver the best results for all. This is also true for all global governance institutions, given the many social, economic, ecological, digital and security determinants of health.

The United Nations galaxy

At the centre stands the United Nations galaxy of international institutions. It starts with the 2030 Agenda’s 17 Sustainable Development Goals, where SDG 3 on health is the furthest from being met, and where the Summit of the Future in September 2024 could provide a major boost. It embraces the UN General Assembly’s high-level meetings on health, the World Health Organization and World Health Assembly as the core dedicated organisations, and the World Bank, International Monetary Fund, International Telecommunication Union, African Union and African Development Bank. It extends to the newer institutions and instruments, led by UNAIDS, the Global Fund, the Pandemic Fund, the prospective Pandemic Agreement and the revised International Health Regulations. Their creation and continuation show the ongoing need to build trust and resilience, and for others to contribute to the task.

The G7

Building resilience and trust ultimately requires a whole-of-governance approach and thus leadership from heads of state and government at their plurilateral summit institutions. Those leaders have the authority to make ambitious agreements directly and quickly, raise the needed resources, and ensure that their governments comply with the commitments they make there. A major responsibility thus lies with the G7 major democratic powers, formed in 1975 and acting directly on health since 1979. At their annual summits, G7 leaders have now made 1,002 collective, precise, future-oriented, politically binding health commitments. Most recently, in June in Apulia, Italy, they produced 24 health commitments, slightly below their per summit average of 28 and well below the peak of 85 they made in Japan in 2016. Their governments have complied with their leaders’ health commitments within a year at an average of 78%, leaving a gap of 22%.

G7 leaders can – and should – do much more. Together their countries possess a predominance of the global capabilities required for global health, notably in finance, scientific capacity, and the intellectual property and supply chains for vaccines and pharmaceuticals. They have previously made major contributions, notably by joining with the UN in 2000–2001 to launch the Global Fund to Fight AIDS, Tuberculosis and Malaria and leading a major advance on maternal, newborn and child health in 2010.

Yet the G7 has done little on mental health, dementia and the other afflictions of ageing people, on digital and artificial intelligence–assisted health, and on protecting health in the face of today’s many deadly conflicts and catastrophic climate change. As leaders of often inward-looking democracies, G7 governors are constrained by what their voting publics want at home, and will trust them to do abroad, to protect all in an intensely interconnected world.

The G20

The bigger, broader G20, made up of systemically significant states, with members equally from developed and developing countries, can also do more. They contain more than 80% of the world economy and two-thirds of its people. The G20’s mission is making globalisation work for all.
Since 2014, in response to the deadly Ebola outbreak in Africa, G20 summits have produced 166 health commitments, which secured compliance at an average of 70%.

In September 2023, the G20’s New Delhi Summit produced 25 health commitments, second only to the closely related 47 commitments on development. India’s follow-up G20 summit in November usefully focused on accountability for delivering them. Brazilian president Luiz Inácio Lula da Silva’s priorities for his November 2024 Rio Summit start with equality, with health as a key component. Still, except on universal health coverage and antimicrobial resistance, the G20 largely remains a responsive rather than a proactive, preventive body, subject to the all-too-familiar deadly cycle of panic then neglect.

Many key political choices are thus needed now to ensure that global health governance, at all levels, is sufficiently effective, resilient and trustworthy to meet today’s soaring needs.

Many suggestions about how to do so are contained in the following pages, where visionary leaders and experts from around the world identify actions to advance in eight key ways:

• strengthen pathways to equitable multilateralism;
• promote health and ecological well-being;
• build resilient health ecosystems;
• promote the social and emotional resilience of communities;
• establish safe digital infrastructure and trustworthy AI;
• expand sustainable investments in community resilience;
• ensure transparency, accountability and voice; and
• strengthen health diplomacy in the face of conflict and insecurity.