Global governance for solidarity, science and solutions for all

The COVID-19 pandemic has thrust health to the centre of global governance, in steadily expanding ways. It demands that all leaders make the needed political choices in favour of solidarity, science and solutions that promote health for all and the social, economic and ecological benefits it brings.

Solidarity
The international spread of the COVID-19 disease and deaths in early 2020 led the World Health Organization, as the long-established, proven, valued central body for global health, to serve as the world’s first responder. It quickly declared a Public Health Emergency of International Concern on 30 January and a pandemic on 11 March. It sought to identify the sources of the virus and offered many forms of help.

Five days after the WHO declared COVID-19 a pandemic, the leaders of the G7 major democratic powers held an emergency summit on 16 March. Ten days later, the leaders of the G20 systemically significant states followed on 26 March, and made COVID-19 the centrepiece of their regularly scheduled summit in November.

United Nations secretary-general António Guterres declared the pandemic “the most challenging crisis we have faced since the Second World War”. The General Assembly called for solidarity and for equitable global access to medicines for all. The UN Development Programme supported UN teams to assess and minimise the impacts in 100 countries.

Led by the WHO, some global solidarity sprung up at the start.

Science
These leaders followed the proven science to focus first on the immediate task of protecting people’s lives and livelihoods. They supported the development of vaccines, and mobilised the doses, dollars and domestic manufacturing facilities to deliver them to the most vulnerable people. Investments in science led in record time to the invention and production of safe, effective, largely affordable COVID-19 vaccines. Solidarity and sharing among their teams quickly brought the benefits alive – and dramatically showed what solidarity fused with science could do.

Sharing these benefits equitably and globally was a much more complex and controversial political choice. Here the science spoke with a single voice – no one was safe until everyone was safe, because variants in unvaccinated countries and communities would breed variants that would penetrate the privileged bastions of the vaccinated to create new waves of disease and death. Following the science, the WHO quickly allied with key partners to create a new innovative mechanism – the Access to COVID-19 Tools Accelerator and its COVAX facility – to assemble doses and dollars to distribute to the poorest people in the poorest places on the planet as soon as possible. Support finally came from the G7 in June 2021, where leaders promised to provide close to one billion doses or the equivalent dollars over the next year. The G20’s special Rome Health Summit in May had endorsed the general thrust, but added “when domestic situations permit”. On 22 September 2021, a global COVID-19 summit mobilised over 850 million additional doses from the many participants there.

Nonetheless, solidarity fused with science was too little, too late to deliver the needed solutions to save millions of lives, control COVID-19 for all and cope with the many other diseases where the necessary action had been crowded out by COVID-19.

Solutions
The COVID-19 crisis showed that real solutions require a whole-of-science, whole-of-government and whole-of-society approach. The global governance delivered directly by some of the most powerful leaders potentially provided the authority and resources that combined into a coherent whole the front-line healthcare heroes, the entire supply chain and the institutional systems that enabled them to work. A critical component was the primary healthcare systems and the universal health coverage needed to combat COVID-19 and give everyone the highest possible physical and mental health.

Moreover, these leaders connected this current health crisis to the social, economic, ecological and political determinants of health, following the pioneering path set by the UN’s 2030 Agenda and its Sustainable Development Goals. They showed that health was a political choice at the highest level, and essential to protect and promote the lives, livelihood and well-being of everyone, everywhere. In 2021, global summit leaders started to make more of the right choices in these ways. The G20’s Rome Summit on 30–31 October promises to do more, pushed by the UN’s biodiversity summit just before and pulled by the COP26 climate summit immediately afterward.

Several of the biggest decisions must be made there, and at the special World Health Assembly soon after: delivering vaccine equity; strengthening the WHO’s finances, authority and independence, giving it new legal powers, ideally in the form of a new treaty for pandemic preparedness and response; and connecting care for nature and its living things in a single whole.

Combining solidarity with science to produce the solutions needed for all to survive and thrive requires that they make the right political choices for all. ▪