To ensure global health security, include everyone
In a globalised world, we are all neighbours, which means our health concerns are intertwined. To keep us all safe, address global inequities and prepare for future crises, we must coordinate concerted multilateral action – on diverse factors ranging from debt to education
Mpox, like Covid-19, has reminded the world again of the fragility of public health, that an outbreak anywhere means danger for people everywhere. Thanks to huge advances in medical technology and in the understanding of what works in pandemic preparedness and response, however, this fragility need not be a fact of life. Global health security is not a distant dream. It is an opportunity that leaders can choose to realise. We even know how: include everyone.
The achievements made in the HIV response, which I lead for the United Nations, illustrate what success requires. Health security depends on protecting global public goods, not monopoly profits; on multilateral action to ensure all countries can resource public health; and on respect for all human rights for all people, preventing the repression of any community, so that all people can access the services they need to keep themselves and others safe. By applying these lessons, world leaders can deliver on their commitments to defeat the pandemics we face now and the pandemics we will face in the future.
Protect global public goods
Advances in medical technology are funded by huge public investment and huge public procurement, and are enabled by widescale voluntary community participation in research. They are not the fruit of any company’s solo effort.
However great any technology is, it will never reach all who need it if the decision about how much to produce, who to sell it to and how much to sell it for is made by one company alone. In the late 1990s and early 2000s, 12 million lives were lost because of delays in making antiretrovirals available in Global South countries. This was due to production being monopolised by a handful of companies in the North. More recently with Covid-19, over 1.3 million lives were lost due to a lack of technology sharing.
Today, it is thanks to the massively increased availability of HIV medicines as a result of generic production that over three-quarters of people living with HIV are on antiretroviral treatment. Now we have the opportunity of a game-changing new technology, an HIV prevention medication that only needs two injections a year. But it will only reach people who need it most – including young women in favelas in Brazil, or gay men in Mexico, if it is produced by generic manufacturers for people in all low- and middle-income countries in every region of the world, and the price per person per year is dramatically reduced.
The mpox vaccine, too, needs to be opened up to generic producers, as it should have been years ago. And the Pandemic Accord currently being negotiated by world leaders needs to include binding commitments to ensure that medical technologies are produced and distributed widely. Doing so will help protect people worldwide, because pandemics know no borders.
Ensure all countries can resource public health
Every advance in global health has depended on multilateral cooperation on resourcing. The HIV response would not have achieved the successes it has without transformational coordinated debt cancellation and aid.
Today, the fraying of global solidarity is undermining health systems and weakening the capacity of the world to prevent and manage crises. When half the countries in sub-Saharan Africa are spending three times more on debt servicing than on health, it should be obvious to leaders that the damage from these fiscal constraints endangers health security worldwide.
Coordinated significant debt restructuring and relief by leading creditor countries, and by the investment firms based in those countries, are possible. Fiscal modelling demonstrates that the costs of action would be much lower than the costs of inaction.
Multilateral action is needed also to strengthen aid and concessional financing for low and low-middle income countries, and to facilitate progressive taxation. That the concrete actions so far taken on all these challenges have been piecemeal demonstrates also that there is an urgent need to redress the inequalities in voice between countries in international financial decision-making.
Protect all human rights of all people
Human rights are crucial for health security. Adolescent girls and young women in sub-Saharan Africa are three times more likely to acquire HIV than their male peers. Driving this inequality is the denial of girls’ and women’s human rights. In Africa 51 million girls are still locked out of school and millions more are denied access to the knowledge, services and support they need to keep themselves safe. Public health depends on prioritising the rights of girls to an education, including comprehensive sexuality education, and to safety from violence.
People can only access prevention, testing and treatment options if they feel safe to do so. Yet 64 countries still criminalise LGBTQ people through laws that were mostly left over by colonisers. Punitive laws leave people afraid to access health services, exacerbating their vulnerability. Laws and practices that exclude and discriminate against any of us endanger all of us. To protect everyone’s health, we need to protect everyone’s rights.
The choice
Leaders can choose to ensure health security. But only if that security is for every person, everywhere.
That ‘I am because you are’ is not only a moral obligation – it is a public health fact. Pandemics have taught us again and again that when our neighbour is endangered, so are we. And in today’s globalised world, we are all each other’s neighbour.
Including everyone is how we will all stay safe.
