Health: A Political Choice - Solidarity Science Solutions

Health: A Political Choice

Edited by Ilona Kickbusch, Global Health Centre, and John Kirton, Global Governance Program

Solidarity Science Solutions Health: A Political Choice

A Global Governance Project Publication

Published by: GT Media Group Ltd

Produced in collaboration with the World Health Organization

Co-Director: Tom Kennedy

Publisher & Co-Director: Khaled Algaay

Co-Editor: Ilona Kickbusch

Co-Editor: John Kirton

Editor: Madeline Koch

Managing Editor: Emily Eastman

Sub-Editor: Amanda Simms

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“Health: A Political Choice” is an official publication of the Global Governance Project and supported by the World Health Organization. The Global Governance Project is a joint initiative between GT Media Group Ltd, a publishing company based in London, the Global Governance Program, based at the University of Toronto, and the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva.

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0.1

Fixing the roof before the rain comes

Tedros Adhanom Ghebreyesus, director-general, World Health Organization

p04

1.1

Recovering from COVID-19: The test we cannot fail

Honourable Abdulla Shahid, president, 76th session of the United Nations General Assembly

p10

1.4

A collective concern

Amina J Mohammed, deputy secretary-general, United Nations

p16

1.6

Investing in future health security

Tharman Shanmugaratnam, co-chair, G20 High Level Independent Panel on Financing the Global Commons for Pandemic Preparedness and Response

p20

0.2

A simple solution for global solidarity

Ilona Kickbusch, founding director, Global Health Centre, Graduate Institute of International and Development Studies

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1.2

A fair future

Right Honourable Gordon Brown, WHO ambassador for global health financing

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1.5

A shot in the arm for global solidarity

Achim Steiner, administrator, United Nations Development Programme

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1.7

A new approach

Mariana Mazzucato, chair, Council on the Economics of Health for All, World Health Organization

p22

0.3

Global governance for solidarity, science and solutions for all

John Kirton, director, Global Governance Program

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1.3

COVID-19: Another reason for universal health coverage

Keizo Takemi, WHO goodwill ambassador for universal health coverage

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2.1

Moving forward with lessons from the past

Carlos Alvarado Quesada, president, Republic of Costa Rica

p24

2.3

Mutually reinforcing policies and research

Shamila Nair-Bedouelle, assistant director-general, natural sciences, UNESCO

p28

3.1

Advancing health by caring for nature

Elizabeth Maruma Mrema, executive secretary, Convention on Biological Diversity

p32

3.3

Investing in One Health

Monique Eloit, director-general, World Organisation for Animal Health (OIE)

p36

2.2

Health is a political choice

José Manuel Barroso, board chair, Gavi; former president, European Commission

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2.4

Beyond borders

Sir Jeremy Farrar, director, and Caroline Schmutte, head of European government relations, Wellcome

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3.2

Taking the threat of anti-microbial resistance seriously

Inger Andersen, undersecretary-general, United Nations; executive director, UN Environment Programme

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3.4

One Health requires a global commitment

Wanda Markotter and Thomas C Mettenleiter, co-chairs of the One Health High-Level Expert Panel

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CONTENTS

Fixing the roof before the rain comes

By Tedros Adhanom Ghebreyesus director-general, World Health Organization

When we say health is a political choice, many people may think of the choices we make in the midst of a crisis.

In fact, many of the most important choices that determine the outcome of a health emergency, such as the COVID-19 pandemic, occur long before the crisis itself strikes.

The pandemic has exposed the consequences of years of underinvestment in public health and pandemic preparedness, even in countries with some of the most advanced medical systems.

We have seen how trust in science and scientific institutions has been frayed by years of politically motivated attacks.

We have seen the impact of inequality in our societies on health outcomes, as the poor, ethnic minorities and other marginalised groups have suffered disproportionately.

If a community is already unable to provide essential healthcare services, and cannot meet basic needs such as maternal healthcare, how can it be expected to cope with a pandemic?

This is why universal health coverage, based on a foundation of strong primary health care, is essential, as the basis of emergency preparedness, and for healthier populations.

The time to fix the roof is before the rain comes, not in the middle of a storm.

So, even as we respond to the threat of COVID-19, we must address the underlying vulnerabilities and structural inequalities that put so many

people at risk. We also must take a hard look at the fragmentation of our global health architecture, and address the gaps that are slowing us down.

This is important not only for this pandemic, but also for the threats of the future – and not only for infectious diseases like COVID-19, but also from non-communicable diseases threats such as those from tobacco and our broken food system, and for environmental challenges such as pollution and climate change.

Understanding and addressing the inequalities and inequities that make some communities so much more vulnerable than others is at the heart of the World Health Organization’s mission and at the heart of public health.

GAPS IN OUR HEALTH SYSTEM

Every year, WHO supports countries to strengthen health policy on a vast range of issues, from mental health to maternal care, nutrition to infectious diseases, water and sanitation to air pollution, while also responding to dozens of health emergencies around the world.

But no single institution can tackle these global challenges alone. And no single country can take on a pandemic by itself. The lack of sharing of data and information has hobbled the global response. Now, vaccine inequity, with more than 75% of doses going to high- and upper-middle-income countries, is hampering our ability to bring this pandemic to an end. Vaccine nationalism and vaccine hesitancy are further complicating the picture, which is

+75%

of doses have gone to high- and upper-middle-income countries

Acting on lessons from the COVID-19 pandemic can prevent the same mistakes from being made again in the inevitable future health emergencies

compounded by the emergence of new variants.

The pandemic has thrived amid the gaps in our health systems and it has exposed the fragmentation of our global health architecture.

Let me outline three key priorities for keeping the world safer.

First, we need to recognise that global health security begins with strong primary healthcare as the foundation of universal health coverage. That means a well-paid and well-trained health workforce, with adequate protective equipment and supplies, and facilities for hand hygiene. It means a health system that has earned the trust of the communities it serves, including in disadvantaged urban and rural areas.

Second, we need better financing for national and global preparedness and response. That includes a substantial increase in domestic investment, as well as in international financing to support low- and lower-middle-income countries, so that they can provide surveillance, laboratory, risk communication and contact tracing capacity, and preparedness systems using a One Health approach.

Third, we need better global governance. The existing global health security architecture is complex and fragmented, and voluntary mechanisms have not worked.

A treaty or other international agreement on pandemic preparedness and response will provide a much-needed overarching framework for global cooperation, setting the rules of the game and enhancing solidarity among countries. This will be the subject of a special session of the World Health Assembly in November.

We also need to recognise that WHO must be empowered and sustainably financed to truly fulfil its mission and mandate.

In the coming months and years, other crises will demand our attention and distract us from the urgency of taking action now. If the world continues down the same path, it will continue to get the same result, which is a world that is less healthy, less safe and less fair.

Now is the time for working together in solidarity to build a future that is healthier, safer and fairer for everyone, everywhere. ▪

TEDROS ADHANOM GHEBREYESUS

Tedros Adhanom Ghebreyesus was elected director-general of the World Health Organization in 2017. He was the first person from the WHO African Region to serve as WHO’s chief technical and administrative officer. He served as Ethiopia’s minister of foreign affairs from 2012 to 2016 and minister of health from 2005 to 2012. He was elected chair of the Global Fund to Fight AIDS, Tuberculosis and Malaria Board in 2009, and previously chaired the Roll Back Malaria Partnership Board, and co-chaired the Partnership for Maternal, Newborn and Child Health Board.

Twitter @DrTedros  who.int

“

Many of the most important choices that determine the outcome of a health emergency, such as the COVID-19 pandemic, occur long before the crisis itself strikes”

A simple solution for global solidarity

By Ilona Kickbusch founding director,

Health Centre,

and Development Studies

Institute of

Global solidarity has been in short supply during the COVID-19 pandemic, and it is still not driving the response. Normally, after the World Health Organization declares a Public Health Emergency of International Concern, countries around the world work together to address the common threat under the auspices of the WHO – but the geopolitical standoff between the United States and China did not allow this to happen in 2020. Indeed, an increasing decoupling of global health has taken place, and is still not resolved despite increased G7 and G20 activities. Current geopolitical constellations have become a threat to global health.

Despite strong efforts by the WHO, multilateral health diplomacy has proven incredibly difficult –reinforced by attacks on the organisation itself and the Trump administration’s intention to withdraw from the organisation. The field of vaccine diplomacy – which refers to all aspects pertaining to developing, manufacturing and delivering vaccines as global public goods – was weakened, despite having started with a breakthrough in the creation of the Access to COVID-19 Tools Accelerator to boost science-based solutions for vaccines, therapeutics and diagnostics. Great hopes were attached to the establishment of COVAX, a new alliance intended to provide a pooling mechanism for countries

to share risks related to vaccine development and make COVID-19 vaccines available to all countries in the world. COVAX has been called the largest and most encompassing and challenging international agreement since the Paris Agreement on climate change – and indeed it constitutes a heroic effort. But the analogy does not hold. COVAX failed as a mechanism of inclusiveness because not everyone signed up. It was severely hampered by vaccine nationalism, with countries ensuring large contingents of vaccines for their own populations and vaccines made available to select countries for geopolitical gain. So Gavi, the Vaccine Alliance retreated to the charity model of global health – depending on official development assistance and – as time moved on – vaccine donations. COVAX does forecast a large supply of vaccine doses to be available to low- and middle-income countries by the end of 2021, but the vaccine apartheid established over the last year will drive geopolitics for years to come.

HISTORICAL LESSONS

Expectations for global solidarity – reinforced by self-interest – were high after the scare of severe acute respiratory syndrome in 2003, when WHO members negotiated the revised International Health Regulations and ratified them in 2005 as an international legally binding framework. But within less than 10 years, health diplomacy was confronted with the failure of countries and international agencies to respond effectively to the first Ebola outbreak, which began in West Africa in early 2014. Once that outbreak was over, the cycle of panic and neglect began again: health diplomats called for a reinforcement of the IHR, a reform of the WHO,

The WHO represents the best opportunity to protect the global community against the failings seen during the pandemic

Global

Graduate

International

the creation of a contingency fund and the establishment of a global health emergency workforce. Among the most important moves was the establishment of the WHO Health Emergencies Programme in 2016 at the request of the World Health Assembly. But the two most important lessons from Ebola were that countries needed to fulfil their obligations under the IHR effectively and that they needed to empower WHO financially and politically. The COVID-19 crisis has made it clear that these lessons were not heeded and that the danger is high that they will not be heeded again.

Today, in 2021, we are at a similar point: various review

ILONA KICKBUSCH

Ilona Kickbusch is the founding director of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva, Switzerland. She served on a panel of independent experts to assess the World Health Organization’s response to the Ebola outbreak and is a member of the Global Preparedness Monitoring Board. She previously had a distinguished career with WHO and Yale University, and has published widely on global health governance and global health diplomacy. She is a member of the WHO Council on the Economics of Health for All.

Twitter @IlonaKickbusch

ilonakickbusch.com

committees have repeated many of the calls from decades past. This time, because of the significant economic and social global impacts, these matters are also debated at the G7 and the G20. There is a strange irony: the very actors that did not deem it necessary to invest in pandemic preparedness are now tasked with finding financial solutions and supporting them with their political clout. This incongruity also applies to the proposal to establish a High-Level Global Health Threats Council at the United Nations that would oversee countries’ willingness to prepare and respond to pandemics.

It is simple. The greatest potential for global solidarity lies with the WHO – an organisation that builds on its ownership by 194 countries. Yet countries are not willing to finance their own organisation adequately through their assessed contributions (AC). Independent expert reviews have been clear – now is the time to act. Increasing AC to cover at least half of WHO’s core budget is an essential investment – the sums are minimal compared with the billions that might be paid into new mechanisms. Many countries remain sceptical about negotiating a Global Pandemic Treaty that would strengthen WHO’s hand in emergency preparedness and response. But reliable financing and political clout through a treaty would make all the difference to global solidarity. It would constitute a straightforward multilateral solution. ▪

An increasing decoupling of global health has taken place, and is still not resolved despite increased G7 and G20 activities. Current geopolitical constellations have become a threat to global health”

Global governance for solidarity, science and solutions for all

By John Kirton director, Global Governance Program, University of Toronto

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 viruses in unvaccinated countries and communities

850m

additional doses were mobilised from a global COVID-19 summit in September 2021

The pandemic has underlined the urgent need for stronger global governance, but, to make the right political decisions, leaders must incorporate these critical considerations

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 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. ▪

John Kirton is director of the Global Governance Program, which includes the Global Health Diplomacy Program, the G20 Research Group, the G7 Research Group and the BRICS Research Group, all based at the University of Toronto, where he is a professor of political science. He is co-author of Reconfiguring the Global Governance of Climate Change and co-editor of, among other books, Africa’s Health Challenges: Sovereignty, Mobility of People and Healthcare Governance, as well as the series of G7/G20 summit publications, including, most recently, G20 Italy: The 2021 Rome Summit and G7 UK: The 2021 Cornwall Summit.

Twitter @jjkirton

 www.ghdp.utoronto.ca

www.g7g20.utoronto.ca

www.brics.utoronto.ca

“

The COVID-19 crisis showed that real solutions require a whole-of-science, whole-of-government and whole-of-society approach”

JOHN KIRTON

Recovering from COVID-19: The test we cannot fail

As in many other small island countries reliant on tourism, the economy was the first casualty. A vibrant, thriving nation came to a standstill, overnight. When flights stopped and tourists stopped arriving on our shores, we effectively became a ‘no income’ country.

By the Honourable Abdulla Shahid, president, 76th session of the United Nations General

Our first priority was to respond quickly to the health impacts. We boosted testing capacity, established treatment facilities, and mobilised and trained healthcare workers. As a net importing country, securing essential food and commodities was especially crucial. Minimising the impact on our economy was our second, equally important priority. Stimulus packages and income support were distributed. Social security, including universal health insurance, single parent support and elderly pensions, continued.

For almost two years, the world has been in the grips of one of the greatest global challenges in recent history. The stark images as all humanity dealt with COVID-19 remain etched in our minds. Healthcare workers outnumbered by patients but fighting with incredible strength and resilience to save every patient. Empty roads, empty airports, empty schools, empty offices and empty treasuries. All engulfed in an eerie silence, interrupted by the sounds of slogans in solidarity with our front-line workers. In the Maldives, as foreign minister, I had a front seat to see the enormous impact on our country and our economy.

There are many lessons that a small country like the Maldives learnt in the wake of the pandemic. Lessons that can be extrapolated globally.

First, the inequalities in the international system have been exposed like never before. The virus demonstrated equity in its impact and spread of devastation, but the multilateral system’s response was unequal. With the varying degrees of shock due to disruptions in supply chains and decreased revenues, asymmetries in the ability to deal with the pandemic and access resources, shortages of life-saving drugs and the digital divide, it is abundantly clear that we are in different boats.

Second, the importance of global cooperation has been

Myriad lessons from the pandemic can be learned and extrapolated globally, but none are more crucial than the importance of multilateral cooperation in supporting an equitable recovery

underscored to an extent that might not have been felt since the end of World War Two. In the Maldives, we would have been unable to attend to the impacts of COVID-19 –be it on health or the economy – without the support of our bilateral and multilateral partners. The adage ‘no one is safe until everyone is safe’ should be the mantra of revitalising multilateralism. But we did not need a pandemic to remind us of the value of strength in unity.

From the initial stages of the pandemic, when information and advice to policymakers and healthcare workers were crucial, to the mobilisation and deployment of medical supplies, medicines and protective gear and, finally, to the research and development of vaccines in record time, throughout this pandemic we can see the important role that global solidarity, international cooperation and multilateralism could play.

RAYS OF HOPE

The tide that has lifted, and that can continue to lift, all boats is multilateralism. That is why this moment is so crucial. The United Nations was born out of the ashes of war. The leaders of the time understood that by working together, the destruction, devastation and despair that were so profound during the war would never be seen again. Today, once again, we have an opportunity to recommit ourselves to multilateralism. To do better. To build back better, stronger, greener and bluer.

This is the context in which the Presidency of Hope begins. If the 75th session of the UN was about responding to the emergency requirements of COVID-19, this 76th session is about recovery.

This is why my first ray of hope is recovering from COVID-19. First, we must ensure that countries have the resources and ability to boost their health responses. This is especially important in the wake of new variants. Policy advice, technical support, shared resources and financial support will be necessary, especially for vulnerable countries. Second, we must ensure that countries have plans in place for sustainable recovery. The Decade of Action – the 10 years that we have left until the deadline of the 2030 Agenda for Sustainable Development – will now be a Decade of Recovery. A decade of rebuilding sustainably – my second ray of hope. In recovering sustainably, we cannot continue to treat the needs of our planet as secondary. Climate change already affects our world. The number of adverse weather incidents we are witnessing is no accident. These are warnings of an impending crisis – warnings we must heed.

Third, it is time to acknowledge that the security of every nation relies on global health security. We need to strengthen our health systems through emphasising universal health coverage for sustainable and equitable development. Ensuring equitable access to COVID-19 vaccines is the first step. Through multilateral efforts we can coordinate the most needed resources for the most needy recipients.

The world today faces a test like never before. How we fare depends on how well we uphold the multilateral institutions that have carried us forward since the Second World War. For the sake of humanity, and for our future generations, let us join hands in the spirit of solidarity and cooperation to march towards a dawn of hope. ▪

HONOURABLE ABDULLA SHAHID

Abdulla Shahid was appointed foreign minister of the Maldives for a second time in 2018, having been appointed minister of state for foreign affairs in 2005 and minister of foreign affairs for the first time in 2007. His parliamentary career has spanned 25 years, including serving as speaker of the People’s Majlis. During the COVID-19 pandemic, he has been a leading voice in highlighting the devastation caused by the crisis on the economies and societies of small island developing states.

Twitter @UN_PGA‏  un.org/pga

A fair future

The containment of infectious diseases is perhaps the purest example of a global public good. In a pandemic, no one anywhere is safe until everyone everywhere is safe, and it is in all our interests that the whole world is vaccinated against a virus as rampant as COVID-19. And it should be in every government’s interest to stop any country pursuing beggar-thy-neighbour policies that would restrict the flow of diagnostic treatments and life-saving vaccines across the world. Put simply, this is a global problem that requires a global solution.

All the instruments for containing the disease are in place. Working close to the World Health Organization, the Access to COVID-19 Tools Accelerator is coordinating the supply of diagnostics and treatments; the WHO has recently updated its vaccination plan; and the global bulk-purchasing COVAX facility and the COVID-19 Africa Vaccine Acquisition Task Team, known as AVATT, are there to distribute vaccines to the countries that need them most, and World Bank support can build the capacity of countries to administer them.

But in the ‘arms’ race to inoculate the world, we are losing badly, and our failure to do so is at the expense of our collective safety. While more than 60% of all western adults have been fully vaccinated, only 4% of African adults and under 4% in low-income countries have received the shots they need. The world is now unjustly divided between the vaccine rich who are immunised and currently safe, and the vaccine poor whose

By the Right Honourable Gordon Brown, WHO ambassador for global health financing

lives continue to hang in the balance. This callous betrayal of the Global South cannot now be attributed to a shortage of vaccines. Instead, the Global North is stockpiling them and even when it holds a surplus of vaccines and has signed delivery contracts it does not need, it is failing to send unused vaccines south.

VACCINE HOARDING

This de facto hoarding of vaccines in the Global North that should now be airlifted to the Global South should raise profound moral questions about our ability to come together as an international community. People are right to ask that if the world cannot carry out the relatively straightforward task of distributing vaccines to those who need them when we have the supplies to do so, then what faith can people have that we can respond to other global challenges from climate change to nuclear weapons proliferation?

Our failure is all the more unforgivable because of the gap between the promises the richest countries have made and the reality on the ground. Hosting the G7 summit in June, UK prime minister Boris Johnson promised the West would ensure the vaccination of the world by 2022. At the global COVID-19 summit, which US president Joe Biden convened in September, a promise was made to

There is a yawning chasm in the distribution of vaccines worldwide, but with programmes now in place, they can be distributed to the countries that need them – and lessons can be carried forward in how to work together

RIGHT HONOURABLE GORDON BROWN

Gordon Brown was appointed as the World Health Organization’s ambassador for global health financing in September 2021, and is also United Nations Special Envoy for Global Education. He served as prime minister of the United Kingdom from 2007 to 2010, and chancellor of the exchequer from 1997 to 2007. He is chair of the High-Level Steering Group for Education Cannot Wait, the Inquiry on Protecting Children in Conflict and the International Commission on Financing Global Education Opportunity. He is also an adviser to the Graça Machel Trust and a senior panel member at the Kofi Annan Foundation Initiative on Electoral Integrity.

Twitter @gordonbrown  gordonandsarahbrown.org

vaccinate 40% of low-income countries by the end of 2021 and 70% by next September.

To its credit, the US has led the way by offering a total of one billion vaccines by next September, with the European Union donating around 450 million and other countries such as Japan, the UK, Canada and Norway offering donations. But most of the pledges are for 2022 and not 2021, and there is still no detailed month-by-month plan for transferring vaccines from countries with unused stocks. And although the main global institutions – the WHO, the World Trade Organization, the International Monetary Fund and the World Bank –are making valiant efforts to maximise vaccine donations, only the leaders of the richest countries who over-ordered and are now being oversupplied can release the unused stocks to the countries that need them most.

But there is a way forward. In addition to an immediate airlift of 240 million vaccines that are available now, another 212 million unused vaccines can be sent out by the end of November with 150 million more in December, 280 million in January and 245 million in February. Through COVAX and AVATT, doses can be distributed to the countries that need them.

And the opportunity to move quickly is with us now because of the vast pick-up

+60%

4%

<4%

in global manufacturing. Six months ago, 500 million vaccines a month were being manufactured, now it is 1.5 billion, and by January, the figure will be 2 billion – enough doses to contain the pandemic. As the science fiction writer William Gibson wrote, “the future is already here ... it’s just not evenly distributed.” If we want to prevent Gibson’s dystopia, then we must act now and share vaccines equitably. ▪

People are right to ask that if the world cannot carry out the relatively straightforward task of distributing vaccines to those who need them when we have the supplies to do so, then what faith can people have that we can respond to other global challenges from climate change to nuclear weapons proliferation?”

COVID-19: Another reason for universal health coverage

By Keizo Takemi, WHO goodwill ambassador for universal health coverage

Several years have passed since universal health coverage has become both an element of the Sustainable Development Goals and a political choice made by global leaders, who continue to include universal health coverage on their own agendas whenever they assemble at the G7, G20, United Nations General Assembly and many other forums.

Then, COVID-19 made a sudden appearance in early 2020. The global community has spent trillions of dollars combating the virus, the highest ever yearly spending for a single health agenda. Has this detracted attention and commitment from universal health coverage? It

should not. In fact, the COVID-19 pandemic demonstrates clearly why we need to invest in universal health coverage, more than ever.

At present, vaccination is one of the highest priorities in combating COVID-19. As of autumn 2021, high-income countries have provided vaccines to almost all citizens who wish to get the shot. There is, however, a stark disparity between high- and low-income countries. In low-income countries, only a small fraction of the population has access to vaccines. This is not solely a problem for the poor; the effects are universal because, during a pandemic, we are only as strong as our weakest link. We are not protected until everyone is protected.

THE ANSWER

What is needed to deploy vaccines globally, including to vulnerable and hard-to-reach populations? Is it financing, the health workforce, cold chain, health centres, vaccine production, recording and monitoring systems, or stewardship? The answer is all of the above. All these factors have positive effects. In other words, the answer to the problem is universal health coverage.

As universal health coverage goodwill ambassador for the World Health Organization, I have been advocating for universal health coverage in various forums. Although I have always had many reasons to support why we need to invest in universal health coverage, COVID-19 brings us another powerful reason for us all to push for it. ▪

Keizo Takemi is a member of the House of Councillors of the Japanese Diet, and a member of the ruling Liberal Democratic Party. He is also the World Health Organization’s goodwill ambassador for universal health coverage. Senator Takemi was a research fellow at the Harvard School of Public Health and has played several important roles at the United Nations, including as a member of the High Level Panel on UN System-Wide Coherence in Areas of Development, Humanitarian Assistance and Environment (appointed by Kofi Annan) and the UN High Level Commission on Health Employment and Economic Growth (appointed by Ban Ki-moon). He also served as Japan’s senior vice minister for health, labour and welfare and as the state secretary for foreign affairs.

The COVID-19 pandemic demonstrates clearly why we need to invest in universal health coverage, more than ever”

KEIZO TAKEMI

Universal health coverage can solve many of the problems that COVID-19 has brought to the fore, ensuring collective health and many other social benefits

A collective concern

By Amina J Mohammed, deputy secretary-general, United Nations

When an individual falls ill, nothing can seem more solitary. But, in fact, one person’s health is a collective concern profoundly influenced by political choice.

The COVID-19 pandemic underscores this truth. It has taken more than 4 million lives and devastated the global economy. The pandemic has pushed an additional 124 million people into extreme poverty and increased the total number of those without enough to eat by nearly 320 million. As a result, in 2020, nearly one in three people lacked access to adequate food. Violence against women is rising, students are out of school, and all of this is slowing progress towards achieving the Sustainable Development Goals.

The world has learned the hard way that health equity, solidarity and cooperation are essential to the common good. That is why all need to prioritise the clear political choice to strengthen health systems so that they can adapt to evolving demographic, environmental and epidemiological challenges.

This requires a One Health, whole-of-society approach that includes addressing underinvestment and strengthening national health systems, which are at the core of a synergistic approach to prevent, prepare for and respond to future outbreaks and other health emergencies. These health systems will ensure that physical and mental health services are accessible to everyone at all times – even in crisis.

The COVID-19 pandemic is a problem without a passport. It crosses borders indiscriminately and affects people in all countries, confirming that we are only as strong as the weakest system, meaning no one is safe until everyone is safe and health is a global public good.

THE SPIRIT OF COOPERATION

Global health threats demand multilateral responses. The United Nations is bringing countries together in a spirit of cooperation and solidarity.

Global cooperation and a whole-of-society approach will be integral to overcoming the pandemic –and building a stronger, more equitable system

Prior to the pandemic, UN member states, the UN Development System and major global health actors joined forces, through the Political Declaration on Universal Health Coverage and the Global Action Plan for Healthy Lives and Well-being for All, to accelerate national progress towards these ends and advance the SDGs.

In response to the COVID-19 pandemic, the Access to COVID-19 Tools Accelerator , including its COVAX facility – the one global tool to procure and deliver vaccines for low- and middle-income countries –stands out as an example of success for ensuring equitable access. It has shipped more than 220 million vaccines, with many more in the pipeline.

COVID-19 is a stark reminder that nationalism in the face of a global threat poses risks to us all. As a global community acting with shared purpose, we can make the choice to recover better, leveraging the pandemic response to promote investments in public health functions and preparedness, to enable research, innovation and learning, to strengthen primary health care, and to address inequalities within and among countries.

One such opportunity is the importance of local manufacturing of vaccines and other health commodities as a key component of pandemic preparedness and response. In particular, there is an urgent need for sustained production capacity in

low- and middle-income countries that will strengthen regional and global health security, expand equitable access to health products and facilitate scaling up routine national immunisation programmes. This devastating pandemic has proved that the world urgently needs strong political will for effective solidarity to save lives and build a healthier and more equitable world. ▪

AMINA J MOHAMMED

Amina J Mohammed is deputy secretary-general of the United Nations and chair of the United Nations Sustainable Development Group. Previously she served as minister of environment of Nigeria. She first joined the UN in 2012 as special adviser to SecretaryGeneral Ban Ki-moon with the responsibility for post-2015 development planning. In Nigeria, she served as an advocate for increasing access to education and other social services, and advised four successive presidents on poverty, public sector reform and sustainable development.

“

The COVID-19 pandemic is a problem without a passport. It crosses borders indiscriminately and affects people in all countries, confirming that we are only as strong as the weakest system”

Twitter @AminaJMohammed  www.un.org/sg/en/dsg

A shot in the arm for global solidarity

Fairer, faster access to COVID-19 vaccines is how we end this pandemic and get the Sustainable Development Goals back on track. SARS-CoV-2, measuring approximately 100 nanometers in diameter, continues to wreak havoc on sustainable development, preying upon inequities, thriving in the face of division and challenging our resolve. COVID-19 and the other multidimensional challenges before us appear daunting – not least rising poverty, growing inequalities and a climate crisis that is now “widespread, rapid, and intensifying”, according to the Intergovernmental Panel on Climate Change. If the sprint towards recovery and a reimagined future is a race between science, solutions and solidarity, we must ensure a three-way tie for first. However, right now, solidarity must rapidly pick up the pace. Since the virus first swept across borders and boundaries, the global community has rallied to mobilise resources to fight a pandemic that is upending the way we live, work and cooperate. Perhaps most striking has been the development of multiple safe and effective vaccines in record time. The World Health Organization continues to lead from the front –from helping countries prepare and respond to the pandemic to getting

By Achim Steiner, administrator, United Nations Development Programme

vital supplies to the front-line health workers to supporting the world’s poorest and most vulnerable people. And a first-of-its-kind platform, the Access to COVID-19 Tools Accelerator and its COVAX facility, is expediting the development and manufacture of vaccines while advancing fair and equitable access for every country in the world.

Yet the world faces what the World Economic Forum calls an alarming

“equation of inequity” that reveals glaring deficiencies in solidarity. By 6 October 2021, just 3.75% of people in low-income countries were vaccinated, compared with 61% in high-income countries. The lack of accessible and affordable vaccines for all is driving new infections, avoidable deaths and suffering while Delta and other variants trigger new setbacks. Without urgent action to make vaccines a global public good, affordable and accessible to everyone, COVID-19 vaccine inequity will delay the end of the pandemic and result in a two-track socio-economic recovery. Global solidarity needs a shot in the arm to boost vaccine equity. Part of the solution lies in plainly outlining the extent to which vaccine inequity is damaging both nation-states and the global community. The Global Dashboard for Vaccine Equity, a collaboration of WHO, the United Nations Development Programme and the University of Oxford, does just this. To accelerate universal access to vaccines, it is empowering governments, policymakers and other partners with new data and analytics on how vaccine inequity affects our prospects for recovery. It illustrates that without immediate global financial support, low-income countries would have to increase their healthcare

The cost of inaction is more avoidable deaths and suffering, and a slower and unequal recovery. Solidarity is urgently needed

spending by 30% to 60% to fully vaccinate 70% of their populations. High-income countries would have to increase their spending by just 0.8% to achieve the same results. Yet we know it is also about how and when these finances are spent.

The dashboard also lays out alternative scenarios. Consider Mozambique, with the highest relative increase in public debt to gross domestic product ratio due to vaccine procurement costs. The projected increase in public debt of $367 million due to vaccine costs could alternatively provide healthcare for 9.2 million people, or 29% of the population.

The new data also demonstrate that a global acceleration in scaling up vaccine manufacturing and sharing enough doses with low-income countries would pay massive dividends – adding $38 billion to their GDP forecast for 2021 if they had similar vaccination rates to high-income countries. Moreover, this would dovetail with debt relief and other liquidity measures, such as the International Monetary Fund’s $650 billion special drawing rights allocation, allowing all developing countries to play a full part in the global green recovery.

ACHIM STEINER

Achim Steiner has been UNDP administrator since 2017. He is also the vice chair of the United Nations Sustainable Development Group, which unites 40 entities of the UN system that work to support sustainable development. Prior to joining UNDP, he was director of the Oxford Martin School and professorial fellow of Balliol College, University of Oxford. Mr Steiner led the United Nations Environment Programme (2006–2016), and was also director-general of the United Nations Office at Nairobi. He previously held other notable positions including director-general of the International Union for the Conservation of Nature and secretary-general of the World Commission on Dams. Twitter @ASteiner  undp.org

The United Nations, led by WHO, is driving critical efforts to roll out vaccines more rapidly and equitably in developing countries. UNICEF is working with manufacturers and partners on procuring COVID-19 vaccine doses, as well as freight, logistics and storage. Already the world’s largest single vaccine buyer, UNICEF procures more than two billion doses of various vaccines annually for routine immunisation and outbreak response on behalf of nearly 100 countries. Other UN agencies bring their unique added value to the table. UNDP is helping governments to deploy digital solutions to boost vaccine delivery, use data analytics to drive greater equity and ‘green’ COVID-19 vaccination by scaling up reliable clean energy solutions.

As Dr Tedros Adhanom Ghebreyesus, WHO director-general, has put it, “economically, epidemiologically and morally, it is in all countries’ best interest to use the latest available data to make life-saving vaccines available to all”. In helping to advance

61% 3.75%

this objective, the new insights from the Global Dashboard for Vaccine Equity can provide a booster shot for global solidarity by demonstrating how universal access to vaccines will drive progress across the Sustainable Development Goals – our collective North Star to guide us out of this pandemic. Vaccine equity will also leave a legacy of strengthened health systems and breakthroughs towards universal health coverage. Indeed, there is now a clear route forward.

Rallying around the unifying strength of the UN, we need the urgent cooperation of vaccine manufacturers, vaccine-producing countries and countries that already have high vaccination rates to tackle the acute vaccine supply shortage in low- and lower middle-income countries. By rolling up our sleeves, harnessing the very best science, data and analytics, we can finally outpace this wicked virus and chart a course towards a sustainable recovery for all. ▪

By 6 October 2021, just 3.75% of people in low-income countries were vaccinated compared with 61% in high-income countries

Investing in future health security

A multilateral fund and a global governance mechanism bringing health and finance together could prevent a pandemic like this from ever happening again

We are nowhere near the end of the current pandemic. As devastating as it has been, COVID-19 may be a dry run for a future pandemic that could take more lives and have an even more profound impact on human society. Scientists have warned this could come at any time. The world does not lack the resources. We have the scientific and innovative capacities, and the finances needed. In our report, ‘A Global Deal for Our Pandemic Age’, the G20 High Level Independent Panel advocates how we can and must

By Tharman Shanmugaratnam, co-chair, G20 High Level Independent Panel on Financing the Global

Commons for Pandemic

Preparedness and Response

mobilise these resources to sharply reduce the risk of future pandemics.

Resilient national health systems are the bedrock of global preparedness. Governments working with international institutions must embark on reforms to mobilise domestic resources and make the sustained investments required to avoid future outbreaks, from trained human resources to well-equipped primary and tertiary healthcare systems. This will require additional public spending on health of about 1% of gross domestic product in many low- and middle-income countries over the next five years.

However, safety from pandemics will also require a basic

shift in thinking about international cooperation. This is fundamentally not about aid, but about collective investments in global public goods from which all countries benefit. It is the ultimate case for both national self-interest and international solidarity at the same time.

THARMAN SHANMUGARATNAM

Tharman Shanmugaratnam co-chairs the G20 High Level Independent Panel on Financing the Global Commons for Pandemic Preparedness and Response, with Ngozi Okonjo-Iweala and Lawrence Summers. It recently launched its report and recommendations. He has been senior minister in Singapore since 2019, and is also coordinating minister for social policies. He previously served for several years as deputy prime minister and finance minister. He earlier led a G20 Eminent Persons Group on Global Financial Governance. Tharman also chairs the Group of Thirty, an independent council of economic and financial leaders from the public and private sectors and academia.

We must strengthen global public goods for pandemic security at every level – national, regional and global. We must build tightly networked early warning systems, strengthen One Health, ensure countries have the capacities to detect and counter infectious disease outbreaks quickly, and develop an end-to-end ecosystem to provide countries everywhere with much swifter access to vaccines, therapeutics and other essential medical supplies.

Twitter @tharman_s  pandemic-financing.org

Achieving this requires strengthening multilateralism.

First, we must strengthen the global health organisations. There is no solution to pandemic security that does not involve a central role for an empowered World Health Organization, with its finances on a more secure multilateral footing.

Second, we must make better use of international financial institutions. The World Bank and other multilateral development banks, and the International Monetary Fund, are unique institutions, able to catalyse both domestic investments by governments and private finance. We must make global public goods for both climate and pandemic security part of their core mandates.

Third, we need a new multilateral funding mechanism to complement the existing organisations: to overcome today’s siloed funding of global health security, mobilise the much larger scale of needed resources on a proactive and sustained basis, and plug the gaps in global public goods in an agile manner.

A multilateral fund to mobilise $10 billion per annum as proposed by the G20 High Level Independent Panel is entirely affordable. With contributions spread across countries on a fair and equitable basis, they will amount to less than one thousandth (0.1%) of the annual government budgets of most countries, and an even tinier percentage of their GDP.

These investments in global health security are a matter of financial responsibility, besides being a scientific and moral imperative.

COVID-19 is a tragic reminder that the human and economic damage of a pandemic are orders of magnitude larger than the costs of investments in prevention and preparedness. However, to mobilise greater international resources on a sustained basis, we need a global governance mechanism that brings health and finance together. This can be achieved most effectively by establishing a board comprising health and finance ministers from an inclusive G20+ group of countries, with adequate representation of both major contributors of funds and developing countries, and the leaders of the WHO, World Bank, IMF and World Trade Organization. The permanent, independent secretariat for this board is best constituted by these four major multilateral institutions, and housed at the WHO.

This new G20+ governance mechanism to ensure proactive funding of the global health security ecosystem will complement and support global health governance itself at the WHO and the World Health Assembly.

The system is gravely underfunded. We must fix this urgently, both to tackle the ongoing pandemic and to prepare for the next dangerous outbreak. The additional international commitments are a very small cost to pay to avoid blundering into pandemics again and again. It will be economically and politically myopic, and morally indefensible, to defer them. ▪

A new approach

By Mariana Mazzucato, chair, Council on the Economics of Health for All, World Health Organization

Health is a fundamental human right. Alongside a healthy and sustainable environment, a healthy population must be the ultimate goal of economic activity. If the goal is Health for All, then we must ask

what sort of economy can deliver that? This means designing all economic tools – from budgets, to procurement, to the structure of loans – to deliver on the goal.

Countries have come a long way in better prioritising health. However, health continues to be viewed as a variable in the economic equation, a peripheral concern of economic policies or a cost, disassociated from its contribution to the social fabric and dynamics of a thriving and resilient society. This status quo view has led to where we are at present: a major health

A broadened framing of health and its investments will pave the road to Health for All

MARIANA MAZZUCATO

Mariana Mazzucato is a professor in the economics of innovation and public value at University College London, where she is the founding director of the UCL Institute for Innovation and Public Purpose. She chairs the World Health Organization’s Council on the Economics of Health for All, established in May 2021. She is also a member of the OECD Secretary General’s Advisory Group on a New Growth Narrative and of the United Nations High Level Advisory Board for Economic and Social Affairs, among other roles. Her most recent book is Mission Economy: A Moonshot Guide to Changing Capitalism

Twitter @MazzucatoM  marianamazzucato.com

crisis has wiped out the gains from decades of global development and exacerbated persistent inequities.

Investing for health is key to an inclusive economy. This requires a fundamental rethink of how value in health and well-being is measured, produced and distributed across the economy, and integrating that into all policies to pursue economic activity, productivity and wealth for the common good.

The World Health Organization Council on the Economics of Health for All aims to develop a new

narrative that transforms financing for health from an expenditure to an investment in a ‘healthy society’, grounded in fundamental truths –namely that health and the economy are interdependent; that health is in itself a key economic sector but also a cross-cutting lens through which to view many different sectors; that health is critical to the resilience and stability of economies worldwide; and that we can channel and shape public and private investments in health to achieve global cooperation towards supranational goals.

This broadened framing of health and investments for health will enable us to move from focusing on maximising value for money within a given health budget through narrowly understood efficiency gains, towards creating a new political economy for Health for All. This is an ambitious agenda that foregrounds the investment in the major social, economic, environmental and political determinants of health that have cumulative impacts and shape the trajectory of people’s lives. ▪

With Health for All, a new narrative - one that sees health as an investment for society rather than an expense - can create healthier, more resilient societies

“

Health continues to be viewed as a variable in the economic equation, a peripheral concern of economic policies or a cost, disassociated from its contribution to the social fabric and dynamics of a thriving and resilient society”

Moving forward with lessons from the past

By Carlos Alvarado Quesada, president, Republic of Costa Rica

What was your motivation for initiating the COVID-19 Technology Access Pool to harness the power of science for all?

At the beginning of the pandemic, we were overcome with fear and uncertainty, not knowing the virus, its causes, how long it was going to last, how it would behave, or if we were going to be able to find a cure or treatment. But we did have experience from dealing with previous epidemics that shed light on the challenges we would probably face. We knew we needed to understand the virus, building upon experiences with other COVID-19 viruses; to be able to research and develop together – as fast as possible –possible treatments, therapeutics and vaccines; and to be ready to make all those available in an affordable, fast and equitable way. Ensuring equitable access was already a significant concern from the early stages of the health emergency; we knew what was coming, bearing in mind experiences such as responding to HIV/AIDS,

The world’s rapid and coordinated response to COVID-19 has its origin in previous epidemics, with the need to research and develop together front and centre

where availability and affordability were the greatest barriers that kept millions of people from developing countries at risk, despite full access to anti-retrovirals in the developed world – barriers that were overcome thanks to public health initiatives that increased competition, such as voluntary licensing, and resulted in enormous reductions of prices for anti-retroviral therapy. We need to learn from those lessons and be better prepared!

As a global community we are committed to the 2030 Agenda for Sustainable Development and we knew that the pandemic was putting at risk achieving the third Sustainable Development Goal. So many people were at risk of being left behind unless action was taken.

What is your vision of social solidarity?

Solidarity should be at the core of public policy and especially in issues related to health. In my country, Costa Rica, we set up a social security system in 1949 that is based on solidarity, and ensures universal health coverage and access to quality health services. Our strong social security system is perhaps the key to the levels of social development and equality we have achieved. So, solidarity is at the core of Costa Rica’s public policy responses – it’s in our DNA. Access to health is a fundamental right and we have worked hard to guarantee it to all people.

How is that expressed through C-TAP?

The principles of the Solidarity Call to Action are precisely all about solidarity: establishing that health is a global public good and that multilateral action requires that knowledge, data and innovation be shared to tackle global crises. Recognising the substantial public investments in medical research, and the need to prompt innovation, C-TAP aims to find a balance and invites the voluntary sharing of licences, which should be done in transparent and non-exclusive ways to scale up production and ensure equitable access. This unprecedented moment needs to be tackled using extraordinary measures that make sure everyone around the world has access to life-saving treatment.

My hope is that as a global community we can translate C-TAP principles in practice, which will enable us to be better prepared to respond to any health crisis. Unfortunately, COVID-19 has shown us an ugly picture and dramatic situations. Despite the rapid development and approval of vaccines, we have not delivered on our promise of equitable access. We have failed to protect those at higher risk first, everywhere. That needs to change. New tools such as a World Health Organization Pandemic Treaty will create

better frameworks for regulating and coordinating our responses in all parts of the world. Also, the current climate crisis, biodiversity loss and environmental degradation all strongly link to the spillover of zoonotic diseases. We will face more health emergencies unless we take drastic measures now to reverse the environmental challenges.

What hurdles must C-TAP overcome?

C-TAP is a platform that could be very beneficial not only for addressing the current pandemic but also for addressing the ones to come. We will continue to face this sort of challenge more frequently. We must be prepared. We should not pass by this opportunity to strengthen the mechanisms we already have in place. We must take stock, reassess and, if necessary, change gears. C-TAP can help in scaling up production and ensuring equitable access around the world. The most difficult hurdle that remains is resistance from industry. It should be seen as a win–win possibility, a very beneficial middle ground for everyone. ▪

CARLOS ALVARADO QUESADA

Carlos Alvarado was elected president of the Republic of Costa Rica in 2018. A professor, politician and author, he has served as minister of human development and social inclusion, executive president of the Joint Social Welfare Institute and minister of labour and social security.

Early in 2020, he proposed that the World Health Organization create a platform for developers of COVID-19 therapeutics, diagnostics, vaccines and other health products to voluntarily share their intellectual property, knowledge and data with manufacturers, which became the COVID-19 Technology Access Pool.

Solidarity is at the core of Costa Rica’s public policy responses – it’s in our DNA. Access to health is a fundamental right and we have worked hard to guarantee it to all people”

During any crisis the first instinct is to protect oneself. This is precisely what we have seen with the COVID-19 pandemic, with governments doing everything in their power to carry out their duty to protect their citizens first. However, when it comes to a global health crisis involving infectious disease, keeping your own people safe also means making sure that others are protected too. As COVID-19 rages on, with the Delta variant continuing to spread in many parts of the world, and new variants such as the C.1.2 and Mu beginning to emerge, for many governments the reality that ‘no one is safe until everyone is safe’ is finally sinking in.

Health is a political choice

By José Manuel Barroso, board chair, Gavi; former president, European Commission

Indeed, based on the current global distribution of COVID-19 vaccines, this means that right now no one’s safety is guaranteed. Some of the wealthiest countries may have vaccinated over two-thirds of their population and are making plans for boosters, but with just 2.5% of people in low-income countries having received their first jab, all people – not to mention economies – remain at risk. The longer the virus is allowed to spread, the greater the chances that new variants will emerge that are more dangerous, even to people already vaccinated.

COVAX was created to prevent this sort of scenario, by providing a mechanism through which all countries could access COVID-19

vaccines, including the 92 lower-income countries that would otherwise have limited or no access. As the only global solution centred on equitable access to vaccines, it has proven it works, securing around two billion doses early on when competition for doses was fierce. So far more than 363 million doses have already been delivered to 144 countries. But along the way we have hit major supply bottlenecks, and this has created serious delays. We are nowhere near where we would like to have been at this point.

Despite the challenges, by early 2022 we expect to have delivered enough doses to protect all high-risk groups globally, including front-line health and social care workers, and vulnerable

COVAX can make even more of a difference if governments stop hoarding vaccine doses and allow the free flow of these crucial supplies

people, and beyond, around 20% of the population in low-income countries.

G20 governments are helping and not just in terms of funding this work. Several have recently committed to donating 1.3 billion doses to low-income countries through COVAX, with 140 million already delivered. This has gone a long way to help bridge the acute supply shortage we suffered earlier in the year on the back of export bans and under-supply from manufacturers.

Although donated doses are very much welcome, in a pandemic timing is everything. Many of these doses will come at a point when COVAX’s supply lines are ramping up and when the health systems of countries, which have already faced huge disruption because of the pandemic, will be operating at close to maximum capacity, while at the same time trying to prevent outbreaks of other diseases with support from Gavi by keeping routine immunisation programmes going.

JOSÉ MANUEL BARROSO

José Manuel Barroso was appointed chair of the board of Gavi, the Vaccine Alliance, in January 2021. He served as prime minister of Portugal from 2002 to 2004 and as president of the European Commission from 2004 to 2014. He holds a master’s degree in law from the University of Lisbon, as well as a master’s in economic and social sciences/political science from the University of Geneva. He also holds a post-graduate diploma from the University Institute of European Studies in Geneva, and lectures at many renowned universities in Europe and the United States.

Twitter @JMDBarroso  www.gavi.org

By signing more deals with manufacturers, further diversifying our portfolio and manufacturer base, and with the help of dose donations, COVAX will be able to rapidly accelerate the pace of deliveries, although we will still fall significantly short of having two billion doses available for supply by the end of the year, as we had forecast in the spring. We cannot hide the fact that many of the delays we have faced are because of actions by governments. If we had received initial funding earlier and if governments had not hoarded doses, we would not have needed doses to be donated. Moreover, until just two months ago, many governments still had export bans preventing the free flow of vaccines, as well as many of the vital components and materials needed to make them. All these factors continue to hinder the global vaccine distribution effort to this day.

What we really need governments to do now is truly get behind COVAX and allow it to deliver. First, we need those doses not already delivered to be made available as quickly as possible. Moreover, we need visibility on when they will arrive so countries can adequately prepare for their delivery. Governments possess more doses than they have thus far pledged and not all of these are needed for domestic national vaccination programmes – this surplus should be shared also.

We also need leaders to support our call for transparency. All too often COVAX has faced delays in the speed and volume at which it can access these doses because of a lack of transparency regarding manufacturers’ order books. By insisting that manufacturers are transparent with their order timelines and COVAX’s place in the queue, we can ensure a level playing field where

no one – particularly anyone living in developing countries – gets bumped to the back of the line.

We also need G20 governments to prioritise COVAX. We are already struggling with manufacturers, however, to maintain contracted supplies and ensure COVAX is not once again pushed to the end of the queue. We also ask those countries with orders that are not needed at this time to give up their place in the queue and allow COVAX to take it so we can get doses to countries now.

Finally, countries need continued support for roll-out. As this largest vaccine roll-out in history is under way, we need to be sure that countries have the support they need to deliver vaccines. Strengthening health systems will not only help ensure quality delivery but will also help countries mitigate the secondary effects of the pandemic, as well as build systems critical to global health security for the future. Ultimately the solution lies in global leaders recognising the impact of their domestic policies on this global crisis, and that the only solution is a global solution. ▪

By Shamila Nair-Bedouelle,

COVID-19, with its terrible consequences for the global economy and our globalised health system, has emboldened the naysayers of globalisation. At the same time, the pandemic has demonstrated the virtues of a globalised research system. Around the world, we have seen public and private actors working together across borders and disciplines to tackle this new coronavirus and accelerate the development of treatments, protective personal gear, medical equipment and vaccines, all for the public good.

The current pandemic has made a convincing case for opening up research across borders and ensuring transparency in sharing data and information. This trend aligns with the mandate of the United Nations Educational, Scientific and Cultural Organization to foster sharing scientific information and data for the public good. In fact, UNESCO will submit a Recommendation on Open Science to its members for adoption this November when they convene for the biennial General Conference.

Openness comes naturally to scientists, for whom sharing information and data is second nature. We know from the latest edition of the UNESCO Science Report that international scientific collaboration is growing, even if only 24% of scientific publications currently involve international co-authorship. We are also seeing a trend towards greater intraregional collaboration within Asia, Africa and Latin America.

Worldwide, one-third (34% in 2019) of scientific publications concern health sciences, according to the UNESCO Science Report. Moreover, international collaboration in health sciences has grown slightly, involving 20.3% of all publications in this field over 2014–2016 but 22.5% over 2017–2019. International scientific collaboration is essential not only to tackle health pandemics like COVID-19 – for there will be other pandemics – but also to address other

Mutually reinforcing policies and research

pressing global challenges such as climate change, biodiversity loss and environmental degradation. Countries must not be afraid to acknowledge vulnerabilities exposed by either domestic or international research. It is easy to celebrate science when

researchers achieve a breakthrough, but science must also be heard when it is the bearer of bad tidings.

During the pandemic, governments everywhere have turned to their biomedical communities for solutions. Many have allocated generous research

Devastating worldwide events such as COVID-19 in turn require a global response – governments must act now to create a blueprint for joined-up action on future crises

assistant director-general, natural sciences, UNESCO

budgets to these communities. That is all very well but it is those research communities that were well funded before the virus emerged that have been best equipped to respond to the crisis. Research communities are not born overnight. They must be nurtured over time. Currently, four out of five countries still spend less than 1% of their gross domestic product on research. In many countries, funding for research remains low or erratic. Researchers enjoy little status. This makes poor economic sense. Why invest in training a scientist or an engineer only to waste that investment by denying them the means to carry out their mission effectively?

In 2015, governments around the world pledged to raise their research expenditure as a share of GDP when they adopted the Sustainable Development Goals. Within three years, 32 countries had effectively raised their research effort. But another 13 headed in the opposite direction. Scientific communities need sustained adequate funding to thrive. This is one of the main messages of the Recommendation on Science and Scientific Researchers adopted by UNESCO’s member states in 2017.

4/5 1%

SHAMILA NAIR-BEDOUELLE

Shamila Nair-Bedouelle is the assistant director-general for natural sciences at the United Nations Educational, Scientific and Cultural Organization. She previously served as director of the OzonAction programme at the UN Environment Programme. She has pursued her research interests in parallel to her career at the United Nations, and was director of research at the University of Paris V since 2000. From 2002 to 2007, she served as scientific officer and deputy scientific coordinator of scientific programmes of the European Commission.

Twitter @unesco  unesco.org

For humanity to solve the myriad crises it faces, it will be very important for research and public policies to be mutually reinforcing. During the pandemic, policymakers have often been faced with a range of unpalatable options necessitating trade-offs among health, economics, individual rights and social well-being. Scientific analysis and advice have helped them to make informed decisions in an extremely difficult situation. Now, decision makers have an opportunity to build greater resilience to future pandemics by adopting policies that support scientific institutions.

Despite the need for research and public policies to be mutually reinforcing, scientists and policymakers are not always on the same path. Scientists have been producing valuable research on COVID-19 in countries where governments have been reluctant to listen to science. Similarly, scientists have been producing valuable research on climate change mitigation and adaptation in countries where it has been government policy to minimise the importance of climate change. This antagonism is problematic, because scientific knowledge can only be transformational if backed by political will. If decision-makers refuse to acknowledge that there is a problem, they will not support policies that facilitate problem solving or heed research that proposes practical solutions.

Scientists themselves have obligations to the wider community. They must be attuned to the ethical issues that their research may raise. The ethics of science has long been a focus of UNESCO’s work, through the World Commission on the Ethics of Scientific Knowledge and Technology and the International Bioethics Committee. Most recently, this work has led to the elaboration of a Recommendation on the Ethics of Artificial Intelligence, to be submitted for adoption at this year’s General Conference. ▪

Research communities are not born overnight. They must be nurtured over time”

countries still spend less than of their gross domestic product on research

The COVID-19 pandemic has revealed two important truths about global politics: the world does not take global health seriously enough, and governments are not prepared to respond to global threats collectively. To be ready for future crises, leaders must better balance domestic challenges with international matters. In today’s interconnected world, they are inseparable.

Global health threats go beyond borders; so, too, must our response. Choosing efficiency and short-term thinking, by only following a national agenda, will prevent us from investing in the necessary long-term structures to protect against future pandemics.

Leaders need to stand as part of a world alliance. We need global systems and institutions that are always functional and ready, as well as politically and financially independent. And they need sustained leadership and investment. Global health should feature regularly on political agendas –not only during crises. We need to see

By Sir Jeremy Farrar, director, and Caroline Schmutte,

regular discussions on global health security at the United Nations Security Council, the G7 and G20, and across the European Union.

Pandemic preparedness is a constant, long-term investment. Rich countries, including the G7 and G20, must agree on a set of preparedness and response tools, and commit to financing and adopting them. If we fund vaccine development, we must do so with a global market in mind, for example by funding the Coalition for Epidemic Preparedness Innovations. If we vaccinate people, we must cover all countries and communities to avoid dangerous virus mutations. If we create centres of pathogen

Beyond borders

Devastating worldwide events such as COVID-19 in turn require a global response –governments must act now to create a blueprint for joined-up action on future crises

head of European government relations, Wellcome

surveillance, they should be part of a global surveillance network.

Much of the economic devastation brought by COVID-19 could have been averted. Pandemic preparedness is one of the most rewarding investments leaders could ever make, and should be a priority for finance ministers around the world. The cost will be billions –but still only a fraction of the trillions the COVID-19 pandemic has cost so far. This is a matter of self-interest, going beyond aid. It is an investment in national health, economic stability and innovation.

The COVID-19 pandemic is a telltale sign of how the world will address the shared challenges of this century, from climate change to drug-resistant infections and future energy needs. We must use crises like these to come out of them better. If governments, scientists and the private sector can work together, we can create a blueprint for these shared challenges and reduce inequalities for generations to come. Leaders have a choice to make. It is one that will help to define the 21st century. ▪

SIR JEREMY FARRAR

Sir Jeremy Farrar joined Wellcome as director in 2013. He is a member of the UK government’s Scientific Advisory Group for Emergencies, the UK Vaccine Taskforce and the Principles Group of the Access to COVID-19 Tools Accelerator, and chairs the World Health Organization’s R&D Blueprint Advisory Group. In 2018 he received the President Jimmy and Rosalynn Carter Humanitarian of the Year Award and in 2019 was knighted for services to global health.

Twitter @JeremyFarrar

CAROLINE SCHMUTTE

Caroline Schmutte joined Wellcome in 2018 to lead its German office, which expanded in 2021 to become Wellcome’s European office. From 2013 to 2018, she led the German office of the Bill & Melinda Gates Foundation. She previously worked as a private sector development specialist at World Bank Group and engagement manager at McKinsey.

Twitter @CaSchmutte @wellcometrust

 wellcome.org

“

The COVID-19 pandemic is a telltale sign of how the world will address the shared challenges of this century, from climate change to drug-resistant infections and future energy needs”

Advancing health by caring for nature

By Elizabeth Maruma Mrema, executive secretary, Convention on Biological Diversity

COVID-19 has reminded us of the intricate yet delicate links between the health of people and the health of the planet. Choosing to restore humanity’s relationship with nature is urgently needed to advance health and well-being for all

Biodiversity encompasses all the complex interactions among living organisms that form the perfectly balanced ecosystems that support life: the air we breathe, the water we drink, the food we eat. There is no human health without biodiversity, which is also integral to the sectors that modulate health outcomes, such

as pharmacy, biochemistry, biotechnology and agriculture (see Figure 1).

As highlighted in the 2020 ‘IPBES Workshop Report on Biodiversity and Pandemics’, most emerging infectious diseases are caused by wildlife-origin pathogens, and the risk of pandemics is increasing rapidly, driven by exponentially increasing

anthropogenic changes – land-use change, agricultural intensification, and wildlife trade and consumption. The relationship between biodiversity and infectious disease is complex, and the loss and degradation of biodiversity undermine the web of life.

As our health and well-being depend on nature, it is our responsibility to preserve the planet and biodiversity.

A BIODIVERSITY-INCLUSIVE APPROACH

A more integrated, cross-sectoral and biodiversity-inclusive One Health approach can help us simultaneously address the common drivers of biodiversity loss, climate change and increased pandemic risk while supporting better health and well-being.

The Convention on Biological Diversity to this agenda contributes through the Global Action Plan for Biodiversity and Health. The draft, adopted at the 15th Conference of the Parties, calls for a biodiversity-inclusive One Health approach. A special virtual session of the Subsidiary Bodies to the CBD was convened to investigate linkages among biodiversity and health, One Health, the response to COVID-19 and possible future pandemics.

Building on the ongoing and excellent work of the Tripartite+ and the recently established One Health High-Level Expert Council, we urgently need to improve our understanding of the complex linkages among biodiversity, our shared environment, and human and animal health, and promote co-benefits through more integrated policies that can help advance the health, biodiversity and climate agendas.

A GREEN AND HEALTHY RECOVERY

The COVID-19 pandemic recovery provides opportunities for setting biodiversity spending targets in stimulus measures and recovery plans. As highlighted in the WHO Manifesto for a healthy recovery from COVID-19, it is imperative to protect and preserve nature as part of a healthy and green recovery.

With biodiversity declining faster than at any time in human history, the deterioration of nature threatens our quality of life. To restore humanity’s relationship with nature, we need a whole-of-government and whole-of-society approach. We need to shift away from ‘businessas-usual’ across a broad range of human activities, as underscored in the fifth edition of the Global Biodiversity Outlook (see Figure 2). We have a responsibility to ensure that COVID-19 economic stimulus and recovery measures help conserve and ensure the sustainable use of biodiversity.

Figure 1

Figure 2

Loss of biodiversity jeopardising human well-being and sustainable development

LIVING IN HARMONY WITH NATURE

The COVID-19 pandemic has seen an unprecedented mobilisation by all countries to shape a global health response. Furthermore, it has illustrated the need for strong governance and frameworks to address global challenges and preserve global public goods.

The CBD works together with governments and all of society, including Indigenous peoples and local communities, civil society and businesses, the financial sector, women and youth, as well as partners including the United Nations Environment Programme and the Rio Conventions, to catalyse momentum for addressing pressing environmental challenges in an integrated and systemic manner.

A post-2020 global biodiversity framework is being developed under the auspices of the parties to the convention. The framework’s first draft comprises 21 action targets to be achieved by 2030 and will be a key instrument to galvanise urgent and transformative action and help us achieve a vision of living in harmony with nature (see Figure 3).

By supporting efforts to achieve the Paris Agreement and the Sustainable Development Goals, the adoption of the post-2020 global biodiversity framework will pave the way for tackling climate change, biodiversity loss, ecosystem degradation and a wide range of socio-economic challenges by delivering numerous co-benefits from healthy ecosystems, thereby ensuring sustainable outcomes for human health and well-being. ▪

Ecosystems, species & genetic diversity

Human needs are met

Benefits shared equitably

Means of implementation

Elizabeth Maruma Mrema was appointed executive secretary of the Secretariat to the Convention on Biological Diversity in 2020, having served as interim executive secretary since 2019. She was previously director of the Law Division of the United Nations Environment Programme, where she has held many positions over two decades, including deputy director of the Ecosystems Division and executive secretary of the UNEP/Secretariat of the Convention on the Conservation of Migratory Species of Wild Animals. Before joining UNEP, Mrema worked with Tanzania’s Ministry of Foreign Affairs and International Cooperation and lectured in public international law and diplomacy.

ELIZABETH MARUMA MREMA

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Most emerging infectious diseases are caused by wildlife-origin pathogens, and the risk of pandemics is increasing rapidly, driven by exponentially increasing anthropogenic changes”

Taking the threat of anti-microbial resistance seriously

anti-microbial

Human, animal and planetary health are one and the same. We depend on the health of the planet and other species for our survival. As the COVID-19 pandemic continues to affect many parts of the world, we are seeing another emerging threat to human health: anti-microbial resistance. AMR occurs when bacteria, viruses, fungi and parasites change over time, no longer responding to pharmaceutical drugs used to treat illnesses in humans and animals. Overuse or misuse of anti-microbials, including antibiotics, tips the scales and can exacerbate the triple planetary crisis of climate change, nature and biodiversity loss, and pollution and waste.

A staggering 700,000 people die each year from resistant infections, and the financial consequences are also grave. AMR costs an estimated $1.5 billion per year in healthcare and productivity costs in the European Union alone. Strengthening the One Health approach, which recognises the interconnection between people, animals and nature, will be critical to treating our sick planet.

The good news is that we are starting to see progress. Important new collaborations such as the One Health High-Level Expert Panel and the Global Leaders Group on AMR seek to step up action. The G7 and G20 have both issued declarations backing the One Health approach. These initiatives will help improve science for coordinated interventions to ensure strong global stewardship of nature to prevent health risks.

ON THE ACCELERATOR

We are on the right track. But we need to accelerate action.

Ensuring strong financial support for actions on AMR will be critical. In 2020, only $220 million was committed to One Health activities in 13 countries –including India, China and some West African countries. Yet, to prevent future pandemics, we need to invest close to $3.4 billion per year.

This might seem like a lot, but compared to the estimated global economic cost of COVID-19 at $15.8 trillion – the billions invested now would pay off in the future. We need to channel financial recovery packages towards investments in One Health, unlock more private sector financing and build public-private partnerships.

The United Nations Environment Programme is working with member states to tackle these issues in an integrated manner. Our forthcoming report on the environmental dimensions of AMR, to be launched at the UN Environment Assembly 5.2 in 2022, will offer solutions for tackling AMR within an environmental framework.

It is time for us to act on the science and respond rapidly to AMR.

Let us not ignore the lessons of 2020 and make the same mistake again.

The choice is ours. ▪

INGER ANDERSEN

Inger Andersen is an undersecretary-general of the United Nations and the executive director of the UN Environment Programme. From 2015 to 2019, she was the director-general of the International Union for the Conservation of Nature. Ms Andersen has more than 30 years of experience in international development economics, environmental sustainability and policy making and has held various leadership roles at the World Bank and UN.

Twitter @unenvironment  unenvironment.org

As the world reels from COVID-19, it must stay alert to another threat to people’s health that puts at risk our ambitions of a healthy future for all

By Inger Andersen, under-secretary-general, United Nations; executive director, UN Environment Programme

Investingin

By Monique Eloit, director-general, World Organisation for Animal Health (OIE)

One Health

The COVID-19 pandemic is a reminder of how human, animal and environmental health are intrinsically linked and require a cross-sectoral approach through One Health. We already knew that more than 70% of emerging infectious diseases are zoonoses transmitted to humans by animals, but we are now realising how certain environmental factors such as global warming or human pressure on ecosystems can foster the emergence of zoonosis. This means that instead of thinking only in terms of specific

issues or diseases, we should think of ‘health systems’.

A pandemic is not just another disease. Because of its capacity to spread and the threat it poses to each of us, it affects not only our health systems but also our professional lives and economies, and our social and family lives, as well as diplomacy and international relations. It calls into question our societal choices and challenges the political level.

Integrating the One Health concept into policies constitutes an approach that will undoubtedly lead to more effective

Long-term political commitment, better informationsharing, and scientific cooperation can translate into a stronger global health system

health policy action. But, for this, we need the commitment of our global leaders to ensure long-term investment in One Health.

The recent declaration of the G20 health ministers in Rome, as well as their Call to Action on “Building One Health Resilience”, expresses a political commitment to this. However, a political commitment needs to be backed up by governance structures if it is to be translated into an action plan. This is the role performed by Tripartite+, the collaboration among the World Health Organization, the Food and Agriculture Organization, and the World Organisation for Animal Health, currently being expanded to include the United Nations Environment Programme to better address environmental health.

BUILT ON SCIENCE

Another concrete expression of what can achieve a strong political commitment and push is the establishment of the One Health High Level Expert Panel, which will deliver the best scientific advice on One Health–related matters, following the initial proposal of the French and German foreign ministers in the framework at the Alliance for Multilateralism and the Paris Peace Forum. This panel already supports the Tripartite+ to develop a One Health Global Action Plan.

The same long-term political commitment and support will be needed for other areas such as research, data sharing and capacity building to implement an ambitious plan of action. In this regard, we must identify critical research and information gaps and support initiatives to address these gaps, including socio-economic studies to assess practices that trigger health risks such as illegal wildlife trade.

We must also strengthen the sharing of information, samples, genomic data and other types of data as well as risk assessment approaches, including the application of foresight and multi-sectoral, joint approaches to better predict, prevent, detect and control new pandemic threats. Initiatives such as the new WHO Global Pandemic and Epidemics Intelligence Hub in Berlin will certainly help us to achieve these goals.

It is also necessary to build transversal and efficient health workforces,

MONIQUE ELOIT

Monique Eloit is the director-general of the World Organisation for Animal Health (OIE). Prior to her election, she occupied the position of OIE deputy directorgeneral from 2009 to 2015. A doctor of veterinary medicine, she has also been the chief veterinary officer of France and served as national delegate to the OIE from 2005 to 2009. Twitter @OIEAnimalHealth  oie.int including veterinary services. In this regard, it is worth mentioning the long-standing cooperation between OIE and WHO in performing joint external evaluations to assess the capacity of our members to implement the International Health Regulations and the OIE International Standards when considering zoonosis control. In addition, the WHO Academy and other potential partners will develop One Health learning opportunities to allow health workforces not only to address potential future crises, but also to manage so many challenges that threaten human, animal and planetary health.

OUR COMMON CHALLENGE

Last but not least, with the IUCN World Conservation Congress held

in Marseille in September, which recognised the environmental dimensions of One Health, and the United Nations biodiversity conference in Kunming in October and the climate change conference in Glasgow in November, it is more than necessary to pay more attention to areas such as risk assessment, biosafety, ecosystem protection, biodiversity conservation, rehabilitation and restoration, as well as wildlife and environmental health.

This is our forthcoming common challenge, and you can count on the OIE to address this goal and make One Health a reality on the ground. ▪

By Wanda Markotter and Thomas C Mettenleiter, co-chairs of the One Health High-Level Expert Panel

One Health requires a global commitment

A high-level expert panel will work towards advancing the One Health agenda, creating a stronger and more resilient health ecosystem that joins the dots on human, animal and environmental risks

Evidence pointing to a zoonotic origin of the COVID-19 pandemic once again highlights how closely linked human, animal and environmental health are. It also emphasises the need for a holistic approach, not just in theory but also for practical implementation. The One Health approach, which acknowledges that humans, animals and the wider environment are linked and interdependent, is not new. Still, it is now even more urgent to translate it into real change and future actions that will prepare us for future pandemics and also aim to prevent them from happening in the first place. One Health

in practice requires an integrated, unifying, systems-based, intersectoral approach to achieve sustainable health outcomes. Its focus should not just be anthropocentric. Broader topics such as access to clean water, food security, health and environment all have sector-specific focus areas beyond the scope of One Health approaches. Still, their interface is where there is a shared responsibility for addressing health challenges collectively.

ADVANCING ONE HEALTH

In May 2021, the One Health High-Level Expert Panel was established to bring together diverse scientific expertise

from every region of the world to advance the global One Health agenda. This panel is an excellent example of breaking silos and rethinking the way forward. It is advising four international organisations: the Food and Agriculture Organization, the World Organisation for Animal Health, the United Nations Environment Programme and the World Health Organization. The panel is tasked with assessing health risks arising from the human–animal–environmental interface. It will identify scientific evidence and action gaps and advise on collective actions and effective collaboration needed to prevent

WANDA MARKOTTER

Wanda Markotter is the director of the Centre for Viral Zoonoses in the Faculty of Health Sciences at the University of Pretoria. She occupies the DSI-NRF South African Research Chair in Infectious Diseases of Animals and the chair in People, Health and Places at the Future Africa Institute. Her interdisciplinary research programme focuses on bat pathogens and the risk of spillover in Africa.

future pandemics. The High-Level Expert Panel is an essential step in recognising the complex multiand interdisciplinary issues at the intersection of human, animal and environmental health. This initiative is critical in transforming One Health from a concept into concrete policy. It will provide evidence-based recommendations for global, regional, national and local action that is practical.

global levels. Political commitment and allocation of resources that are distributed equally are essential for successful implementation.

A HEALTHIER ECOSYSTEM

THOMAS C METTENLEITER

Thomas C Mettenleiter has been with the Friedrich-Loeffler-Institut since 1982, first in Tübingen, then on the Isle of Riems. In 1986–1987 he had an 18-month research fellowship at Vanderbilt University in the United States. From 1994 to 2019 he chaired the Institute of Molecular Virology and Cell Biology, and has been president of the FLI since 1996. He is a member of the National Academy of Sciences Leopoldina and the recipient of several honourary professorships as well as the Robert von Ostertag Medal of the German Federal Chamber of Veterinarians. His main field of research is virus infections of farm animals.

The panel specifically aims to document and analyse One Health approaches to identify best practice examples but also bottlenecks, consider what we know on the ground, identify gaps and advise on implementation going forward. Surveillance, including reporting, must be redefined in a One Health approach. It should not focus solely on pathogen detection in animals and humans but also include monitoring and modulation of factors that may drive spillover, including environmental aspects.

The COVID-19 pandemic also demonstrated very clearly the global interconnection of health. Therefore, it is also crucial that One Health translates into action in all world regions, including at the individual, community, sub-national, national, regional and

However, it is also the responsibility of every individual to cooperate in order to tackle threats to health and ecosystems. Discussions, recommendations and activities must address this as one overarching concept, with each aspect equally important and resourced. We need to also recognise that there are substantial political, legal, ethical and societal barriers and complexities in developing a unified One Health framework that is practical on a local level. Despite this, we need to recognise that One Health is not only about pandemic preparedness and prevention but is in fact much more far-reaching. Commitment to implementing it successfully will create a healthier ecosystem for all, addressing several other concerns such as biodiversity loss, climate change, food security and social inequalities. There are clear advantages in this approach to improve health for all, as well as sustainable economic stability and resilience. ▪

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The One Health approach, which acknowledges that humans, animals and the wider environment are linked and interdependent, is not new. Still, it is now even more urgent to translate it into real change”

Health: A Political Choice