An ‘off the shelf’ cure for fragmentation?

An ‘off the shelf’ cure for fragmentation?

The virus of fragmentation is afflicting our countries and institutions, sickening people and planet – but, with its globally shared promise to leave no one behind, the 2030 Agenda offers an ‘off the shelf’ cure

In 2015, countries and communities joined hands to craft and agree on the 2030 Agenda for Sustainable Development, a historic plan of action for people and planet. Much progress has been made, including reducing poverty and child mortality. Yet life expectancy dropped between 2019 and 2021 in the wake of the Covid-19 pandemic, the first such drop since 1950. The pandemic has stalled, and even reversed, steady improvements in public health. At the current rate of progress, universal health coverage, a pathway to delivering on everyone’s right to health, remains beyond reach, with approximately two billion people facing the effects of “catastrophic or impoverishing health spending”. Just 15% of the Sustainable Development Goal targets are on track.

How did we end up with the future we have?

Consider the fact that taxpayers give fossil fuel companies $11 million in subsidies every minute – which are supercharging the climate emergency – even as droughts, floods, fires, hurricanes and heatwaves are harming and destroying the livelihoods of millions of people. Violent conflicts are at their highest levels since the Second World War. We are seeing pushback on human rights, the rule of law, gender equality and civic space. Today, another ‘disease’ afflicts our countries and institutions, sickening people and planet: a virus of fragmentation. The 2030 Agenda, with its globally shared promise to leave no one behind, represents the best, ‘off the shelf’ cure.

Bridging countries

Time, political will, financing and action remain in short supply. In this time of polycrisis, with global threats growing in number and complexity, we must think and act differently. As United Nations secretary-general António Guterres says, we must prepare for the health threats to come – from the next pandemic to climate threats – to prevent them where we can and respond fast and effectively where we cannot.

The World Health Summit and the SDG Summit in 2023 represent new opportunities to secure the rights and well-being of all and protect our planet. That includes extending universal health coverage and pandemic preparedness and response based on a human security approach so we can realise resilient health systems that flexibly tackle health emergencies and multiple threats to health. We can also bring a globally networked innovation and access ecosystem for medical countermeasures to life by committing to sharing solutions such as vaccines and other health technologies as global public goods. This would save lives and restore trust in our global systems.

We must also reverse other areas of fragmentation affecting health and well-being. The Paris Agreement is a public health agreement as much as it is one of climate action. By delivering on it, we can advance the right to a clean, healthy and sustainable environment together with people’s health and well-being.

Retiring ‘trade-offs’

The 2030 Agenda is also prompting a re-think of the metrics needed to secure the future of people and planet. That means looking beyond gross domestic product to leverage synergies across sectors. For instance, a just energy transition would dramatically reduce harmful greenhouse gas emissions while advancing social justice, human rights, gender equality, health, education, jobs and livelihoods.

Smart use of data and analytics are key to scaling the integrated solutions to responding to the multidimensional aspects of health and well-being. The UN Development Programme’s ‘SDG Push’ analysis shows that it is still possible for countries to outperform their pre-Covid development projections by investing across core SDG ‘drivers’ including health, social protection, a green transition, digitalisation and governance.

Institutions for the 21st century

The UN system, as our primary global anchor to promote peace, security, and development, must also evolve. Secretary-General Guterres has an ambitious plan for a revitalised UN through the Our Common Agenda report, and a spirit of multilateral collaboration is being nurtured through initiatives such as the SDG3 Global Action Plan. This has paved the way for the UN Comprehensive Response to Covid-19, which integrated health, development and humanitarian support through the pandemic. There is much more to be done on pandemic preparedness and response, but the UN and its many partners are now better equipped to respond to complex health emergencies. Efforts to stay and deliver in Afghanistan, Sudan, Syria, Ukraine and beyond demonstrate this fact.

Global health governance is evolving in other ways. Gavi, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the US President’s Emergency Plan for AIDS Relief are integrating their disease-specific responses with broader efforts to strengthen health systems and prepare for pandemics. The International Health Regulations are undergoing long-awaited amendments; a new pandemic accord is in the works; and other strong proposals have been put forth to make Covid-19 the last pandemic of its kind. The mRNA vaccine technology transfer hub in South Africa initiated by the World Health Organization is a clear demonstration of how developing countries are becoming a nucleus for the solutions that our global community now needs.

Whether this all ultimately makes the world safer depends on the same essential elements: political will at all levels for multisectoral and timely responses, an empowered WHO and a shared commitment to equity. As ever, finance is pivotal. That involves reforming the international financial architecture and directly tackling the global debt crisis at a time when many developing countries are spending, on average, 1.4 times more simply to service their debt than they allocate to health care. These shifts could unlock hundreds of billions of dollars to invest in health, climate and all 17 SDGs.

Solidarity over separation

The estimated 24 million excess deaths and counting due to Covid-19 should not be the jolt we need to take pandemic preparedness seriously. Nor should countries and communities be locked into a never-ending cycle of polycrisis to grasp the importance of the SDGs. In a world riven by the impacts of conflicts, geopolitical tensions and the climate emergency, we have a clear way out. The 2030 Agenda represents one of the only platforms that all countries still agree on for navigating through this sea of uncertainty. We must act upon it as our global community’s best hope to defeat the virus of fragmentation. Solidarity can win over separation.