Convergence: a growing challenge for global health governance
G20 Summit

Convergence: a growing challenge for global health governance

The number of meetings and negotiations on pandemic prevention, preparedness and response are not matched by bold outcomes. Countries must come together to build the convergence required

There is increasing concern that the commitment to pandemic governance has again fallen into the cycle of panic and neglect at both national and international levels. There is great impatience to see decisive action from governments and international bodies, yet the number of meetings and negotiations on pandemic prevention, preparedness and response – PPPR – now under way are not matched by bold outcomes. 

Indeed, the sheer quantity of global gatherings could stand in the way. They are the result of 20 years of insistent advocacy to ‘put health high on the political agenda’. They are based on the rationale – the mantra of the pandemic years – that global health issues are so pressing that they must also be dealt with not just by other portfolios – especially finance ministers – but by the heads of state and government themselves. 

At present, meetings in at least three venues are critical. They offer an opportunity for a new dynamic of ‘horizontal forum shifting’ across diverse international political entities and organisations – some inclusive, some less so. If one venue does not support an agenda, state parties and civil society advocates can move to another or simply create a new one, such as the G20’s health and finance ministers’ meeting and its task force. This can also happen within venues: two or more instruments or declarations are now being discussed in parallel at the World Health Organization and at the United Nations. 

Additional deliberations

At the WHO, both a pandemic accord and a revision of the International Health Regulations are being negotiated, leading to additional complications in deciding what issue should be resolved under which instrument, especially since the IHR comes into force by a decision of the World Health Assembly based on article 21 of the WHO constitution, whereas any measures of an accord under article 19 would first need ratification at the national level. Aside from the political dynamics this brings, it also means additional deliberations – because a constant check on overlaps and mandates becomes necessary. 

But some consider the WHO too focused on health to ensure the necessary commitment of other sectors and government leaders. The increase of pandemic meetings was a good opportunity for forum shifting to achieve preferred results by changing the game – in this case, because health ministers are considered ‘weak’, the commitments are sought from the UN’s Pandemic Summit in September 2023 which nominally is at the level of heads of state and government. 

The dynamics are further complicated because this year has three health negotiations under way at the UN – the Pandemic Summit, the High-Level Meeting on Universal Health Coverage and another on tuberculosis. As each health issue is related to the others – no PPPR without a strong commitment to universal health coverage – each constituency is keen to see its own agenda reflected in the other political statements. Civil society groups have been particularly active, also in platform hopping, yet deeply frustrated by being excluded from much real decision-making. 

This expands the range of interest groups with a stake in the outcomes of each separate negotiation. Despite strong advocacy groups calling for new global governance mechanisms beyond the WHO, the UN Pandemic Summit negotiators do not seem ready for bold statements or commitments. Indeed, forum shifting can use such political declarations to water down commitments that need to be made in negotiating legally binding instruments. 

While we are used to strong states ‘playing’ the different forums to optimise their power – well known from intellectual property negotiations – we now see ‘weaker’ parties, such as developing countries, deploy forum-shifting strategies to try to reshape the rules. This is illustrated by the significant number of health meetings under India’s G20 presidency with the explicit agenda “to build global convergence on an agile, aligned global health architecture”. 

Ongoing threats

The meetings highlight the ongoing threat of pandemics and the urgent need for integrated surveillance systems, medical countermeasures, digital health initiatives, and vaccine research and development at global levels – all also being debated in the other venues – but with the specific claim to ‘voice the challenges of the Global South’. This is reinforced by the middle-income countries from the Global South hosting consecutive G20 presidencies – Indonesia, India, Brazil and South Africa – and the prospective addition of the African Union as a G20 member. Indeed, in the pandemic accord negotiations there is a constant critique that the equity concerns of the Global South are not sufficiently taken into account. 

This new development in global governance for health needs close consideration. Yes, it reflects the multipolar world – but how many negotiations on health can any one country conduct at the same time? Small countries have already complained, as the pandemic accord now has informal meetings to complement the formal negotiations. How can civil society keep track? The WHO is also overburdened by all the meetings it must contribute to in other venues – some of which would like to proceed without it – while ensuring that its own negotiations fare well. 

Yet here is the entry point: the WHO constitution states that the organisation is “to act as the directing and co-ordinating authority on international health work”. Countries must come together to build the convergence that is required – and maybe this time the countries of the Global South can take the lead to empower the WHO through a process generated at the G20.