G20 performance on health

The 2025 G20 Johannesburg Summit is a critical opportunity for collective leadership to address global health challenges. South Africa – the first African country to hold the G20 presidency – has placed health at the heart of the G20 and global agenda. Framed by the overarching theme of ‘Solidarity, Equality, Sustainability’, the G20 Health Working Group has convened four times this year to shape the G20’s health priorities. These technical discussions should translate into robust commitments in the Johannesburg Summit declaration, with possible linkages to G20-wide priorities in finance, digital transformation and sustainable development.

Deliberations

From 2008 to 2024, health took an average of 9% of the words in the G20 declarations per summit. Between 2008 and 2019, health averaged just 4% per summit. The 2020–2024 period saw a dramatic rise to average 21%.

This surge, starting with the 2020 Riyadh Summit at 68%, coincided with the Covid-19 pandemic and a broader global emphasis on health security and resilience. This expansion shows that recent summits have responded to the heightened urgency and complexity of global challenges in the pandemic and post-pandemic eras.

Decisions

G20 leaders have made a total of 177 commitments on health, placing it 13th among all subjects. Although they began discussing health as early as 2008, they only started making formal health commitments at their Brisbane Summit in 2014, where they produced 33 such commitments, accounting for 16% of the total.

Starting just before Covid-19 and then as it spread, the 2019 Osaka and 2020 Riyadh summits each generated 14 commitments (for 10% and 13%, respectively). This rose to 35 (16%) at Rome in 2021, 17 (8%) at Bali in 2022 and 25 (10%) at New Delhi in 2023. Rio de Janeiro in 2024 produced 11 health commitments, for 6%.

Delivery

As members’ compliance with the summit commitments is a crucial measure of the G20’s credibility, the G20 Research Group has assessed 31 priority health commitments, finding an average compliance of 70%, close to the overall average of 71%.

Compliance after the Ebola shock in 2014 was low: the Brisbane Summit had 72% health compliance. This dropped to 65% for 2015 Antalya, and further to 30% for 2016 Hangzhou. Compliance rose to 66% for the 2017 Hamburg Summit, followed closely by 2018 Buenos Aires for 64%, and back to 66% for 2019 Osaka.

During the pandemic and after, compliance rose to 70% for 2020 Riyadh, 69% for 2021 Rome, 76% for 2022 Bali and 78% for 2023 New Delhi. By May 2025, compliance with the one priority health commitment assessed from the 2024 Rio Summit was 83%.

Causes

Shock-activated vulnerability clearly causes compliance, as commitments made during and since the Covid-19 pandemic have had higher compliance. These summits made more focused commitments on health, and summits with fewer commitments and broad language tended to have lower compliance. From 2014 to 2019, between 8% and 14% of the declarations’ words were on health, with compliance averaging 69% for those summits. From 2020 to 2023, there were more targeted health commitments, rather than general ones, and compliance was higher. 

Another cause of compliance is linkages to other sectors. Compliance improved when health was linked with other policy domains, such as sustainable development, which includes climate and gender. The high compliance with the health-related commitments for the 2021 Rome Summit (76%), 2022 Bali Summit (78%) and 2023 New Delhi Summit (83%) followed those commitments’ explicit interrelationship with the One Health Approach, health technologies, the Sustainable Development Goals, and the economies of low- and middle-income countries.

Conclusion

The 2025 G20 presidency has incorporated these lessons. South Africa’s Health Working Group meetings have strategically connected health to economic recovery, gender equity, digital innovation and labour force development. Side events co-hosted with the Joint Finance-Health Task Force have further reinforced an integrated policy response.

South Africa’s presidency offers a model of how to anchor global health commitments in equity, systems thinking and cross-sectoral cooperation. If the G20 succeeds in adopting clear, measurable and actionable commitments – and backs them with coordinated follow-up – the Johannesburg Summit could set a new benchmark for health governance in the years ahead.

The Johannesburg Summit thus marks a pivotal moment to solidify the G20’s role as a global health governor. It should underscore South Africa’s longstanding policy orientation towards universal health care and equity – reflected domestically in its National Health Insurance roll-out and internationally in its multilateral leadership during and after the Covid-19 pandemic. With just five years left to achieve the SDGs, this year’s G20 will need to shift further from discussion to action. The world is watching.