Cosmopolitan moments are short points in time at which the global community comes together and creates new institutions and mechanisms that it has not otherwise been willing to introduce. Now is perhaps such a unique moment. It could generate a political drive for change in global health governance in the face of increasing interdependence and structural global vulnerability.
The increasing interest of heads of state and government has moved global health issues into the arena of ‘high politics’. Former US President Barack Obama and other heads of state are personally involved in the Ebola response. Ebola is discussed by the United Nations Security Council, the International Monetary Fund, the World Bank, the African Union, and the European Union’s foreign policy council. German Chancellor Angela Merkel has put health as a priority on the G7 agenda and agreed to address the World Health Assembly of the World Health Organization (WHO) in May 2015. These leaders must now act forcefully on matters of global health governance. There is no time to lose.
Increase of systemic risks
Today, health security is a systemic challenge to the whole global community and to every part of the world. Africa is beset with outbreaks of zoonotic diseases: North Africa with Middle East respiratory syndrome (MERS), Brazil with dengue, Asia with influenza; the whole world is alarmed by the increasing threat of antimicrobial resistance – and the list goes on. Also – as with Ebola and in Syria – there is a growing interface between health and humanitarian crises, as outbreaks hit fragile states, war-torn countries and poor communities.
Let us be clear about three issues:
– the situation is going to get worse and the world is not prepared for the next health crisis, which could well be an airborne disease;
– each and every health crisis is also the expression of a systemic crisis, deeply linked to processes of globalisation, ecological imbalances and structural inequalities; and
– every major health crisis affects the whole of society: communities break apart, trust in the government diminishes, food systems deteriorate, and the economy suffers.
David Nabarro, the UN Secretary General’s Special Envoy on Ebola, has warned that outbreaks of deadly animal-to-human viruses such as Ebola are becoming more likely in Africa due to climate change, deforestation, extractive industries and population movements. Yet the proposed post-2015 Sustainable Development Goals (SDGs) do not see global health security as central to sustainable development. There has since been a suggestion to introduce an SDG 18, which reads: “Take appropriate action to reduce the vulnerability of people around the world to new, acute, or rapidly spreading risks to health, particularly those threatening to cross international borders.”
There is also a need to consider global health security when revising the zero draft for the third International Conference on Financing for Development, which will take place in Addis Ababa, Ethiopia, in July.
The way forward
Despite increasing local and global health risks, the international agency set up to address them is caught in political gridlock and suffers from wholly inadequate funding. For many, WHO is no longer fit for purpose and is attacked for having responded too late to the Ebola outbreak. As always, there are proposals to create new agencies and new funds.
It is simple: in order for an institution to be effective, the states that have created it and sit in its governing bodies have to want it to be effective, and to design and fund it accordingly. But, while increased collective action and investment are required, governments hold on to the purse strings and shy away from both international cooperation and national implementation. WHO is supposed to work miracles on a budget equal to that of the university hospital in Geneva. It has taken a philanthropist to push the boundaries of global health action and debate, and contribute significantly to WHO’s funding. Will the G7 be willing to take the lead for a new multilateralism in health and commit to reforming and strengthening WHO?
In a global risk society, WHO’s constitutional role “to act as the directing and coordinating authority on international health work” means being at the centre of a global warning and response system for global health crises. WHO can only lead if it has the political support, funding, staff and instruments to act at its disposal: strong, revised International Health Regulations and the Emergency Response Framework. Such leadership reaches far beyond individual ministries of health – in the Ebola crisis, WHO Director General Margaret Chan was in constant contact with government leaders, the UN Secretary General and members of the UN Security Council, as well as the leaders of other agencies.
The High-Level Panel on the Global Response to Health Crises appointed by the UN Secretary General can provide an overall political and strategic plan to solidify relations such as the 21st-century approach to global health governance, and have the plan adopted by heads of state and government at the UN General Assembly. This would position WHO in a global political landscape where many decisions on health are taken by government leaders and leaders in other sectors. It would also define the profile of the next WHO Director General, whom WHO members will have to appoint in two years’ time.
Yes, there will be many issues and details that need to be resolved on how to strengthen the global warning and response system, build a well-trained global and local health reserve workforce, and establish a fund that is ready to disburse in times of crisis and a significant research effort. But these matters will fall into place once the key element is set: in order to ensure global health security, states must work together and they must work with others in the context of a strong multilateral organisation.
The G7 must send a clear political and financial signal to other Gs and regional groups, as well as the BRICS group of Brazil, Russia, India, China and South Africa, that it is fully committed to joint action on global health security. In doing so, it can also respond to the critical voices that fear that a focus on health security will express the self-centred interest of only the developed world. The G7 can help set in motion a new phase of global health governance. This is a political choice.