Taking action together
Deeper G20 engagement with the United Nations would bring far-reaching benefits – and global health is an effective place to begin
The G20’s role in global health has expanded significantly – as have expectations. Under Germany’s 2017 G20 presidency health gained new prominence and the World Health Organization is now invited to the summit, sending a strong signal to connect the G20 with the United Nations. Given the G20’s expertise and role in financing, the issue of global health funding has filled a gap. Japan’s 2019 presidency focused on joint efforts of health and finance authorities on financing universal health coverage in developing countries, linked to the first UN high-level meeting on the issue in 2019. There was a strong interaction between G20 and UN goals, with Japan using its G20 presidency to push a health agenda at the UN.
The Covid-19 challenge silenced any questions about whether the G20 should deal with health issues. But new geopolitical constellations and political shifts within G20 members reduced interactions with the UN system, so important to both the German and the Japanese presidencies, and turned the G20 to cooperate with financial institutions. A major step was the creation of the G20 Joint Finance and Health Taskforce, which first met during Italy’s G20 presidency in October 2021, building on the work done under the 2020 Saudi Arabian presidency.
As with the debates on financing universal health coverage, the pandemic demonstrated that many public goods that traditionally belonged to the domain of national governments have become global. Not investing in them has severe economic consequences. Covid-19 provided a chance for the G20 – together with the Bretton Woods institutions – to show that they are fit for new financing challenges with truly new instruments. For this reason, many global health advocates call for a stronger interface between health and finance ministers.
Analogies have been made with the 2008 global financial crisis: facing major health, social and economic consequences, the G20 must stabilise the world once again. By defining the key answer as the need for an economic intervention, the G20 became the major ‘solutions platform’. It is no surprise, then, that it led to the creation of the Financial Intermediary Fund for Pandemic Prevention, Preparedness and Response in 2022 under Indonesia’s presidency.
The fund has been welcomed by many parties. But contrary to the success of the stability measures approved by the London Summit in 2009, G20 responses to the pandemic between 2020 and 2022 have been meagre. The pandemic is not over, the world is not yet better prepared for another pandemic and the financial impact on countries remains devastating. The International Monetary Fund expects Covid-19 will cost the global economy $12.5 trillion through 2024. Yet at this point the pandemic fund has only been able to reach 10% of its funding goal of $10 billion – and some of this money constitutes pledges that might not get paid out in view of other crises overtaking the concern with pandemics.
There is a trend to respond to global health challenges by adding new institutions and mechanisms in ever new constellations of governance by the same established global health actors who criticise the UN system – and to define this as innovative. But the financing model of global health as a global marketplace, linked to major funding institutions, donor countries and key foundations and built on official development assistance and replenishment processes, remains unchallenged, even by the G20.
The G20 is not accountable to the countries affected by its actions, the institutions it creates and the reforms it adopts. All G20 proposals should be assessed on whether they comply with the principle of a democratic and equitable international order as set forth in various UN instruments. This situation has revitalised the call for fundamentally rethinking global health governance and funding and a reinvigorated discussion on how to finance global goods for health. One proposal is for a single Global Health Fund with clear priorities and high levels of accountability in the interface with the UN system, especially the WHO.
Overshadowing the key issue
For a long time, the key legitimacy argument in favour of the G20 was that its decision-making was more efficient than the UN’s inclusive global governance, nurturing the myth that when heads of state and government come together, they will act. The G20’s neglect of the interface with the UN system has dangerously overshadowed the real issue at stake: the weakening of the democratic, equitable and inclusive governance of global health and the refusal of important UN members – especially many G20 members – to commit to and invest in a strong multilateral system and a robust global cooperation and financing mechanism in the face of a pandemic. This includes funding for the WHO.
The geopolitics hampering the UN and its institutions have crept into G20 and G7 deliberations. Decision-making is as difficult in the G20 as it is in the UN when major powers refuse to cooperate or put pressure on others. Future G20 legitimacy in health in 2023 will hinge on its ability – under India’s presidency – to link G20 deliberations back to the UN system to ensure contributions and acceptance by its members, especially low- and middle-income countries. The opportunity is provided by three big UN initiatives in 2023 – the High-Level Pandemic Summit, the high-level meeting on universal health coverage and negotiations for a global pandemic treaty at the WHO. Deeper G20 engagement with the UN would benefit both the G20 and the UN. Indeed, rather than work around the UN, the G20 should lead on driving the much-needed UN reform. Why not start with global health?