To ensure global health security, the world should harness the infrastructure used to fight AIDS
In these times of compounding global health crises, the importance of universal health coverage, which Japan has long championed, has never been clearer. As Prime Minister Fumio Kishida set out in The Lancet, ensuring Health for All is crucial to global security, as it is key to respond to – and adequately prepare for – the future pandemics that scientists warn are on the horizon. Noting how the international Covid-19 response exposed the vulnerabilities in our global health systems, he called for reimagining the global health architecture.
How can Health For All be achieved? How can we prepare for pandemics and ensure that health crises do not rip through economies and societies? From the experience of the global AIDS response and its role in driving progress on health overall, three key lessons can be drawn.
First, it will be vital to harness the capabilities developed to fight AIDS. Official development assistance from the G7 members to the HIV response has been crucial in fighting the AIDS pandemic. To respond to Covid-19, governments built upon surveillance systems that were developed to track HIV, and harnessed what has been called the HIV infrastructure, from laboratories all the way to community networks. So too with the Ebola and Mpox responses. Continuing to build up the tried and tested systems developed by the AIDS movement is key to responding effectively to all current and future pandemics.
Second, it is essential to ensure that developing countries have sufficient resources to provide Health For All. The World Bank has issued a stark warning: if urgent action is not taken, two-thirds of developing countries are set to see health investment per capita stagnate or decrease until 2027, compared to 2019 pre–Covid-19 levels. In 2021, lower-income countries spent four times as much on repaying international debt as they did on health. The G7 is uniquely placed to bring public and private creditors into debt negotiations and to improve domestic legislation to enable fast and fair debt restructuring or cancellation, so these governments can devote vital resources to health instead of debt payments. A full deployment of the reallocation of the special drawing rights at the International Monetary Fund, agreed to by the G7 at the Elmau Summit in 2022, is also needed, prioritising pandemic response and prevention. A growing portion of official development assistance should support health investments. For sustainability, domestic revenues also need to grow, which will require closing tax loopholes and progressive fiscal reforms.
Third, it is critical for our collective global health security that developing countries get access to medical technologies at the same time as rich countries. This has not happened in the Covid-19 pandemic. Capable companies in the Global South were not allowed to produce Covid-19 vaccines, tests and treatments because a small number of pharmaceutical companies were granted monopolies on the technology. Yet the AIDS response has taught us that it was the production of generics in developing countries that drove down the cost of HIV medicines by 99%. With substantial funding from the G7 governments, HIV medicines were purchased and delivered at scale. Now, three-quarters of people with HIV are on treatment, able to live long and healthy lives. These lessons need to be applied to Covid-19, to new long-acting technologies for HIV prevention and treatment, and to international pandemic preparedness processes. Health technologies need to be recognised as public goods, requiring governments and companies to share knowledge, transfer technology and support regional manufacturing in the Global South, especially in Africa, to ensure access to medicines for all.
From aspirations to achievements
This moment of polycrisis can only be overcome through bold action driven by courageous leadership. In this interconnected world, it is an opportunity the world cannot afford to miss. Prime Minister Kishida is right that this G7 has a key role to play in ensuring that Health For All and pandemic preparedness move from aspirations to achievements.