During the Global Health Summit, hosted by Italy on May 21st, the G20 and the European Commission (EC) co-signed the Rome Declaration. We applaud their recommitment to strengthening health systems for global health security and Universal Health Coverage (UHC). However, in our opinion, the Declaration is not bold nor concrete enough on effective global health cooperation, strengthening health systems and intellectual property rights. It also fails to critically assess the importance of public financing and governance in health systems, and lacks urgency on solving the global health workforce crisis. We raised these points during the EC/G20’s consultations with civil society organisations a month before the Summit. Looking at the final Declaration, we identify some missed opportunities.
We are pleased with the G20 and EU Member States’ promise to cooperate more effectively and multilaterally in the Covid-19 response, preparedness for future pandemics and financing for global health security. The Rome Declaration emphasises that global health security requires strong health systems, UHC with Primary Healthcare at its centre, and a healthy health workforce. It includes 16 principles guiding the commitments and we are happy to read that investments in health are considered both a global public good (preambular section) and a human right (principle 1).
…but missed opportunities
On the following critical points, however, we think the Declaration could have been more bold and concrete to really guide more effective cooperation.
1) The Declaration refrains to act on the acute necessity of sharing patents, knowledge and technologies to deal with public health threats.
It mentions voluntary licensing agreements and patent pooling (principle 7), but this is not enough. If we want to end the Covid-19 pandemic, we need to end it everywhere and as quickly as possible. All available factories of qualified pharmaceutical companies should be running right now to make enough Covid-19 vaccines for everyone in every corner of the world. Therefore, Wemos advocates the G20 and EU Member States to push forward with sharing of data, knowhow and intellectual property to maximise global manufacturing capacity for vaccines.
The WHO has set up the Covid-19 Technology Access Pool: C-TAP. Through this pooling mechanism for data, knowhow and intellectual property, we can maximise manufacturing capacity and decrease inequity. So far, no government or pharmaceutical company has shared their technology for Covid-19 vaccines in C-TAP. We continue to urge countries to do what it takes to end the pandemic and actively support C-TAP.
2) The Declaration does not mention concrete commitments to invest in the global health workforce.
It stresses the need for investment in the global health and care workforce, education and training (principle 9) – including through innovative initiatives such as the WHO Academy. However, low staffing levels have hampered progress towards UHC and are associated with the spread of pathogens and risk of outbreaks. The G20 and EC commitments could have better addressed this by building on already existing action plans and strategies to strengthen health workforces worldwide. For instance, the High-Level Commission on Health Employment and Economic Growth (2016) led to a Working for Health Programme that was to be supported with a Trust Fund of USD 70 million, but to date raised only 7 million USD, from only two donors. We would have liked the G20 to promote this Programme by urgently calling on donors to commit to these investments.
3) The Declaration fails to stress the need for more public funding for stronger health systems.
It mentions public funding only once (principle 15). Adequately functioning and resilient health systems that provide access to all and leave no one behind require public funding, as is also underscored by the WHO. Countries that have made significant progress towards UHC, including public health services for health protection, have health systems that rely predominantly on public funding from compulsory funding sources – mobilised in a progressive way, e.g. via fair taxation system – and on effective pooling of resources for redistribution according to need. To support countries in raising public resources, we need to address the problems in the broader financial architecture that hinder domestic resource mobilisation, like tax injustices, illicit financial flows and the debt burden.
The Declaration puts public funding at the same level as private funding and reiterates the use of innovative and blended finance mechanisms (principle 16). Yet, such financing mechanisms, involving the use of public resources to attract private commercial funding, are not the solution. These mechanisms are often promoted on the premise that there is not enough public funding. But this does not have to be the case, since raising public funding is a political choice that needs action at domestic and global level. Moreover, as we highlight in our paper ‘Risky business’, these innovative financing mechanisms are often more expensive than the public purse and less effective in reaching the furthest left behind than the public option.
More concrete commitments needed for strong health systems
In short, while the Rome Declaration acknowledges that investments in global health (security) are essential for a sustainable future, more concrete commitments are needed if we want countries to be able to address future global health threats and deliver universal health coverage for all. These should address key issues underlying strong health systems, including sharing patents, knowledge and technologies to deal with public health threats, sustainable investments in the health workforce and a ‘public first’ approach in health financing.
Photo: ©European Union, 2021, photographer: Etienne Ansotte