India plans to use its G20 presidency to build consensus on global health resilience

The complex and evolving nature of today’s healthcare challenges means that in many cases a united global response will be more effective than individual countries acting independently.

Our global experience of the COVID-19 pandemic proved that when a health emergency strikes, scientists, governments, political leaders, the private sector — including large companies and start-ups – and regulators from across the world must come together fast and work seamlessly as an integrated whole to develop a vaccine for the new disease. COVID-19 also demonstrated that having enough vaccines doesn’t mean that everyone everywhere will get access to those life-saving jabs.

When a highly transmissible virus triggers a pandemic in a highly interconnected world, saving people in a few countries may delay the damage, but it won't cease it. With the wisdom of the recent past, the world must rethink the healthcare model collectively.

We need a strong and efficient global health architecture. It must be able to contain a health outbreak in the region of origin, without allowing it to assume the proportion of a pandemic. When the next health emergency strikes, the global health system should also have a clear mandate, ability and accountability to develop, manufacture and distribute vaccines, medicines and diagnostic tests for the targeted disease, based on the countries' needs, not their prosperity levels.

In idea terms, we came close to a global solution when the Access to COVID-19 Tools Accelerator (ACT-Accelerator) coalition was conceptualised in 2020 and worked to create end-to-end solutions to the pandemic. As a platform, it brought together governments, scientists, businesses, not-for-profits and philanthropists to ensure that tests and treatments for COVID-19 are developed, produced and equitably distributed to all who need to access them.

It's time to reimagine the contours of the accelerator to cover more challenges and cover them better. Such an accelerator in healthcare, with a nimbler global structure and well-oiled mechanisms for governance and public-private partnership, is needed for a scope much beyond COVID-19 because that was not the last pandemic.

Our next global health emergency may arise from among the health threats we know of, such as antimicrobial resistance or another viral outbreak, or it could be something completely unforeseen. But having a defined framework globally, mock drills and the capacity to manage such health threats at a regional level will give us the experience to fine-tune the global health architecture.

The ACT-Accelerator, with its four pillars covering diagnostics, therapeutics, vaccines and health systems, is a good starting point for soul-searching on what worked and what needs to improve. While there is a broad-based consensus on how the first such global structure served with speed by bringing together diverse stakeholders, much of the action on its part was voluntary and lacked the force of a formal structure. Based on the recent evaluation report of the accelerator, what we must do is redefine the existing scope of the global health accelerator and expand it to areas where the world’s response needs to be in sync for it to be more effective.

An independent evaluation of the ACT-Accelerator in October 2022, showed that while representatives of middle and low-income countries found the mandate of the accelerator extremely relevant, given their own deficiencies in developing, making and procuring vaccines, drugs and diagnostic kits, they felt their voices went unheard and their inputs were not seriously considered in decision-making. This compromised the effectiveness of the response to the health challenges at hand.

A global health accelerator with a more formal form, shape and governance structure with clear accountability and complete transparency, will respond much more effectively to the challenges of the next health emergency.

India, which has recently assumed the G20 presidency, will strive to build a consensus among member countries on the need for such a permanent institutional platform. We will deliberate on how its new avatar can have an expanded scope on healthcare, along with much stronger governance and accountability.

The pandemic also made us realise that many low-and middle-income countries in the Global South were left to fend for themselves with very little means to protect their people. This experience prompted us to re-think the need for innovative ways to build local-level capabilities that can ensure that people there are able to access diagnostics, vaccines and medicines within days of a health threat emergence. That is what is needed to save lives and economies.

While imagining and drawing up the contours of the next global health architecture, the global community must course-correct to ensure that the needs and contexts of vulnerable low-income countries, who are equal end-users of these services, are understood and factored in. Doing so will mean that the world is better equipped to manage future pandemics in a unified manner and the initiative needs to be owned by all.

Besides harnessing the political will of world leaders for this initiative, we must also think big and bold in terms of Vaccine-Therapeutics-Diagnostics Networks spread across the globe to effectively address the next big health emergency. The idea behind investing in such regional research and manufacturing capabilities across diversified geographies is critical for the world to deliver collectively to effectively combat any future health challenge.

Over the last three years, we saw that even when companies had the capacity, they couldn’t always deliver essential products to parts of the world and sometimes even to their own countries. That’s because at times the demand surge in some medical products was unpredictable or unanticipated; at other times, scaling up proved challenging and supply chains were disrupted. Also, the acute concentration of R&D and technological strengths, as well as manufacturing, in a few countries of the world restricted the timely delivery of essential medical products, particularly to low and middle-income countries.

The global leadership has a responsibility to ensure that once tests and treatments are developed with the support of these networks, they reach all countries equitably within a defined short-time span. The role of a global medical countermeasures coordination platform should be planned during India's G20 presidency.

Many of today's healthcare challenges, be it antimicrobial resistance or new emerging strains of COVID-19, are too complex to be resolved by one country, no matter how powerful and resourceful it is. These challenges also cannot be addressed only by one sector, no matter how efficient it is. We need to develop partnership models — intercountry and multisectoral — led by global leaders across countries and sectors.

Despite the unprecedented models of collaboration during COVID-19, there is scope for deepening the participation of existing players and bringing more under the umbrella. The future version of the health architecture should have models to bring different governments, international organizations, philanthropies and the private sector together, in ways that ensure seamless functioning becomes the norm while leveraging the strength of each sector.

Infusing a new life into the idea of a global health accelerator, coupled with research and manufacturing networks, may save us from re-inventing the wheel and provide solutions to manage the next health emergency. India will sow the seeds for breathing life into this global health framework during its G20 presidency. How it grows, depends on whether the world can act in unison for this cause.