Even as the US, led by President Donald Trump, withdrew from global health engagements through a petulant exit from the World Health Organization (WHO) and the evisceration of its international aid agency, two events in Geneva on May 19 unfurled the flag of global solidarity.
One, international negotiations on the Pandemic Treaty ended, with all participating WHO members agreeing on the final text. The treaty was cheered by an anxious world badly bruised by Covid’s devastation and wary of more zoonotic pandemics on the horizon. It is the second-ever global health treaty to be concluded under auspices of the WHO, after the Framework Convention for Tobacco Control adopted in 2003.
The second was the convening of a forum—Digital Health Without Borders—to advance digital health applications across the world with impact, efficiency and equity. The event, organised by Dr Rajendra Gupta from India, was addressed by WHO’s Director General Tedros Adhanom Ghebreyesus and leading digital technology experts as well as prominent representatives from the domains of medicine, nursing and public health. They advocated universal access to impactful digital health technologies to prevent pandemics and promote primary care-led universal health coverage.
These affirmations of a ‘one world’ approach are reassuring in a polarised political environment where the US and some other countries are retreating from adherence to principles of global solidarity. While the US and Argentina have quit the WHO, western European nations like the Netherlands and Germany have reduced their commitments to global aid. Trump and Musk have eviscerated USAID, which was a major contributor to global health programmes aimed at tackling infectious diseases like HIV-AIDS and tuberculosis, as well as maternal and child health protection. Scientific agencies like the National Institutes of Health have been disconnected from global research.
Global health, as a policy and practice domain, evolved through stages. Initially, colonial powers like Britain and Belgium invested in establishing institutes for ‘tropical medicine’ to protect their soldiers, traders, administrators and local labourers from infectious diseases like malaria and cholera. After decolonisation, western nations talked of ‘international health’ while engaging with developing countries.
The HIV-AIDS pandemic triggered a scare and made western nations direct resources for its control across the globe. In this era, aid came with many strings attached. It enabled researchers from high-income countries to design and direct research in other countries, while gaining publications and patents. It provided an opportunity for western funders to mandate use of medical technologies supplied by their companies and impose their ‘experts’ and consultancy firms. UN agencies such as WHO, UNICEF, UNFPA and UNDP also shaped and supported global health initiatives, but high-income countries often influenced their agendas and actions.
After the adoption of the Millennium Development Goals (MDGs) by the UN in 2000, funding for international health came not only from government aid agencies but also from rich private foundations like Gates, Rockefeller and Bloomberg, as well as charities like the Wellcome Trust.
Recently, the Novo Foundation has emerged as a major global health funder. Multilateral lenders like the World Bank and continental banks in Asia and Africa support countries with soft loans for strengthening national health programmes. These channels of global health financing continued after adoption of the Sustainable Development Goals (SDGs).
High-income western countries have traditionally supported global health programmes, abiding by their commitments to global development assistance and as ‘soft diplomacy’ instruments to advance their geopolitical and trade interests. Later, China and rich west Asian countries also started supporting global health programmes for similar reasons. Apart from bilateral channels, donor countries have also channelled funds through UN agencies to advance their strategic interests.
Amid this economic and political power play, moral motivation of the global health enterprise dimmed and global solidarity became a shibboleth. In the era of international health, donors posed the question “what can we do for you?” In the era of global health, the question should have been reframed as “what can we do together?”
The world faces many common threats, from pandemics and anti-microbial resistance to climate change and commercial forces propelling the global epidemics of non-communicable diseases and obesity. Global health votaries must utilise both multilateral forums and bilateral channels to address such common threats. Simultaneously, high and upper-middle-income countries must help in strengthening health systems of low and lower-middle-income countries as their frailty will endanger global health security and economic stability.
This was taught by Covid pandemic. “No one is safe till everyone is safe” should not be a vacuous platitude. Access to essential drugs, vaccines and technologies must be universal, while co-investments in development of a multi-layered, multi-skilled health workforce will benefit the whole world.
Espousal of global health by high income countries drew impetus from their evangelical advocacy of economic globalisation as the mantra for global prosperity. While access to global financial and labour markets boosted economic growth around the world, dice were loaded in favour of rich countries. Even as Thomas Friedman exulted that the ‘world is flat’ due to globalisation, rich countries used restrictive patent protection practices to show that even a flat surface can be tilted in their favour.
But Western enthusiasm for globalisation vanished when non-western economies started growing fast. As countries like China, India, Brazil and South Africa gained economic muscle and unbridled capitalism triggered a financial crisis in the West, fear of becoming ‘submerging economies’ led western economies to pursue protectionist policies and abandon multilateralism. The ‘slash and burn’ retreat of western capitalism from globalisation is typified by the Trump administration’s assault on global trade and health through tariffs and tirades.
Vast majority of countries are still wedded to global solidarity and multilateralism. Even as countries must develop their economies and health systems with a strong passion for self reliance, they should foster global solidarity. As digital health advances ‘sans boundaries’ between countries, it will enable big-data studies on a vast array of gene-environmental interactions in different populations and identify frugal, but highly impactful, health system innovations that can help all countries. As the song on a Disney World ride goes, “It is a small world after all”.
(Views are personal)
(ksrinath.reddy@phfi.org)
K Srinath Reddy is a cardiologist, epidemiologist, and a public health advocate