World needs to be prepared to manage any future health emergencies

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Dr Mansukh Mandaviya

Minister of Health and Family
Welfare; Chemicals and Fertilizers, Government of India

The complex and evolving nature of today’s healthcare challenges meant that in many cases a united response mounted by the world as a whole will be way more effective than the reaction of the sum of its parts—that of individual countries. Our global experience in the pandemic proved that when a health emergency strikes, developing a vaccine for a new disease takes scientists, governments, private sector—large companies as well as start-ups, regulators, and political leaders from different countries—to come together fast and work seamlessly as an integrated whole. It also proved that having enough vaccines doesn’t mean that everyone everywhere will get access to those life-saving jabs.

In case a highly transmissible virus triggers a pandemic in a highly interconnected world, saving people in a few countries may delay the damage but not deter it. With that wisdom in the recent past, the world needs to rethink the healthcare model collectively. What we need today is a strong and efficient global health architecture. It should be able to contain the health outbreak in the region of origin without allowing it to assume the proportion of a pandemic. 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
needs of the countries, not their prosperity levels, when the next health emergency strikes.

A Healthcare Accelerator Beyond Covid-19At least in idea terms, we came close to a global solution when the Access to COVID-19 Tools Accelerator (ACT-Accelerator) coalition was conceptualized 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 needed 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, which is not the last pandemic. Our next global emergency may be from amongst the health threats we know of—antimicrobial resistance, another viral outbreak, or something
completely unforeseen. But having a defined framework globally, the experience of mock drills, as well as the capacity to manage such health threats at a regional level will give us the valuable experience to fine-tune the global health architecture.

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 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. What is clearly needed is to 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 based on the recent evaluation report of the accelerator.

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, diagnostic kits, they felt their voices went unheard, and their inputs were not seriously considered into decision-making. That, the evaluation summed, compromised the effectiveness of the response to the health challenges at hand.

If a global health accelerator can have a more formal form, shape, and governance structure with clear accountability and complete transparency, it can respond much more effectively to the challenges of the next health emergency. India, which has recently assumed the G-20 presidency will strive to build a consensus among member countries on the need for such aa permanent institutional platform that deliberates on how it’s new avatar can have an expanded scope on healthcare along with much stronger governance and accountability.

The Voice of South The pandemic also made us realize 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 has prompted us to re-think the need for innovative ways to build local-level capacities that can ensure that people there are able to access diagnostics, vaccines, and medicines days within the emergence of a health threat that can save lives and economies.

While imagining and drawing up the contours of the next global health architecture, we, 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 insufficiently so 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 across countries for the initiative, there is a need to think big and boldly 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 in case of any future health challenge. During the last three years we witnessed that even when companies had the capacity, they couldn’t always deliver essential products to other parts of the world and sometimes even to their own countries. That was because at times the demand surge in some medical products was unpredictable or unanticipated; at other times, scaling up proved challenging; supply chains were disrupted widely. 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 in 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 hence the role of a global medical countermeasures coordination platform we should plan during India’s G-20 presidency.

Global Political Will and ActionMany healthcare challenges before the world today, 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. That needs us to develop models of
partnerships—intercountry and multisectoral—to be 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 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 today may save us from re- inventing the wheel and having solutions to manage the next health emergency. India will sow the seeds for breathing life into this global health framework during its G-20 presidency. How it grows, depends on whether the world can act in unison on this cause.

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