At a time, in our quest to achieving SDGs, when building robust primary healthcare should be our top priority, we are witnessing a challenging knock-on effect of the pandemic—in terms of reduced access and even demand for health services among vulnerable communities, more so in low income and low-middle income countries (LICs and LMICs).
As the fear of the pandemic recedes from the public memory, even as it is far from over, we are also standing on the cusp of two realisations. First, the global-level inequity in health systems and pandemic preparedness; second, the realisation of an opportunity to make health systems stronger and resilient not only to avert and prevent pandemics, but also to help realise Universal Health Coverage (UHC) as a prelude to achieving Sustainable Development Goals on Health (SDG3).
No one was prepared for pandemic, but some suffered more:
While almost all countries were poorly prepared for a pandemic, once solutions started emerging, there was a tendency among the richer countries and those which had the capacity to corner resources – be it the technology for producing vaccines, the diagnostics or the requisite therapeutics including oxygen and other essential medical supplies. In fact, some rich countries are tending to dump or discard nearly expired stocks of unused vaccines or diagnostics while a vast majority of people in many low-resource countries remain unvaccinated or do not have access to timely interventions.
It is only when we can ensure that the poorest of the poor and the low-income countries are able to access countermeasures—technological solutions–vaccines, therapeutics, and diagnostics within a reasonable time, can we claim that we have collectively succeeded in mounting a global response to a global crisis. These realisations should form the foundation for G-20 deliberations as well as other global discussions.
Why India’s G-20 presidency matters?
As India steers the Presidency of G-20 countries this year, it is perhaps for the first time that the Troika of G-20—the preceding presidency (Indonesia), the current presidency (India) and the succeeding presidency (Brazil)—are all from the Global South. In practice this should mean establishing formal multi-country frameworks and ecosystems that give a strong voice to the Global South in the international decision-making, to ensure that no country is left behind in any global health crisis in the future. India, being a strong voice from the global South, is aptly taking the initiative under G-20 to build a consensus on how a pandemic prepared world should look like in future. India’s voice also matters because of its experiences in the pandemic. The country has played a crucial role in making vaccines for its own population and sending vaccines to a large number of LIC and LMICs through the COVAX facility and the COVID-19 Vaccine Delivery Partnership (CoVDP).
India has also been a front-runner in rapidly developing nation-wide digital interventions during Covid-19 Through Co-WIN the country managed to democratise the process of vaccination, a mammoth task in a country with the size and complexity of India. In addition to the digitally savvy, Co-WIN also had a provision to reach those who didn’t know how to book their slot for vaccination on smartphones. India today is in the pole position to lead global fora including the G20 to ensure that digital interventions can go beyond delivering vaccines, diagnostics, therapeutics, and contact-trace as well as, is able to reach the ‘outliers’—those who still do not have access to smartphones and technological solutions. The related digital solutions for e-consultations and access to other essential public health functions provide a stage for achieving UHC and achieve SDG3.
What Pandemic Preparedness means in practice for G-20?
Pandemic preparedness for the global community at the outset means strengthening the collective actions that were set in motion when the Covid-19 began. Global commitments through previous G7 and G20 to tackle pandemic took roots and the Pandemic Fund was launched during the Indonesia G-20 Presidency.
The Pandemic Fund needs to be fully resourced and have a governance structure that will give voice to LICs and LMICs, if it were to make a difference. The first round of funding prioritizes strengthening comprehensive disease surveillance, early warning, laboratory systems, human resources and public health workforce capacity. Future rounds need to focus on strengthening Primary Health Care and the workforce of the PHC in resource poor contexts to deliver more effectively quality essential public health functions and ensure that health systems in every nook and corner of the world is crisis ready.
Effective preparation for a health emergency also means bolstering health systems—particularly primary health care infrastructure and building a strong health workforce that is able to detect outbreaks early, organize itself to conduct containment and rapid response while maintaining high quality essential public health functions.
One reason India could swiftly mount an agile response to Covid-19 is because it already had a nation-wide army of community-based female activists the ASHA, Anganwadi workers and together with the Auxiliary Nurse Midwives and other healthcare functionaries had the capacity to reach its population quickly with the most basic health services needed during an emergency. Such a strong cadre of health workforce is an inspiration and necessity for every LIC and LMIC and offers important lessons which can inform the G-20 health deliberations.
Before next pandemic, not losing sight of current health crises
While we prepare for health outbreaks of future, we cannot afford to ignore the ongoing health crises—such as Anti-Microbial Resistance, and the major sub-crises within AMR – Tuberculosis, with India accounting for almost 25% of the global burden. AMR is a silent epidemic, and TB is an epidemic within this epidemic. As we run out of current and ever-evolving new generations of antibiotics to treat infections, due to a host of factors including overuse and misuse of antibiotics, TB patients are paying a big price already.
Microbial resistance to antibiotics continue to be a challenge, when treating severe infections which manifest as Pneumonias, Septicaemias, several food-borne bacterial infections on the one hand as well as chronic debilitating diseases such as Tuberculosis, fungal, viral and bacterial infections on the other. The G20 India’s Presidency has put tackling AMR high on the agenda and it is hoped that there will be consensus and commitment together with elimination of diseases like Tuberculosis, that continues to be a disease of the poor and challenges health systems in many states in India as well as other LICs and LMICs.
While Covid-19 has wrecked unprecedented devastation, it has also managed to do something unusual—finance ministers everywhere now recognise that human capital development through a robust and resilient health system is necessary for wealth generation, economic stability and economic growth of countries. Health can no longer be a cost, it is an investment.
Finance Ministers and the G20 Health and Finance task forces need to recognise that robust health and investment on health systems, particularly a strong Primary Health Care is essential for economic recovery and stability. As we slowly emerge out of the biggest black-swan event of the century, we cannot let this crisis go to waste. With Covid-19 fading as a global threat, we probably have a very narrow window to turn this realisation into global action. And the G-20 presidency under India is probably that rare multi-lateral platform to make this happen.
(The author is Senior Adviser Health, UNICEF New York)
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