Global collaboration for health: rhetoric versus reality [Lancet Editorial]

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The Lancet
Sep 12, 2020 Volume 396 Number 10253 p735-798, e25-e29
Global collaboration for health: rhetoric versus reality
The Lancet
The 75th session of the UN General Assembly (UNGA) opens on Sept 15, 2020. Being held remotely for the first time, the meeting will inevitably be dominated by the COVID-19 pandemic, but other issues on the agenda that have resonance for global health include the climate crisis, peace, disarmament, and humanitarian assistance. Underpinning this year’s agenda is the UN theme of multilateralism, under the banner ”The future we want, the United Nations we need: reaffirming our collective commitment to multilateralism”. Yet the meeting comes at a time when global collaboration and cooperation are in disarray.

The UNGA is traditionally built on bold rhetoric of global collaboration and exhaustive debate over some of the world’s most intractable problems. But rather than expressing a shared vision for a common future, countries are now undermining global cooperation through rising nationalism, open hostility towards multilateral institutions, and a growing tendency to look after their own interests—eg, rushing to secure supplies of potential COVID-19 vaccines. Health is precariously caught in the middle of these tensions. Science has become increasingly politicised, with multiple and conflicted interests at play, and often little sense of solidarity within or between nations.

An immediate casualty of these opposing forces is the global effort towards vaccines for COVID-19. COVAX, the COVID-19 Global Access Facility, is led by WHO; Gavi, The Vaccine Alliance; and the Coalition for Epidemic Preparedness Innovations, and aims to rapidly develop and equitably distribute effective vaccines. Variable commitment to COVAX reflects the tension between nationalism and collaboration. 170 countries plan to participate, but the USA, for one, is opting not to join COVAX. Instead, the USA has secured bilateral deals with several pharmaceutical companies for millions of doses of promising COVID-19 vaccines. Similar deals have been struck by Australia, the EU, and the UK. In July, Médecins Sans Frontières warned that “These bilateral deals will reduce the initial global vaccine stocks available for vulnerable groups in poorer countries and undermine global efforts to ensure fair allocation”.

Insufficient collaboration is also jeopardising the Pan American Health Organization, with many member states, including Brazil, Venezuela, and Mexico, withholding essential funding at a time when Latin America is under mounting pressure from COVID-19. Meanwhile, the USA continues its deeply disappointing withdrawal from WHO.

The climate emergency is another subject on which rhetoric has fallen flat in the face of nationalistic inaction. The global response to COVID-19 depends heavily on the idea of creating a better future for human and planetary health, and commitment to this approach is non-negotiable for sustainable recovery. It is disappointing that the UNGA’s formal general agenda does not more extensively cover climate change beyond the item “Protection of global climate for present and future generations of humankind”, although there is a Summit on Biodiversity on Sept 30, as well as activities across New York City.

Hopefully, the summit will also return the UNGA’s focus to the Sustainable Development Goals, which must still be met by 2030, and to defining a post-2020 biodiversity framework. An early indication that nations might work to protect health in the face of climate change as laid out in this year’s WHO manifesto for a healthy and green recovery from COVID-19 is seen in the commitment to the Resilient Recovery Platform. Launched in Japan on Sept 3, 2020, the platform is a global sharing of policy and actions to address the response to COVID-19 coupled with the response to the climate emergency, with stakeholders such as governments, businesses, non-governmental organisations, and civil society. The participation of 80 countries shows a willingness to engage in overhauling socioeconomic models towards a sustainable future. But will it be translated into action?

Global solidarity cannot be garnered through rhetoric alone. COVID-19 has brought into clear view that every person’s health is interconnected, and the UNGA is a platform with the power to reorientate global interests in such a way as to protect the health and lives of all people in every nation. The need for global cooperation has never been more visible or more crucial. Unfortunately, the UN has so far in 2020 not been able to transform rhetoric into reality. This should give pause for serious reflection. Global crises call for global responses, and we have yet to see them.