Today's Editorial

Today's Editorial - 12 October 2023

G20 declaration on health

Source: By Anonna Dutt: The Indian Express

All three health priorities of India’s G20 presidency found a mention in the G20 New Delhi Leaders’ Declaration released. The declaration spoke of strengthening primary healthcare, health workforce, and essential health services to better-than-pre-pandemic levels, ideally within the next two to three years. In addition to focusing on epidemics such as tuberculosis and AIDS, the G20 recognised the importance of research on long COVID.

The declaration also stressed the importance of one health approach — where diseases in animals, plants, and humans are tracked by the same mechanism — with focus on tackling antimicrobial resistance.

The G20 health track that concluded last month was one of the most successful under India’s presidency: not only did India manage to build consensus on all three of its priority areas, it also managed to launch a proposed repository of scalable digital health platforms.

What were the three priorities?

The three priorities kept in mind the economic and social disruption caused by Covid-19, and what could be done to prevent such losses in the future.

The priorities included:

Building resilient systems for health emergency prevention, preparedness, and response

Strengthening cooperation in the pharmaceutical sector with focus on ensuring equitable availability and access to vaccines, diagnostics, and therapeutics during a pandemic

Creating a platform for sharing digital health innovations and solutions to ensure better and universal health coverage, like CoWIN and e-Sanjeevani

The consensus was reached with some compromises — India did not insist on countries contributing towards a $200-million fund for a digital health programme, or on a permanent platform for sharing knowledge, intellectual property rights, and resources for developing vaccines, diagnostics, and therapeutics.

What is this digital health programme?

With the pandemic highlighting the importance of digital health innovation, India committed to developing a platform for sharing scalable solutions under the World Health Organisation (WHO) that can be utilised by its member states. This culminated in the launch of Global Initiative on Digital Health (GIDH), with four main pillars — an investment tracker, a repository of existing digital health solutions, knowledge sharing for implementation and country-specific adaptation of these solutions, and an ask tracker to monitor the needs of different countries.

While a $200-million fund proposed by India did not find consensus among countries, several non-profits have committed to the fund. India has committed to offering its vaccine management platform CoWIN, its tele-medicine platform e-Sanjeevani, and its Ayushman Bharat Digital Mission platform as digital public goods to others.

This initiative, delegates present on the negotiating table said, may help in ending the “epidemic of pilots” where several similar initiatives are launched in different countries but aren’t scaled up.

A World Bank report released on the sidelines of the health ministers’ meeting took a look at the Ayushman Bharat Digital Mission, and said it was “an example of a concerted effort to fill in the health information gaps and connect health information dots.” Around 44.2 crore unique IDs have been created and 110 digital health services integrated into the mission as of August 2023, the report said. However, it went on to add that there are concerns regarding data protection and privacy.

What is the interim medical countermeasure platform?

While there was no consensus on creating a permanent platform for ensuring equitable access to medical countermeasures during a pandemic, the committees agreed to develop an interim platform to promote an end-to-end network for research and manufacturing them till a legally binding pandemic treaty can be agreed upon.

The outcome document said that the interim platform should be led by an inclusive decision-making arrangement, including effective representation of low- and middle-income countries, and convened by the WHO. Although there is an in-principle agreement by the G20 member countries on the need for such a platform, there is no clarity yet on how soon the platform can be developed.

Why have some opposed this interim platform?

Delegates present at the negotiating table said the push for this interim platform has come from G7 countries, which currently hold the majority of the patents for drugs, diagnostics, and vaccines. Even though the outcome document specifically mentions lower- and middle-income countries having a voice in the platform, many said it is likely to replicate the failures of the ACT accelerator — a similar platform developed to share medical countermeasures during Covid-19 — by giving more say to the G7 countries.

One of the senior delegates present at all the negotiations said, “This will replicate what the ACT did. Even the people who were on the table are not clear about the negotiations that happened during the pandemic. Also, now that Covid-19 is no longer a public health emergency of international concern, those agreements no longer stands and poorer countries have to keep paying high prices to maintain the level of vaccination.”

Another said that an interim measure would be used as an excuse by the G7 countries to keep delaying a legally binding pandemic treaty.

What is the role proposed for traditional medicine?

India’s G20 presidency also pushed for integration of evidence-based traditional medicine practices with modern medicine. A global summit on traditional medicine was hosted on the sidelines of the health ministers’ meeting last month.

The outcome document said: “We acknowledge the potential of evidence-based traditional and complementary medicine practices in public health delivery systems, provided they are rigorously and scientifically validated.”