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Abstract by the authors: Adequately preparing for and containing global shocks, such as COVID‐19, is a key challenge facing health systems globally. COVID‐19 highlights that health systems are multilevel systems, a continuum from local to global. Goals and monitoring indicators have been key to strengthening national health systems but are missing at the supranational level. A framework to strengthen the global system—the global health actors and the governance, finance, and delivery arrangements within which they operate—is urgently needed. In this article, we illustrate how the World Health Organization Building Blocks framework, which has been used to monitor the performance of national health systems, can be applied to describe and appraise the global health system and its response to COVID‐19, and identify potential reforms. Key weaknesses in the global response included: fragmented and voluntary financing; non‐transparent pricing of medicines and supplies, poor quality standards, and inequities in procurement and distribution; and weak leadership and governance. We also identify positive achievements and identify potential reforms of the global health system for greater resilience to future shocks. We discuss the limitations of the Building Blocks framework and future research directions and reflect on political economy challenges to reform.
Abstract by the authors: Over the past two decades, global health diplomacy, foreign policy for health, and global health policy have changed substantially. Diplomacy is a constitutive part of the system of global health governance. COVID-19 hit the world when multilateral cooperation was subject to major challenges, and global health has since become integral to geopolitics. The importance of global health diplomacy, especially at WHO, in keeping countries jointly committed to improving health for everyone, has once again been shown. Through a systematic review, this Series paper explores how international relations concepts and theories have been applied to better understand the role of power in shaping positions, negotiations, and outcomes in global health diplomacy. We apply an international relations perspective to reflect on the effect that those concepts and theories have had on global health diplomacy over the past two decades. This Series paper argues that a more central role of international relations concepts and theories in analysing global health diplomacy would help develop a more nuanced understanding of global health policy making. However, the world has changed to an extent that was not envisioned in academic discourse. This shift calls for new international relations concepts and theories to inform global health diplomacy.
Abstract by the authors: The shift in the global burden of disease from communicable to noncommunicable was a factor in mobilizing support for a broader post-Millennium Development Goals (MDGs) health agenda. To curb these and other global health problems, 193 Member States of the United Nations (UN) became signatories of the Sustainable Development Goals (SDGs) and committed to achieving universal health coverage (UHC) by 2030. In the context of the coronavirus disease 2019 (COVID-19) pandemic, the importance of health systems governance (HSG) is felt now more than ever for addressing the pandemic and continuing to provide essential health services. However, little is known about the successes and challenges of HSG with respect to UHC and health security. This study, therefore, aims to synthesize the evidence and identify successes and challenges of HSG towards UHC and health security. (…)
Abstract by the author: Global health has gained increased attention as a concept and academic discipline in recent years.1 The COVID-19 pandemic has highlighted the world’s interconnectedness and how public health threats are no longer the concerns of single nation-states, regions or discrete sectors. The war in Ukraine has further exemplified the fragility and complexity of global markets and its implications for food security and the well-being of millions far away from the actual conflict. The realisation that ‘we are all in this together’ is gaining momentum and is further exacerbated by extreme weather events, the looming energy crisis and brewing political unrest, all mediated by a global news industry at an ever-increasing pace. The need for transformation has never been greater and global health has the systemic potential to be an explanatory, investigative and constructive entity.(…)
Abstract by the authors: The WHO plays a crucial role in global health but has had well-documented issues with funding in terms of the models of funding adopted, the size and sources of contributions and the influence of certain donors in driving specific priorities. This year the WHO Foundation has been launched as a way to broaden the WHO donor pool. We describe a lack of clarity about the applicability of Framework of Engagement with Non-State Actors (FENSA) norms and practices to this new entity. The risks regarding undue corporate influence at the expense of independence were at the core of the protected negotiations underpinning the development of the FENSA that guides the WHO itself, but do not appear to be reflected in the Foundations’ governance structures. Considering past failed initiatives, and how many global health challenges, including non-communicable diseases and climate change, are driven by powerful transnational companies, the WHO cannot afford to be seen to sacrifice independence or impartiality to the commercial determinants of health in pursuit of funding.
Abstract by the authors: The World Health Organization (WHO) continues to experience immense financial stress. The precarious financial situation of the WHO has given rise to extensive dialogue and debate. This dialogue has generated diverse technical proposals to remedy the financial woes of the WHO and is intimately tied to existential questions about the future of the WHO in global health governance. In this paper, we review, categorize, and synthesize the proposals for financial reform of the WHO. It appears that less contentious issues, such as convening financing dialogue and establishing a health emergency programme, received consensus from member states. However, member states are reluctant to increase the assessed annual contributions to the WHO, which weakens the prospect for greater autonomy for the organisation. The WHO remains largely supported by earmarked voluntary contributions from states and non-state actors. We argue that while financial reform requires institutional changes to enhance transparency, accountability and efficiency, it is also deeply tied to the political economy of state sovereignty and ideas about the leadership role of the WHO in a crowded global health governance context.
Abstract by the authors: Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We aimed to characterise the past, present, and predicted future of global health spending, with an emphasis on equity in spending across countries.
Abstract by the authors: The World Health Assembly is the WHO's supreme decision-making body and consists of representatives from the 194 WHO Member States who take formal decisions on the WHO's policies, workplan and budget. The event is also attended by representatives of non-governmental organisations, the private sector, the press and even members of the public. Based on participant observation at six World Health Assemblies, in-depth interviews with 53 delegates to the WHA, and an analysis of WHA Official Records, this article examines the ritualistic aspects of WHA negotiations. We argue that analysing the WHA as a ritual provides an insight into power and legitimacy within global health. Not only are certain understandings of health issues and courses of actions decided by the Assembly, but also the very boundaries of global health community are set. The rules of the ritual place limits on different categories of actors, while both formal and informal rules of behaviour further serve to include or exclude actors from the rituals. Success in negotiation is measured by through the inclusion of certain ideas, norms and values in the wording of resolutions and is achieved through the repetition of language in speeches and by adhering to the rules of behaviour.
Abstracts by the authors: The September 2019 United Nations High Level Meeting on Universal Health Coverage (UHC) aims to mobilize top-level political support for action on UHC to advance the health Sustainable Development Goal (SDG). A driving force behind this meeting is the "UHC Movement," led by UHC2030, which focuses on coordinating and amplifying efforts by WHO, the World Bank, civil society, and the private sector to strengthen health systems and achieve UHC. In line with Horton and Das, this paper contends that while the argument about UHC is won, it is crucially important to focus on "how" UHC will be delivered, and specifically, whether ongoing efforts to advance UHC align with efforts to realize the right to health. This paper offers a preliminary assessment of how UHC2030S contributions to global health governance advance, or not, the right to health care. It builds on a 2014 Go4Health study which identified key normative overlap and gaps in UHC and right to health care principles. Given the importance of civil society participation in advancing health rights, this analysis is complemented by an examination of how UHC2030 might amplify ongoing efforts to advance the right to health care in two UHC2030 partner countries, Kenya and Uganda.
Abstract by the authors: Despite many efforts to achieve better coordination, fragmentation is an enduring feature of the global health landscape that undermines the effectiveness of health programmes and threatens the attainment of the health-related Sustainable Development Goals. In this paper we identify and describe the multiple causes of fragmentation in development assistant for health at the global level. The study is of particular relevance since the emergence of new global health problems such as COVID-19 heightens the need for global health actors to work in coordinated ways. Our study is part of the Lancet Commission on Synergies between Universal Health Coverage, Health Security and Health Promotion. We used a mixed methods approach. This consisted of a non-systematic literature review of published papers in scientific journals, reports, books and websites. We also carried out twenty semi-structured expert interviews with individuals from bilateral and multilateral organisations, governments and academic and research institutions between April 2019 and December 2019.
Abstract by the author: Global Health has increasingly gained international visibility and prominence. First and foremost, the spread of cross-border infectious disease arouses a great deal of media and public interest, just as it drives research priorities of faculty and academic programmes. At the same time, Global Health has become a major area of philanthropic action. Despite the importance it has acquired over the last two decades, the complex collective term "Global Health" still lacks a uniform use today. The objective of this paper is to present the existing definitions of Global Health, and analyse their meaning and implications. The paper emphasises that the term "Global Health" goes beyond the territorial meaning of "global", connects local and global, and refers to an explicitly political concept. Global Health regards health as a rights-based, universal good; it takes into account social inequalities, power asymmetries, the uneven distribution of resources and governance challenges. Thus, it represents the necessary continuance of Public Health in the face of diverse and ubiquitous global challenges. A growing number of international players, however, focus on public-private partnerships and privatisation and tend to promote biomedical reductionism through predominantly technological solutions. Moreover, the predominant Global Health concept reflects the inherited hegemony of the Global North. It takes insufficient account of the global burden of disease, which is mainly characterised by non-communicable conditions, and the underlying social determinants of health. Beyond resilience and epidemiological preparedness for preventing cross-border disease threats, Global Health must focus on the social, economic and political determinants of health. Biomedical and technocratic reductionism might be justified in times of acute health crises but entails the risk of selective access to health care. Consistent health-in-all policies are required for ensuring Health for All and sustainably reducing health inequalities within and among countries. Global Health must first and foremost pursue the enforcement of the universal right to health and contribute to overcoming global hegemony.
Abstract by the authors: In 2017, the G20 health ministers convened for the first time to discuss global health and issued a communiqué outlining their health priorities, as the BRICS and G7 have done for years. As these political clubs hold considerable political and economic influence, their respective global health agendas may influence both global health priorities and the priorities of other countries and actors.(…)
Abstract by the authors: A number of authors advocate for a radical, innovative shift in global health governance, as complex global health challenges cannot be longer be borne by WHO alone. Network governance emerged as a leading institutional design to guide 21st century global health governance. We argue WHO needs to take up the role of meta-governor, for which it should ensure five key functions: consensus building among different sets of actors and networks, steering, ensuring policy coherence, facilitating knowledge innovation through exchange and learning and finally, ensuring democratic accountability. WHO may need to reconsider its divisionalised bureaucratic structure and move towards a ‘beehive’ configuration. In order to be better deal with the complexities of global health, it should become a learning organisation with relational capabilities and a matrix structure, which is loosely coupled to key issues, networks and actors.
Résumé des auteurs : Le dernier numéro de Politique africaine sur la santé date de décembre 1987. Ce dossier vise à combler ce vide de plus de 30 ans et à rendre compte des changements considérables intervenus récemment dans l’univers de la santé publique en Afrique. La configuration des politiques de santé sur le continent a en effet connu une mutation profonde au cours des trois décennies qui séparent ces deux dossiers thématiques. Cette évolution constitue la base empirique de ce dossier. Chacun des cinq articles de ce volume illustre les ruptures opérées par la globalisation des politiques de santé, à partir de l’étude d’une question spécifique : la couverture santé universelle à travers le numérique, le «financement basé sur les résultats» (FBR), la prise en chargedu diabète, l’accès universel aux traitements antirétroviraux et l’approvisionnement en médicaments antipaludiques. Entre césure et continuité, logiques et contradictions, la Global Health est soumise à l’épreuve des faits dans ce dossier et dans cette introduction. Nous proposons dans un premier temps de revenir sur l’historique des changements qui ont accompagné ces évolutions, puis nous soulignerons trois articulations principales qui permettent, de notre point de vue, d’analyser ces mutations : les idéologies à partir desquelles la Global Health se déploie, la dynamique du « retour de l’État en Afrique » au début de ce XXIe siècle et les marchés qui accompagnent ces nouvelles politiques.
Résumé des auteurs : L’asymétrie de pouvoir dans les partenariats de recherche en santé mondiale constitue un enjeu de justice et d’équité pour les institutions de recherche, les chercheurs et les communautés, en particulier dans les pays en développement. Pour les chercheurs, l’asymétrie de pouvoir peut constituer un obstacle pour une recherche efficiente et équitable et ils sont à risque d’être en situation de vulnérabilité. Ces enjeux sont largement discutés dans la littérature mais ce phénomène reste encore étudié au plan théorique et peu de données empiriques sont disponibles, particulièrement dans les pays en développement. Cette étude a donc pour objectifs d’identifier les facteurs et les mécanismes de l’asymétrie de pouvoir en recherche en santé mondiale dans la perspective de chercheurs dans un pays du sud.
Abstract by the authors: This comparative case study investigated how two intergovernmental organisations without formal health mandates - the United Nations Development Programme (UNDP) and the World Trade Organization (WTO) - have engaged with global health issues. Triangulating insights from key institutional documents, ten semi-structured interviews with senior officials, and scholarly books tracing the history of both organisations, the study identified an evolving and broadened engagement with global health issues in UNDP and WTO. Within WTO, the dominant view was that enhancing international trade is instrumental to improving global health, although the need to resolve tensions between public health objectives and WTO agreements was recognised. For UNDP, interviewees reported that the agency gained prominence in global health for its response to HIV/AIDS in the 1990s and early 2000s. Learning from that experience, the agency has evolved and expanded its role in two respects: it has increasingly facilitated processes to provide global normative direction for global health issues such as HIV/AIDS and access to medicines, and it has expanded its focus beyond HIV/AIDS. Overall, the study findings suggest the need for seeking greater integration among international institutions, closing key global institutional gaps, and establishing a shared global institutional space for promoting action on the broader determinants of health.
Abstract by the authors: Country experiences of responding to the challenges of COVID-19 in 2020 highlighted how critical it is to have strong, in-country health security capacity. The UK government has invested in health security capacity development through various projects and agencies, including the UK Department of Health and Social Care, whose Global Health Security Programme provides funding to Public Health England (PHE) to implement health security support. This article describes the results and conclusions of the midterm evaluation, undertaken by Itad, of one of Public Health England’s global health projects: International Health Regulations Strengthening, which operates across six countries and works with the Africa Centres for Disease Control. It also highlights some of the key lessons learned for the benefit of other agencies moving into supporting national health security efforts.
Abstract by the authors: The ongoing debate on the conceptual underpinnings of constructivism and global health partnerships (GHPs) in global health studies has a dimension that deserves closer attention. This paper attempts to draw attention to a few aspects of the debate using Finnemore’s constructivist analysis. According to this study, global actors need to rethink their paradoxical notions of pandemic crisis survival in light of the growing demand for mobilizing diverse global health agents and the necessity of constructing complex GHPs to address challenges of international significance. A global response based on solidarity and multilateralism is the only way to effectively combat this pandemic. Against this backdrop, the article analyses this development through an ideational ontological case study of the GAVI, the Vaccine Alliance. This article contributes to the debate by explaining how the GAVI Alliance fostered global collaboration and can serve as a template for future GHPs.
Abstract by the authors: In response to the COVID-19 pandemic, several international initiatives have been developed to strengthen and reform the global architecture for pandemic preparedness and response, including proposals for a pandemic treaty, a Pandemic Fund, and mechanisms for equitable access to medical countermeasures. These initiatives seek to make use of crucial lessons gleaned from the ongoing pandemic by addressing gaps in health security and traditional public health functions. However, there has been insufficient consideration of the vital role of universal health coverage in sustainably mitigating outbreaks, and the importance of robust primary health care in equitably and efficiently safeguarding communities from future health threats. The international community should not repeat the mistakes of past health security efforts that ultimately contributed to the rapid spread of the COVID-19 pandemic and disproportionately affected vulnerable and marginalised populations, especially by overlooking the importance of coherent, multisectoral health systems. This Health Policy paper outlines major (although often neglected) gaps in pandemic preparedness and response, which are applicable to broader health emergency preparedness and response efforts, and identifies opportunities to reconceptualise health security by scaling up universal health coverage. We then offer a comprehensive set of recommendations to help inform the development of key pandemic preparedness and response proposals across three themes—governance, financing, and supporting initiatives. By identifying approaches that simultaneously strengthen health systems through global health security and universal health coverage, we aim to provide tangible solutions that equitably meet the needs of all communities while ensuring resilience to future pandemic threats.
Abstract by the authors: The historical trajectories of three crises have converged in the 2020s: the COVID-19 pandemic, rising inequality and the climate crisis. Global health as an organising logic is being transformed by the COVID-19 pandemic.We point to an emerging consensus that the triple threats of global heating, zoonoses and worsening, often racialised inequalities, will need to be met by models of cooperation, equitable partnership and accountability that do not sustain exploitative logic of economic growth. Health governance is challenged to reconsider sustainability and justice in terms of how local and global, domestic and transnational, chronic and infectious, human and non-human are interdependent. In this article, we discuss their intersection and suggest that a new set of organising ideals, institutions and norms will need to emerge from their conjunction if a just and liveable world is to remain a possibility for humans and their cohabitants. Future health governance will need to integrate pandemic preparedness, racial justice, inequality and more-than-human life in a new architecture of global health. Such an agenda might be premised on solidarities that reach across national, class, spatial and species divisions, acknowledge historical debts and affirm mutual interdependencies.
Abstract by the authors:
Background:The Global Health Security (GHS) Index has been developed to measure a country’s capacity to cope with a public health emergency; however, evidence for whether it corresponds to the response to a global pandemic is lacking. This study performed a multidimensional association analysis to explore the correlation between the GHS Index and COVID-19-associated morbidity, mortality, and disease increase rate (DIR) in 178 countries (regions).
Methods: The GHS Index and COVID-19 pandemic data – including total cases per million (TCPM), total deaths per million (TDPM), and daily growth rate – were extracted from online databases. The Spearman correlation coefficient was applied to describe the strength of the association between the GHS Index, sociological characteristics, and the epidemic situation of COVID-19. DIRs were compared, and the impact of the GHS Index on the DIR by the time of “lockdown” was visualized.
Results: The overall GHS Index was positively correlated with TCPM and TDPM, with coefficients of 0.34 and 0.41, respectively. Countries categorized into different GHS Indextiers had different DIRs before implementing lockdown measures. However, no significant difference was observed between countries in the middle and upper tiers after implementing lockdown measures. The correlation between GHS Index and DIR was positive five days before lockdown measures were taken, but it became negative 13 days later.
Conclusions: The GHS Index has limited value in assessing a country's capacity to respond to a global pandemic. Nevertheless, it has potential value in determining the country’s ability to cope with a local epidemic situation.
Abstracts by the authors: The city of Wuhan in China is the focus of global attention due to an outbreak of a febrile respiratory illness due to a coronavirus 2019-nCoV. In December 2019, there was an outbreak of pneumonia of unknown cause in Wuhan, Hubei province in China, with an epidemiological link to the Huanan Seafood Wholesale Market where there was also sale of live animals. Notification of the WHO on 31 Dec 2019 by the Chinese Health Authorities has prompted health authorities in Hong Kong, Macau, and Taiwan to step up border surveillance, and generated concern and fears that it could mark the emergence of a novel and serious threat to public health.
Abstract by the author: Among all pathogens of public health concern, influenza virus is unique and somewhat notorious for its ability to constantly evolve and to rapidly spread; its potential for catastrophic impact and its ubiquitous presence in wild and domestic animals. The only way to address such a serious challenge is by timely and effective global collaboration. One such collaboration began 65 years ago: the WHO Global Influenza Surveillance Network (GISN), just 4 years after the WHO constitution had came into force.
Abstract by the authors: Through this report we wish to highlight the ongoing novel coronavirus outbreak, that took place in China. The importance of this deadly pathogen, originating from a viral family, having a history of pandemic is highlighted.The symptoms of this disease with the treatment and preventive measures are outlined. We have briefly mentioned the situation in the past and have compared it with the recent statistics. The initiatives taken in order to prevent any further progression of this disease are also touched upon briefly. The outbreak of Coronavirus Disease 2019 (COVID-19) causing novel coronavirus-infected pneumonia (NCIP), has affected the lives of 71,429 people globally. Originating in China, the disease has a rapid progression to other countries. Research suggests remarkable genomic resemblance of 2019-nCoV with Severe Acute Respiratory Syndrome (SARS) which has a history of a pandemic in 2002. With evidence of nosocomial spread, a number of diligent measures are being employed to constrain its propagation. Hence, the Public Health Emergency of International Concern (PHEIC) has been established by the World Health Organization (WHO) with strategic objectives for public health to curtail its impact on global health and economy.
Abstract by the authors: In the United States and around the world, COVID‐19 represents a mass fatality incident, as there are more bodies than can be handled using existing resources. Although the management and disposition of bodies is distressing and heartrending, it is a task that local, state, and federal governments must plan for and respond to collaboratively with the private sector and faith‐based community. When mass fatalities are mismanaged, there are grave emotional and mental health consequences that can delay recovery and undermine community resilience. Using insights from one author's mass fatality management research during the 2010 Haiti earthquake, this Viewpoint essay explores how mass fatalities are being managed in response to COVID‐19. Based on the researcher's findings a decade ago, it is apparent that many lessons have not been learned. The essay concludes by providing governments with practical lessons on how to manage mass fatalities to facilitate and promote community resilience.
Abstract by the author: Handwashing with soap under running water is a key intervention for preventing the spread of COVID-19. However, in Africa, before the COVID-19 pandemic, this simple and effective intervention for preventing sanitation-related diseases such as cholera, diarrhoea, dysentery, typhoid, and soil-transmitted helminth infections was not practised by many people, especially in communities in rural areas and low-income urban settlements. Only 15% of the population in sub-Saharan Africa have access to basic handwashing facilities with soap and water.1 In urban areas, less than a quarter (24%) of the population have access to handwashing facilities.1 Prevalence of handwashing in sub-Saharan Africa after exposure to excreta has been estimated at 14%.
Abstract by the authors: The COVID-19 pandemic affects all countries, but how governments respond is dictated by politics. Amid this, the World Health Organization (WHO) has tried to coordinate advice to states and offer ongoing management of the outbreak. Given the political drivers of COVID-19, we argue this is an important moment to advance International Relations knowledge as a necessary and distinctive method for inclusion in the WHO repertoire of knowledge inputs for epidemic control. Historical efforts to assert technical expertise over politics is redundant and outdated: the WHO has always been politicized by member states. We suggest WHO needs to embrace the politics and engage foreign policy and diplomatic expertise. We suggest practical examples of the entry points where International Relations methods can inform public health decision-making and technical policy coordination. We write this as a primer for those working in response to COVID-19 in WHO, multilateral organizations, donor financing departments, governments and international non-governmental organizations, to embrace political analysis rather than shy away from it. Coordinated political cooperation is vital to overcome COVID-19.
Abstract by the authors: The global response to the COVID-19 pandemic has laid bare weaknesses and major challenges in the international approach to managing public health emergencies. Populist sentiment is spreading globally as democratic nations are increasing their support for or electing governments that are perceived to represent "traditional" native interests. Measures need to be taken to proactively address populist sentiment when reviewing the IHR (2005) effectiveness in the COVID-19 pandemic. We discuss how populism can impact the IHR (2005) and conversely how the IHR (2005) may be able to address populist concerns if the global community commits to helping states address public health threats that emerge within their borders.
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