7.4
PREPARING FOR A SAFER WORLD TOGETHER
on regional capacities and priorities. Regional instruments can implement and operationalise global commitments. 2. Prioritise equity in access to pandemic health products and health systems capacities. New international instruments should have equity and solidarity as core principles. Equitable access to vaccines, treatments, diagnostics, personal protective equipment and health personnel must be ensured, particularly for low-income countries. Legally binding provisions could cover equitable technology and knowledge transfer to boost regional and local manufacturing capacities, including through pooling intellectual property rights and providing incentives for technology sharing. Commitments must go beyond access to boost national public health capacities, health and social safety nets, and community level action, with international support aligned to national plans. 3. Establish sustainable and coordinated financing mechanisms. Predictable, coordinated financing is essential for equitable pandemic prevention, preparedness and response capacities worldwide. Initiatives such as the G20 Joint Finance-Health Task Force should be integrated within the broader pandemic response architecture. Humanitarian and development assistance for health should be coordinated with domestic health spending to maximise impact and build sustainable capacities. 4. Adopt whole-of-government and whole-of-society approaches. Pandemic response requires unprecedented collaboration beyond just the health sector, including coordination across ministries of finance, security, transportation and foreign affairs. Legal instruments and national commitments must engage relevant government stakeholders, while also tapping into the capacities of civil society, private sector and local communities. A coordinated multisectoral response should be institutionalised. 5. Develop accountability mechanisms for transparency. Independent accountability mechanisms strengthen capabilities for pandemic preparedness and response through transparent evaluation and learning. Legally binding commitments should promote accountability mechanisms and ensure action on recommendations. Accountability processes should be non-punitive and grounded in principles of transparency, learning and continuous improvement. 6. Balance binding and voluntary instruments for flexibility. Overemphasising legally binding elements may reduce political support and flexibility. The right
balance is needed between binding and voluntary components. Binding agreements may be most feasible and impactful for foundational principles such as equity, transparency, solidarity and cooperation. Specific technical provisions could be maintained as voluntary standards and best practices, especially during a pandemic. 7. Organise thematic negotiations for coherence. The pandemic response architecture incorporates diverse technical issues. Organising negotiations according to thematic areas such as health systems, economic resilience and access to countermeasures can promote more focused progress. Clustering related technical elements can help develop a more coherent framework and architecture across the instruments. 8. Regional leadership and localisation. Global agreements and initiatives must empower regional and local leadership while strengthening national capacities. One-size-fits-all centralisation often undermines response agility. Legal instruments should recognise regional entities and provide avenues for decentralised regional coordination and financing under national oversight. The Covid-19 pandemic has triggered a rare alignment of political will for strengthening global pandemic prevention, preparedness and response capacities. However, this opportunity could be squandered by fragmented initiatives operating in silos. It is critical to strategically integrate ongoing global and regional proposals into a unified pandemic response architecture to prepare the world to manage future crises equitably and effectively. The considerations outlined here aim to promote the level of policy coherence, coordination, transparency, flexibility and localisation needed to transition from the current fragmentation into a truly integrated, equitable and multisectoral approach to pandemic prevention, preparedness and response. With continued political commitment, strategic focus and collective action, we have an opportunity not just to tweak existing mechanisms, but also to truly reform and transform the global health system to build resilience against future threats. The window of opportunity is narrow, so urgent action is needed to harmonise and synergise the current landscape of initiatives towards integrated pandemic prevention, preparedness and response capacities worldwide. ▪
PRECIOUS MATSOSO Precious Matsoso is director of the Health Regulatory Science Platform at the University of the Witwatersrand and adjunct professor at the University of Sunway. She co-chairs the Intergovernmental Negotiating Body for the Pandemic Accord and was on the Independent Panel for Pandemic Preparedness and Response. She was director- general of the South African National Department of Health. She chaired the World Health Organization’s Executive Board and the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme, and was a member of the United Nations High-Level Panel on Access to Health Technologies.
ELIL RENGANATHAN Elil Renganathan is a professor of public health and policy at Sunway University in Malaysia. He is a member of the Advisory Council for Healthcare Reform in Malaysia, a member of the Independent Evaluation Panel of the Global Fund to Fight AIDS, Tuberculosis and Malaria, and head of the secretariat of the Panel for a Global Public Health Convention. He has held senior positions in global health, including leadership and global roles at the World Health Organization.
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Health: A Political Choice – From Fragmentation to Integration
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