coverage and pandemic preparedness and response based on a human security approach so we can realise resilient health systems that flexibly tackle health emergencies and multiple threats to health. We can also bring a globally networked innovation and access ecosystem for medical countermeasures to life by committing to sharing solutions such as vaccines and other health technologies as global public goods. This would save lives and restore trust in our global systems. We must also reverse other areas of fragmentation affecting health and well-being. The Paris Agreement is a public health agreement as much as it is one of climate action. By delivering on it, we can advance the right to a clean, healthy and sustainable environment together with people’s health and well-being. RETIRING ‘TRADE-OFFS’ The 2030 Agenda is also prompting a re-think of the metrics needed to secure the future of people and planet. That means looking beyond gross domestic product to leverage synergies across sectors. For instance, a just energy transition would dramatically reduce harmful greenhouse gas emissions while advancing social justice, human rights, gender equality, health, education, jobs and livelihoods. Smart use of data and analytics are key to scaling the integrated solutions to responding to the multidimensional aspects of health and well-being. The UN Development Programme’s ‘SDG Push’ analysis shows that it is still possible for countries to outperform their pre-Covid development projections by investing across core SDG ‘drivers’ including health, social protection, a green transition, digitalisation and governance. INSTITUTIONS FOR THE 21ST CENTURY The UN system, as our primary global anchor to promote peace, security, and development, must also evolve. Secretary-General Guterres has an ambitious plan for a revitalised UN through the Our Common Agenda report, and a spirit of multilateral collaboration is being nurtured through initiatives such as the SDG3 Global Action Plan. This has paved the way for the UN Comprehensive Response to Covid-19, which integrated health, development and humanitarian support through the pandemic. There is much more to be done on pandemic preparedness and response, but the UN and its many partners are now better equipped to respond to complex health emergencies. Efforts to stay and deliver in Afghanistan, Sudan, Syria, Ukraine and beyond demonstrate this fact. Global health governance is evolving in other ways. Gavi, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the US President’s Emergency Plan for AIDS Relief are ACHIM STEINER Achim Steiner has been the administrator of the United Nations Development Programme since 2017. He is also the vice-chair of the UN Sustainable Development Group, which unites 40 entities of the UN system that work to support sustainable development. Prior to joining UNDP, he was director of the Oxford Martin School and Professorial Fellow of Balliol College, University of Oxford. He led the UN Environment Programme (2006–2016) and was also director-general of the United Nations Office at Nairobi. He previously held other notable positions including director-general of the International Union for the Conservation of Nature and secretary-general of the World Commission on Dams. X-TWITTER @ASteiner undp.org
integrating their disease-specific responses with broader efforts to strengthen health systems and prepare for pandemics. The International Health Regulations are undergoing long-awaited amendments; a new pandemic accord is in the works; and other strong proposals have been put forth to make Covid-19 the last pandemic of its kind. The mRNA vaccine technology transfer hub in South Africa initiated by the World Health Organization is a clear demonstration of how developing countries are becoming a nucleus for the solutions that our global community now needs. Whether this all ultimately makes the world safer depends on the same essential elements: political will at all levels for multisectoral and timely responses, an empowered WHO and a shared commitment to equity. As ever, finance is pivotal. That involves reforming the international financial architecture and directly tackling the global debt crisis at a time when many developing countries are spending, on average, 1.4 times more simply to service their debt than they allocate to health care. These shifts could unlock hundreds of billions of dollars to invest in health, climate and all 17 SDGs. SOLIDARITY OVER SEPARATION The estimated 24 million excess deaths and counting due to Covid-19 should not be the jolt we need to take pandemic preparedness seriously. Nor should countries and communities be locked into a never-ending cycle of polycrisis to grasp the importance of the SDGs. In a world riven by the impacts of conflicts, geopolitical tensions and the climate emergency, we have a clear way out. The 2030 Agenda represents one of the only platforms that all countries still agree on for navigating through this sea of uncertainty. We must act upon it as our global community’s best hope to defeat the virus of fragmentation. Solidarity can win over separation. ▪
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Health: A Political Choice – From Fragmentation to Integration
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