ILONA KICKBUSCH Ilona Kickbusch is the founding director of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva, Switzerland. She served on a panel of
independent experts to assess the World Health Organization’s response to the Ebola outbreak and is a member of the Global Preparedness Monitoring Board. She previously had a distinguished career with the WHO and Yale University, and has published widely on global health governance and global health diplomacy. She is a member of the WHO Council on the Economics of Health For All. She is co-editor of, most recently, Health: A Political Choice – Investing in Health For All . X-TWITTER @ IlonaKickbusch ilonakickbusch.com
and together. The political declarations on universal health coverage and pandemic prevention at UNGA reiterate health as a universal goal – that everyone wants for themselves and for others, from individuals to states. But those declarations leave it at statements about redoubling efforts for universal health coverage and prioritising preparedness. The polarisation after Covid has shown clearly that health has become a key area of action where the stark inequalities of the global system become tangible. All the development aid for health, all the philanthropy and charity were reduced to Band-Aids as the power divide played out through vaccine nationalism and the lack of access to medical countermeasures. This is why negotiations for a pandemic accord are so controversial and difficult – power and politics are back because global norm setting is more than a functional enterprise. The stakes are very high, as are emotions and frustrations. But the UN Pandemic Summit did one thing right: it was bland because the negotiations on a pandemic accord are at the World Health Organization, to which it gave priority. Attempts at forum shifting did not work. Indeed, the summit was badly timed and probably unnecessary at this point. THE EMERGING POLITICAL MESSAGE The emerging political message is clear: before new debates arise about integration, coherence and cooperation in matters of global health and the reform of its institutions, two basic issues of inequality need to be addressed: representation and democratic governance and the elementary financial determinants of the system. At UNGA, Angola’s President João Manuel Gonçalves Lourenço highlighted the lack of sufficient representation in global governance institutions to contribute to formulating realistic solutions to their problems. The G20 has addressed this by inviting the African Union to join. The BRICS is working on broadening its influences as a voice of the Global South by expanding its membership. The G7 in turn is refining itself as a forum of democracies.
William Ruto, president of Kenya, stated it clearly at the Climate Ambition Summit: “Neither Africa nor the developing world stands in need of charity, handouts or harms from the developed countries. What we need is fairness: a fair financial system; fair market access for green assets, products and services; fair national regional trade mechanisms.” Barbados prime minister Mia Mottley in turn called for a loss and damage fund following the Bridgetown Initiative and said “it is painful” that the Global North continues asking countries “to increase borrowing to build resilient infrastructure for something that we did not do”. UN secretary general António Guterres called for reforming the financial institutions and architecture, and the G20 declaration (with India clearly defining itself as the voice of the Global South) echoed the calls of the Bridgetown Initiative on debt and access. In the pandemic accord negotiations, the principle of common but differentiated responsibilities was put on the table. The paltry sum available for the Pandemic Fund combined with a complex application procedure still reflects the approaches of the systems that must be overcome. UNAIDS executive director Winnie Byanyima drew attention to the fact that Africa has made $79 billion in debt repayments in 2021 – but that the pandemic fund has only $3 billion to disperse. There is therefore every reason why the UN and its organisations are rocked by political debates – the world is changing dramatically. This is where these debates must happen, in the only inclusive forum that enables them, including the WHO. This does not mean that the organisations are not fit for purpose: they are integral political platforms for reshaping the world. They must respond to this role with sound judgement. We cannot afford their demise, as happened with the League of Nations. All the African leaders who spoke at UNGA reiterated its importance to them – those leaders who did not come might want to keep this in mind. Multilateralism will continue to be a patchwork and very much more difficult over the next years. The solutions will not come quickly. They will need to be bold, but they are worth fighting for. ▪
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Health: A Political Choice – From Fragmentation to Integration
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