In the wake of COVID-19, global health was catapulted up the international political agenda. The pandemic highlighted the global security nature of diseases and the need for more effective international agreements for efficient and equitable pandemic prevention and response. A reshaping of global health architecture and strategies are required, considering emerging trends like health security, global demographic shifts and lack of health professionals worldwide.
A new era of contributions to global health beyond the health sector is needed, as stated in the recently adopted Council Conclusions “Better health for all in a changing world”.
As we approach the Belgian Presidency global health conference ‘Building an African Union/EU Partnership in Global Health’, on March 20, the new Commission's mandate and the European Council's Strategic agenda, it is vital to identify the trends and challenges for global health 2.0. In particular, planetary health, Artificial Intelligence (AI), financing global health and the link with industrial policy.
Global health: a planetary health approach
The triple planetary crisis of climate change, biodiversity loss and pollution has implications for populations across the world, disproportionally affecting women and girls. Extreme heat and weather will lead to food insecurity, with dire economic and human consequences.
A preventative planetary health approach is required, fostering collaboration beyond the health sector. This should involve relevant ministries, civil society, the private sector, and local communities. It should also establish independent accountability mechanisms to achieve a balance between binding and voluntary instruments to address global health challenges effectively.
The ongoing difficult negotiations for an international pandemic preparedness agreement indicate a significant loss of momentum for equity and cooperation on pandemics at the global level based on a planetary one health approach.
Deep wounds caused by the poor global pandemic response remain and rebuilding trust and mutual respect are essential to address the current trust deficit that deepened between different parts of the world. This includes trust between and within countries, governments and civil society, government and the private sector, scientists and citizens. Trust building required not only to ensure advancement towards a global planetary health approach but to ensure a successful outcome for the negotiations which, are subject to ongoing challenges, lack of consensus and power imbalances between regions.
There is a real risk that agreement will only be found on the lowest common denominator instead of converging upward towards a common aspiration, with negotiations focusing on political bottlenecks such as intellectual property rights and inequity. Therefore, given the limited time until the expected agreement on the pandemic treaty in May, the Belgian Presidency must lead on behalf of the EU member states to push towards a compromise based on the highest possible denominator.
Digital technologies and AI: the importance of data for global health
Another area with massive implications for global health is in data and digitalisation. Digital technologies and Artificial Intelligence (AI) in healthcare can potentially transform global access, enhance the quality of care, and improve patient outcomes. Ownership of data by the producer, respect for privacy of personal data and a global health data space are required to ensure that the potential of digitalisation is carefully harnessed across all regions and new inequalities and biases are tackled upfront.
Work is ongoing in different regions regarding the creation of health data spaces. For example, in the European Union, the European Commission published its proposal for a regulation on the European Health Data Space (EHDS) in May 2022. Efforts are also being made in Africa to enable ownership, privacy, interoperability and access to data via the VODAN network, an operational network that seeks to facilitate the establishment of an African Health Data Space using the FAIR data principles.
The FAIR data principles were defined in 2016 and adopted in 2020 at the G20 Hangzhou summit. The principles set out that data should be “Findable, Accessible, Interoperable and Reusable”. Despite being in existence since 2016, their full potential impact has not been realised due to a deficiency in information and practical experience on implementing the guidelines, resulting in inconsistent interpretations.
As we move towards Global Health 2.0, it is crucial to emphasise the significance and value of health data from diverse regions, particularly in treatment, surveillance and research, to ensure that the advantages of emerging technologies and enhancements to existing ones can be experienced globally. Failure to train AI models with data from under-resourced regions poses a risk of inadequate algorithmic service to these populations and, consequently, a global shortfall in algorithmic efficacy. In advancing technology, it is imperative to avoid the exacerbation of inequities and biases between regions. Increased efforts are required to transition away from fragmentation of data collection platforms towards integration.
Therefore, it is recommended to set up close collaboration between the development of an African health data space and the EHDS to make rapid progress towards respectful partnerships based on the FAIR data principles.
Financing global health: social and economic determinants
Global health challenges necessitate cross-sectoral collaboration in line with the Sustainable Development Goals. Many of the primary determinants of health come from outside the traditional health sector with factors such as the environment, food, war and income inequalities influencing health. However, despite this, financing for health in different parts of the world is often not concentrated on addressing the social and economic determinants of health outcomes. To make significant progress with Global Health 2.0, budgets need to sufficiently reflect this, and more spending should focus on preventative measures such as enabling access to nutritious food and clean water.
When addressing healthcare challenges, responses must be focused on people. A person-centric approach should focus on what people need to stay healthy rather than on institutions or specific disease conditions. A more aspiring agenda for global health should not be merely focused on the absence of disease but also look at people’s functional potential and building equity. This must also be accompanied by a place-based approach to tackling health challenges, which requires localised action and a shift towards an approach that focus on prevention rather than disease solutions.
While the Health in all Policies approach has been on the agenda for many years, greater efforts are required to implement a more transdisciplinary approach to policymaking, which would yield better outcomes for populations across the globe.
Industrial policy globally: opportunities for health
The pandemic showed that global supply chains and local industrial ecosystems are integral to delivering better health outcomes, but the link between health and industrial policies has been neglected in the past. Major disparities still exist when it comes to production capabilities whereby many low and middle-income countries, particularly in the African region, do not receive the technical transfer or know-how nor have the necessary infrastructure for production. Procurement has also been monopolised for too long in industrialised countries limiting the scope and potential of production facilities in Africa. Recognising the nexus between local industrial ecosystems and pharmaceutical and health policies is imperative to design more effective and equitable strategies.
This involves establishing practical regional hubs and technological capabilities, considering learning timelines, investment, technology transfer, and competition dynamics. Localised approaches are needed to ensure access and affordability in regions across the world, which requires capacity building and technical transfer. Emphasising equity and solidarity is vital and should encompass equitable technology and knowledge transfer to boost regional and local manufacturing capacities.
Urgency plus agency are drivers of change that need to be used as a springboard for urgent policy shifts for future pandemic preparedness. This would avoid broken supply chains that expose African countries to the scale of risk that occurred during COVID-19.
Furthermore, the Belgian Presidency must facilitate the team Europe approach with the EU’s Global Gateway initiative and prioritise the security of pharmaceutical supply chains and the development of local manufacturing.
Essentially, global health will continue to be shaped by emerging trends in the years to come. However, advancing towards Global Health 2.0 is dependent on solid partnerships between global and regional actors and institutions, based on mutual trust despite the challenges posed by the divisions and fragmentation in global political realities. This must be at the fore of the Belgian presidency conference and serve as a priority in the new mandate of the Commission and the Council’s strategic agenda.
Lieve Fransen is a Senior Advisor on Health, Social and Migration Policies at the European Policy Centre.
Elizabeth Kuiper is Associate Director and Head of the Social Europe and Well-being programme at the European Policy Centre.
Danielle Brady is Policy Analyst for the Social Europe and Well-being programme. Her interests include EU health and social policies.
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This commentary is part of the EP Elections Task Force.