Global Health Governance Changing With Shift In Economic Centre Of Gravity, Speakers Say 16/03/2018 by Catherine Saez, Intellectual Property Watch Leave a Comment Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window)Political and economic shifts have modified the post-war world order, and global health governance has to adapt to this new environment, speakers said at an academic event in Geneva this week. Among the changes: with the decline of United States funding for global health, new actors such as China and India could take leadership roles, they said. Ilona Kickbusch, Director, Global Health Centre, the Graduate Institute, Michel Sidibé, Executive Director, UNAIDS, Michèle Boccoz, Assistant Director-General for External Relations, WHO, Rajiv K. Chander, Indian Ambassador and Permanent Representative The Graduate Institute of Geneva Global Health Centre and Durham University organised a symposium on innovation and pathways in global health governance on 13 March. David Held, professor of politics and international relations at Durham University (US), presented two of his books. The first is titled, Gridlock: the growing breakdown of global cooperation, and the second, Beyond Gridlock. The global centre of economic gravity has shifted towards the East, he said, and this has created tensions in the world, leading to a crisis of liberalism, the election of Donald Trump in the United States, the positive vote on Brexit in the United Kingdom, and the rise of the far right in countries such as France and Germany. Gridlock describes how the post second world war multilateral order has been shaken by economic and political shifts and has led to a gridlock. In particular, he said, the gridlock pathways include an emerging multipolarity, institutional inertia, and the fragmentation of institutions. The multipolarity that comes with the rise of new powers such as India, China, and Brazil makes multilateral agreements more complicated to reach, he said. Institutional inertia comes from the fact that the core multilateral institutions are finding it difficult to adapt to changes and cling to their decision-making rules, which do not reflect the changing economic and political landscape, he added. This inertia leads to people trying to find ways around those multilateral institutions, like alternative agencies, through agreements, leading to a “confusing mosaic of authority,” he said. Held’s second book, Beyond Gridlock, shows that although the gridlock is pervasive, the system is more resilient than first thought. One of the most interesting elements of this resilience is that negative fragmentation can be turned into cooperation, involving new kinds of actors, such as domestic constituencies. Held said he is currently working on a third book on how to change the future. Changes in Global Governance, WHO Mandate, AMR Michael Merson, professor of global health at Duke Global Health Institute (US), underlined the ability the world deployed to respond to the AIDS pandemic but wondered how long organisations could raise funds to continue fighting the infection, while only half of those with AIDS have access to AIDS medicines today. Adam Kamradt-Scott, associate professor at the University of Sydney, said a fundamental change happened in the World Health Organization’s mandate in 2015, as the Health Emergency Programme was approved. This turned the WHO from a norm-setting organisation into an operational agency, he said. This programme raised expectations from governments, and people, and turned WHO into a first responder, which “of course” it is not, he said, adding that some member states resisted the programme as they perceived it as interfering in their domestic affairs. On the relative lack of response on antimicrobial resistance (AMR) by member states, Suerie Moon, visiting lecturer at the Graduate Institute and director of research, Global Health Centre, Geneva, said there are only so many spots at the top of health issues, and some other pressing issues eclipsed the AMR issues for a while, such as AIDS. The question on AMR is whether the key protagonists will seize the policy window to put in place durable mechanisms over the next decades, according to Moon. There is no global fund, no treaty, and no appetite for it, she said. One of the reasons for this lack of appetite is the uncertainty around the issue. Taking health issues to the UN Security Council can be the “most optimistic” way of raising funds for those issues in the US, Merson said. Kamradt-Scott reflected on concerns about the securitisation of health issues, but said taking them to the UN Security Council could be considered as a tool to engage actors, such as the US and the United Kingdom. He also remarked that in low and middle-income countries, the military have most of the necessary resources to address urgent health issues. Moon pointed out the decline of US financial contribution in global health and said that decline could have dire consequences but also allow less central players to take more leadership roles, she said. China, although still a recipient of aid, has at the same time became a large donor, and it remains to be seen how China will assume this role in the future, Merson said, adding that India also needs to be looked at in that context. Political Leadership in Global Health Governance According to Indian Ambassador Rajiv K. Chander, permanent representative to the UN in Geneva, global leadership begins at home, but at the same time it should take on board the interests of others. India is producing 80 percent of the world generic medicines, and 60 percent of global vaccines, he said, adding that this is an example of practical leadership. UNAIDS Executive Director Michel Sidibé said the AIDS crisis led to the rise of a major civil society movement and activism in science. In a few years, AIDS became treatable, and the treatment which once included 18 pills twice a day has been reduced to 1 pill a day. There is a need to move from disease-specific to people centered approaches, he said, so to include fragile population, which exists “from Baltimore to Bamako.” Sidibé added that finance ministers should consider health as an investment rather than a cost, and impact analysis should be done to demonstrate that. He underlined the role of prevention, as no developing countries will be able to pay for the costs generated by non-communicable diseases, even with innovation and affordable prices, he said. There is a need to demonstrate that there is no better return on investment than prevention, he added. Michèle Boccoz, WHO assistant director-general for external relations, described the new vision for WHO as established in the General Work Programme 2019-2023 (IPW, WHO, 29 January 2018). Working with Private Sector On collaborating with the private sector, Sidibé said UNAIDS has a solid experience with the private sector, and the UN Sustainable Development Goals will never be achieved without partnering with the private sector. The private sector should not be seen as bringing money, but as quickening the pace of action, he said. Chander agreed that public-private partnerships are important, but the pivotal role has to be played by the state. A sound policy framework is crucial for allowing all to participate in the process, including the private sector and civil society, according to Chander. The recently approved WHO Framework of Engagement with Non-State Actors is protecting the organisation’s integrity, said Boccoz. The WHO is now seeking to establish a policy of engagement (excluding the tobacco and the arms industry), she said. The organisation needs to engage with digital technologies and the pharmaceutical industry, and to conduct risk/benefit analyses. A steering committee is currently analysing the questions, she said. 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