RIYADH, 17 April 2020 –
The Civil Society 20 Engagement Group (C20) has prepared a comprehensive list of urgent recommendations and priorities for action to the G20 Health Ministerial meeting scheduled on April 19th 2020. The recommendations have been drafted by leading global health experts representing civil society organizations from around the globe, who came together to provide an inclusive voice to the G20 on global health agenda; stressing the following recommendations and priorities for action:
- G20 nations and multilateral financial institutions must commit at least US$8 billion of new funding to address urgent gaps in the global response to COVID-19, including funding WHO, research and development (R&D) for new diagnostics, treatments, vaccines, strengthening surveillance, and sufficient supply of protective equipment for health workers. This has been fully costed by the Global Preparedness Monitoring Board. We ask for this expenditure and all procurements to be transparent, subject to public scrutiny, with mechanisms to prevent corruption, and support accountability to citizens. Oversight bodies that include civil society and other stakeholders should be established to scrutinise decisions and help maintain public trust.
- In addition, the G20 should lead a global response to immediately double the level of public spending on health in developing countries by raising an additional $160 billion via debt cancellation and additional aid as a first step towards a $500 billion Marshall Plan for health, as recommended by the UN. This funding should be used to surge and strengthen public health systems including the training and recruitment of millions of paid and protected health workers as well as the suspension of user fees and insurance conditions to ensure unconditional access to all health services for all free at the point of use, as advised by the WHO.
- Consider channeling a portion of COVID-19 response funds through additional, targeted support via the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Global Drug Facility, to enable a very rapid, highly effective response to COVID-19 at a scale that will be difficult to replicate through bilateral spending. This would also allow for resources invested in the global response to COVID-19 to protect and bolster HIV, TB and malaria programme infrastructures, by strengthening health systems, supporting resilient supply and procurement systems, and facilitating a quick, and flexible response to stock outs of key commodities globally.
- R&D efforts should be needs-driven, evidence-based and should be considered as a shared responsibility. G20 countries must therefore attach public interest access principles to any funding for R&D for new tools to fight COVID-19 to ensure that the end product is affordable, accessible and available for everyone who needs it. Technology and intellectual property owners should commit patents, know-how, cell lines, copyright, software, data, and all other relevant intellectual property to be openly available in the public domain. This includes open, non-exclusive licensing to the benefits of scientific progress, and price transparency of all costs and pricing. For example, G20 countries should support the Coalition for Epidemic Preparedness Innovations (CEPI) to develop a vaccine, and Unitaid, while ensuring that any products developed are available and affordable for all who need them. Given the unprecedented global demand, G20 governments will also need to dramatically scale up investments in the manufacturing of all COVID-related medical tools in the global public interest, and to equally support enhanced manufacturing across the world.
- The G20 must consider the collective global response to COVID-19, not just health systems “at home” but also in countries where health systems are weaker, especially in low- and middle-income countries and challenging operating environments. This must include an empowered and capacitated community response and investments in manufacturing capacity.
As a forum for the world’s largest economies, the G20 is uniquely positioned and has a responsibility to address global health threats. The COVID-19 outbreak is an urgent reminder that we need to increase investment in what we know works: strong international partnerships, building health systems that reach everyone, building capacity for data sharing, research and development (R&D) that is affordably accessible by all, and an approach to care that is rooted in respect for human rights. The response must apply the principles of universal health coverage (UHC) and multi-sectoral collaboration. This includes empowering and capacitating community and civil society partners to help deliver the response, including in collaborative bodies, such as WHO.
COVID-19 is a global crisis of health, economic, social and political dimensions that requires a collective global response where we prioritise leaving no one behind. The G20 has proved itself as an effective partnership in the response to crises. In 2008, the G20 mobilised in response to the financial crisis and now a collective response to this global health emergency is required with a focus on the following priorities for action:
- Collective Action: When the world has come together to prioritise the health of everyone, countless lives have been saved, for example through partnerships like the Global Fund, Unitaid, the Global Polio Eradication Initiative and Gavi, the Vaccine Alliance. These multilaterals are well placed to help respond to new outbreaks. We ask G20 countries to recognize the coordinated efforts and the substantial funds made available for the COVID-19 response by multilateral donors. Governments, technology and intellectual property owners and researchers should urgently coordinate with WHO as well. G20 countries should encourage the Global Fund, as the largest multilateral provider of grants for health, to continue using funding flexibilities to support COVID-19 responses in countries, and to reinforce systems for health to build countries’ capacities to prevent, detect and respond to existing and emerging health threats. Furthermore, promote access to safe, effective, quality, and affordable diagnostics and health products for all, while ensuring that essential HIV, TB and malaria services are protected and bolstered by the resources invested in COVID-19. For example, invest to scale-up molecular testing and appropriate triage and care of people affected by COVID-19 and TB.
- Invest in research and development (R&D) and manufacturing capacity: There is currently no vaccine or treatment available for COVID-19 – the development of which is necessary to bring a crisis to an end. It is essential that alongside investments in coping with the crisis, investments are also made to solve it. Understanding that this pandemic affects everyone, an unprecedented effort to produce and distribute new treatments and vaccines will be required through partnerships and strategies for production, distribution and access. There must be a commitment by the G20 countries to any new tools developed for COVID-19 being globally available, appropriate and affordable. Access and affordability should be integral requirements of the entire research and development (R&D) and manufacturing process. This should include promoting the full use of TRIPS flexibilities, voluntary licensing and technology transfers, as well as supporting resilient supply and procurement systems to facilitate quick, flexible and coordinated responses to ensure access and prevent stock-outs of technologies, equipment and supplies globally.
- Strengthen health systems: Health systems in all countries are being overwhelmed, with a lack of health care capacity for patients and a lack of personal protective equipment (PPE) for health workers. With over 10,000 confirmed cases across Africa and over 50,000 across Latin America, there are concerns about the capacity of the health systems to respond as case numbers grow, for example there are only 4 intensive care beds in Liberia and many countries do not have ventilators or extensive testing.
- Leave no one behind: A globally coordinated, gender and rights-based response is needed. COVID-19 will disproportionately affect women and girls, vulnerable and marginalised people, such as people living in poverty, people who are malnourished, elderly people (including those with dementia), homeless people, people with disabilities, ethnic communities, prisoners, migrants, refugees, and people with existing health conditions. The health response must prevent stigma and discrimination, include psychological care, and ensure safe and quality health care including sexual and reproductive health care. G20 countries must ensure that women and girls have access to Gender Based Violence (GBV) prevention and response services, including GBV survivor services such as temporary shelter, safe housing, and financial support. Health workers must also be prioritized both in access to care and specific economic and social support. Women are globally around 70% of the health work force, many live in substandard surroundings and are facing special discrimination due to their work.
- Prevention of secondary impacts: The response to COVID-19 will have knock-on impacts on access to routine health services, including sexual and reproductive services. As WHO highlighted, “Previous outbreaks have demonstrated that when health systems are overwhelmed, mortality from vaccine-preventable and other treatable conditions can also increase dramatically”. We must work to balance fighting this pandemic while maintaining essential health services. Lessons can be learned from the TB, HIV and malaria responses, such as on health education on prevention, contact tracing, preventing stigma and discrimination, the role of communities, women’s organizations and civil society, and addressing challenges of isolation. Community health workers can be activated for awareness raising, prevention and early notification.
The WHO has recommended that all user fees for all health care should be urgently suspended at least for the period of the pandemic and entitlement to health care made universal and unconditional regardless of insurance status.
We urge the G20 to echo, promote and provide practical support to implement this advice. Without action, the excess death toll from non-COVID-19 related health conditions is likely to be even higher than that for the virus itself.
Civil Society 20 (C20) is one of the eight official Engagement Groups of the G20. It provides a platform for Civil Society Organizations around the world to bring forth a non-government and non-business voice to the G20.
Independent of government, the C20 is guided by the C20 Principles of transparency, collaboration, independence, internationalism, inclusiveness, and respect for human rights and gender equality, which also serve as the central pillars of the engagement group’s work. For more information, please visit https://civil-20.org/