The global health leaders addressed the importance of having a joint financing of world health emergencies in the future in response to the fragility of the global health system as seen in the face of the ongoing COVID-19 pandemic. The Health World Group meeting was held from June 6-8. The much-needed agreement is expected to be officiated in September.

Apart from the new global emergency fund, the G20 Indonesian presidency has also drafted a policy brief on the One Health concept in an attempt to build stronger global health system architecture. This was conducted as a side event on June 8.

The global health leaders of the G20 Health World Group discussed intensively the technicalities of building trust to facilitate greater sharing of genomic sequencing data, and on how a well-formulated financing scheme -- the Financing Intermediary Fund (FIF) -- might function under the auspices of the World Bank to support preparedness and response for future pandemics.

Health Minister Budi Gunadi Sadikin revealed Indonesia’s preparedness for joint commitment and has committed to donate US$50 million to the FIF.

Budi stated, “As part of the G20 presidency mandate, Indonesia will lobby organizations and donors in order to seek common ground and ensure that the fund will be put to good use and benefit the right targets, countries in need and most importantly their people.

“In this case Indonesia is being practical; we have learnt from what happened in the past two-and-a-half years, particularly understanding which institutions are proven to be the most successful in prudently delivering the funds in time,” he said.

Budi called on G20 member states to seize the moment and not let the pandemic stride by without learning valuable lessons.

“Only because of great earthquakes, lofty mountains rise. I believe this is true, not only for volcanoes, but also for our humanity. In the midst of every crisis lies great opportunity,” he said.

Budi urged G20 member states to play an active role in strengthening the resilience of the global health system by addressing three issues.

First, by mobilizing financial resources for pandemic prevention, preparedness and response.

Second, by properly managing funding, learning from the successes of medical countermeasures initiatives, such as COVAX and the ACT-accelerators that have worked quickly and efficiently during the pandemic to usher in vaccines, therapeutics and diagnostics.

Third, by optimizing genomic surveillance and promoting trusted data-sharing mechanisms, allowing the world to quickly identify novel pathogens that may pose new threats to global health security.

According to Budi, COVAX and the ACT accelerators are not formalized; for future health treatments we need a more permanent coordinated platform.

“This platform must have the ability to address five core elements of global pandemic preparedness, comprising: access to countermeasure, emergency coordination, collaborative intelligence, community protection and clinical care for patients in need,” Budi stated.

Budi acknowledged that the management of a huge fund, such as FIF, would come with many challenges driven by conflicting interests and ambitions from big donors and organizations.

Addressing the G20 Health Working Group, World Health Organization (WHO) Secretary-General Dr. Tedros Adhanom Ghebreyesus commended Indonesia’s presidency for prioritizing the establishment of global health system architecture and putting it at the heart of the G20 agenda.

“We must learn from the lessons this pandemic is teaching us, because history tells us that it will not be the last one,” said Dr. Tedros.

Dr. Tedros added that even as the world was bringing this pandemic under control, “we must put in place the measures to prevent and to prepare for future pandemics and mitigate their impacts. Drawing on the findings from multiple experts, the WHO has developed a proposal for stronger global health architecture for preparedness and responses.”

The WHO proposal includes key recommendations for stronger governance, systems and tools as well as more generous financing.

Dr, Tedros added that the WHO is committed to working jointly with the World Bank on the design of FIF to be able to provide catalytic emergency funding. 

The Health Working Group also discussed ways to manage and coordinate global data sharing of potential pandemic pathogens, claimed by experts to be one of most contentious topics to deliberate due to data access and data-management issues. 

The G20 Health Working Group’s first session also featured Dr. Bruce Aylward speaking  on the global architecture for health emergency preparedness and response, Sir John Bell on building a resilient health system to prevent diseases and improve preparedness for future pandemics, Dr. Fifa A. Rahman on pandemic emergency resource mobilization and the importance of LMIC participation in the global health architecture and Dr. Soumya Swaminathan on the implementation of functional data-sharing platforms for global genomic surveillance and pathogen genomic data sharing to detect future health threats.

Participants also considered the need for affordable and equitable access to essential supplies to counter pandemics, describing how to expand, copy or formalize and refine the existing ACT-accelerator. 

The June 7 meeting also discussed further leveraging GISAD+ to refine data-sharing mechanisms and surveillance capacity across the globe. 

Peter Bogner of the GISAID initiative addressed the session, delivering his ideas on optimizing GISAID+ model for the epidemic and pandemic potential pathogens.

Closer to One Health

Meanwhile, the drafting of a policy brief on the One Health concept serves as the foundation for the new standard and mechanism in delivery health care and preventive measures to tackle future threats.

Deputy Minister of Health Dante Saksono Harbuwono said the One Health concept would play a critical role as the world is reeling from the COVID-19 pandemic and beginning to build a stronger global health architecture to prevent future health threats, particularly emerging infectious diseases/zoonosis that hold high interface between human and animal.

“Principally One Health will provide a strong foundation that links humans, animals, plants and environment. Through One Health we will be able to perform proper and thorough surveillance that involves working with other sectors, such as animal health and environmental health,” he said during a press conference following the One Health workshop last Wednesday. 

Dante cited three measures that must be collectively implemented by countries: increasing the surveillance on pathogens with high interface between human and animals (wild animals in markets, farms and forests); strengthening commitments to share data universally in a timely manner and transparently; and preparing society to respond quickly and accurately to health threats from humans, animals and plants to prevent and to overcome infectious disease outbreaks.

This side event, themed “Implementing One Health Approach to Achieve Health Security and Economic Stability”, was a part of the talks held in the second G20 Health Working Group. It was attended by representatives from both human and animal health sectors, as well as international development organizations.

The event, featuring speakers from quadripartite (WHO, FAO, OIE/WOAH, UNEP); the World Bank; and the United States delegation, was a follow-up from the 2011 Rome Declaration.

According to Dante, Indonesia has initiated the development of a self-assessment questionnaire (SAQ) to assess the implementation of One Health in G20 member states and G20++ member countries.

The SAQ covers seven areas to be assessed: multisector coordination, emergency planning and preparedness, surveillance and risk analysis, laboratory, risk communication and community empowerment, human resource development and monitoring and evaluation.

“Today we are steps closer to implementing One Health; we have drafted a policy brief that contains points to follow up on. Making a priority list on health challenges by using the One Health approach and mobilizing human resources, partnership and funding are two of the measures advised in the brief,” Dante said. 

Also speaking in the press conference, team leader of the Australia Indonesia Health Security Partnership (AIHSP) John Leigh said that in the past two or three decades, the world has been battling diseases that originally came from animals.

In his view, countries must therefore start looking at human, animal and environmental health as an integrated sector. 

“We hope to prevent many more possible diseases if we can monitor the condition of animal health in our surroundings. What we must focus on are sites where human and animals have many interactions,” he noted.

Leigh conceded that there were challenges in implementing such an approach, namely human resources and funding.

One Health is not only important in preventing future pandemics, but it is key in responding to food insecurity.

He mentioned that due to growing antimicrobe resistance as a result of the widely used antibiotics in agricultural practices, the resistant pathogens most likely posed more potential harm to human health.

“We need this integrated approach that involves the agriculture and health sectors to prevent this. Likewise, with other environmental problems, such as responding to growing pollution and the impacts of climate change,” he said.  

G20 Leaders' Summit in Bali in November of this year is expected to adopt agreements formulated by the second G20 Health Working Group.

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