The G20 is a Unique Opportunity to Revitalize and Recalibrate Public Health in India

The Group of Twenty, or G20, is a unique forum for international cooperation that puts the world’s major advanced and emerging economies in promoting and fostering policy coordination to achieve global economic stability, sustainable growth, and prevent future financial crises. Created in the backdrop of the financial crises that arose in several emerging economies in the 1990s, its inaugural meeting was held December 15–16, 1999, in Berlin.^[1]

The World Health Organization (WHO) also responded to the crisis by setting up the Commission on Macroeconomics and Health (CMH) in January 2000.^[2] Recognizing that while globalization entailed increased sharing of ideas, cultures, life-saving technologies, and efficient production processes, it was “under trial” as its benefits were not reaching the poor and it also had the potential for new and emerging challenges such as the HIV/AIDS pandemic or armed conflict and terrorism spreading rapidly across the world.

The CMH, therefore, called for investing in health and development by scaling up essential health interventions.^[3] India has made a remarkable journey since that inflexion point--making these investments wisely, undertaking key health sector reforms, and is now poised in the leadership position of the G20, having assumed its presidency on December 1, 2022.^[4]

G20 MATTERS FOR GLOBAL PUBLIC HEALTH– WHY AND HOW

The G20 countries account for half the world’s land mass, two-thirds of the world’s total population, and a staggering 85% or more of global GDP.^[5] These imply both a large magnitude of health burden on the one hand and a depth of experience and strong base of resources on the other. The G20 Health Working Group was established under the German Presidency in 2017 to develop a shared international agenda on issues such as strengthening health-care systems, reducing malnutrition, health-crisis management, and scaling up the fight against pandemics; these are India’s domestic priorities too.^[6]

In the context of development assistance for health (DAH), G20 members include the world’s largest providers of DAH, emerging donors, and DAH recipients.^[7] The G20 leadership is, therefore, tasked with providing stewardship for harnessing DAH for equitable health gains, delivering it to bolster health services, and shape transformative partnerships for sustainable impact.

In a globalized world, health threats--antimicrobial resistance, climate change or air pollution--abound, and traditional borders offer little or no protection. Global public health security comprises the activities required, both proactive and reactive, to minimize the danger and impact of acute public health events that endanger people’s health across geographical regions and international boundaries. COVID-19 has exemplified this as never before and is a key actor in the continuing global response. Several major G20 members have been some of the worst hit in terms of cases and deaths. India demonstrated its health system resilience by leveraging indigenous resources and industry to bounce back with skilling human resources, testing kits, drugs, and vaccines.^[8]

WHAT THE INDIAN PRESIDENCY PLANS TO ACHIEVE

India remains committed toward consolidating the ongoing agenda set by the Italian and Indonesian Presidencies.^[9] Prevention and preparedness for health emergencies remain the foremost task even as the pandemic is still not over. India should aim to synergize the ongoing discussions and initiatives not just within the G20 but also across other actors including the WHO, World Bank, and G7 to further consolidate our health security imperatives.

India has the unique distinction of the highest number of United States Food and Drug Administration-compliant companies with plants outside of the USA. Of the 20 global generics, 8 are from India and half of the exports are to highly regulated markets. WHO sources about 65%–70% of vaccine requirements from India. India has a special responsibility in leveraging this collective strength in vaccines, therapeutics, and diagnostics for the benefit of the low- and middle-income countries (LMICs) in the journey toward SDG3--ensure healthy lives and promote well-being for all at all ages. A G20 Centre for Collaborative Pharmaceutical Research and creating a governance and financing framework under which LMICs have access to life-saving products are some of the high-focus priorities.^[10]

The Task Force on Digital Health was set up in 2020 under the Saudi Arabian Presidency. The shift from a “data-driven approach” to a “data first approach” is an important one toward future health service delivery. India is emphasizing inclusive digital health solutions, through digital public goods, to bridge the digital divide.^[11]

AN OPPORTUNITY FOR PUBLIC HEALTH

The G20 was set up to serve as an intergovernmental forum for international economic cooperation. The spotlight is on health not just on account of COVID-19 but for the forum to transform to a humanistic forum for sustainable development. The public health architecture needs revitalization to develop capacities to contain health and nonhealth threats before assume the proportion of an epidemic.^[12] India’s proposed One Health Mission will coordinate, support, and integrate all existing One Health activities in the country and fill gaps where it is appropriate.^[13] The Mission seeks to develop a “unified pandemic preparedness plan” for addressing priority “One Health diseases” (diseases of zoonotic nature, transboundary animal diseases as well as diseases of epidemic/pandemic potential) through cross-ministerial coordination as well as engage with nongovernmental stakeholders including academia, private sector, and international agencies for “better disease control and preparedness.” The ambit of One Health includes neglected tropical diseases, vector-borne diseases, chronic conditions such as mental health, food safety and food security, environmental contamination, and climate change.^[14]

Strengthening health systems to operationalize One Health entails addressing critical gaps: databases and information sharing; showcasing of best practice examples for One Health implementation; mapping of existing initiatives and capacities; and building the next generation One Health workforce; an integrated One Health surveillance system; and, mechanisms for routine and emergency coordination with relevant stakeholders.^[15]

The Indian Public Health Association considers these developments a unique opportunity for public health practitioners, researchers, and professionals to enhance knowledge and skills that translate into quality public health practice to promote and protect population health. These need to happen in synergy with all-round efforts by the union and state governments to invest in and sustain public health systems.