Under India’s Presidency in 2023, the G20 has tabled two critical and interrelated issues: Health Emergencies Preparedness and Response and Strengthening Equitable Access to Medical Countermeasures (MCMs), including strengthening research and development and manufacturing networks globally. The Indian Presidency has created momentum to drive these issues forward by convening key stakeholders for meaningful discussions during the G20 Health Working Group meetings.
Building on the collaboration and lessons learnt from the COVID-19 pandemic, the time for action is now. COVID-19 was unprecedented in its global scale, the novelty of the virus and the wide socio-economic repercussions and ripple effects it created. Building on 75 years of experience in responding to emergencies in complex operating environments at rapid speed and scale, UNICEF shipped billions of products (including medical countermeasures such as vaccines, diagnostics, medicines and oxygen products as well as cold chain and safe injection equipment) to over 100 low and middle-income countries around the world, overcoming complex logistics and supply chain challenges, to support countries’ COVID-19 response. This was possible due to long-standing procurement, logistics, market shaping and in-country delivery and supply chain experience across essential supplies for both routine and emergency situations. As a result of this mammoth response, in 2022 alone the value of goods and services procured by UNICEF rose to the highest in its history: $7.383 billion, with new global crises and existing protracted emergencies accounting for much of this increase.
Taking the lessons from the global COVID-19 response, to tackle the next pandemic as well as to stamp out smaller outbreaks, the world needs a diversified product portfolio with different MCMs, expanded product development and production spread across the world, and stronger and more resilient health systems including primary health care. This year’s G20 and G7 discussions have placed an emphasis on these three areas (Research and Development, manufacturing and in-country delivery needs), in addition to a focus on equity. Further, the G20 and G7 discussions support the broader global discussions on the need for global collaboration across the MCM value chain.
Equity needs to be at the heart of access to medical countermeasures, and global collaboration needs to prioritize reaching the most underserved, the hardest to reach and the most vulnerable, including children and women. This must be factored in across the value chain, end to end, starting at the Research and Development process and all the way to last mile delivery.
The world needs to make more investments in research and development for key public health threats including those with limited market size, where demand is unpredictable and where low commercial incentives result in limited research and development and to create more risk-sharing incentives for industry to engage in product development for products with market failures. Public funding needs to incentivize product characteristics that are suitable for low-income and low-resource settings and that access terms are written into the financial investments to ensure fair access and supply for low- and middle-income countries. It is critical to ensure vulnerable populations including women and children are not an afterthought and that products for these populations are developed in parallel or as rapidly as possible.
Going forward there needs to be a geographically diverse manufacturing base for medical countermeasures, with investments made during the ‘peace time’ to ensure the capacity exists for emergencies and that we can scale up surge capacity as needed. This will help ensure resilience against global shocks and reduced lead times to access to supplies during an outbreak. As the world has seen from outbreak diseases, creating a healthy manufacturing base is a challenge for products with demand that ebbs and flows. Regional manufacturers will need to develop a diverse product portfolio to include both routine and outbreak disease products to ensure commercial viability and long-term sustainability.
For genuine end-to-end access, upstream and downstream activities ranging from research and development all the way to in-country delivery need to be prioritized together and inform one another to accelerate access. This will help ensure countries are prepared to roll out and scale up administration and use of products once ready. Strengthening health systems needs to be an integral part of preparedness, including strengthening primary health care systems at the community level – this will ensure systems are better prepared to deliver novel MCMs when they become available. Engaging with communities is essential to reduce hesitancy and increase trust and uptake in medical countermeasures. Given the cascading effect of any health emergency on interconnected sectors and systems, there needs to be a multi-sectoral approach including collaboration and coordination among actors from multiple sectors including health, education, nutrition, water, sanitation and hygiene.
To bring diverse global efforts together, a medical countermeasure ‘network of networks’ can convene key stakeholders to collaborate and coordinate in solving global gaps in access to health products with the aim to ensure equitable access in low and middle-income countries.
As a global community, we are in a position to reinvigorate efforts to ensure more equitable global access to medical countermeasures in future public health emergencies. While global pandemics galvanize all stakeholders, we must be equally vigilant and responsive to regional and country-specific outbreaks to ensure these are stamped out as rapidly as possible and with the right tools. This will help increase both regional and global health security.
UNICEF is committed with partners to harness the momentum. We have to address identified gaps and take urgent preparative action in order to strengthen preparedness and response to public health emergencies.
[Photo by Fernando Zhiminaicela]
Tara Prasad is a global health expert on access to medicines, leading UNICEF Supply Division’s work on partnerships for access to supplies for public health emergencies. The views and opinions expressed in this article are those of the author.