GLOBAL HEALTH SUMMIT G20 Italian Presidency and EU Commision ROME 21 May 2021

The Global Health Summit planned in Rome for 21 May (under the Italian Presidency of the G20 and in collaboration with the European Commission) must not end in a show of powerful people; rapid and effective solutions are needed to counter the pandemic which on a global level is worsening day by day. Fortunately, Marina Sereni, Luigi di Maio, Roberto Speranza and Mario Draghi (naturally in concert with their foreign colleagues and with the support of the international medical-scientific community) have more than a month to propose concrete solutions avoiding the Summit of Rome on Global Health ends up in a media event, but without practical effects.

 Today Mario Draghi declared: “The Global Health Summit is a special event of the Italian G20 Presidency held in cooperation with the European Commission. It will provide a timely opportunity to share the lessons learned during the COVID-19 pandemic. We will discuss how to improve health security, strengthen our health systems and enhance our ability to deal with future crises in a spirit of solidarity." Ursula von der Leyen - President of the European Commission added: “The world needs to be better prepared to protect humanity against future pandemics. We have to learn our lessons, and all countries need to better work together for improving global health security. To support these efforts the European Union will co-host a #GlobalHealthSummit with the #Italian #G20 Presidency. “

 https://www.governo.it/it/approfondimento/global-health-summit-21-may-2021/16562

But how to give substance to these high-sounding declarations which for now appear to be only good intentions? The first objective of the forthcoming Rome summit should be to negotiate an agreement - based on solid technical foundations - that will put an end to the prevailing babel in the field of vaccines.The most technically equipped regulatory bodies (such as the EMA of the European Union and the CDC of the United States) are pursuing valid selection criteria; and due to their severity they appear to some of the scientific community almost too rigid in terms of safety and efficacy of vaccines.

We know that we have to face the "squaring of the circle". It is, in fact, very difficult to check the operation of all the gears of a high-speed train in full swing. Beyond metaphor, it is a difficult task to monitor the side effects of hundreds and hundreds of millions of vaccines administered to people in absolute emergency after having dramatically shortened the usual times required for clinical trials.

The utmost rigor and the precautionary principle are the pillars of a serious public health policy. However, the messages should be formulated with care and much more prudence by both the technical authorities and the political leaders. Unfortunately, this is often not the case. In these days the media communication of some virologists and some political decision makers is taking on pathological and paradoxical characteristics.

 Continuing at this rate, the fear of getting vaccinated risks overwhelming the fear of being infected by viruses: let's hope not because the results would be catastrophic.

 On both sides of the Atlantic Ocean, the transparency and caution of the regulatory authorities appear some times to be almost excessive and such as to artificially increase the fear of vaccines. Conversely, public communication on vaccines (and vaccination campaigns) in Russia, China and other Asian countries is much more opaque. On the one hand, there is no full transparency of experimental processes and authorization procedures, on the other hand there is no detailed public information for the control of national and international vaccine production and distribution processes.

 The upcoming G20 summit on May 21 should bridge this great gap between the EMA, CDC and the rest of the world. It is necessary to work (as Dr. Anthony Fauci mentioned in a recent meeting with Indian colleagues) for a convergence of the international medical-scientific community to reach a universal approach to anti Covid vaccines (also to be able to prevent the entire range of variants ).

 To achieve this goal in view of the May 21 summit, Italian diplomacy (as president of the G20) could suggest the opportunity and promote a first informal meeting (track2 model) between the highest technical-scientific authorities of the European Union, of the United States, Russia, China and other member countries, both of the G20, and invited to attend the Global Health Summit.

 As President of the G20, Italy has the honor and the burden of preparing a declaration and hopefully a draft agreement to be submitted to all leaders. From May 21st, the hope is that the Global Health Summit will define a unitary and coherent strategy to combat the pandemic on the two main elements: a) to unify the criteria for evaluating the efficacy and safety of vaccines; b) finance vaccination campaigns in the poorest countries in the world. The liberalization of patents, which is talked about so much, is already underway in LDC's (Least Development Countries), but without adequate resources it is of little use because no one is able to produce or distribute vaccines

 At the time of bipolarism and the US / USSR opposition it was possible to establish an international regime for the reduction of nuclear weapons (including inspection activities). After the great crisis of 2007/2008 and the bankruptcy of Letham Brothers, the G20 in London in 2009 entrusted (with undeniable successes) to the Financial Stability Board chaired by Mario Draghi himself the task of placing under special supervision the largest banks and financial institutions which were defined systemic relevance at a global level.

 While it is difficult to find a common language on divisive issues such as Cyber (where civil liberties and democracy clash against the mass surveillance that characterizes digital totalitarianism), healthcare is an area in which multilateral negotiations can have margins of success. The good results obtained multilaterally in particularly sensitive areas such as nuclear weapons or global finance are encouraging precedents: why well-planned negotiations why shouldn't they work for vaccines, standards for national health systems and Global Health?

 The second objective that the Italian Presidency should put at the center of the Global Health Summit on 21 May is a radical reform of the functioning of the World Health Organization. The most striking negative data of the WHO concerns the experience of the pandemic. The first officially recognized case of Covid 19 was detected in Wuhan on November 17, 2019. The WHO declared the pandemic crisis on March 11, 2020. 5 months is far too long, an unacceptable time interval that has allowed dozens (or perhaps hundreds) - of millions of citizens (Chinese and non-Chinese) to travel around the world putting their health and their lives and that of others at risk.

 The leaders of the World Health Organization justified themselves by explaining that in the first months they had received reassuring and incorrect information from China. This is an undeniable fact; at the time it was enough to consult the WHO website and read the documents received from the health authorities of Wuhan and from the province of the Hubei Union.

However, the crucial point is precisely this. The reorganization of the WHO should provide for greater freedom of action for its operators, a bit like for the International Red Cross; bureaucratic constraints and respect for sovereignty are incompatible with an efficient and fast response to health emergencies.

 With the Biden administration, the United States - which is already the largest contributor - should commit to a profound reform of the WHO in the name of active multilateralism. When health is at stake, quick, effective, fair and safe answers are needed: either we are all saved or no one is saved!

The problem is that it is often not easy to distinguish success indicators from propaganda data. In this regard, I limit myself to pointing out to the readers of Formiche( https://formiche.net/2021/04/summit-della-salute-istruzioni-per-luso-scrive-mayer ) the particularity of the Hungarian case which, due to its contradictory data, deserves a specific study in its own right.

 Hungary, in fact, is at the same time the country of the European Union that has carried out the greatest number of vaccinations, but at the same time it is also the Member State of the EU with the highest percentage of deaths compared to the population.

Some observers have hypothesized that this apparent dyscrasia is attributable to the alleged lower efficacy of Chinese vaccines (not approved by the EMA) which Budapest has beeing uses extensively in its vaccination campaigns. But perhaps it is only a suspicion, perhaps one of the many mischievous interpretations; certainly a supplementar and indipendent investigation is needed to reach more accurate conclusions.

Finally, the third and final aspect on which the summit of 21 May should at least start a new path of reflection is the great question of health services in the African continent and in particular in the countries of sub-Saharan Africa. The long-term success in tackling Ebola in some African countries is due to the fact that emergency treatment and prevention campaigns have paved the way for building effective and resilient national health systems in sub-Saharan countties . The future of strategic relations between Europe and Africa is at stake on the construction of efficient national health services , to which Italian foreign policy and cooperation will be able to offer a decisive contribution.

Prof. Marco Mayer

LUISS University Rome