Global Health at UNGA 2023

Global health concerns had the greatest prominence possibly ever at the United Nations General Assembly’s high-level week this year (UNGA).? The ‘high-level’ week is when presidents, prime ministers, and heads of state - in gridlocking fleets of black suburbans - descend on New York City to discuss the critical concerns facing the entire world. Global health was highlighted by three separate High Level Meetings, aka HLMs – a first – with one day each dedicated to pandemic preparedness prevention and response, universal health coverage, and tuberculosis.? Sadly, only one of the five permanent Security Council countries was represented by the head of state, the U.S. by President Biden.? However, the U.S. was present in full force with many U.S. government leaders and diplomats active across numerous venues and events, filling any vacuum that may have been left by the absence of other leaders.?

Project HOPE was present at all three HLMs.? Each event was centered around a political declaration which represented the culmination of months, if not years, of negotiations and offered steps to tackle ongoing health challenges.? As with any UN action, each document includes points of exultation and exasperation for those concerned.

However, all three declarations were marred by the last-minute objection of 11 rogue nations over the redaction of phrases that criticized unilateral sanctions, such as asset freezes or travel bans, as a diplomatic tool – a topic that was only tangentially relevant at best to global health. Of course, the 11 countries are subject to various sanctions for human rights abuses, UN treaty breaches, nuclear proliferation, etc.? They did not block the adoption of the declarations which otherwise garnered global consensus, but they stated they may act against the documents when they are formally ratified in the full General Assembly in the coming months.

The HLM on Pandemic, Prevention, Preparedness and Response (PPPR) was deemed ‘historic,’ by WHO Director General Tedros.? And, as the first truly global action by heads of state in response to the tragedy of the COVID-19 Pandemic, he was correct. He went on to state that, “Resilient health systems, based on strong primary health care are the only defense against pandemics.”? The focus on primary health care is a critical point that often gets lost in discussions on pandemic preparedness that tend to focus on surveillance, diagnostic technology, or vaccine equity. Overall, the political declaration was the weakest of the three with no hard commitments or measurable outcomes. This, however, can be blamed in large part on the fact that two more, potentially more substantive, global agreements are currently being negotiated, and, hence, the very purpose was unclear. Discussions at the event also had a constant refrain of “predictable funding,” to avoid the cycle of panic and neglect that has followed the other four pandemics over the last 15 years.? The largest deficit, however, in the document and process may be the absence of significant discussion of an ‘emergency funding’ mechanism that would release funds to support countries immediately upon detection of the next pandemic. This would seem to be the easiest and most effective pandemic response action the world could take at this time.

The HLM on Universal Health Coverage (UHC) while not historic – it was the second such meeting on UHC – had its accomplishments.? Perhaps key amongst these was the strongest language among all three on the critical importance of health workers to success in advancing global health. ?It may seem obvious, but the recognition of and targeted investment in health workers has been limited or completely absent for decades. Dr. Tedros was almost alone in noting that achieving UHC is first and foremost a political decision by the countries themselves.? And the lack of focus, in the document and the overall movement, on domestic resource mobilization for UHC, is probably the greatest gap.? While financing and taxes are not the bailiwick of public health practitioners, success with UHC is linked to advancing domestic funding as well as global support.?

The Tuberculosis (TB) advocacy crowd was present in full force for their HLM.? And they owned it.? Chanting, placards, and red scarves in support of the fight against TB brought great life to the staid UN event.? More importantly, civil society engagement in the process from the beginning also resulted in the strongest of the three documents. The UN should take note of this and expand ways for civil society to substantively engage in their processes as a means to gain more practical impact in the typically watered-down statements. The event was made stronger by the fact that this was the third HLM on TB as these events are typically on a four-year cycle. The biggest shortfall within the TB effort, was the weak statements in support of health workers. This is all the more surprising given the global push to bring TB diagnosis and treatment from the clinic to the community level.? Such improvements will only be possible by the strong engagement of a well-trained, renumerated, professional health workforce at the community level.

A few key themes ran through all three events.? Financing for health was regularly raised by member states.? This was in the context of the crippling debt many low-income countries have accumulated.? There seems to be interest, if limited action to date, on debt swaps or other mechanisms to link debt relief to addressing health funding gaps, similar to those used to protect forests for example. Continuing support for sexual reproductive health and rights also seemed to take a back seat, particularly in the UHC document.? This is a disheartening trend we have seen elsewhere.

Whatever may have been missing in any of the three high level meetings was undoubtedly covered in the myriad of side events that are wrapped around every UNGA high level week.? This year the events were back to full speed for the first time since the pandemic.? For many, it was still the first time to convene the world’s leading civil society advocates, technical experts, government officials, foundation trailblazers, corporation managers, journalists, and other prominent people from across the global health sphere to discuss ways to advance our critical agenda.? Having attended UNGA events for almost two decades, this aspect of the event is as invaluable as it is intangible and it is exciting to see it back in its full gridlock glory.

The author is the Director of Policy and Advocacy at Project HOPE . He previously served as Director of Health and Humanitarian Assistance at the National Security Council and as a foreign service officer with USAID.

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