By Beryne Odeny (Washington University in St. Louis, Department of Surgery) and Julia Robinson (PLOS Global Public Health) The first in-person CUGH…
By guest contributors Luis Gil Abinader, Adi Radhakrishnan, Alice Kayongo, Sharonann Lynch, Matthew M. Kavanagh
The United Nations (UN) General Assembly will convene three High-Level Meetings on health during its 78th session in New York in September 2023. These meetings present “a historic opportunity” to respectively recommit to ending tuberculosis, delivering universal health coverage, and strengthening pandemic prevention, preparedness, and response. Negotiations are now underway to adopt respective political declarations on these three topics, which are expected to build upon previously adopted commitments and include new pledges to accelerate progress.
Previous political declarations and other international documents provide a firm ground for the adoption of bold commitments on several health issues. Building on previous declarations and other precedents, all three UN political declarations should make bold commitments to protect vulnerable populations, embed equitable access terms on publicly funded research, collaborate on delinkage incentives models, and recognize the importance of community-led initiatives in health. We discuss those four issues in this blog. As we discuss in further detail elsewhere, UN Member States should also adopt bold commitments to strengthen regional manufacturing and research and development capabilities, address digital health gaps, and avoid norms beyond those established in the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS).
Protect all vulnerable populations
Transgender people, men who have sex with men, sex workers, people who use drugs, and people in prisons face discrimination in the health realm often due to existing laws, policies, or practices. Because of this, UN member states have routinely reaffirmed the fundamental rights of these groups in the 2021 political declaration on HIV, in the 2021 political declaration on equitable global access to COVID-19 vaccines, the 2018 political declaration on the fight against tuberculosis, and in a number of additional documents. Reports from the UN independent expert on protection against violence and discrimination based on sexual orientation and gender identity, the UN High Commissioner for Human Rights, and the UN Special Rapporteur on the right to health all recognize the importance of focusing explicitly on the rights of vulnerable populations as well, including the right to the highest attainable standard of health.
In line with previous language use, and practice in concluding such declarations, all three forthcoming political declarations on health should acknowledge the vulnerable populations that are often subject to discrimination. Specifically, they ought to acknowledge the need to protect transgender people, men who have sex with men, sex workers, people who use drugs, and people in prisons, in addition to other populations.
Embed strong equitable access terms on publicly funded research
Public and philanthropic contributions represent a significant portion of pharmaceutical research and development funding. According to several accounts, the United States invested tens of billions of dollars to develop, produce, and purchase mRNA vaccines. Moreover, seventy percent of tuberculosis research and development funding in 2021 came from public entities, with the United States National Institutes of Health (NIH) providing the largest single allocation at 354 million dollars. Public and philanthropic funding is considerable in other areas, like gene therapies. Public and philanthropic funders, however, often fail to contractually require their grantees to openly share knowledge and distribute their products equitably across the globe.
States are beginning to acknowledge these failures. Although weak, a commitment to facilitate equitable access to technologies supported by public institutions was reflected in a resolution adopted by the UNGA in March 2022. Building off that, stronger commitments to embed equitable access safeguards in research and development efforts funded by public or philanthropic institutions should be adopted in all three upcoming political declarations.
Pharmaceutical innovation can be incentivized throughout models that delink research and development costs from prices. Given the potential to promote access to health technologies the importance and need for international collaboration on delinkage features in the 2021 political declaration on HIV, the 2018 political declaration on the fight against tuberculosis, and the 2016 political declaration on antimicrobial resistance. Calls for international collaboration to explore and implement delinkage models also featured in the resolutions adopted by the World Health Organization (WHO) Executive Board, and documents published by the UN Human Rights Council in 2022, 2021, 2019, 2016, and 2013.
Proposals to recognize the importance of delinkage appear in the draft of all three political declarations. None of the three draft declarations, however, currently make bold and actionable commitments to progressively implement delinkage incentive models. While finalized language recognizing the importance of delinkage would be welcomed, States should go further and adopt bold commitments to collaborate on the implementation of these types of incentive models.
Recognize the importance and support community-led initiatives
Community leadership has a measurable impact on the health of populations. This is especially true for key and vulnerable populations, where it has been linked to better HIV prevention and the increase in family planning. Recognizing their importance, UN Member States have called for placing communities at the center of service delivery and monitoring mechanisms in multiple international sources.. For instance, UN Member States have committed “to partner with local leaders and civil society, including community-based organizations, to develop and scale up community-led HIV services and to address stigma and discrimination.”Reports from several UN bodies have also called for ensuring the participation of communities “in the design, delivery and monitoring of all strategies, programmes and interventions that affect them.”
Despite their known positive impacts and recognition in previous internationally agreed documents and reports, language acknowledging the importance of community leadership remains absent or is being disputed by some stakeholders participating in the negotiations of all three draft political declarations. Opposing recognition and commitments to support community leadership is unfounded, given their known positive impact. Efforts to suppress these terms from the political declarations are also inconsistent with international standards and past practice in similar international declarations.
Precedents of strong political commitments on issues relating to ending tuberculosis, delivering universal health coverage, and strengthening pandemic preparedness and response already exist. UN Member States should build on that firm ground this year and commit to protect all vulnerable populations, embed equitable access on publicly funded research, collaborate on delinkage models, and place communities at the center of health service delivery and monitoring.
About the authors:
Luis Gil Abinader is a fellow with the Global Health Policy and Politics Initiative. Gil Abinader is interested in intellectual property, access to medicines, and the global governance of knowledge goods. His current research focuses on patent licensing, technology transfer, strengthening manufacturing capacity in low- and middle-income countries, and alternative models for incentivizing research and development.
Adi Radhakrishan is a fellow at the O’Neill Institute. He is interested in global health and human rights law, with a focus on availability and accessibility of health care. Prior to joining the O’Neill Institute, Radhakrishnan worked as the Leonard H. Sandler Fellow in the Children’s Rights Division of Human Rights Watch, where he conducted research and advocacy on sexual and reproductive health and rights and the human rights consequences of the COVID-19 pandemic.
Alice Kayongo is a senior associate with the Global Health Policy and Politics Initiative at the O’Neill Institute. Kayongo is a public health practitioner and human rights advocate with 17 years’ development experience working largely with civil society, where she has held several positions. She leads efforts to amplify the voice of communities in decision-making processes that affect their health and lives. Her work triggers ownership and increases communities’ meaningful participation in the health and development sector.
Sharonann Lynch is an associate director with the Global Health Policy and Politics (GHPP) Initiative at the O’Neill Institute for National and Global Health Law. Lynch joined GHPP in August 2021 and served as acting director for 18 months. Lynch has worked for more than 20 years in the global health, access to medicines, and humanitarian fields. More recently, Lynch has focused on access to COVID-19 vaccines and diagnostics.
Matthew M. Kavanagh, PhD, directs Georgetown University’s Global Health Policy & Politics Initiative at the O’Neill Institute for National and Global Health Law and is Assistant Professor of Global Health and Visiting Professor of Law. A political scientist by training, with a long history of work in global health policy and politics, he recently served at the United Nations as Deputy Executive Director ad interim and Special Advisor at UNAIDS. His research and writing focuses on the political economy of health policy in low- and middle-income countries and the political impact of human and constitutional rights on population health.