• Congratulate the Japanese Presidency of the Group of Twenty (G20) Nations for placing global health at the centre of the 2019 G20 Summit Agenda.
• Recognize and commend the unwavering track record of the Government of Japan in global health. Since the beginning of the first G7 Summit hosted by Japan in 1979 when the word ‘Health’ first appeared in the official statement by the Heads of State and Government, Japan has continued its leadership role by initiating The Global Fund To Fight AIDS, Tuberculosis and Malaria and the G8 Digital Opportunity Task (DOT) Force at the Kyushu-Okinawa Summit in 2000, towards the Call for Action on Health Systems Strengthening at the G8 Hokkaido Toyako Summit in 2008.
• Support the increased alignment and strengthening of partnerships under Sustainable Development Goal 17 (SDG 17) to jointly achieve SDG 3 to “Ensure healthy lives and promote well-being for all at all ages” by 2030.
• Welcome the greater notion of the role of public private partnerships, especially product development partnerships, engaging the private sector and non-government organizations (NGOs) as essential participants in providing enhanced governance of the policies and programme in G20 nations and beyond as well as driving health innovation.
• Strongly support the three priority focus areas that the Japanese 2019 G20 Presidency has adopted on health 1) on achieving Universal Health Coverage (UHC), 2) the Response to Aging Society, 3) Management of Health Emergencies including antimicrobial resistance (AMR).
• Congratulate Finance and Health Ministers of the G20 for holding their first joint ministerial meeting in Osaka on 28th June 2019.
• Welcome the G20 Finance Ministers and Central Bank Governors communiqué that calls for a stronger collaboration between Finance and Health authorities, with the appropriate contribution of the private sector and NGOs that are crucial for strengthening health financing.
• Welcome existing international initiatives in the space of innovative financing including the international solidarity levy on air tickets, CARB-X, the re-financing mechanism based on loan guarantees implemented by the International Finance Facility for Immunisation (IFFIm) and innovative funding models such as the Global Health Innovation Technology (GHIT) Fund.
• Support the work of the Leading Group on Innovative Finance, that is currently chaired by Japan and administered by the French Foreign Ministry which brings together 66 member states and numerous international and non-governmental organizations focussing on the promotion of innovative financing.
• Welcome the World Health Organization (WHO) led inter-agency Global Action Plan (GAP) with particular reference to: Accelerator 1 on Sustainable Financing, identifying ways to sustainably improve the generation, allocation, and use of funds for health; Accelerator 5 on Research and Development (R&D), Innovation and Access, through sustainable investment in new ideas; Accelerator 6 on Data and Digital Health, and Accelerator 7 on Innovative Programming in Fragile and Vulnerable States and for Disease Outbreak Responses.
• Welcome the World Bank Groups report, “High-Performance Health Financing for Universal Health Coverage: Driving Sustainable, Inclusive Growth in the 21st Century”, and look forward to the positive outcome of the first UN General Assembly (UNGA) High-level Meeting (HLM) on Universal Health Coverage on 23 September 2019, Climate Action Summit, 23 September 2019, UNGA High-level Political Forum on Sustainable Development (HLPF), 24-25 September 2019, and High-level Dialogue on Financing for Development (FfD) on 25 September 2019, all to be convened at the level of Heads of State and Government.
• Welcome the new pull-incentives created by the UK government initiative launched in a 5-year action plan for tackling AMR by using innovative approaches based on value rather than volume.
• Commend the Japanese Presidencies new perspective of using innovation and technology as
well as promoting “healthy and active aging.”
• Welcome the Report of the UN Secretary-General’s High-level Panel on Digital Cooperation “The Age of Interdependence”, urging inclusion of the digital and high technology sector in global and countrylevel public private partnerships to address market failures inhibiting the digital acceleration and amplification of the global goals including SDG 3 and SDG 17.
• Welcome the Caribbean and Pacific Small Island Developing States (SIDS) Digital Health and UHC 2030 Initiative at the 74th UNGA High-level Meeting on Universal Health Coverage.
THE G20 HEALTH AND DEVELOPMENT PARTNERSHIP CALL TO ACTION:
The G20 Health and Development Partnership
RECOMMENDATION 1 – Investing in health innovation and delivering SDG3 and UHC 2030 via a stronger collaboration of G20 Health and Finance Ministers within the G20 framework
It is essential that the wealth and health of nations are united in delivering inclusive economic growth and social equity amongst G20 countries.
• Urge Health and Finance Ministers in their Joint Meeting in Osaka to become the first of a regular and meaningful joint dialogue within the annual G20 calendar with the next joint meeting held in the Kingdom of Saudi Arabia in 2020.
RECOMMENDATION 2 – Scaling up sustainable innovative financing to meet the funding deficit in funding innovation in health
Many public and private organisations, including multilateral organisations participating in the G20, including the OECD, that act as the strategic advisor to the G20, as well as the WHO and the World Bank, are conducting work related to innovative forms of financing for health. However, this work lacks high-level political support and most importantly coordination.
• Call, therefore, for the launch of a time-limited, high-level examination of innovative and blended finance initiatives that are scalable, to supplement current investments in health innovation, with the involvement of international organisations, philanthropic partners and non-traditional actors to report during the 2020 G20 Presidency of the Kingdom of Saudi Arabia and the 2020 G7 Presidency of the United States.
Welcome the vision of the WHO Director General, Dr Tedros, in the appointment of a Chief Scientist. However, given the interrelationship between economics and health,
• Call on the WHO to appoint a Chief Economist to work with Finance and Health authorities of the G20 and the G7 and others to identify sustainable health financing models.
Decentralization of care for disease specific programmes can strengthen peri-urban and rural communities’ access stronger health systems. An example is the Malaria Elimination in Melanesia and Timor Leste Initiative (MEMTI) that uses Global Fund’s financing of USD 25 Million to catalyse and leverage investment into primary health care (PHC) and thus UHC through the Asian Development Bank (ADB).
• Urge nations to leverage disease specific therapeutic delivery programs (AIDS, TB, Malaria) to develop new blended financing instruments to expand UHC and primary health care (PHC).
• Encourage and urge deployment / utilization of rigorous monitoring and evaluation (M&E) as a prerequisite for evidence- and results-based financing. Governments should request and co-finance such M&E.
• Urge Development banks to operate as independent brokers between the private and public sector and share more data towards finance ministries and authorities particularly in showcasing successful interventions that are scalable.
• Urge emerging economies and Middle-Income Countries (MICs) to play a more significant role in co-funding health innovation.
RECOMMENDATION 3 – Deeper and more Coordinated Efforts in the Fight Against AMR and Pandemics and Chronic Non-Communicable Diseases (NCD)
• Urge the successful $14 billion three-year replenishment of The Global Fund to Fight AIDS, TB and Malaria in 2019 under the G7 Presidency of the Government of France.
Express concern even with this replenishment of the overall shortfall in funding for achieving UHC 2030 and SDG 3, as well as by further outbreaks of Ebola and the growing development of antimicrobial resistance, recognizing that there are fundamental market failures in dealing with drug resistant diseases and epidemics and in supporting the Global Action Plan on AMR, The UN Interagency Group on AMR,
• Call upon the G20 Heads of State and Government to urge more G20 and non-G20 countries to join and support the Global AMR R&D Hub that was successfully created under the G20 Presidency of Germany in Hamburg 2017 by ensuring continued support for new diagnostics, vaccines and medicines to tackle the drug resistant disease burden.
The AMR global infrastructure needs to be funded by G20 countries and managed as shareholders pro rata to their GDP. A starting fund of $10 billion would be initially sufficient to create a vibrant and sustainable AMR market and can support both much needed push and pull initiatives.
• Recognize the need for joint development of new therapeutics and rapid diagnostics to ensure correct diagnosis and treatment and thus improve health outcomes and stewardship of antibiotics.
• Urge the expansion of grant funding support for product development for AMR related products including drug-resistant TB.
• Urge that new antibiotic reimbursement models should be implemented based on value and not volume.
• Urge the development of market entry rewards like advance market commitments, new subscription models for sales of antibiotics and/or transferable exclusivity vouchers.
• Urge for more efficient approval pathways for new antibiotics as well as global trials data harmonisation to save millions of dollars in time and cost.
• Call upon G20 Heads of Government to examine the development of regional pre-pandemic stockpile programs that could be developed, and that Japan, having appropriate facilities for this type of products, could provide regional support to Asian countries.
RECOMMENDATION 4 – Innovation in Digital Health
Expressing our strong support for the inclusion of the promotion of global digital health in the G20 by building “data free-flow with trust” at the leader’s Osaka June communiqué and Health Ministers Declaration in Okayama in October 2019 and the prioritisation of digital health in the G20 Presidency of the Kingdom of Saudi Arabia in 2020.
• Urge the G20 Heads of State and Government to build on the joint Finance and Health Ministers Meeting in Osaka by recognising the intersectoral nature of the emerging global digital health ecosystem where a “one government” and multi-stakeholder approach including Ministries of ICT and others will be essential in delivering National Digital Health Strategies.
• Urge support for the official launch of the African Digital Health and UHC 2030 Initiative at the seventh Tokyo International Conference on African Development TICAD 7.
• Call on the G20 Heads of State and Government to recognise the ethical challenges and opportunities of AI & frontier digital technologies in combatting health challenges in burden of disease including cancer care, ageing populations, chronic non-communicable diseases (NCDs), the diseases of climate change, and the advent of connected, people-centric precision medicine.
• Urge the G20 Heads of State and Government to consider a GHIT Fund type-model for the creation of a Global Digital Health Innovation Fund, and to commit to the collaboratively developed “Principles of Digital Development and Principles of Donor Alignment in Digital Health” to reduce fragmentation and duplication of digital health investments.