Although existing health system vulnerabilities were exacerbated by the COVID-19 pandemic, several of the obstacles to fair, healthy, and prosperous societies are a result of structural and persistent inequalities both within and between countries.
Because of the urgent need to provide COVID-19 health services, the treatment and prevention efforts for several non-communicable diseases – which kill more than 40 million people each year – have been negatively affected.
This ongoing inability to undertake routine health services alongside outbreak response surge capacity reflects the gaps in pandemic preparedness which have long been identified – and ignored.
Lockdowns and travel restrictions mean limited access to health services, affecting diagnosis and lifesaving treatments across the world and communicable disease programmes, especially in low- and middle-income countries, have experienced setbacks counteracting decades of gains. Figures show reduced access to screening and treatment paired with increased vulnerability to the disease due to COVID-19 may translate to more than 1.4 million additional deaths due to tuberculosis (TB) from 2020-25.
Building resilience in health systems
The recent World Health Organization (WHO) position paper on building health systems resilience provides a roadmap for reactivating years of underinvestment and divisive policies which have led to vulnerable primary healthcare systems and a failure to create universal health coverage (UHC) globally.
G20 leaders have an opportunity to re-examine domestic and international health financing approaches and repurpose them towards a health system which integrates access and security – and can absorb even pandemic-level shocks while continuing to provide lifesaving health and prevention services.
Since the pandemic began, more than 14 million women globally have lost access to sexual reproductive health services (SRHS). This has resulted in a 37 per cent increase in maternal deaths in low- and middle-income countries (LMICs), reduced access to condoms and contraception, and increases in vulnerability of girls and adolescents to sexual abuse and high-risk teenage pregnancy. Girls and women globally have also reported intensified gender-based violence, especially in refugee and migrant populations.
Just as some authoritarian leaders have leveraged the pandemic to abuse the right to a free press and to oppress government critics and opposition, several governments have manipulated the impact of the health emergency by first classifying abortion services as non-essential, and then severely diminishing access to SRHS, including abortion services, through restrictive laws.
But in a recent report on the right to physical and mental health, the United Nations (UN) special rapporteur on the right to health called on countries to restore essential SRHS and to reaffirm that the rights to that health are human.
G20 leaders should uphold this call and create a path forwards that prioritizes SRHS by ensuring high quality care with uninterrupted access during health emergencies. This must also be accompanied by a restoration of SRHS funds diverted to COVID-19 response efforts and a collective effort to combat funding cuts, such as those in the UK, which jeopardize SRHS programming in LMICs.
Vaccine equity in distribution and manufacturing
In what was predicted – and dreaded – vaccine inequities between rich and poor countries means that, even after nearly one year of having effective and safe vaccines, millions of people still have no access to them. The G20 countries are culpable in creating and continuing this inequitable access to COVID-19 vaccines and treatments due to undermining the COVAX facility, failing to share or redistribute excess vaccines, and refusing to support technology transfer and temporary waivers of intellectual property.
While there is a need for the G20 to act now to distribute vaccines – especially to Africa where there is a ‘one-dose’ coverage rate of only eight per cent – there is perhaps an even greater need for real commitment and action towards setting up mRNA vaccine transfer hubs and investing in vaccine manufacturing across developing countries.