David Heymann
Head and Senior Fellow, Centre on Global Health Security
A Pakistani child, who was displaced with his family by fighting during Pakistan's army operations against the Taliban in the country's tribal belt, receives polio vaccination drops in Rawalpindi on April 8, 2014. Photo by Farooq Naeem/AFP/Getty Images.A Pakistani child, who was displaced with his family by fighting during Pakistan's army operations against the Taliban in the country's tribal belt, receives polio vaccination drops in Rawalpindi on April 8, 2014. Photo by Farooq Naeem/AFP/Getty Images.

With Osman Dar, Consultant Research Fellow, Centre on Global Health Security

A multitude of public-health events in 2013 have demonstrated the continuing need to develop a shared global approach to address the world’s health, well-being and security challenges. Integral to success is the need to recognize their multidisciplinary, transboundary nature, and to strengthen and improve the international institutions and mechanisms developed to address them. 

For example, in the last 12 months GAVI and the Global Fund, multilateral organizations tasked with improving access to medicines and vaccines, have taken strategic decisions to prioritize strengthening health systems, improve financial management, and develop more flexible and efficient funding models. In the field, the global drive to eradicate polio remains precariously poised on the cusp of success. It still faces significant hurdles and, in certain cases, fierce resistance to vaccination in Northern Nigeria, Pakistan and Afghanistan.

Global initiatives, such as the benefit-sharing agreement for pandemic influenza (Pandemic Influenza Preparedness Framework), progressed with new collaborations improving cooperation between countries and institutions. Experience gained and lessons learned from such initiatives will be important in improving the collective global response to recent emerging threats such as MERS coronavirus and H7N9 avian influenza – the implications and risks of which are yet to be fully elucidated.

With 2014 having started in earnest and a myriad of high-priority issues and events across the global health landscape, we asked three of our experts to comment on what they consider to be the challenges and opportunities over the next 12 months. 


Stepping Up Commitment to Addressing Antimicrobial Resistance 

Simon Rushton, Associate Fellow, Centre on Global Health Security  

Although it has been discussed within health policy communities for some time, the issue of bacteria, viruses and other microbes becoming resistant to the drugs used to fight them really broke through into the mainstream of government and public consciousness in 2013. In March, the UK chief medical officer's annual report highlighted the increasing risk posed by antimicrobial resistance, called for it to be put on the government's National Risk Register, and argued that international cooperation through bodies such as the World Health Organization and the G8 would be required to effectively address the problem. The UK's Antimicrobial Resistance Strategy – published in September – similarly reflected on the need for coordinated international action.

One of the key tasks facing governments in 2014 is to make progress on this issue at the global level. The challenges are enormous and wide-ranging, from improving the knowledge of medical professionals and their patients (as well as addressing some of the pharmaceutical industry’s marketing practices) to incentivizing pharmaceutical research and development, and ensuring that regulatory processes allow safe and effective new drugs to reach the market quickly.

G8 health ministers have already held discussions on the issue and the WHO has established a Strategic and Technical Advisory Group to work towards the development of a global strategy. In the coming year, progress on such a global strategy needs to be made, alongside governments giving a clearer indication that they are prepared to commit the resources required to tackle this increasing threat to global health security.


The Polio Campaign and Political Violence

Heidi Larson, Associate Fellow, Centre on Global Health Security

If there is one loud and clear message concerning global health security from 2013, it is about the power of human behaviours and beliefs to trump scientific advancement. War, violence, religious and philosophical beliefs, and perceptions of risk, all presented significant challenges in 2013.

Take, for a start, polio. If you look at the map of most cases today, they are not occurring in zones of peace. Unfortunately there is no vaccine to prevent war, and violence plagued the polio eradication initiative throughout 2013. This started with the targeted killings of polio workers in Pakistan in January, followed by more murders in Nigeria in February and periodic violence throughout the year in both countries, including the killing of police trying to protect the polio vaccinators. Although immunization initiatives have been affected by surrounding conflict and violence in the past, this was a first in terms of vaccinators being specifically targeted because they worked for a global health initiative that some perceived as incongruous with their values and belief systems. The targeting of polio vaccinators continues in 2014, with the killing this week of polio workers in Pakistan, which started one day after the launch of a nationwide vaccination drive.

What does this mean for global health? It means that we not only need scientifically sound health interventions, but culturally sensitive and politically astute strategies to deliver them.


Responsibility for Global Health Financing 

John-Arne Røttingen, Associate Fellow, Centre on Global Health Security

As 2013 was nearing its end, the Commission on Investing in Health launched its report, titled Global Health 2035: a World Converging within a Generation. With clear thinking and solid analyses, it strengthened arguments for why investments in health are good for instrumental economic reasons and for intrinsic reasons. The report demonstrated how preventable infectious, maternal and child deaths can be brought down to universally low levels within a generation. Such a 'health convergence' can be achieved through another convergence seen in 2013: the emerging consensus on universal health coverage (UHC) as the best way to finance health systems. This demonstrates how the 20 years since the World Development Report 1993 have witnessed changes in general macroeconomic thinking on public finance. The report argues that 'No country can achieve UHC on the basis of voluntary purchase of private health insurance […] Achievement of UHC requires compulsory enrolment or automatic entitlement' – a clear call for collective solutions or 'progressive universalism'. When the 'why' (investment case) and the 'how' (UHC) are answered, the global health community needs in 2014 to clearly address the 'who'.

The call for increased financing will need a post-Millennium Development Goals agenda in 2014 with clear commitments from national governments to finance domestic needs, global public goods and, for those countries with capacity, the needs of poorer countries with insufficient resources.


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