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1. Global health at a crossroads: policy recommendations in light of the Lancet Global Health 2050 Report

Author:
Christoph Strupat, Marco Schäferhoff, Martin Siegel, and Anna-Katharina Hornidge
Publication Date:
01-2025
Content Type:
Working Paper
Institution:
German Institute of Development and Sustainability (IDOS)
Abstract:
At a time of global crisis and competing priorities, investing in health is among the most impactful and cost-effective decisions governments and stakeholders can make. Beyond being a fundamental right, health is a catalyst for growth, stability and resilience – particularly in uncertain times. The new Global Health 2050: the path to halving premature death by mid-century (Global Health 2050) report (Jamison et al., 2024) of the Lancet Commission on Investing in Health (the Commission) builds on a legacy of evidence-driven reports to provide strategies for making health a cross-cutting enabler of the Sustainable Development Goals (SDGs). Global Health 2050 provides a roadmap for further health improvements in all countries by mid-century, arguing that by 2050 countries can reduce by 50% the probability of premature death (PPD) in their populations. The Commission calls this goal “50 by 50”. Germany has solidified its role in global health through significant investments in the health sector and by designating global health as a political priority, as demonstrated by its Global Health Strategy and the inclusion of global health as one of the core themes of the Federal Ministry for Economic Cooperation and Development (BMZ). Given this political priority, it is essential to assess the implications of the Global Health 2050 report for Germany’s global health agenda, especially as global health stands at a crossroads following the withdrawal of the United States (US) from the World Health Organization (WHO) and cuts to its global health programmes. Therefore, the aim of this policy brief is to build upon the Commission’s findings and draw from scientific evidence to provide key recommendations for Germany’s global health agenda. Five recommendations have been synthesised that align with Germany’s global health engagement and offer promising strategies to help achieve the 50 by 50 goal: 1. Sustain or ideally increase funding for the Gavi, The Vaccine Alliance, and the Global Fund to Fight AIDS, Tuberculosis and Malaria at the upcoming replenishment conferences and strengthen Germany’s global health leadership through strong bilateral support, investments in pandemic preparedness and response (PPR) and better interministerial coordination. 2. Reconsider non-communicable diseases (NCDs) in future strategic direction of German international cooperation by reducing financial and geo-graphical barriers to access to medicines and addressing key NCD risk factors. 3. Promote health taxes on tobacco, alcohol, and sugar-sweetened beverages that can serve as an effective strategy to improve public health and generate domestic revenue. 4. Increase funding for R&D in neglected diseases. Expand regional manufacturing, and enhance global health innovation coordination to strength-en global health security and reduce dependence on external supply chains. 5. Nepal serves as a good example of Germany’s bilateral health and social protection support: advancing the 50 by 50 goal could be achieved by strengthening national health insurance, addressing climate risks, expanding health taxes and enhancing pharmaceutical access through the Arrow mechanism.
Topic:
Development, Investment, Public Health, Global Health, and Disease
Political Geography:
Global Focus

2. Challenges of Global Health Governance Amid the Growing Use of Force in the World

Author:
Alina Chesnokova
Publication Date:
01-2024
Content Type:
Journal Article
Journal:
International Affairs: A Russian Journal of World Politics, Diplomacy and International Relations
Institution:
East View Information Services
Abstract:
Natural disasters and armed conflicts have accompanied human existence throughout history, always leading to spikes in mortality and morbidity. However, in recent years, the scale and scope of these events have noticeably increased. Since the 1990s, such events annually affect around 217 million people, forcing them to live under conditions of extreme instability and humanitarian crises.1 Despite this, in recent decades, global health management measures amid humanitarian crises caused by armed conflicts have not led to increased equity and quality in the provision of medical care and services in affected areas. Armed conflicts have a profound impact on the architecture of health governance. Military actions often result in the destruction of health care infrastructure, including hospitals, clinics, and essential medical supply chains. Such widespread disruptions hinder the delivery of basic medical services, leading to increased morbidity and mortality. Largescale population displacement is the most common consequence of armed conflicts, resulting in the creation of refugee camps and pressure on host communities. This situation exacerbates health issues, as overcrowding promotes the spread of infectious diseases, compounded by the concurrent collapse of health care systems. Conflicts restrict or complicate the provision of humanitarian aid, impeding the delivery of essential medical supplies, vaccines, and medical personnel to affected areas. The psychological consequences of armed conflict always extend beyond physical injuries, with mental health issues becoming increasingly common.
Topic:
Governance, Humanitarian Crisis, Armed Conflict, WHO, Global Health, and Disease
Political Geography:
Middle East, Palestine, Syria, and Global Focus

3. Beyond the “Gavi-Eligible”: High-Leverage Opportunities for Gavi to Enhance Vaccine Access and Uptake in Ineligible Middle-Income Countries

Author:
Rachel Bonnifield, Morgan Pincombe, and Janeen Madan Keller
Publication Date:
04-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
The global locus of undervaccination is increasingly shifting from the poorest countries in the world—which are eligible for support from Gavi, the Vaccine Alliance (Gavi)—to middle-income countries (MICs) that do not qualify for traditional Gavi support. Given these growing challenges, Gavi must rethink its engagement with those MICs that are ineligible for traditional support. Although this engagement is intended to be “catalytic” and has been intentionally targeted to country needs, it also has been relatively small-scale and ad hoc. Gavi’s next five-year strategic period from 2026 to 2030, known as “Gavi 6.0,” offers a window of opportunity for its board and leadership to consider new and different ways for Gavi to engage with MICs to advance global vaccine access and improve vaccination outcomes. To have the greatest impact in this context, Gavi must lean into its comparative advantage in market shaping and demand consolidation to drive its contributions to global vaccination efforts with finite resources. We offer recommendations for Gavi to operationalize broader engagement with MICs, specifically by enabling an expanded cohort of MICs to access more affordable prices for both newer, costlier vaccines and future vaccines via opt-in framework agreements and by supporting a global coordinating hub to shape a forward-looking immunization innovation agenda.
Topic:
Public Health, Vaccine, Global Health, and Middle-Income Countries
Political Geography:
Global Focus

4. Disinvesting from Low-Value Health Technologies in Low- and Middle-Income Countries: Between a Solution to the Current Fiscal Crises and a Costly Mirage?

Author:
Adrian Gheorghe and Pete Baker
Publication Date:
04-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
In this policy paper we summarise what is known about healthcare disinvestment and outline documented experiences in low- and middle-income countries (LMICs) to draw insights on what has worked, to what extent, and under what conditions. We reviewed the published literature on documented experiences of attempted healthcare disinvestment in LMICs. We identified two common scenarios when disinvestment initiatives were attempted, namely “one-off” and “systematic” initiatives, and characterised them in terms of objectives, resources and political will. We found four documented examples of one-off disinvestment initiatives—Iran, Malaysia, Romania, and Vietnam, two documented examples of systematic disinvestment initiatives by health technology assessment (HTA) agencies in LMICs—Brazil and China, as well as a range of countries like Thailand, India, and Ghana that carry out systematic disinvestment through routine HTA processes. We conclude that disinvestment is costly, time-consuming, and rarely as successful as policymakers intend. Key considerations to improve the chances of success include whether strong pre-existing health prioritisation systems exist (such as an HTA agency) and whether the design of initiatives are tightly matched to the level of political will, the policy objective, and available resources.
Topic:
Development, Science and Technology, Global Health, and Fiscal Crisis
Political Geography:
Global Focus

5. Starting from the Source: Methods and Priorities for Explaining Lead Exposure

Author:
Rachel Bonnifield
Publication Date:
08-2024
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
Lead is a dangerous neurotoxin, and lead poisoning remains one of the most serious and neglected public health challenges in the developing world, with major negative impacts on global health, education, and overall economic development. There is now growing international momentum to mitigate lead pollution, with the goal of dramatically reducing human lead exposure and consequent adverse effects. Yet before lead exposure can be effectively mitigated, it is essential to understand why humans are being exposed to lead in the first place and therefore how policymakers can intervene to stop further exposure. To date, such research into the major sources of lead exposure—broadly referred to as source assessment—in developing countries has been limited. Thus, there is limited information and no global scientific consensus about the most important causes of global lead exposure. Given growing global interest in addressing lead poisoning, there is an urgent need to better understand the major sources of lead exposure in different settings by increasing the volume and quality of related research. Tailored to a policy audience, this paper offers a state-of-the-science review of methods for doing so. First, it provides background for understanding lead exposure—that is, how and why lead enters the environment, how it behaves once there, and how environmental lead results in elevated blood lead levels for humans. Second, it outlines basic principles for source assessment, including a discussion of objectives and terminology. Third, it details the range of methods available for understanding the sources of lead exposure and describes how such methods can be used in combination to understand major sources of lead exposure in a given context. Finally, it considers major policy-relevant gaps in the literature base about sources of global exposure and offers suggestions for a research agenda in this space.
Topic:
Development, Public Health, Global Health, and Lead
Political Geography:
Global Focus

6. Facing the next public health emergency: How do we know how (un)prepared we are?

Author:
Christian Haddad and Hugh Schmidt
Publication Date:
07-2023
Content Type:
Policy Brief
Institution:
Austrian Institute for International Affairs (OIIP)
Abstract:
In the realm of political preparedness, numerous benchmarks, metrics, and best practice models have emerged as integral sites in the ongoing debate. Taking the Global Health Security Index as a specific example, this paper delves into the advantages and disadvantages of such global security rankings. This analysis aims to explore the potential uses and drawbacks of employing metrics to evaluate and modify (inter-)national preparedness plans. Situating this discussion within the broader context of the escalating significance of crisis preparedness and management, particularly in the face of acute disruptions to vital infrastructures and the immense costs they entail, as well as their adverse impact on public health and societal safety. However, the findings of this analysis reveal a notable political and strategic risk associated with an excessive reliance on these metrics. It is important to recognize that these metrics not only rely on robust scientific methodologies but also rest upon selective assumptions about the world and the definition of threats. The case of the Global Health Security Index serves as an example, as the assumptions underpinning these metrics have proven inaccurate in the face of an actual pandemic. Consequently, overconfidence and misguided approaches to crisis preparedness have ensued. Additionally, this work offers a concise historical overview of preparedness thinking, outlines the field of Global Health Security, presents the existing metrics employed, and critically reflects on these tools. While metrics provide valuable insights, they should be approached with caution and an awareness of their limitations. By adopting a critical lens and recognizing the political dimensions inherent in these metrics, policymakers can make more informed decisions and develop more effective preparedness plans in an ever-evolving world of crises.
Topic:
Security, Governance, Public Health, COVID-19, and Global Health
Political Geography:
Global Focus

7. Eight Commonsense Actions on Biosafety and Biosecurity

Author:
J. Stephen Morrison and Michaela Simoneau
Publication Date:
11-2023
Content Type:
Policy Brief
Institution:
Center for Strategic and International Studies (CSIS)
Abstract:
Today, there is a shared sense of vulnerability and a shared resolve across political divides to better protect the United States and the world against the accidental release of biological agents (biosafety), deliberate misuse of biological agents (biosecurity), and naturally occurring spillover of dangerous pathogens. Biosafety and biosecurity are critically important areas where individual freedom, ethics, scientific progress, and national security converge. As biological research and discovery accelerate at an unprecedented pace, they generate new risks that must be managed responsibly. The CSIS Bipartisan Alliance for Global Health Security’s Working Group on R&D Innovation advocates select, commonsense actions to strengthen U.S. and global biosafety and biosecurity: clarify U.S. policies and policy leadership within the White House; increase financial and diplomatic investments; update the rules around synthetic products and viral discovery work; and invest in research on basic lab protections and the new risks of artificial intelligence. Together, these timely, affordable steps can attract broad political support and promote a safer, more secure, and more innovative global bioeconomy.
Topic:
Security, Defense Policy, Infectious Diseases, Biosecurity, COVID-19, and Global Health
Political Geography:
Global Focus

8. US Commitments in Nutrition and Health for a Better Future

Author:
Gloria Dabek, Catherine Bertini, Dan Glickman, and Samanta Dunford
Publication Date:
02-2022
Content Type:
Special Report
Institution:
Chicago Council on Global Affairs
Abstract:
The United States has made big pledges for global nutrition. Our white paper offers recommendations to turn commitments into action. Approximately 768 million people faced hunger in 2020, over 100 million more than 2019, and the number of those without sufficient nutrients is even higher. In the United States, diet-related disease accounted for over half of all deaths in 2018. Globally, approximately 45 percent of the deaths of children younger than five are related to undernutrition. For decades, the United States has also experienced a rise in chronic diet-related diseases like diabetes, with disproportionate effects seen in communities of color. And as the COVID-19 pandemic has illustrated the link between nutrition and both risk and long-term consequences of pathogen infection, urgency to shift governmental nutrition approaches has never been higher. To strengthen domestic and global nutrition, the United States should catalyze critical change, starting with commitments made at the 2021 UN Food Systems Summit and additional funded programs, extending further to reach a wider subset of all people suffering from nutrition- and hunger-related diseases. This white paper analyzes primary nutrition challenges, particularly issues of health, access, and education, and recommends policy actions that community, federal, private, and academic institutions can take domestically and globally to progress toward a well-nourished future.
Topic:
Agriculture, Climate Change, Environment, Food, and Global Health
Political Geography:
North America, Global Focus, and United States of America

9. Transnational Threats (Syllabus Resource)

Author:
Georgetown Journal of International Affairs
Publication Date:
02-2021
Content Type:
Special Report
Institution:
Georgetown Institute for Women, Peace and Security (GIWPS)
Abstract:
The following is material to consider for your syllabus. Specifically, there is: Climate Change and Environment, Displacement, Energy Policy and Security, Global Health Security and Pandemics, Globalization and Demographic Trends, Water Politics and Water Scarcity. Scholarly writing on transnational threats written by diverse scholars and experts. Scholarly writing providing geographic variety and geographically varied perspectives. Studies and analyses examining diversity, equity and inclusion-related dimensions of transnational threats.
Topic:
Security, Climate Change, Demographics, Energy Policy, Environment, Globalization, Water, Displacement, Pandemic, and Global Health
Political Geography:
Global Focus

10. Transitions in Global Health Diplomacy: Views of Donors During the COVID-19 Pandemic

Author:
Cynthia Buckley, Ralph Clem, and Erik Herron
Publication Date:
12-2021
Content Type:
Journal Article
Journal:
Fletcher Security Review
Institution:
The Fletcher School, Tufts University
Abstract:
Sickening and killing people worldwide, the COVID-19 pandemic is disrupting national and international economies and creating enormous human suffering. Current and future geopolitical implications are substantial, requiring long term attention by national security policymakers in the United States and elsewhere.245 Central among these foreign policy concerns is the capacity of states across the globe to deliver health care (and other services) to their populations and the role of health and human security in promoting national security.246 Prior to the pandemic, interest in Global Health Diplomacy (GHD) as a foreign policy tool was growing, reflecting the recognition of border crossing health concerns and the effectiveness of health-focused development aid. Health assistance provided through GHD enables improvements in the quality of life, expansion of infrastructure, and strong donor-recipient ties, each of which can contribute to recipient state capacity. Emerging impacts of the COVID-19 pandemic increase the importance of international health assistance.247 The value of health assistance in generating grassroots aid recognition, thereby capturing “hearts and minds,” is a potent means of building international recognition of both a state’s humanitarian mission and building a positive reputation in recipient state public opinion. In the American context, the four years of the Trump administration were marked by a decline in American bilateral and multilateral engagement in terms of GHD, specifically its stated intention to withdraw from the World Health Organization (WHO).248 Importantly, this coincided with a period of rising efforts in this area by China and Russia. These changes highlight the importance of understanding how changes in GHD participation emerge and enable stronger linkages between GHD studies and global rivalries (more common in the field of International Relations).249 We set out to explore how transitioning patterns of GHD engagement inform the positioning priorities of the United States, Russia, China, and multinational organizations such as the European Union. How have the acute health, economic, and in some cases political crises of the global COVID-19 pandemic altered donor engagement in GHD? What are the effects of changes in the perceptions of their engagement in recipient states? We incorporate data from three strategically important post-Soviet countries—Estonia, Ukraine, and the Republic of Georgia—to illustrate how major players in GHD are viewed on the ground. Situated on a long arc from the Baltic Sea to the Black Sea and beyond to the Caucasus, these states neighbor Russia proper. Proximity to Russia itself implies a core national security problem: Moscow has actively undermined the territorial integrity of Georgia and Ukraine, seizing parts of both via kinetic warfare while causing massive infrastructure damage (including healthcare infrastructure), thousands of deaths, and the internal displacement of millions.250 Estonia has been the target of cyberattacks emanating from Russia, and all three countries must cope with relentless disinformation campaigns intended to destabilize their governments and societies. These three cases provide insights into how citizens in recipient states view GHD engagement in a time of crisis.
Topic:
Diplomacy, Pandemic, COVID-19, Donors, and Global Health
Political Geography:
Global Focus