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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. Overcoming Barriers to Improve Antimicrobial Access, Innovation, and Stewardship in India

Author:
Parshuram Hotkar, Deepak Jena, Mohammed Abdul Rahman, Snigdha Das Sweety Shreyashi, and Javier Guzman
Publication Date:
07-2023
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
India is racing against the clock in its fight against antimicrobial resistance. A combination of complex regulatory and procurement systems, a lack of health insurance penetration, and little groundwork on state and national action plans has stymied progress. A multi-fold approach is needed to improve access to, and innovation of next-generation antimicrobials and enhance stewardship practices. Improving access to the World Health Organization’s list of Watch and Reserve categories of antimicrobials through existing and new procurement channels, strengthening stewardship and diagnostic facilities in hospitals, and developing an environment conducive to antimicrobial research and development is key to achieving these goals.
Topic:
World Health Organization, Innovation, Public Health, Global Health, Healthcare System, and Antimicrobial Resistance
Political Geography:
South Asia and India

8. The Future of UK Global Health Policy: Challenges and Opportunities

Author:
Pete Baker
Publication Date:
11-2023
Content Type:
Policy Brief
Institution:
Center for Global Development (CGD)
Abstract:
Since 2019, the UK’s strong reputation in global health has been undermined by a series of deep cuts and a distracting departmental reorganisation. 2024 may, however, represent a turning point, with new Foreign and Development Ministers, both with a strong track record on development, the implementation of a new development white paper, and a possible election which may bring a new government with new priorities. In this paper, we summarise the challenges and opportunities in global health on which the UK will need to act if it wishes to restore its reputation. We review UK global health aid expenditure data up to 2022, current UK global health policies, and major external global trends. We find that in 2018, the UK reported spending £2.17 billion (0.1 percent of Gross National Income (GNI)). By 2022, this fell to £1.73 billion (0.07 percent of GNI). If the UK had continued at 0.1 percent of GNI level, it would now have an additional £844 million to spend on global health annually. Bilateral programmes, Foreign Commonwealth & Development Office-managed aid programmes, and reproductive health programmes were particularly hard hit by the cuts. We identify three global trends that the UK must accommodate: an acute-on-chronic health financing crises in low- and middle-income countries; changing demographics, burden of disease, and increasing global threats; and the inadequacy of global health architecture. Finally, we recommend a five-point plan for the UK government to take forward: 1) Champion debt relief and “health taxes” to increase resources for health; 2) Support countries to strengthen health system efficiency; 3) Prioritise limited UK financing on key, measurable objectives in a few low-income countries. 4) Conduct a multilateral aid review that focuses on developing country priorities; and 5) Direct UK health system strengthening funding through the World Bank and long-term bilateral programmes.
Topic:
Development, Foreign Aid, and Global Health
Political Geography:
United Kingdom and Europe

9. 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

10. Strategic Opportunity for the Middle Corridor?

Author:
Selcuk Colakoglu
Publication Date:
10-2022
Content Type:
Journal Article
Journal:
Baku Dialogues
Institution:
ADA University
Abstract:
Connectivity initiatives across the Eurasian landmass have been on global and regional agendas since the dissolution of the Soviet Union, with the newly independent countries of the Silk Road region prioritizing efforts to reach international markets so as to strengthen their strategic independence from Moscow. Amongst the numerous Silk Road connectivity initiatives, the Middle Corridor has the aim of building an efficient East‑West corridor involving countries located between the European Union and China (except for Russia). This essay analyses the pros and cons of the Middle Corridor project from the perspective of some of the countries most concerned, starting with Türkiye. It also examines how the COVID‑19 pandemic and the 2022 Russia‑Ukraine war have affected the implementation of this initiative.
Topic:
Pandemic, COVID-19, Global Health, and Russia-Ukraine War
Political Geography:
Eurasia