Internetconsultation Global Health Strategy

Reactie

Naam	Charlie Nederpelt
Plaats	Den Haag
Datum	21 augustus 2022

Vraag1

Session 1: Diplomacy and human rights-based

Question 1: How could we best include the input of marginalized groups in our diplomacy efforts?

Question 2: The Netherlands is often referred to as a donor with courage. If the Netherlands wants to continue being such a donor, which are the (health-related) themes we should focus on?

Question 3: How can the Netherlands best align the national and international efforts regarding Global Health?

Question 4: How can the Netherlands make more effective use of its diplomatic network abroad, including embassies, permanent representations and thematic experts (such as health attachés)?

Question 5: How can the Netherlands' position within the UN (and its reputation in the field of international (human) rights) be used to advance global health objectives?

Question 6: How can we systematically link diplomatic efforts in Brussels, Geneva and New York to the benefit of coherence and greater effectiveness?

A2: A donor with courage prioritizes real world impact and evidence-based policy decisions. The right framework to decide which themes Dutch global health efforts should focus on, is to start with demand, then consider what expertise NL has to offer. According to the Global Burden of Disease studies, the most significant causes of amenable disease burden (in DALYs) are: cardiovascular disease, neonatal deaths, infectious disease, poor nutrition, and access to safe and effective essential surgical care. Consequently, Dutch global health efforts should prioritize cost-effective and proven efforts and investments that address these issues. The Disease Control Priorities and the WHO UHC investment case are foundational in priority setting. The Dutch government and healthcare system have expertise in virtually all of the 111 highest priority interventions identified. Focusing on these interventions means spending to improve access to and quality of personal healthcare services (most importantly vaccination programs, labor rooms, cardiovascular risk management, screening and testing for HIV and TB), promoting guideline adherence (screening & prevention of perinatal disease, fighting antibiotic resistance, e.g. overuse in the context of diarrheal disease and respiratory infections), and stimulation of healthy diet and lifestyle.

A5: the Netherlands is famous internationally for our equitable, effective and affordable healthcare system. At the core of this system is our mandatory basic health insurance (BHI). As an advocate of the positive right to good health, the Netherlands should emphasize the importance of a (mandatory) universal BHI. It places the responsibility of improving health with the insurer, and incentivizes them to promote health and decrease spending, which is positive change provided that health outcomes are independently and unbiasedly measured. A BHI will constitute predictable, reliable income for healthcare providers, allowing them to start and stay working in the local health sector, limiting medical migration/brain drain. The insurance system will also enable data collection for quality insurance, granted it is done appropriately and in moderation, not consuming too much time. The dynamic introduced by insurance will positively impact health, prevent catastrophic spending on healthcare, improve access to health services, and allow for transparency and regulation of the healthcare sector.

Vraag2

Session 2: Health systems strengthening

Question 7: How can we reach everyone, especially the most marginalized people, to ensure their access to information and medical service?

Question 8: How can we make use of the specific knowledge and experience of all different sectors involved in global health? How can we also involve the private sector in meeting the people in greatest need?

Question 9: How can we promote green and sustainable health systems strengthening?

Question 10: How can we gear health systems strengthening most effectively towards better preparedness?

A7: Unfortunately, universal health coverage is hardest to achieve for those who have the least. Reaching the most marginalized people will require additional investments and efforts, as evidenced by the difficulty in completing the 95/95/95 targets in the global fight against HIV/AIDS.
In the context of scarcity, especially in LMICs, rapid expansion of access to medical information and services may start by prioritizing the most cost-effective interventions, the ‘low hanging fruit’. As investment in public health is a pro-development force, this may in fact be considered fair as more people are helped at the same cost, and economic progress will enable the system to later on include all (marginalized) people.

A8: The best investments for global health are not all medical in nature. Access to up-to-date information requires access to energy and information technology. Healthy/diverse/nutritional food requires a professional agricultural industry. Reaching medical services requires roads and personal transportation, etc. It is clear that private sector involvement is essential. The private sector is already active in LMICs, and will be as long as the legal and financial picture is positive.
The private sector is already active, and should be strongly encouraged by the government, to:
Co-develop sustainable agriculture for diverse and nutritionally rich crops (most importantly protein sources, iron, zinc, vitamin A and folate).
Collaborate with LMICs to research, develop and produce sustainable and affordable instruments, machinery and hospital infrastructure.
Develop mobile banking, and related financial services to sustain the health insurance system.
Create low-tech, reliable health information systems

A9: It is certainly relevant to be aware of the climate impact of the healthcare sector, but it should also be considered that the countries in dire need of health system strengthening are, generally speaking, not the polluters. There are currently no good alternatives to single use plastics and autoclaves for sterility, air-conditioning in operating theatres, etc. Weighing climate impact too heavily in deciding on health investments in LMIC may be unfair, considering the disproportional footprint of donor countries. The largest climate gains are made elsewhere, and I believe efforts should be distributed in a similar fashion.

Vraag3

Session 3: Pandemic prevention, preparedness and response

Question 11: Which lessons should we learn from our approach in earlier pandemics, and more specifically, what could we do better?

Question 12: What are the most pressing gaps in the current global health architecture regarding PPR, and how should/can they be addressed?

Question 13: How can we best ensure sustainable financing for PPR?

Question 14: To what extent should new international agreements be legally binding?

Question 15: To what extent should the Netherlands promote the sharing of IP, knowledge and data in the context of PPR?

Question 16: How could we best communicate to a global public audience in order to not only prevent but also respond better to a pandemic?

A11: National governments should develop and implement plans to ensure surge capacity in diagnostics, patient transport, hospital beds, and outpatient clinics. Governments should also maintain stockpiles of disinfectants, equipment for supportive care, and personal protective equipment. There is no ‘fair’ financial incentive for the private sector to maintain these, as they would offer these at prices much higher than market value, which citizens would subsequently deem too high.

A12: There is no global directive for management of pandemics/health disasters, as states retain their sovereignty. As long as states can rebuke the WHO, a ‘global health architecture’ is hard to achieve. The political economy of cross-border collaboration is thus the pressing gap, as evidenced by the not-sharing of vaccines and equipment. If there is no popular support for sharing/collaboration, or if there is no perceived political benefit to do so, this will not improve.

A15: Knowledge and data on disease characteristics, clinical management etc. should flow freely. The issue of IP is more difficult, as companies should retain their incentive to invest in research and development. Governments could consider purchasing this IP in situations of overwhelming demand; invest in its own R&D; pressure pharmaceutical companies to release the IP; or, alternatively, develop a fairer system for intellectual property of medicine/vaccines, as newly patented drugs always rely on technology/drug targets/other biological mechanisms discovered and developed by publicly funded research (for example: https://www.pnas.org/doi/10.1073/pnas.1715368115)

Vraag7

Miscellaneous

Question 25: Do you have any other thoughts, ideas or comments you would like to share regarding the Global Health Strategy?

A25: It is most important to have a strategy based on solid evidence and experience. In its international diplomacy, the Netherlands should emphasize this, referencing the highest grade evidence by the WHO UHC Investment Case and vaccination policies, Disease Control Priorities, Copenhagen Consensus, World Bank primary health care analyses,etc. This is ultimately more important than what expertise the Netherlands currently has to offer, as we should develop our own strengths to align with what is needed worldwide (demand-based approach).