Internetconsultation Global Health Strategy

Reactie

Naam	Anoniem
Plaats	Geneva, Switzerland
Datum	22 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?

1. The Netherlands should use its position and influence to ensure participation of marginalized groups in governance mechanisms – including when it comes to priority setting, decision-making, and resource allocation. The Netherlands should be a champion for clear mechanisms for civil society and communities as well as public health and scientific experts to engage generally, but also formally within the governance set-up of new and existing initiatives that the Netherlands plays a role in.

2. Addressing Neglected Tropical Diseases (NTDs) is an example of how ODA can be targeted towards tackling poverty and achieving many SDGs. NTDs are a proxy for poverty, affect populations with little political voice, cause stigma and discrimination, especially of girls and women, have an important impact on morbidity and mortality, and are relatively neglected by research. NTDs are, in effect, a litmus test that reveal the existence, or lack, of UHC. As many donors step away from financing this area leaving gaps, the Dutch government should show courage in championing action on this very important and often neglected area.

4. Both for the setting of priorities and the implementation of the strategy, the Netherlands should use its diplomatic network to proactively seek partnerships with and input from stakeholders and governments of low and middle income countries as a means of truly seeking solutions to problems identified by those most affected. This could include working through embassies to convene meetings with governments to champion health priorities and gather input.

5. Access to medicines is a core component of the right to health. Realizing that right requires new innovation approaches so that medical technologies are developed, affordable and accessible. The Netherlands can promote policy coherence between different frameworks and initiatives being proposed at WHO, UN and elsewhere, including its position co-chairing the Intergovernmental Negotiating Body, and play a role ensuring that health tools are designed from the start for the places and for the people that need them and are available and affordable in an equitable manner to all, consistent with public health and human rights principles, as well as SDG3.

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?

7. Neglected Tropical Diseases are a litmus test of the strength and coverage of UHC, so the Dutch should leverage and invest in NTD programmes to reach marginalized populations. To reach the most marginalized with health tools, health tools should be developed to meet the specific needs of such populations, which have been historically neglected by the dominant pharmaceutical business model. This includes giving special attention to the needs of gender, racial/ethnic differences, people living in poverty, children, migrants, people with co-morbidities, and other vulnerable, and marginalized populations within the R&D process.

8. DNDi leverages partners’ assets, capacities, and expertise to implement projects at all stages of the R&D process, integrating capabilities from academia; public research institutions; NGOs and other PDPs; governments; and pharmaceutical and biotechnology companies. Critical to this success is a common vision and R&D that addresses priority public health needs must be the overarching objective. The Netherlands can support cross sectorial partnership, set clear objectives and facilitate links between partners in the global north and south.

10. The Netherlands should ensure priorities for health systems strengthening reflect the needs of global health and are aligned with the SDGs on existing and emerging health threats – e.g. climate sensitive diseases. The health impacts of climate change, which already is and will continue to affect the burden of climate sensitive diseases, warrants action nationally and internationally. The impacts of climate change will continue to disproportionately burden developing countries. Therefore actions, such health system strengthening and the development of new health tools to address such diseases, should be designed to meet needs of those disproportionally affected.

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?

11. COVID-19 response has shown that there is urgent ‘unfinished business’ in equitable access to health tools. Decisions about whether and how to discover, develop, produce, allocate, and price technologies cannot be left to narrow national interests or market forces. The Netherlands should advocate for globally-agreed norms and binding rules governing R&D and equitable access to essential health tools to guarantee such tools are made available as global public goods regardless of where they are discovered, developed, or produced.
12. The pandemic has shown that existing structures for discovering, developing, manufacturing, and delivering health tools do not work to mitigate outbreaks and protect people, everywhere. Future mechanisms should facilitate a more distributed R&D infrastructure that strengthens and invests in R&D, surveillance, manufacturing, and regulatory capacity through regional and national networks and hubs, not only through donor driven mechanisms. To accelerate the R&D process and ensure the benefits of scientific progress will be developed as global public goods the Dutch Government should promote terms and conditions on R&D funding, agreed upfront and applied across all funding streams.
13. To break the cycle of panic and neglect, sustainability of financing can be enhanced by focusing not only on responding to future pandemics but to existing health priorities, including existing epidemics, pandemic-prone and climate sensitive diseases. Much of the infrastructure that is needed to ensure development and delivery of medical countermeasures for pandemics – including for surveillance, research, clinical trials, manufacturing, regulatory systems, health services, procurement, and access platforms – could be used, robustly supported, and strengthened during inter-crisis times for ongoing health priorities and be ‘kept warm’ so that it can be scaled up and repurposed when needed for pandemics.
15. The Dutch should champion measures that embed the principles of access, affordability, and equity into the R&D process to address inequities seen with COVID-19, but also accelerate the R&D process itself. This includes a framework that ensures globally agreed norms and binding rules across the innovation lifecycle, to speed negotiations and enhance efficiency and affordability. Such rules should include transparent terms and conditions that ensure open sharing of research data, knowledge, and technology on non-exclusive basis.

Vraag4

Session 4: Products and supply

Question 17: What is necessary to improve local research and production medical supplies, medicines and vaccines?

Question 18: How can the private sector contribute to the production and distributions of medical supplies, medicines and vaccines?

Question 19: How can we facilitate local production?

17. Dutch policies should encourage investment in priorities driven by scientific leaders in LMICs that will fundamentally change how research priorities are defined and implemented. The strategy should include allocation of resources for harnessing and strengthening health R&D infrastructure, and training research personnel, in endemic countries. This includes enhancing clinical research capacity, strengthening ethics review, adapting regulatory pathways and promoting gender-responsive R&D for women and children, as well as investing in sustainable procurement and supply platforms for health tools that are produced. These investments have long term benefits as skills and resources can be deployed to address other health needs.

18. While traditional investments in academia and industry have led to important progress most recently with COVID-19 vaccines, to deliver maximum impact for the most neglected it is essential that the limitations of the market driven approach to global health and development are recognised. The Dutch strategy should rather reimagine global health R&D coordination, collaboration and financing to support a more distributed, decentralised and democratic approach to the production of knowledge and innovation including to support innovation and manufacturing hubs in low and middle-income countries, building on existing partnerships the Netherland’s have in many countries.??

19. Dutch Government should promote the sharing of relevant know-how, technology transfer, and IP by non-exclusively licensing, including through mechanisms such as the WHO COVID-19 Technology Access Pool and Medicines Patent Pool, to interested entities so that new manufacturing sites have the equipment, expertise, know-how, and power to produce and deliver new innovations safely and rapidly at scale to ensure sufficient supply. The Netherlands should encourage international and regional entities to procure locally produced health tools. Investment in regional and national networks should be promoted to facilitate a more distributed, decentralized, and democratic approach to the production of knowledge and innovation.

Vraag5

Session 5: One health multisectoral approach

Question 20: There are noticeable links between global public health and other themes, including climate, food security and nutrition, clean leaving environment (e.g. WASH/clean water and air), animal health, economy, school health (e.g. CSE, ASRHR) and sustainability (social, economic and environment). Which should be the priorities that are also practically feasible for the Netherlands in this regard?

Question 21: How do we best engage in this intersectional approach of global health?

20. Building on areas of expertise, the Netherlands should continue to make the links between climate and the effects on global health. Climate change will continue to affect the spread of climate sensitive diseases, such as dengue and other NTDs, due to changing temperatures and rainfall patterns. The impacts of climate change will continue to disproportionately burden developing countries. Therefore, the Netherlands should ensure the links are made between global health and climate and that the development of, and access to, new health tools to address climate sensitive diseases are prioritized within adaptation efforts.

21. The Dutch government should champion health within their priorities at international climate process and fora, to fully appreciate the links between the two areas as well as the disproportionate burden such climate-related health effects will have on vulnerable and marginalized populations.

Vraag6

Session 6: Sustainable financing

Question 22: How do we establish sustainable and innovative health financing with the strategy?

Question 23: How do we ensure best the blending of public and private funding for the Global Health Strategy?

Question 24: How do we ensure sustainable financing for the WHO and the global health architecture at large?

24. R&D requires adequate, sustainable government funding which should be available at the national, regional, and international levels, as well as mechanisms to incentivize innovation and secure access. However, it is not just what is funded that it is important but also how. Funding and incentive mechanisms should promote open, collaborative approaches that aim from the start to deliver affordable products efficiently, for all diseases and products of public health importance. To ensure that R&D investment results in health products that deliver maximum impact, the Netherlands should continue to support alternative models of R&D, such as PDPs, which prioritize marginalized people.

Vraag7

Miscellaneous

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

25. Alternative models for development, such as PDPs, seek to rebalance the Global Health system through partnerships in LMICs to foster engagement in R&D that puts people’s needs first. Core funding from the Netherlands enables DNDi to approach drug development in a results-oriented and cost-effective manner. This results in significantly lower costs for drug development than seen in the private sector, and treatments which are adapted for the needs of, and are affordable and accessible to, patients in resource-limited settings.

We therefore commend the Dutch Government on its commitment for continued resources to support PDPs with the 2022 PDP IV Fund.