Internetconsultation Global Health Strategy

Reactie

Naam	Health Action International (Dr T Reed)
Plaats	Amsterdam
Datum	15 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: Through public/open transparent consultation processes, including impact assessment, involving those to be affected/benefited by proposed policy measures from the start. Involve relevant stakeholders/concerned parties in evaluation/assessment of actions. Ownership should be established at onset. Employing in-country open dialogue spaces, with all stakeholders is a great way of ensuring ownership, direction and the will to succeed.
2: NL has been one of the most active governments in the field of (global) access to medicines and has the opportunity to press universal access to health technologies to address shortcomings identified in the response to the Covid pandemic. Early support for WHO Covid-19 Technologies Access Pool (C-TAP) should be followed by steps that go beyond funding and engages Dutch expertise/public generated knowledge.
3: Dutch universities and public research institutions can play a greater role in an alternative R&D model, not incentivised by IP. Socially sustainable licensing guidelines for University Medical Centre to include practical pathways for tech transfer and knowledge sharing. Dutch government makes the point in discussions with other EU members about the need to exclude TRIPS+ clauses in trade deals while preserving policy and legal spaces for TRIPS flexibilities.
4: Enhance two-way flow of knowledge between HQ and diplomatic posts, which can be left in a vacuum, while being treated as a 'grant recipient' by HQ. The relationship with local partners is of specific value and it must be based on respect for their autonomy and expertise. Local NGOs and other Civil Society organisations should be consulted and diplomatic corps (including health attaches) should be made available especially in those countries with shrinking CS space.
5: The presence and contribution of the NL to the international human rights protection framework should be used to shape its global health policy objectives through values like respect for human dignity, universal access to health technologies and freedom from discrimination in access to healthcare.
6: Internal coordination between health, economic and foreign affairs could be streamlined through a global health taskforce on which health and trade attaches in Brussels, Geneva and New York sit. Such taskforce would discuss/implement policy while serving as a clearinghouse of feedback from international agencies.

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?

Question 7: In order to disseminate information in the most efficient way, reliance on trusted local partners/stakeholders and constituencies can be a good strategy, combined with an open and fluid dialogue with national authorities. National authorities should keep records on the needs of their populations, especially of groups in situation of vulnerability or marginalisation, but there is rarely the political will or knowledge on how that should be done, to be truly inclusive.

Question 8: All stakeholders and concerned parties (especially those in closest contact with those in need) should be invited to share their experiences and insights, in a transparent domestic multi-stakeholder engagement. Regarding the contribution of private sector a first and critical step would be for companies to respect legal framework both domestic and internationally. NL government should make sure that Dutch companies do not, by action or omission, compromise global health policy goals, principles and commitments. Ethical obligations are non-negotiable.

Question 9: Listen to the communities most affected by climate change and support remedy/mitigation measures such shorten supply routes, refurbish buildings in a more eco-friendly way and support moratorium on exploration/exploitation of fossil fuel. In terms of Health technologies, waste and obsolescence is a massive climate burden and more pressure should be brought to bear on manufacturers to green-up manufacturing from bench to patient.

Question 10: Contribute to better coordination among national authorities, international donors and multilateral organisations. Particularly, ensure that International Health Regulations (IHR) are adapted in national and administrative frameworks, with clear assignation of responsibilities and budgetary allocations. NL must use its leverage at multilateral financial institutions to make sure that developing countries are allowed to have enough financial reserves as well as policy space, to take adequate measures in the shortest time, in the case of pandemic or other health emergencies.

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?

Question 11: We need better international leadership and coordination to achieve an effective response to a pandemic that does not leaven impoverished populations behind. Adoption of waiver on IP that would enhance manufacturing capabilities for needed health technologies across the globe. Reinforce WHO stewardship with resources while not supporting the creation of ad-hoc parallel structures led by non-health actors.

Question 12: Clear imbalance in manufacturing capacity, fuelled by patent-based monopolies, with most facilities located in Global North. Disruptions and bottlenecks in supply chains. Lack of skilled health care personnel/facilities in developing countries. A new fund for PPR should be established to fund preparation and response to pandemics and other health emergencies. A new IPR regime (or amendment of TRIPS agreement) should be drafted to allow for emergency/expedited use of licenses by governments in pandemics and other health emergencies

Question 13: Tax on financial transactions and other ad-hoc fiscal measures. NL could set up fund with seed money through multilateral financial institutions

Question 14: Ideally the new pandemic treaty should be legally binding, in particular regarding border closures, government use of patents and public manufacture of health technologies. If there in no consensus on a global international treaty, the NL should push for a coalition of the willing in order to achieve a high numbers of signatories (as with ICC).

Question 15: It should be a cornerstone of the Dutch proposal expressed in 3 intertwining elements : (1) vigorous tech transfer schemes engaging global south researchers in the early stages of projects with potential for a pandemic (this would also include access to CT protocols, results and relevant data); (2) systematic pursuit of public return on public investment in R&D by Dutch institutions with promising results being transferred/ceded/licensed to international instruments like CTAP, MPP and others and (3) waiving IP and enacting of measures (at Dutch, EU and global level) to streamline use of Compulsory Licensing in pandemics an health emergencies.

Question 16: Rely on WHO expertise, adapt it to other (Dutch or elsewhere) realities. Be transparent on public health decisions, make sure they are evidence-based and that audiences know the risks and consequences of actions and omissions.

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?

Question 17: Public return on public investment from public-funded/supported institutions and better coordination with Global South organisations. Joint discussion of a new Global R&D agenda shaped by needs and not profit.

Question 18: Private sector can collaborate with such institutions like MPP and the Mrna Tech transfer hub and assume its responsibility in maintaining stock and making sure that medicine shortages do not occur.

Question 19: Ensure IP is shared and technology transferred to diversify production and scale-up manufacturing

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?

Question 20: Antimicrobial resistance is synonymous with the One Health approach, but the holistic view suggested in the question is often ignored in the 'turf war' between the three core pillars of one health modelling. Crucially, the fourth pillar of one health is ignored - that of healthy societies. By which we do not mean individual or public health, but democratic, equal, just, free and transparent societies. Only when a society is healthy can we hope to achieve a one health model as currently conceptualised.

Question 21: The NL has a wealth of expertise in all of the areas mentioned in the question. Moreover, Dutch development civil society is acutely attuned to in-country nuance, especially if there are genuine and trusted partnerships with domestic civil society at community level. Thus, a ground up approach to multi-sectoral (multi-stakeholder) engagement is feasible and is already happening in Dutch partnerships in some countries. There does however need to be more trust and respect for partners in both NL and LMICs.