Internetconsultation Global Health Strategy

Reactie

Naam	IAVI (JC Osborne)
Plaats	Amsterdam, Netherlands
Datum	20 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?

Q1:
The Netherlands can use its international reputation as a defender of human rights to bring marginalized and criminalized groups out of the shadows. There are groups that are at greater risk of acquiring certain diseases, such as men who have sex with men and sex workers for HIV. When these groups are criminalized, they face greater stigma and barriers to accessing care. The Netherlands should use its influence to advocate for de-criminalization of homosexuality and sex work in contexts where it is prohibitive to vulnerable groups’ right to health care.

Q3:
Global health investment abroad also poses a great benefit for domestic priorities. Now is an important time to renew commitments to global solidarity and ensure that people everywhere have access to affordable and acceptable medical technologies. Health security abroad is not only beneficial for the communities directly served, but also contributes to social justice efforts globally and economic development in the Netherlands. The Dutch Global Health Strategy can prioritize local research and development (R&D) ecosystems by investing in strategic partnerships in LMICs.

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?

Q7:
Many vulnerable and “hard to reach” communities are left out of regular health services. These are also people who fall between the cracks of official health interventions. Health systems need to be adaptive and realize the added value of existing organizations and partnerships that already have good relationships with marginalized groups. It should be a priority of governments to take seriously the robust actions of civil society organizations in research and decision-making processes. Supporting projects that employ sustained community engagement is critical for ensuring health products and services are accessible by all.

Q8:
One innovative way to take advantage of private sector expertise and resources is via Product Development Partnerships (PDPs); non-profit organizations which bring together both the public and the private sector’s resources and expertise to share the risk involved in develop new affordable and accessible tools to fight poverty-related diseases like HIV/AIDS. In PDPs, private sector engagement is incentivized through publicly supported enterprises which provide expertise, networks and resources in for example AIDS vaccine R&D and matching these with relevant technologies and expertise of private sector partners.

Q10:
Health systems strengthening means investing in strategies for development that benefit those who are currently left out of the system. A strong health system therefore recognizes the need to focus on diseases that are most affected by poverty and other areas of inequality. Further investment in preventing poverty-related diseases like HIV/AIDS and TB is of key importance for responding to an important issue in developing health systems’ current struggle, as well as ensuring the world of the Netherlands’s steadfast commitment to comprehensive international development. Investment in clinical and research partnerships can help strengthen future responses to various infectious disease threats.

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?

Q11:
The world is facing multiple pandemics, where fast yet deliberate action is needed. Previous research on HIV, for instance, helped pave the way for a swift R&D process for a COVID-19 vaccine. Medicines and technologies, however, can only serve their purpose within well-functioning health systems, where strategic partnerships are set up between pharmaceutical producers, public institutions, and civil society. The Netherlands can also promote data sharing and technology transfer together with EU bodies such as EDCTP, accelerating innovation when it is needed most.

Q12:
There are many lessons to be learned from past and present pandemic responses, including fostering agility in existing agencies and early vaccine R&D. Sustained research and intervention on community-level vulnerabilities has also been left out of the response to pandemics, especially in terms of what interventions are acceptable at a local level. Importantly, increased support for global health R&D generally may increase resilience and broader health systems readiness for future pandemics. This way existing epidemics, such as TB, also profit from these mechanisms.

Q14:
New international agreements are necessary to harmonize responses by governments, as coordination could increase trust in governments during crises. However, new agreements should not come at the expense of existing structures that already respond well to pandemic threats. Community-supported and publicly visible institutions have proven necessary in the AIDS and COVID-19 pandemics. These organizations serve as links to populations and should also be formally integrated within the decision-making structure of any new international agreement.

Q15:
The Netherlands should promote technology and data transfer and work with EU initiatives that support local manufacturing. In public health emergencies of international concern, sharing knowledge and encouraging the sharing of vaccine and treatment strategies is crucial. Attention needs to be devoted right now to making sure pharmaceutical products are developed so that manufacturing facilities in LMICs can produce them in times of crisis. Preparedness efforts should focus on strengthening the existing partnerships that enable resource-poor health systems to produce vaccines quickly and efficiently.

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?

Q18:
An important part of equitable medicines access is the PDP structure, which are not-for-profit organizations that bring together various sectors and typically focus on earlier-stage translational scientific work, aiming to accelerate pre-clinical work and clinical trials which can take promising scientific concepts from the laboratory to the field; focusing on areas which are underserved by traditional (for-profit) markets. The Netherlands can also make better agreements with pharmaceutical companies to share the gains made from publicly funded research and product development with markets in lower-resource settings.

Q19:
Vaccine equity has become one of the biggest failures of the COVID-19 pandemic. In order to prevent the unequal access to vaccines and other life-saving medical products, high-income countries should invest in PDPs. PDPs have a proven focus on global access and use of local researchers and facilities for diseases where there is no viable market for pharmaceutical companies. Governments can invest in these structures that facilitate knowledge transfer and local ownership over global health R&D. Innovative investment should also prioritize the entire pipeline of R&D, from the pre-clinical stage to licensure and 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?

Q20:
Global health interventions cannot be on-size-fits-all in their design. Different contexts across the globe present different cross-sectoral challenges. Global health strategies should commit to ongoing research processes that seek to uncover vulnerabilities and ultimately promote accessible solutions. Strategies that involve community engagement, for example, facilitate empowerment and autonomy, leading to improved outcomes in multiple sectors. Additionally, focus on poverty-related and neglected diseases such as HIV, TB, and emerging infectious diseases should be a priority, as these are exacerbated by inequalities in many sectors.

Q21:
Governments need to recognize the many factors that contribute to risk of infectious diseases and that those risks can be mitigated by focusing on prevention and strengthening global and local partnerships. Adopting a “health in all policies” approach would ensure that a focus on health is always a component of international development. Renewed support for international partnerships would foster a multi-stakeholder, multi-level perspective for tackling the complex challenges posed by global health issues. The impact could be meaningful for improving outcomes for key groups, improving global security, and promoting economic growth in all parts of the world.

Vraag7

Miscellaneous

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

Question 25:
The Netherlands should focus on drawing from the resources that are available domestically and in other high-income settings to strengthen partnerships and facilitate capacity-building in lower resource settings, placing equity at the center of the Global Health Strategy. The government can engage with partnerships to combine efforts in product development, health systems strengthening, and community engagement. There is also a need for more inter-ministerial collaboration in global health contexts, where BZ and VWS can work together more, also in ensuring sustained support of EU initiatives such as EDCTP.

Bijlage