'No one is safe until everyone is safe': This year's UNGA calls for health for all

The agenda for the 78th United Nations General Assembly (UNGA) was characteristically ambitious, as global leaders convened in New York for six days in September to discuss and debate the world's most pressing problems, from poverty to climate change to the war in Ukraine.

And at this year’s UNGA, global health played a major role, with three of the four high-level political declarations coming out of the gathering focused on protecting the world from future pandemics, achieving universal health coverage, and working to end tuberculosis (TB).

As the world continues to deal with the consequences of being caught off-guard by COVID, the General Assembly's first-ever high-level meeting on pandemic prevention, preparedness, and response (PPR) aimed to get governments working together to strengthen global health security before the next major global health threat hits. Delegates adopted a declaration acknowledging the need for stronger international collaboration and coordination to avoid a repeat of the catastrophic health and socio-economic impacts of the COVID pandemic. Recognizing that the pandemic disproportionately impacted low- and middle-income countries (LMICs), the declaration noted that 84% of states are still experiencing disruptions in at least one essential health service.

On what Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), called "a historic day for public health," member states committed to working towards ensuring everyone has "equitable and timely" access to lifesaving medical countermeasures, including vaccines, technologies, and diagnostics. To that end, the declaration called for better sharing of good practices, challenges, and evidence – for example, genomic sequences – through measures such as mutually agreed technology transfers and voluntary patent pools. It also encouraged more investment in local and regional vaccine production, especially in LMICs.

Member states resolved to use training, recruitment, and job development to build up the global supply of health workers and combat brain drain from developing countries, as well as to protect those working on the frontlines of global health from harassment, stress, and lack of adequate infection controls.

The wide-ranging declaration also pushes member states to finish work on the Pandemic Accord, a legally binding agreement on principles, priorities, and targets for pandemic preparedness and response, with the final proposal due May 2024.

"The pandemic literally punched holes into our social protection systems and safety nets," said General Assembly president Dennis Francis at the opening of the High-Level Meeting on PPR on Sept. 20. "The mantra of no one is safe until everyone is safe demands that in times of a pandemic all nations unite and act in solidarity."

Throughout the week, speakers stressed that the world's ability to deal with future pandemics relied on achieving health for all. At a side meeting on what global leaders need to do to prevent the next pandemic crisis, Dr. Juan Pablo Uribe, Global Director for Health Nutrition and Population at the World Bank and Director of the Global Financing Facility for Women Children and Adolescents, said without equitable, affordable access to healthcare and financial protections that allow people to get care when they need it – for example, to make sure they can afford to take time off work to visit a clinic – populations become more vulnerable to pandemics and our capacity to respond is weakened.

"Before the COVID pandemic, access to essential health services had stagnated. And the financial protections that our systems were providing to our most vulnerable people … were going down," Uribe said. "We're talking about countries where the most basic needs are not being met on a day-to-day basis, and we're asking them to have a pre-emptive capacity to respond to a future (pandemic) risk."

Countries can't afford to neglect their health systems as they work to protect themselves from the next pandemic, Uribe added. "We need to show with our actions, with our budgets, with our investments that health systems as a whole are a priority," he said. "If health systems remain on the sidelines of government priorities, we will not be better prepared."

The focus on equitable access to healthcare continued at the high-level meeting on Universal Health Coverage (UHC), when delegates approved a declaration that recognized "every human being has the right to the highest attainable standard of physical and mental health." UHC ensures that everyone has access to the full range of quality health services they need, when and where they need them, and without facing financial hardship.

At least 4.5 billion people – more than half of the global population – were not fully covered by essential health services in 2021. The declaration, which has not been formally adopted by the General Assembly yet, stressed the responsibility of governments to find the motivation and the money to make UHC a reality, highlighting the dire underfunding of national health systems and the shortage of health workers. The WHO projects a shortfall of about 10 million health workers by 2030, mainly in LMICs.

A running theme in the meeting was the importance of international cooperation and solidarity in efforts to close the gaps in access to care, especially in developing countries. Working together to strengthen primary healthcare systems around the world is crucial to achieving UHC, many of the speakers said. There were also calls for a global budget for national investment and international support for extending health coverage in crisis areas.

Rebecca Akufo-Addo, First Lady of Ghana, meanwhile, urged developed countries to help LMICs access and distribute generic medicines. “Let's make the political choice of universal health coverage,” she said. “Health must be accessible to all. If we want to, we will get there."

At the third high-level summit on health, member states approved a political declaration reaffirming their collective commitment to end TB by 2030. After falling between 2005 and 2019, the annual number of deaths from the disease started to rise again in 2020, and in 2021 it killed about 1.6 million people.

Through the declaration, countries resolved to continue to support the WHO's Multisectoral Accountability Framework to monitor and track progress to end TB. They also committed to implementing national tuberculosis strategic plans or health strategies with multisectoral approaches, recognizing that TB disproportionately affects certain groups – such as vulnerable and disadvantaged populations as well as those living with medical conditions including cancer, diabetes and HIV – and that the disease contributes to the cycle of ill health and poverty.

“Why, after all the progress we have made – from sending a man to the moon to bringing the world to our fingertips – have we been unable to defeat a preventable but curable disease that kills over 4,400 people a day?” asked Francis, before leading the audience in a chant of “End TB! End TB!”

Other notable events at this year's UNGA that addressed global health issues included:

• A high-level side event that spotlighted the crucial role community-based health care plays in moving the world toward UHC, with a focus on how those systems can include support for mental health and disability responsive interventions. As an example of a successful model, the meeting looked at the Sheikh Hasina Initiative of Community Clinics in Bangladesh, where about 14,500 community clinics around the country operate as one-stop service centers for health, family planning, and nutrition, as well as for screening mental health and neurological disorders. The model has considerably improved healthcare delivery at the grassroots level – especially to women and children – as it boosts access to low-cost or no-cost healthcare resources, including 30 essential drugs, contraceptives and insulin.
• A meeting calling for member states to commit to finding a combined approach to fighting eliminable diseases and building resilient health systems. The meeting highlighted the progress Southeast Asia has made on disease elimination – of the 50 countries that have eliminated at least one neglected tropical disease, seven are in the Southeast Asian region.
• A high-level sideline event urging governments to put women, children, and adolescents at the center of global health efforts. South African President Cyril Ramaphosa said securing the health of those groups will "fundamentally improve the health and well-being of all humanity." According to UNICEF, 15,000 children under 5 die every day, most of them from preventable causes. Ramaphosa noted that if, between now and 2035, member states invested $5 per person per year in health systems and high-impact health interventions for women and children in high-burden countries "the value of the economic and social benefits would be nine times greater than that amount."