As the world finds its way towards recovering from the devastating impacts of the Covid-19 pandemic, the G20 summit could have taken a key role in health outcomes required for the recovery as well as for preparing for the future. The G20 rhetoric to strengthen health systems and build regional and local manufacturing capacities especially in low- and middle-income countries raised expectations, yet the outcomes fall short of the commitments required towards these goals. The leaders’ declaration fails to commit to actions that can truly transform existing health systems to address the health needs of all and put people’s health above profits.  

PSI is concerned that the summit’s flagship outcome on health, the ‘Pandemic Fund’ housed at the World Bank, is neoliberal business as usual. The fund appears to serve the existing system where the private sector sets the agenda of global health governance.  

Further, the outcomes have failed to deliver on key areas: 

Health workforce rights: The declaration lacks any commitments on securing decent work and the rights of the health workforce. To build resilient health systems, countries will have to not only invest in the skilling of the health workforce, but fund the employment of enough health workers to meet the severe shortfalls in the numbers of health and care workers, and ensure fair wages, secure employment and working conditions free of harassment, violence, and labour rights violations. 

Greater public investment in health: The joint task force of the health and finance ministries have failed to deliver on the need of the hour: increased public spending on health. Even with the glaring evidence of the failure of the private health sector in addressing health needs, the declaration continues to promote the role of private players in health, including as public-private partnerships which entail public subsidisation of private profit-making and which as abundant evidence shows, does not work. It remains vague on the commitment of G20 leaders to increase public funding of national health systems.  

Local manufacturing of health products: Learning from the pandemic, any efforts in establishing regional hubs for research, development, production, and supply of vaccines and medical countermeasures need to be publicly owned and led. While the declaration acknowledges the need for increasing regional cooperation towards promotion of local manufacturing, its emphasis on public-private partnership in achieving the goals, and on voluntary mechanisms for sharing of technical information and know-how completely ignores the lessons learnt in the ACT-A initiative. The ACT-A established as a public-private initiative encouraging voluntary sharing of information by the pharmaceutical companies involved in COVID-19 vaccine manufacturing failed to achieve its objectives as none of the private pharma companies agreed to share information. This, while the research for developing the vaccines was funded almost entirely by public money. 

IP barriers: Although the TRIPS waiver proposal was crushed by the WTO, governments can still sidestep patent barriers by committing to make full use of the existing TRIPS flexibilities. In light of the current experiences of vaccine inequity and its crippling impact on human lives, G20 member states should have committed to measures ensuring use of the TRIP flexibilities in the declaration. Instead, the declaration only acknowledges and accepts the decision of the 12th WTO Ministerial Meeting. 

PSI along with our Indonesian affiliate FARKES Reformasi took active part in the C20 that worked to develop priority concerns on health to be addressed by the G20 states. The C20 Working Group on Vaccine Access and Global Health had raised all the above concerns in the several rounds of communication with the G20 Health Working Group. While it is disappointing to see that the leaders’ declaration failed to address most of the issues, PSI is committed to continue working with our affiliates, and other civil society groups in global and regional platforms like the G20 to advance rights of the health workforce and in turn build quality public health services.