Health topics at the G20 meetings in 2017

Health is essential – and without it people neither can educate themselves, nor work and look after their families. Without health there is no productive agriculture and no guarantee that public and private investment will yield sustainable results in all fields. Furthermore, in today’s globalized and interconnected world, health problems in one country may quickly affect other countries. These are findings which were included in the program of G20 meetings in 2017 attended by representatives from 20 industrial and emerging countries, who got together several times before and for the actual summit in Germany. In this context, the German Ministry of Health had an important role to play. Among a set of responsibilities, it was the host of the G20 health ministers meeting.

The science academies of the G20 countries met earlier on in March 2017 focusing on the topic of global health care in their recommendations to their countries’ governments. Under the auspices of the Leopoldina Akademie der Wissenschaften (German Academy of Sciences), they issued a paper with the heading: "Improving Global Health - Strategies and Tools to Combat Communicable and Non-communicable Diseases" at the Science20 Dialogue Forum on March 22, 2017. They stress that any expansion of international cooperation promoting global health care should be guided and assisted by scientists. The academy believes that the development of resilient health care systems in all countries and the distribution of findings on health and hygiene are success-factors for progress. They recommend the extension of vaccinations programs combined with measures strengthening people’s trust in vaccinations. Worldwide access to diagnostics, medicines and medical devices at affordable prices should be made possible.

The vfa (German Association of Research-Based Pharmaceutical Companies) issued a press release to comment on the paper.

As part of the B20 health initiative, high-ranking industry representatives of the G20 countries also developed recommendations on global health care. It was published in May 2017 in a joint Policy Paper “Stepping Up Global Health – Towards Resilient, Responsible and Responsive Health Systems“. Also this alliance stressed the importance of developing and expanding efficient health systems in places where they currently do not exist. Furthermore they very much believe that, as far as solutions for antimicrobial resistance, neglected tropical diseases (NTD) and epidemic prevention are concerned, research & development will offer solutions. The initiative advocates public-private partnerships (such as the Coalition for Epidemic Preparedness Innovations, CEPI). This is the ideal way to promote research and product development with the goal to battle infectious diseases but also for all aspects associated with the fight against neglected tropical diseases. At the same time, the B20 Health Initiative underlines the need for innovation-friendly economic systems that provide the necessary incentives for the research and development of new medicines and measure the value of new medicines based on their benefit for the patients.

As far as antibiotic research is concerned, the initiative explicitly recommend that the G20 member states support the public-private partnership “Global Antibiotic Research and Development Partnership“ (GARDP) and “Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator“ (CARB-X) (Germany is already committed to the GARDP partnership). The alliance point out that in many countries, apart from the multi-resistant germs prioritized by the WHO, multi-resistant tuberculosis bacteria are also very relevant. Apart from incentives to promote the research into new antibiotics, the prevention and responsible use of antibiotics should be encouraged. Access to new and existing antibiotics should also be provided to those countries that, under current circumstances, cannot afford them. The G20 states should, in conjunction with industry, develop suitable funding mechanisms. In addition, they should help poorer countries to establish monitoring systems that provide data on the resistance situation in the respective country.

Finally, the industry experts recommend the promotion of “Digital Health”. The G20 states should improve the networks required for the transmission of health data and the use of big data for health care provision and simultaneously ensure the protection of personal data. To do so, standardized rules and internationally valid guidelines should be developed such as the "OECD Recommendations on Health Data Governance". Furthermore, the experts believe that international technical and semantic standards must be established that facilitate the exchange and the combining of health data. They also insist on substantial investments into the network infrastructure. According to them, the expansion of effective digital networks facilitating procedures such as remote diagnosis and e-learning could greatly improve the health care provided to patients. In particular those affected who live in rural areas in the emerging and developing countries. This would help to achieve the sustainable development goals in the health sector.

During the May 2017 meeting organized by the B20 Health Initiative, the AMR Industry Alliance was set up. In this context several industry sectors (including research-based pharmaceutical companies, generic producers, diagnostics, medical technology and biotechnology companies) want to work together to help fight antimicrobial resistance. They base their activities on the "Declaration by the Pharmaceutical, Biotechnology and Diagnostics Industries on Combating Antimicrobial Resistance" issued at the Economic Forum in Davos in January 2016.

On May 19 and 20, 2017, the health ministers of the G20 states met for consultations on global health in Berlin. It was the first meeting ever of the health ministers of the G20 group of countries.

One of the topics covered at that meeting was the improvement of global health crisis management. The Ebola epidemic in 2014 revealed the need for better and faster coordination between countries, supranational organizations such as the WHO, aid organizations and companies (among them producers of vaccines and therapeutic medicines). Another issue that was discussed at the ministerial conference was the trialing of communication and notification channels between states and organizations. To this end, a pandemic crisis exercise was conducted during the meeting.

Closely connected is the need to strengthen the health infrastructure in poorer countries. Those countries must put in a position that they can adequately respond to a developing epidemic. In addition, a situation where, in the wake of such epidemics, health care for patients with other diseases collapses, would be less likely. This was another subject addressed by the ministers. Generally speaking, health care systems should be strengthened to ensure that goal of “universal health coverage” announced by the United Nations in 2015, i.e. of health care services for everyone including those who live in poorer countries, can be met. According to the ministers, health is essential for the economic development and social cohesion of any country. The necessary health care services do not just include specific therapies but also measures promoting hygiene and access to clean water. All this, they stressed, required sustainable funding.

During their consultations on the problem of antimicrobial resistance the G20 health ministers referred to the 2015 recommendations of the G7 states and the World Health Organization WHO. The German Health Ministry issued the following statement: “If antibiotics are no longer effective, one of the indispensable pillars of our health care system is collapsing. Based on the German Antimicrobial Resistance Strategy, Germany is leading the way in the battle against antimicrobial resistance. The efforts – whether they target hospital hygiene, a considered use of antibiotics in human and veterinary medicine or the development of new active ingredients – must also be continued internationally as part of the G20 presidency.”

The health ministers concluded their meeting by issuing the "Berlin Declaration of the G20 Health Ministers". The vfa (German Association of Research-Based Pharmaceutical Companies) issued a press release to comment on the declaration.

During the Civil20 Summit, which took place in Hamburg on June 18-19, 2017, international representatives of Non-Governmental Organizations (NGOs) – the Civil20 or C20 – finalized their “Recommendations to the G20” on how to shape globalization. One chapter deals with global health. They handed it over to the German government.

The C20 group consists of national and international civil society organizations. On an annual basis they convene to engage with and provide content to the work of the G20 and to speak with one voice on behalf of the international civil society on globally relevant topics. Since 2013 the C20 have been officially recognized as an “Engagement Group” of the G20.

In the battle against antimicrobial resistance the group recommends giving priority to the development of therapeutics and vaccines against tuberculosis. National contributions to the WHO should be increased and the WHO itself should be reformed and strengthened.

The C20 believes that in order to strengthen the health care systems of poorer countries, the goal must be to work towards “universal health coverage” (see above).

On July 07 and 08, 2017, global health was on the agenda of the G20 Summit in Hamburg. In the “G20 Leader’s Declaration”, the heads of government reaffirmed many of the positions included in the declaration issued by the health ministers (see above).

The vfa (German Association of Research-Based Pharmaceutical Companies) issued a press release to comment on it.

Whenever sudden health crises caused by epidemics arise, pharmaceutical companies are confronted with the request to provide – ideally within weeks – vaccines or therapeutics that in most cases, however, have not even been developed. Swift development is prevented by the costly and lengthy development steps required to create a new vaccine. In the case of the Ebola crisis in 2014, one did at least manage, with the help of the authorities, pharmaceutical companies and aid organizations, to greatly accelerate the trialing of vaccines that, up to that point, had only been tested on animals. Nevertheless, until this day, no Ebola vaccine has reached the licensing stage although one is about to be submitted for licensing.

This demonstrates that a more effective global crisis management requires not just organizational but also medical and pharmaceutical preparation. An important step could consist in developing, as a preventative measure, vaccines against certain infectious diseases that are currently considered as “exotic” and establishing technologies that, whenever the need arises, facilitate a much faster development and production of vaccines than is feasible today. Research-based pharmaceutical companies are involved in a variety of projects to this end; since 2016, their work has been systemized and intensified by the Coalition for Epidemic Preparedness Innovations (CEPI)).

As far as the strengthening of health care systems is concerned, the vfa welcomes the fact that projects related to global health are increasingly led by the insight that problems affecting poor regions cannot simply be solved by providing medical goods at reduced prices but require the establishment and expansion of a genuine health infrastructure.

The research-based pharmaceutical industry has been helping to overcome the problems caused by antimicrobial resistance and is engaged in discussions with other stakeholders to see how this work can be intensified. The development of new antibiotics will, however, only make sense and be helpful if effective efforts are undertaken to prevent new resistance from developing and spreading in the first place.