Global health and health diplomacy: what to expect in 2022?

We all had some degree of hope that the end of 2021 and the beginning of 2022 would bring us the much-awaited retraction of the pandemic. However, the emergence of the new Omicron variant dragged us away from the end of the tunnel we were longing for. Many countries, including some with powerful health systems, excellent living conditions, and high levels of vaccination, are hitting record numbers of contagions every day.

So far, the challenge on the horizon for 2022 is to overcome the pandemic and the immense sanitary and socio-economic inequality, achieve social and economic recovery founded on an actually more equitable basis, and establish relations with the planet that are definitely more sustainable.

These huge challenges take place in a geopolitical backdrop that deteriorated over 2021. The United States-China dispute now seems to be outlined more clearly as a West-East dispute, with an alliance between China and Russia that is still timid but seems to be coming, and a West with a clearly fragile United States and a hesitating Europe.

Ukraine, Taiwan and the Chinese Sea are in the spectrum of contentions between the world’s current three giants, fronts that should be followed from up close as they may become the theater of confrontations with very heavy consequences for the world, including military ones. The internal American front, where Biden’s plans for recovery are beginning to suffer significant corrosion from the Democrat hordes themselves, does not favor Biden in the international scenario, and he will be facing crucial mid-term elections next November.

On the Asian-Pacific front, the powerful RCEP (Regional Comprehensive Economic Partnership), the world’s largest trade bloc, is already in force - since the first day of 2022. The RCEP was signed in November 2020 by 15 countries of the Asian-Pacific area - ten members of the Association of Southeast Asian Nations (Asean), plus China, Japan, South Korea, Australia, and New Zealand - after eight years of negotiations. It will include the management of health products. China is consolidating its position in its area.

In Latin America, a possible return of a “pink wave” begins to rear its head for 2022, with the election of Gabriel Boric in Chile, joining the other elected “left-wing” presidents in Mexico, Argentina, Bolivia, Peru, and Honduras, where right-wing and ultra-right aspirations were blocked. This year, presidential elections in Colombia, in June, and in Brazil, in October, point to the consolidation of progressive governments in the region. It is possible that these results will be able to restore, including in the health sector, effective regional cooperation and strong joint action of Latin American countries in the international scenario. This may mean the strengthening of the Community of Latin American and Caribbean States (Celac) and even the restoration of Unasur on a new foundation. Argentina will succeed Mexico in the presidency of Celac in 2022, while Brazil remains out of the regional multilateral, which has been discussing many health-related subjects with the support of Cepal, including the cooperative production of vaccines and other consumables in the search of regional sovereignty in this now critical area of the medical-industrial complex.

On the other hand, the United States will be hosting the Ninth Summit of the Americas in early summer this year. One can expect results such as a redesign of relations in the hemisphere; with the weakening of the US in the global scenario and China’s advances in LA-C through agreements with Celac, it is possible that the summit produces a pragmatic redefinition of the North-American policy that is most favorable for the region.

How can all this impact global health via health diplomacy?

One does not need to be an acute observer to notice the growing presence of health in the global scenario. The pandemic, its evolution and new possible threats of the same kind are being included in the calculations of all of the world’s leaders and all multilateral, global or regional dimensions.

The first round of global health in 2022 will take place between 24 and 29 January at the meeting of the Executive Council of the World Health Organization (EC/WHO), consisting of 34 member states. The Council defines the agenda and the resolutions to be adopted at the World Health Assembly (WHA) in May 2022. It is presided by Patrick Amoth, from Kenya. Argentina occupies one of the vice-presidencies.

The list of issues to be debated by the EC/WHO is long and includes examining the result of the WHA’s Extraordinary Session, held in November 2021, to consider the development of a convention, agreement or other international WHO instrument on the preparation and respond to pandemics. The result of this special session was pointing at the distant year of 2024, when the 77th World Health Assembly will be held, to present its conclusions and recommendations. Incompetence or irresponsibility?

Other than the pandemic, many other topics are on the list to be discussed, including non-transmissible chronic diseases, mental health, cervix cancer, epilepsy and other neurological conditions, obesity, alcohol abuse, nutrition of mothers, babies and children, innocuity of foods. In the field of infectious diseases, in addition to COVID-19 the Council will also be examining proposals and resolutions on preparation and response to public health emergencies, HIV, viral hepatitis and sexually transmitted diseases, tuberculosis, vaccines and immunization programs, polio, and influenza.

Five South-American countries have seats in the Council (Argentina, Colombia, Guiana, Paraguay and Peru), in addition to two members of the Community of Portuguese Language Countries, Guiné Bissau and Timor East. An articulation of these countries could create a consistent front of interventions and votes to influence the best possible configuration in the resolutions that will be adopted in May 2022 at the World Health Assembly. Argentina has just taken its seat as president of the United Nations Human Rights Council. Health has been gaining thematic importance in the HRC, including human rights during the pandemic, tackling the right to access to consumables to fight COVID-19.

The small club that is the CPLC is getting ready for a meeting of Ministries of Health, in February. To prevent this from being a rhetoric event, Brazil and Portugal must commit to helping African countries whose official language is Portuguese in the context of consumables to fight the pandemic, including vaccines.

In April, China will be hosting the second part of the Biodiversity COP15. Should it fail, we know that new pandemic infirmities will be challenging humanity in the future.

Conclusion

The COVID-19 pandemic has shown it is actually a syndemic. A syndemic has multiple combined causes that transcend the traditional agent-host relation (coronavirus-human being), and because it has consequences that go beyond disease and death.

The coronavirus originated in environmental changes that promoted virus spilling between species, as explained by the One Health approach, and the distribution of the disease is conditioned to economic-social factors, as explained by the thousands of epidemiological studies done all over the world. On the other hand, the consequences of the pandemic deeply impact social and economic conditions all over the world, making it more difficult to return to social normalcy, as pointed out by hundreds of global reports.

A disease with multiple causes must also have multiple responses. To fight a syndemic is necessary to provide responses of all governments, all society types. Adequate national responses are not sufficient either. What we need are properly coordinated global responses.

The historical role of the United Nations in the fight against global crisis must also be activated in this COVID-19 syndemic. This pressing issue must be urgently discussed by the United Nations Assembly and by the entire global and regional multilateralism in September 2022: not only the pandemic, but also how to eliminate, reduce or mitigate socio-economic inequalities, aggressions to the planet and the political crisis of lethargy and indifference of multilateralism when facing the causes of this world that is diseased from the social, economic, environmental, and public health points of view.

*Paulo M. Buss is the director of CRIS/Fiocruz, president of ALASAG and a member of the National Academy of Medicine. This article was originally published on Le Monde Diplomatique Brasil