Fiocruz organizes meeting of National Institutes of Health in Rio amid Brazil's G20 Presidency

As a vital part of health systems, the National Public Health Institutes (NPHIs) are meeting for the first time within the context of the G20 from Monday to Wednesday (September 9-11) at the Rio Othon Palace in Rio de Janeiro. Co-organized by Fiocruz, the International Association of National Public Health Institutes (Ianphi), and the Brazilian Ministry of Health, with support from Africa CDC, the G20 National Health Institutes Conference discusses prevention, response, collaboration, and funding for current and future health emergencies, as well as ways to support the bloc's priorities. The event will produce a statement with proposals to be sent to health ministers of the 19 largest economies in the world plus the African Union and the European Union, with Brazil currently holding the presidency.

At the opening ceremony, Health minister Nísia Trindade Lima said that holding this first conference of NPHIs in the G20 context adds to Brazil’s efforts to advance the international health cooperation agenda. "We hope to bring health to the center of central discussions within Brazil's priority of reducing inequities, poverty, and inequalities," said the minister. “We do not want the G20 to be a routine forum among countries, but for health to address contemporary challenges aiming for a qualitative change. For example, when we talk about climate change and health, we often discuss mitigating its effects, but we need to discuss the necessary transformation in our relationship with human health and the health of the entire planet. At this moment, I believe these challenges are extremely important for all health institutes," she added, suggesting that future editions of the conference should be held within the G20 framework.

In a video message, WHO director-general, Tedros Adhanom, emphasized that the time to invest in public health is precisely before epidemics occur. He highlighted that "one of the most important lessons of COVID-19 pandemic is that an advanced medical system is not the same as a strong health system”. “For too long, many high-income countries have invested heavily in high technic medical advances but neglected investments in public health. When the pandemic struck, many of these countries were overwhelmed and struggled with some public functions, such as contact tracing. In contrast, many low-income countries, with fewer resources but more experienced in epidemics, developed stronger public health infrastructures. This illustrates a fundamental principle: the time to invest in public health is before a crisis strikes," said the WHO director-general. 

Contact with the population

At the frontline of the health system, institutes operate both in serving the population and supporting the formulation and implementation of health policies, working together with government agencies in their countries. They are often the ones to detect outbreaks in their early stages, diagnosing new emergencies. Networking allows for the exchange of experiences, training of health professionals, and strengthening of epidemiological surveillance.

Fiocruz president, Mario Moreira, recalled that the roots of the Foundation’s international cooperation date back to the time of Oswaldo Cruz and that it was based on this tradition of friendship and collaboration that the institution proposed the conference within the G20 framework. "It is essential that we have this moment to promote international cooperation and strengthen our national public health institutes, creating synergy with the G20's global health goals and reinforcing the role of these institutions in increasing health system resilience and emergency response," he said. “Together, we will seek strategies to address them through technical, scientific, and political cooperation among us.”

Moreira also noted that Fiocruz is the "scientific, technological, and industrial base of the Brazilian Ministry of Health," and is "a fundamental and important player" in the Brazilian public health system, addressing national demands in a country with continental dimensions. "Our experience in Mozambique has granted us the capacity and, above all, the confidence to advance similar projects. These initiatives are clear demonstrations of the Brazilian government's commitment to strengthening cooperation with other countries, regions, and of the international presence of Fiocruz, with a special focus on the Global South, especially after the sad and difficult times of national isolation," he declared.

For three days, around a hundred representatives from NPHIs of G20 countries, invited nations, and partner institutions will discuss topics such as the relationship between climate and health, equity in care, and the importance of more resilient systems. Participants include institutions such as Fiocruz itself and the CDCs of the United States, China, Africa, and Europe, among others, which have been crucial in detecting epidemics.

In addition to the suggestions to health ministers, participants will discuss ways to support and implement the decisions made by the G20 in their countries, international cooperation, and possible sources of funding. Special emphasis will be placed on the priorities established by the G20 Health Working Group, coordinated by the Brazilian Ministry of Health, such as pandemic prevention and response with a focus on local and regional production of medicines, vaccines, and supplies; equity in health access; and digital health. One of the conference’s objectives is to guide an international cooperation plan to improve NPHI actions concerning G20 agendas.

Without forgeting

Paulo Buss, director of the PAHO/WHO Collaborating Center for Global Health Diplomacy South-South Cooperation, recalled the creation of Ianphi in 2006, during a meeting at Fiocruz headquarters in Rio de Janeiro when he was the Foundation’s president. Buss highlighted the importance of NPHI contributions to the G20 due to their experiences. "Here, we represent our institutes that are part of the health system of each country. So, here we are public servants, serving the health of each of our countries and global health."

Ianphi president, Duncan Selbie, noted that the association now has 123 members in 103 countries. He highlighted three priorities for the three days of work: strengthening surveillance, including climate surveillance; strengthening response through the Global Health Emergency Corps (GHEC); and developing the workforce. “We need to know each other. We need to be able to share information. We need to be able to respond in ways that make sense together,” he said.

Selbie emphasized the importance of breaking the cycle of "facing a crisis, panicking, and then forgetting" and not recognizing the importance of investing in preparedness. "Prevention needs to be seen as an investment, not as a cost. How much would we have saved if we had invested in preparedness before COVID-19? How many more times do we need to learn the same lessons? We have heard about Mpox, avian flu, and other diseases we face as a world. Investing in prevention and preparedness is an investment in health, wealth, and the outcomes we want to see.”

Recurring epidemics

The conference is supported by Africa CDC, which includes 42 member states, and among its strategies is the creation and strengthening of National Public Health Institutes on the continent. Its deputy director-general, Raji Tajudeen, highlighted that the priorities of the G20 Health Working Group align with those of his institution. He recalled that the continent has been facing recurring epidemics of both communicable and non-communicable diseases. "And this has a significant social and economic impact," said Tajudeen.

Recently, the WHO declared the Mpox outbreak a global public health emergency. The continent still struggles with lack of access to medicines, supplies, and infrastructure. “Today, we have a continent of 1.4 billion people, but we only produce 1% of the vaccines we need. We need to reach 60% by 2040, and we are counting on G20 member states to advance this particular agenda. No one is safe until everyone is safe.”

The opening conference was led by Brazilian ambassador Alexandre Ghisleni, head of the Special Advisory on International Affairs (AISA/MS) and coordinator of the Health Working Group. He highlighted the strength of the bloc, and that, each year, the country holding the presidency brings its priorities to the table. Some topics frequently arise, such as digital health, health financing, and pandemic preparedness. “We have priorities. Digital health is one of them. Prevention as well, but from the perspective of strengthening local production, for example. So, there is a certain continuity.” For Ghisleni, the contribution of NPHIs to the G20 can impact global health. “What we do is not just to benefit those around the table. It is of global interest,” he stated.

On its last day, a Declaration, outlining IANPHI's commitment to the priorities set by the G20, will present suggestions and contributions to the bloc’s Health Group. The document will include a reflection on the support requested from the group to strengthen the development and establishment of NPHIs and the systems in which they operate.