 "Gautam I Menon is the Dean of Research at Ashoka University")
The nations that form the G20 account for the bulk of the world’s economic output, as well as for about 60 per cent of its population. The G20 grouping allows its member countries to coordinate approaches to policy on trade, health, climate, and a number of other issues.
India’s assumption of the presidency of the G20 in 2023, forming the G20 troika with Indonesia and Brazil, marks the first time that the troika has been constituted solely by members from Low and Middle-Income Countries (LMICs). This should be an opportunity to shape action, particularly in health care, toward their needs.
What could these countries do together that might make a difference in the future?
In health, India has identified the following priorities: health emergency prevention, preparedness, and response, with a special focus on OneHealth and anti-microbial resistance; the strengthening of cooperation in the pharmaceutical sector with a focus on access to safe, effective, and affordable medical countermeasures, as well as digital health innovations and solutions to aid universal health coverage and the improvement of healthcare service delivery.
The Covid-19 pandemic exposed deep vulnerabilities in the capacity of countries to deliver health services in a pandemic situation. The world failed, through much of the Covid-19 pandemic, to address inequalities in vaccine access between high-income and low-income countries. The lessons learnt from this failure must inform future policy.
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Of emerging infectious diseases, three out of four spill over to us via animals that are their primary or intermediate hosts (i.e. are 'zoonotic'). One cannot separate human health from animal health or, even more broadly, the health of entire ecosystems. This is the OneHealth philosophy. It aligns well with the 'One Earth, One Family, One Future' theme for the G20 articulated by Prime Minister Narendra Modi.
Add the impacts of future climate change and the need for a OneHealth perspective becomes even more urgent. Most people will experience climate change through their connections to water: three-quarters of all the natural disasters are linked to water. When climate refugees abandon large sections of the world’s low-lying areas, as sea levels rise and saltwater intrudes into aquifers, they will crowd into already over-populated cities, increasing the risk of infectious disease spread.
Climate-change-driven food stresses will exacerbate existing inequalities. Apart from these, the predicted increase in frequencies of extreme events, with droughts, wildfires, and storms among them, add further unpredictability, with consequences for mental and physical health.
Another clear danger to human health is the increasing ability of the bacteria that cause disease to evade antibiotics. The pace of antibiotic discovery has slowed greatly in the past decades. The costs of bringing new drugs to market impose substantial barriers.
Dealing with anti-microbial resistance involves improving our current stewardship of antibiotics. It also requires a better understanding of those social determinants of disease that contribute to antibiotic misuse.
Developing nudges that encourage more rational use of antibiotics at the individual level, as well as shifts in government policy to penalise indiscriminate antibiotic use, is an area where G20 countries could share lessons and seek common ground. Political leadership is essential here.
Covid-19 has illustrated how gaps in vaccine distribution, exacerbated by hoarding, place an undue burden on poorer countries. Multi-lateral initiatives that address the interests of LMICs in this regard must be strengthened. Diversifying locations where vaccines and drugs are made, while enabling the transfer of the appropriate technology, would contribute to greater equity.
Here, India, the largest manufacturer of vaccines in the world, could provide leadership.
Lastly, digital health. The ability to maintain a long-term, accessible record of the trajectory, medical reports, and treatment regimes of individual patients, transferable across states and possibly across countries, will be an increasingly important dimension of health in the future.
To this end, India’s Ayushman Bharat Digital Mission, launched in 2020, envisages a national health ecosystem, accessed through a Unified Health Interface. It provides a unique health ID to each Indian citizen, called the ABHA number. The mission, at the outset, assumes digital health to be a public good, placing interoperability within this ecosystem as a key priority.
More than 360 million Indians, a number in excess of the population of the US, have so far been issued ABHA numbers.
India’s experience with digital health should be useful to other LMICs. But, alongside, we must also engage in conversations regarding the privacy and security of health data, the elimination of the digital divide, as well as the requirement of balancing public good with privacy when we seek to personalise medicine. These should form part of the G20 deliberations.
Mahatma Gandhi said, “Recall the face of the poorest and weakest man you have seen, and ask yourself if this step you contemplate is going to be any use to him”.
One would do well to keep these words in mind when formulating policy, and not just for health.
(Gautam I Menon is the Dean of Research at Ashoka University, Sonepat. He also heads its Centre for Climate Change and Sustainability. The views expressed are his and do not represent his institutions.)
Disclaimer: These are the personal opinions of the writer. They do not reflect the views of www.business-standard.com or the Business Standard newspaper
Disclaimer: These are personal views of the writer. They do not necessarily reflect the opinion of www.business-standard.com or the Business Standard newspaper
