Rome offered G20 Leaders who met last week their San Francisco moment. San Francisco provided the venue in 1944 where world leaders took stock of the profound dislocation wrought by the second world war and agreed the then radical system of multilateral cooperation that has evolved into what serves us today—albeit at times inadequately. 

There is no escaping the fact that it has not been an easy year for leaders, health ministers, and their officials. Demands have been relentless, and amidst the uncertainty and tragedy wrought by covid-19, a maelstrom of advice and critique have been dispensed in large and equal measure. 

Nonetheless, one cannot but feel disappointed, even dismayed, by the Declaration following the Rome Global Health Summit on 21 May, which does not reflect any sense of the need for prioritised and urgent action. After all, leaders have had over a year to bear witness to an unfolding pandemic; and ample time to learn that me-first, me-alone nationalistic responses offer little in the way of effective and sustainable protection against health threats that confront and unite us in our globalised world. 

Moreover, and crucially, leaders had in front of them a roadmap of recommendations laid out in a recent report from the Independent Panel for Pandemic Preparedness and Response—which they failed to directly acknowledge in their Declaration. The Report by the Independent Panel sets out a number of immediate actions that the international community must take to save lives now. These include providing at least one billion vaccine doses to the 92 low- and middle-income countries who are part of the Gavi COVAX Advance Market Commitment,  no later than 1 September 2021. G7 countries need to provide 60% of the US$ 19 billion required for ACT-A in 2021, and WTO and WHO need to convene major vaccine producing countries and manufacturers to get agreement on voluntary licensing and technology transfer arrangements for covid-19 vaccines. 

Yet equally, if not more importantly, the Independent Panel proposed a set of far-reaching actions to transform the global institutional architecture for health to help prevent and manage future pandemics. These include establishing a Global Health Threats Council (led by heads of state), adopting a pandemic treaty, vesting greater powers (and autonomy) in the World Health Organization, establishing an International Pandemic Financing Facility, and formalising universal periodic peer reviews of national pandemic capacities as a means of accountability and learning between countries. In effect, leaders were presented an agenda for a San Francisco global health moment.

And beyond the lessons and the roadmap, perhaps for the first time in generations, health is at the very top of political agendas and public concern in all regions of the world. Rome undoubtedly provided a unique moment to be seized with vision, boldness, and resolve for a reset of the global health ecosystem. 

The Summit was co-convened by the G20 Italian Presidency and the European Commission. Unusually, the outcome document revolved around a set of 16 “principles and guiding commitments.” The Summit’s webpage asserts that “Principles can be a powerful guide for further multilateral cooperation and joint action.”  

While the principles, such as solidarity, use of scientific evidence, and listening to diverse voices are to be welcomed, it is hard to accept that at this crucial moment they can be seen as an adequate substitute for real commitments with targets, specific timeframes, and resources. Particularly given their general nature i.e., “support and enhance the existing multilateral health architecture,” or “ensure full implementation of the International Health Regulations.”

Commitments can be judged according to whether they are binding or non-binding in legal form, deep or shallow (i.e., defined by how much they require change from the status quo) and strong or weak in terms of monitoring, enforcement, and sanctions in relation mechanisms to incentivize compliance. In relation to assessing G7 and G20 commitments, Kirton et al of the G20 Research Group suggest discreteness, specificity (i.e., measurability), future orientation, ambition, and timeliness as important factors which inform their quality. 

The lack of hard commitments is illustrated by the use of “voluntary” no less than three times in the Declaration as in: “…voluntary licencing agreements of intellectual property, voluntary technology and know-how transfers,” and in reference to the principles themselves—“voluntary orientation for current and future action for global health…” In the context of a global pandemic and with ambitions to reset the global health architecture, these leaders fell back on voluntarism. At the Summit, co-host and President of the European Commission, Ursula von der Leyen asserted that the G20 would hold itself accountable for progress at the G20 Heads of State meeting in October—but without specific commitments, what does it mean to be accountable for a “voluntary orientation?”  

By any set of criteria, the guiding commitments set out in the Declaration seem half hearted and lacking in conviction. It would be naïve to think that G20 leaders have the political leeway of the Independent Panel in terms of committing to radical transformations. And it would be equally fanciful to believe that all members of the G20 could agree on all aspects and the exact level of ambition of the much-needed overhaul of the system envisioned by the Panel. At the Summit itself, a number of leaders did refer to some of the reforms set out in the report of the Independent Panel. Nonetheless, the failure to get beyond first principles in the Declaration is hardly what one would have expected in light of the gravity of the situation and the opportunity at hand. 

Ursula von der Leyen tweeted that “The first G20 summit on health marks the beginning of a new chapter in global health policy.” While that remains to be seen, what is the case is that we see differences in the health priorities and the quality of commitments made in BRICS, G7, and G20 communiques. Is it a vain hope that the G7 meeting in June produces stronger and deeper outcomes? We will only get what we demand and, as such, we call on the G7 to make meaningful political commitments to ensure that the recommendations of the Independent Panel are fully realised in a timely way to ensure that the covid-19 pandemic is the last pandemic that the people around the world have to endure—as the title of the Independent Panel’s report demands.

Kent Buse, Director, Healthier Societies Program, The George Institute for Global Health

Yogan Pillay, Affiliate, Centre for Innovation in Global Health, Georgetown University

Competing interests: none declared