G7 responds to “If not us, who?” with “Not us.” So where are we now with the global health cooperation agenda, ask Kent Buse and Katri Bertram

There was a time when the G7 made deep and strong commitments on global health—and largely met them. For example, what was then the G8 founded the Global Fund in 2000 in Japan and the Muskoka initiative in 2010 in Canada, focusing political commitment and mobilising billions of dollars to tackle AIDS, tuberculosis, malaria, and maternal and child mortality respectively. These commitments transformed—and saved—the lives of millions of people in low- and middle-income countries (LMICs). 

The 2021 G7 Carbis Bay Communique tells a different story. At a transformational moment, in the midst of the biggest pandemic in a century, one might have expected a series of bold commitments to end the global pandemic as quickly as possible, addressing challenges such as vaccine equity, as well as fundamentally resetting global health collaboration as recommended in the report of the Independent Panel on Pandemic Preparedness and Response. 

One might have expected such leadership from the G7, not least because less than a month earlier, speaking at the Rome Global Health Summit, German Chancellor Angela Merkel had raised the question, “if not us, who?”

Instead, G7 leaders delivered five pages on health and a four-page annex full of rhetoric, citing the health ministers’ communiqué. G7 leaders made few concrete, strong, or deep health-related commitments at Carbis Bay. In doing so, the G7 has renounced its role as global health leader. The richest countries fell far short on vaccine donations, committing only a billion new doses to COVAX. 

We are particularly concerned that it barely engaged with the recommendations laid out by the Independent Panel and strongly backed the United Nations Secretary-General. While it acknowledged the proposal for a Pandemic Treaty, a Global Health Threats Council, and reforms to pandemic financing; and gave a nod to strengthening WHO, mentioned human rights and gender, and committed to establishing a stronger global surveillance network, it failed to indicate how it might support any of these initiatives. It also failed to commit to the much-needed technology transfer for production of vaccines beyond voluntary licensing and transfers.

The G7 has not risen to the challenge, responding to the question “if not us, who?” with “not us.” This can’t be seen as anything other than an historic missed opportunity for real leadership, genuine solidarity, and much needed reform to the system of multilateral cooperation on health.

The multilateral system, which to date has depended on G7 charitable contributions—to countries, to programmes, and to WHO—is left in limbo. The G20 in Rome failed to deliver more than “guiding principles.” BRICS have gone further in their recent call for multilateral reforms, and responses to covid-19 that include tackling vaccine patents. Yet, as with Carbis Bay, each summit communique points fingers at others to act.

Yet the demands of the Independent Panel were more challenging than the dispensation of charity through their aid budgets. They called for genuine political reforms: more power to WHO, more pooling of sovereignty and accountability, and mobilising and meaningfully engaging civil society. They also called for full funding and immediate vaccine donations at scale to COVAX and greater urgency around TRIPS waiver negotiations. The G7 has not addressed any of these systemic recommendations, and has caveated vaccine donations with a wildcard “when domestic situations permit.” Such vaccine nationalism and insufficient donations continues to block COVAX from becoming effective. And by continuing to block TRIPS waiver negotiations, it has left LMICs both without charitable contributions or means to produce their own vaccines.  

Time is running out to implement urgent reforms to ensure that future pandemics do not again cost millions of lives and trillions of dollars by becoming endemic. Implementation of existing recommendations to tackle covid-19, and reform the multilateral global health system, as recommended by the Independent Panel, must begin immediately with a more coordinated and systematic approach of the G7 and G20. But we also need a more fundamental shake up: 

1. 1. The multilateral health architecture, with its longstanding fragmentation, must be reformed so as to address multi-sectoral and societal drivers of health (gender, commercial, education, climate, etc.). We suggest that a neutral institution convene a process to better understand and propose solutions to address the political barriers that have hampered the implementation of past reform ideas.
   2. The current maldistribution of power and privilege must be addressed. The current model relying on charitable leadership from the G7 needs to be replaced with a model that is more inclusive of the wider membership of the UN. 
   3. Values-based cooperation with a people-centered approach at its core must complement institutional reforms. Communities and civil society must be meaningfully engaged and play a central role in agenda setting, prioritisation, funding decisions, and accountability.
   4. Transparency and accountability for commitments—including through better disaggregation of data to understand who wins and loses—must become the norm in global health. Citizens need to be able to track how grand rhetorical commitments are translating into action, have insight into who profits from taxpayer funds (whether ODA or domestic), and be able input and feedback into decision-making and funding decisions.

The Rome and Carbis Bay summits have shown that the G7 and G20 are not willing to step up, but have rather stepped back, in the face of the ongoing global pandemic. Global health cooperation is left in limbo. As with the climate emergency, and gender equality, it is time to rethink global health, upend current power structures, and reinvigorate global health with the commitment, action, and inclusive engagement that is needed.   

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

Katri Bertram, Founding Partner, Partners for Impact (PFI)

Competing interests: none declared.