Imagine you are attending a panel held by the largest conference in your field and none of the panelists show up. This was the scene at AIDS 2022, a conference held in Montreal this past July, by the biggest AIDS advocacy organization – the International AIDS Society (IAS). The scene was captured in a picture shared on Twitter, and over 900 times with over 2,300 likes. The presenters at this panel discussion, all from low- and middle-income countries, had either been denied a visa or had their visas delayed. The photo is a symptom of the systemic inequity of how global health information and opportunities are inequitably distributed. However, it also represents an opportunity for an exciting solution – moving conferences to visa-friendly countries.
The opportunity to participate in major global health events remains unfairly tilted in favor of global health practitioners in high-income countries. Between 1997 and 2019, 71% of major global health conferences were held in high-income countries. This disparity generates inequity by imposing hardships on participants in low- and middle-income countries.
The result: those who see and experience the majority of disease burden, are a minority among attendees.
We, a Peruvian plastic surgeon and an Australian physician, through our work as global surgery fellows know the invaluable professional and personal growth we have obtained through global health collaborations. Recently, we had the opportunity to directly experience the value of the global health community coming together at an international conference in the UK. However, the experience was tainted as multiple colleagues in low- and middle-income countries were unjustly unable to attend due to visa issues because they did not have the “right” passport to their name.
Visa struggles are an issue for only 9% of European and North American academics while their counterparts in Africa and Asia face challenges to a significantly higher degree – 33% and 40% respectively.
To see the real life implications of the visa burden we only need look at the AIDS 2022 conference where many participants in low- and middle-income country suffered time and financial losses due to rejection of their visa applications. Prof. Adeeba Kamarulzaman, the IAS president, acknowledged this when he stated that there were “high numbers of denials and pending visas that prevented many registered delegates, including IAS staff and leadership, from entering Canada”.
In addition to visa challenges, the costs to attend conferences, including registration, food, accomodation and transportation, tend to be higher for participants from low- and middle-income countries when global health conferences are held in high-income countries.
It is unlikely that the global health community alone will be able to change immigration policies which are often based on broader geopolitical circumstances. Therefore, we must consider other alternatives such as organising global health conferences in more visa friendly countries. This possibility has already proved successful. When AIDS 2016 was hosted in South Africa, over 60% of delegates were from low- and middle-income countries. The 13th International AIDS conference being hosted in South Africa led to the inauguration of a HIV/AIDS research chair at the University of KwaZulu-Natal, bringing new opportunities to the institution. By relocating global health conferences to low- and middle-income countries we reaffirm our priorities and promote connection between high-level decisionmaking and the affected communities.
Shifting the organization of global health conferences to low- and middle-income countries will not be without its challenges, but the key is choosing visa-friendly locations. Rather than hosting a conference in the USA, for example, where average visa costs are $160 and the volume of paperwork required is overwhelming and intrusive (USA visa applicants are required to provide all their social media handles), a visa to a country like Rwanda only costs $30 and is available via a straightforward online application.
Undoubtedly, travel costs may disincentivise travel to and between some low- and middle-income countries. However, conference hosts can partner with major airlines to offer discounts to attending delegations. In addition, holding a conference in an affordable country, where food and accommodation prices will not break the bank, will surely lead to increased diversity among the conference participants.
To be agents of a much needed positive change, we all need to use our voices and voting power when it comes to conference ballot time, in order to support conference locations that are easily accessible to all. The voices of our colleagues in low- and middle-income countries deserve to be heard and high-income countries can no longer hold a monopoly over global health conference hosting.
The image of empty panelist chairs at AIDS 2022 in Montreal, Canada was yet another wakeup call. One that we hope will be a turning point in global health. The time is now for us to decide what side of history we wish to be on.
About the authors: Atenas Bustamante is a Peurivian Plastic Surgeon who advocates for women in healthcare, supports plastic surgery training globally and contributes to health systems strengthening efforts in Peru. She is presently a Global Surgery Fellow and a member of the Department of Health Policy and Advocacy at Operation Smile.
Mikyla Rata is an Australian physician based in Senegal who conducts research and advocates for surgical systems strengthening globally. She is a Global Surgery Fellow and part of the Health Policy and Advocacy team at Operation Smile.
Competing interests: None
Handling Editor: Neha Faruqui