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Last week, the world waited with bated breath to see whether G20 health ministers would seize the moment at their annual summit to take bold and necessary action to end the pandemic, build the global health architecture for the future, and recommit to health priorities that have taken a back seat during the past two years.The answer was rather muddled. The G20 health ministers did agree on several key principles and high-level priorities, many of which were positive, but their health declaration stopped short of providing a clear road map to translate these ambitions into concrete actions. Advocates were particularly disappointed in the lack of immediate actions, including calls for specific financial commitments, to address the shameful inequities in rollout and ongoing acute needs for COVID-19 vaccines and other tools.While the G20 didn’t provide much specificity regarding new pledges, it did highlight the importance of research and development (R&D) in all aspects of global health, including bolstering pandemic preparedness, combatting antimicrobial resistance (AMR), achieving universal health coverage (UHC), and strengthening digital health. As discussions in other forums such as the United Nations (UN) General Assembly, the World Health Organization (WHO), and the Global Health Security Agenda ramp up, G20 leaders have set the framework from which to build concrete reforms to the international system.Putting R&D at the core of the agenda This year’s G20 health declaration included strong language on R&D throughout. In discussing the Access to COVID-19 Tools Accelerator, pandemic preparedness initiatives, and reinvestment in key programs to achieve the Sustainable Development Goals (SDGs) and UHC, G20 leaders put R&D front and center. One particularly encouraging sign was the explicit callout from health ministers acknowledging R&D as a central pillar of pandemic preparedness, something that was notably absent in global health security frameworks, including the International Health Regulations, prior to the start of the pandemic. The COVID-19 crisis has exposed the need to enshrine greater global governance and coordination of R&D into the global health security architecture. The mention by G20 health leaders acknowledges a political shift on the issue and increases the prospects that R&D coordination and governance provisions will be integrated into a potential pandemic treaty and other WHO reform discussions in the coming months. The G20 health declaration also underlined the continued commitment toward combatting AMR, including by developing new safe and effective antimicrobials and sustaining reliable supply and production of existing antimicrobials. For the past few years, the agenda for the G20 has consistently included AMR with a focus on multidrug-resistant tuberculosis (TB), which is estimated to account for one-third of all AMR-related deaths globally. Leaders recognized that sustainable and robust resources for TB R&D are needed to accelerate development of new tools and deliver on previous commitments from the G20 and the UN high-level panels on TB, AMR, and UHC.Health ministers underscored the need to strengthen the resilience of supply chains; increase and diversify global, local, and regional vaccine manufacturing capacity; and build expertise for low- and middle-income countries (LMICs). Acknowledging that equitable access to medical countermeasures continues to be a major challenge, global leaders recognized the need to develop more balanced systems and infrastructure that provide greater coverage and capacity in LMICs. G20 leaders also reiterated that while vaccines have been at the top of everyone’s agenda, we must ensure that all countermeasures, especially therapeutics including oxygen therapies and diagnostics, are reprioritized as key elements of global response efforts and that the pipeline for new countermeasures continues to receive investments. Given the accelerated development of new diagnostic tools and the scale of testing needed for COVID-19, it was a positive development that G20 nations acknowledged that the introduction of testing capabilities should also be leveraged for other infectious diseases including TB, malaria, and HIV. To achieve the SDGs by 2030, the systems that are being built to respond to the pandemic must also serve to strengthen health systems overall and help in the fight against other disease threats.Where do we go from here?G20 health ministers reaffirmed their commitment to global solidarity, including by working toward equitable distribution of vaccines and supporting WHO’s goal of vaccinating 40 percent of the global population by the end of 2021. Despite this, no specific pledges were made to provide additional funding to the Access to COVID-19 Tools Accelerator, nor did leaders commit to increase vaccine dose sharing to address the acute needs of LMICs.The lack of specific targets or road maps for how to achieve the outlined principles and new investment pledges by G20 countries means that leaders must now work out how to operationalize these ideas in other multilateral meetings this fall. Many advocates are now pinning their hopes on the Biden administration’s call to convene heads of state at a Global COVID-19 Summit next week on the sidelines of the UN General Assembly and looking for tangible actions during the G20 Joint Health and Finance Ministers’ Meeting or World Health Assembly deliberations on a new pandemic treaty or framework convention.These forums will now have to pick up the baton, since we need global governance to be more inclusive, equitable, and accountable. This G20 health ministers’ declaration was a step in the right direction, as it set a framework for improving global health R&D coordination and governance, but it put the onus on other forums to follow through with concrete actions. Global leaders must now seize the moment and deliver on their promises. 

The Global Health Technologies Coalition (GHTC) applauds the US government’s efforts to host a Global COVID-19 Summit on the margins of the United Nations General Assembly next week and calls on heads of state, multilateral and regional bodies, and private-sector and non-governmental leaders to take this moment to take a fresh look at how to tackle the pandemic globally and solve the inequities that have plagued the COVID-19 response the past year and a half.GHTC is committed to the shared targets of vaccinating the world, saving lives now, and building back better. Within these priorities, we call on summit stakeholders to commit to bolstering global investments in robust surveillance and data sharing, including for genomic sequencing; increased testing and analysis to detect emerging variants; and research and development (R&D), including supporting clinical trials for “wave 2” therapeutic and vaccine candidates as well as increasing regional manufacturing capacities for all medical countermeasures. GHTC also supports the creation of a global health security financial intermediary fund that can be leveraged to mobilize resources for immediate COVID-19 response needs and bolster research, development, and manufacturing capabilities in every region as part of longer-term pandemic preparedness systems strengthening.GHTC stands ready to convene partners to assess gaps in the upstream R&D aspects of the COVID-19 response, to remove policy barriers, and to enable product developers to advance progress on delivering and deploying technologies fit for purpose for the lowest-resource settings. We are also committed to leveraging our platform to elevate perspectives of national and regional stakeholders from lower- and middle-income countries to ensure global investments in R&D and manufacturing capacity strengthening are driven in a way best suited to strengthening pandemic preparedness in each local context.Finally, we call for the establishment of a global envoy or focal point to galvanize support and align efforts when a new COVID-19 road map for ending the pandemic is developed, and to ensure accountability and global representation. The global community must come together and hold each other accountable to eliminate every bottleneck slowing down a truly global response to the COVID-19 pandemic. No one is safe until everyone is safe, and tangible collective action is the only way we will meet the targets of vaccinating the world, saving lives, and building back better.

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign up now to receive our weekly R&D News Roundup email. Moderna and Novavax are both developing vaccines for combined protection against COVID-19 and the flu, the companies announced last week. Moderna is working on a single-dose vaccine that combines a booster dose of its authorized COVID-19 and a booster of its furthest along experimental flu shot. Novavax has launched an early-stage trial for a combined flu and COVID-19 vaccine composed of its COVID-19 vaccine candidate, not yet authorized by the US Food and Drug Administration, and its influenza shot NanoFlu, along with an adjuvant or vaccine booster. The Novavax trial will be conducted in Australia among 640 healthy adults between the ages of 50 and 70 who have been previously infected with COVID-19 or given an authorized COVID-19 vaccine at least eight weeks prior to the study. Results are expected in the first half of 2022.The COVAX vaccine-sharing facility’s global vaccine deliveries will fall almost 30 percent below its original target of distributing 2 billion doses in 2021, the initiative’s leaders estimate. The new supply forecast predicts another 1.1 billion doses will be made available this year, in addition to the 330 million already released for delivery before the end of August, for an estimated total of 1.4 billion vaccine deliveries by the end of 2021. The shortfall is the result of a variety of factors, including restrictions on exports from the Serum Institute of India, problems increasing manufacturing at vaccine facilities, and lags in regulatory approval, according to COVAX leaders. Under the most likely forecast, COVAX would reach 2 billion available doses between January and February of 2022.COVID-19 has set back the fight against other global health challenges like HIV, tuberculosis (TB), and malaria, according to a report released by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Compared to 2019, the number of people tested and treated for TB fell by about 18 percent in 2020—and the number of people treated for extensively drug-resistant TB by 37 percent. The number of people who sought testing for HIV declined by 22 percent, and those opting for HIV prevention services fell by 12 percent. However, the report also noted the adoption of innovations, from dispensing multi-month supplies of TB and HIV drugs to using digital tools to monitor TB treatment, adopted by health agencies and ministries around the world, which will hopefully outlast the pandemic.