“This is really a historic meeting,” said Dr Ilona Kickbusch, co-chair of the European Health Forum at Gastein (EHFG). “Twenty years ago was the very first time there was any talk of a European global health strategy, and it took place right here at Gastein.”

“It was in 2003 that global health first became a part of the EU’s health strategy,” Kickbusch recalled. “But then it disappeared, only to come back in 2010 as the first global health strategy, and now we are working on a second one.” 

Two decades down the road, with public consultations formally closed last week, the European Union (EU) is set to release its second Global Health Strategy before Christmas this year.

“The consultations have taken us from Stockholm to Madrid, but also from Abuja to Columbia,” said Francisco Perez-Cañado, a senior expert at the EU’s Directorate-General for Health and Food Safety (DG SANTE). 

“It has been one of the widest consultations to date, not only including what our stakeholders feel in the member states, but also across the world, and in particular in the Global South.”

The EU plan aims to outline how the region will respond to future pandemics and health threats, and reflect a policy vision that embodies the bloc’s values. In light of the COVID-19 pandemic, EU officials hope to impress upon member states that ensuring more equitable global access to health products worldwide will safeguard global health.

“It is clear that no single government or institution can address this threat of future pandemics alone,” said Paul Zubeil, Deputy Director-General for European and International Health Politics at the German Ministry of Health. 

“The challenges of global health and our reality have changed dramatically since the last EU strategy plan in 2010, so it is a good sign the new European strategy is taking shape. It is absolutely necessary.”

While the draft strategy to be delivered later this year is sure to be ambitious, its  proposals will be at the mercy of the EU’s deliberative processes, and the final plan – expected sometime in the first half of next year – will reflect the views and priorities of its 27 member states.

“You will need to be very lucid that what will come out of the global health strategy will also be a composition of geopolitical agendas,” said Sandra Gallina, Director-General of DG SANTE. “My heart is with Africa, but our member states have many different geopolitical priorities.”

Nevertheless, the inclusive approach to consultation undertaken by the EU has raised hopes that the final plan will ensure that the region retains the role it assumed during the pandemic as a global health leader.

“Global leadership by the EU starts at home,” said Perez-Cañado. “The global health strategy must no longer be only about development, but a truly holistic health approach.”

North-South cooperation: partnerships, not charity 

While the previous EU global health strategy was crafted in European capitals, the new consultative approach has placed an emphasis on the inclusion of partners from across the Global South. 

“It’s been amazing how the EU has really consulted in a different sort of way,” said Catherine Guinard of the Wellcome Trust. “I think the values and ethos of the strategy – equity first and foremost – are so important to its salience and its ambition, and it is quite exciting to think about global health 10 years from now, where the EU has got a comprehensive, coherent roadmap for global health with this strategy as its kind of North Star.”

This inclusion of the views of stakeholders in low and middle-income countries (LMICs) in the drafting process is key to the new plan’s legitimacy, and to many, represents a watershed moment for the transition from charity dynamics to those of partnership. 

“The fact that we’re here is, in itself ,an indicator of some success,” said Dr Ayoade Alakija, member of the Africa Union’s African Vaccine Delivery Alliance and WHO Special Envoy for the Access to COVID-19 Tools Accelerator. “It’s an indicator that the world is listening, that we’re progressing from where we were, to where we should be.”

Alakija was the host of one of the consultative meetings held in the Nigerian capital of Abuja between European Commission officials and delegates from 17 African countries. 

“I remember when that invitation from the ambassador was sent out, there were gasps from some countries saying, ‘Oh my goodness, this is now fully beginning to indicate true inclusion and partnership as opposed to tokenistic participation’,” Alakija said. “Instead of inviting us to the table and saying, here’s what we made earlier, you invite us to co-create.”

Clemens Martin Auer, president of the European Health Forum at Gastein, stressed: “We must stop thinking in terms of charity, and we must begin to think in terms of empowerment.”

Health and climate

Europe’s understanding of the relationship between climate and health is key to the region’s strategic vision. 

“I would love to see the EU really step up and use this strategy as an opportunity to articulate how it will lead on climate and health,” Guinard said. “There’s real awareness across governments now that climate-health is a real issue, but I think there is a gap in leadership.”

To make progress, Guinard explained, the plan needs to push for a transdisciplinary approach in which health policy is integrated with climate, transport, energy and other associated policy areas. 

“On climate and health, this is a real chance to show how the EU can bring together its unique capabilities across policy, science, and politics to really drive effective change to populations in Europe, but also in the Global South,” she concluded.

No future without a health workforce 

Shortages in the health workforce are perhaps the most critical silent crisis threatening progress on global health agendas worldwide, and the EU strategy is no exception. 

For low- and middle-income economies, staff shortages in rich countries can have devastating knock-on effects for the progress of their health systems, causing medical talent to be frequently poached by high-income economies. 

“This year alone, the UK has hoovered up about 60,000 medical professionals from Nigeria – from Nigeria!” said Alakija. 

“How on earth are we going to have healthy societies in those countries? If we’re going to have a global health strategy, it has to address the difficult questions.”

“We have a lot of – I would say hoovering – of talent from Romania, from Bulgaria, that come over to Western Europe,” Gallina said. “That doesn’t work in Europe, and what we absolutely don’t want is a depletion of the health workforce in Africa.”

Furthermore, the physical and mental well-being of health workers around the world after years on the front lines of the pandemic – an oft-ignored consideration and major contributor to current and future shortages of medical staff – are reaching a crisis point. 

“The health workforce is at the end of its tether,” said Gallina. “That is the crude reality. They are very tired. There is a crisis.”

As one health worker advocate said: “We cannot magically pull a doctor out of a bag. If we are going to put an end to this endless crisis of shortage of health workforces by 2030, we have to start building the pipelines now.”

Pandemic Preparedness: “wake up”

Another essential component of the strategic vision pertains to pandemic preparedness. The status quo, Gallina remarked sharply, is far from acceptable. 

“So let me wake you all up,” she told the room. “Either our patterns change, or the next pandemic will find us in the same place that we were with COVID.

“We need to stop being in this reactive mode,” Gallina continued. “I am fed up that we in health are forced into reaction mode all the time. We wait for something to hit us in the head, and only then do we react.”

The primary mechanism the EU has selected to push for this change of posture is the World Bank’s Fund for Pandemic Prevention, a financial intermediary fund (FIF) to finance investments to strengthen pandemic preparedness and response, with a focus on low- and middle-income countries. 

With the WHO signed on as lead technical partner, the fund aims to address critical gaps in country capacities in areas such as disease surveillance, laboratory systems, and health workforce.

“Yes, we put in $450 million, and the US has put in $450 million, but the important thing will be the proof in the pudding,” Gallina said. “The World Bank must not run this as a development project. It is a health project. 

“A health project means that you listen to the health professionals that you have,” she explained. “If it becomes a development project, it’s lost. It will achieve other things, but not the things we want.”

Any successful approach to global health cooperation must also be adaptable. As crises are unpredictable, so too must world health vehicles be flexible to respond to that reality.

“At the Commission, we often don’t have real tools to push what we want to push, so sometimes we are inventing our tools [as we go],” said Gallina. “And at international level, it might have to be the same.”

Towards a better future

Though the final form of the new strategic plan will not be known for several months, the feeling in the room was one of optimism.

“The strategy isn’t just written for the challenges and the problems we know about now”, Guinard said. “But by embedding the science, it is also about the challenges that we don’t know about yet.”

If the plan is to succeed, global cooperation – and the interests of all stakeholders – will be critical. 

“For a collective future to be what we all want it to be, a global health strategy cannot really just be about health,” Akidja said. “We all need to begin to say ‘no!’, it’s not just health. It is education. It is the elimination of poverty. It is food insecurity. It is gender. It is about women’s rights.

“It is important if we are going to build partnerships that we talk together, because I think there is more that connects us in that which divides,” Akidja said in concluding. “Your health is my health, and your health security is my health security.”

Image Credits: Arthur Olesch, Urska Erklavec, Urska Erklavec.