From speech to action: using Brazil’s 2024 presidency of G20 to embed equity in global health
BMJ 2024; 386 doi: https://doi.org/10.1136/bmj.q1582 (Published 23 July 2024) Cite this as: BMJ 2024;386:q1582Read the series: Latin America’s global leadership in health
The G20 brings together the 19 largest economies in the world plus the European Union and the African Union. In 2024, Brazil holds the presidency for the first time. As the forum consolidates its centrality in global economic and policy affairs, Brazil’s presidency must allow the country to finally turn the page from its recent negationist and unequal health policies under Jair Bolsonaro’s government and lead the world towards a more equitable and public oriented global health architecture.
The outcome document that the G20 is expected to adopt in November is the result of careful negotiations throughout the year by members, civil society inputs, and experts. In late 2023, Brazil listed four priorities for its G20 health working group: pandemic prevention, preparedness, and response; digital health; climate change and health; and equity in health as a cross-cutting issue.12 They highlight that global health cannot be detached from financial, climate, and economic considerations.
Brazil has been attempting to regain its leadership role in global health,345and has reaffirmed the importance of multilateral institutions such as the World Health Organization. This goal needs to deal with massive domestic challenges that include an overburdened universal healthcare system, pressure from private providers and insurers, and continued misinformation and mistrust against public health fuelled by the covid-19 pandemic. In May, unprecedented flooding in the southern state of Rio Grande do Sul collapsed the region’s infrastructure and healthcare systems and highlighted the intrinsic relation between climate and health.6 Several proposed legislative changes in Brazil could also be detrimental to public health: the National Congress is discussing a draft bill to give drug companies exclusive rights to data from clinical trials,7 which would reduce pharmaceutical competition and impair access to medicines; it has approved a bill (pending presidential assent) to dismantle protection for people who take part in clinical trials;8 and continues to clash over a bill that would make it harder to access safe abortion.9 Against this backdrop, there have been some positive developments: the federal government has called for the promotion of digital health and launched a new industrial health strategy aligned with local manufacturing concerns.
In this context, it is therefore not surprising that Brazil has been using the G20 to internationalise its domestic concerns and propose a new (if modest) framing for the complex global health landscape. The following are the most pressing issues in terms of creating a renewed health architecture based on equity.
G20 priorities
On pandemic prevention, preparedness, and response, the WHO International Negotiating Body (INB), co-chaired by Brazil from 2022 to July 2024, will continue working towards agreement on a pandemic accord. It needs to solve the conundrum related to technology transfer, including how to enable the effective use of flexibilities on intellectual property rights and ensuring benefit sharing for technologies developed through joint efforts from different parts of the world.10 Human rights based provisions also cannot continue to be ignored.11 If the G20 discussions can lead to an outcome that promotes access through the regional production of medicines, vaccines, and strategic health supplies, it may help WHO’s negotiations on the pandemic accord.
The G20 should also promote the benefits of digital health but must focus on the global south’s needs regarding access to basic infrastructure and to artificial intelligence (AI) technologies. The promotion of digital public infrastructures, proposed originally by India’s 2023 presidency of the G20, has been a cornerstone of this year’s activities,12 but these infrastructures could enable private corporations to exploit healthcare systems by taking their data. Also of concern are algorithmic biases in the deployment of AI and privacy risks for individuals and communities.
The health related implications of climate change disproportionately affect countries in the global south and marginalised communities worldwide by displacing populations, creating new disease burdens, and exposing populations to new pathogens and pandemics. The G20 is an opportunity to expand the agenda of antimicrobial resistance and One Health with more financial commitments by high income countries and in a way that tackles the specific needs of global south countries.
Against all geopolitical and financial odds, there is real potential for Brazil’s G20 presidency to achieve meaningful outcomes that contribute to reforming the existing global health architecture. To do so, it should commit to the following. Firstly, it must mobilise G20’s health working group to successfully support equity based pandemic treaty negotiations. Secondly, it needs to promote digital public infrastructures that are true commons and do not create dependency on private software, databases, and technology providers. Thirdly, building on the 77th World Health Assembly resolution, it must channel more financial resources from G20 countries to provide further evidence of the link between climate and health, strengthen ongoing initiatives for antimicrobial resistance, and enshrine the important role of traditional knowledge for environment protection as a health issue. Finally, it needs to translate equity in health into concrete financial commitments to launch the proposed Global Alliance against Hunger and Poverty.
More generally, structural governance reform which tackles finance, health, and climate remains necessary. Civil society’s participation in this process has been and will continue to be particularly welcome. But even in the best case scenario, these won’t be enough. Growing expenditure on wars and military industries has been prioritised over health. Geopolitically, political denialism of climate change, science, human rights, and inequity are on the rise. Such a broader context may counterbalance any positive achievements in global health. This also makes the importance of broader global governance reforms even stronger. In this challenging context, Brazil’s renewed leadership, alongside other global south countries, must continue to pave the way— both inside and outside the G20—to improve the root causes of today’s problematic global health governance.
Footnotes
Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; externally peer reviewed.
This article is part of The BMJ’s spotlight on Latin America's global leadership in health (bmj.com/health-in-latin-america).