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November 17, 2022

In evaluating the G20 Bali Leaders’ Declaration, Global Health Technologies Coalition (GHTC) recognizes and applauds several encouraging commitments but urges leaders to walk the walk when it comes to making greater investments in research and development (R&D) and addressing emerging and persistent health threats with greater urgency. 

Promising support for The Pandemic Fund, ACT-A, and enhancing local capacity 

GHTC was pleased to see G20 leaders launch The Pandemic Fund in concert with this week’s summit in Bali. We believe this fund will be a critical mechanism for new R&D capacity-building investments and will help facilitate a coordinated and consistent approach to pandemic preparedness and response strengthening. We also echo the declaration’s focus on equity and inclusive membership in The Pandemic Fund’s governance structures, though we remain concerned that concrete targets and accountability provisions should have been included to establish a deeper commitment to diverse representation.  

Additionally, GHTC welcomes G20 leaders’ expressed support for the Access to COVID-19 Tools Accelerator (ACT-A), highlighting the continued importance of this cooperative framework to accelerate the development, manufacturing, distribution of, and equitable access to new health technologies in the fight against COVID-19. As the initiative enters a new phase, R&D must continue to be a central pillar to ensure that vaccines, therapeutics, and diagnostics keep up with new variants. While we commend G20 leaders for highlighting the need to draw lessons from ACT-A external evaluations, they did not specify recommendations from those reports that they look to act upon. Several evaluations noted the need for greater integration of lower- and middle-income countries and partners in ACT-A’s model and that a joint platform should be established to coordinate work across product areas. We urge leaders to take tangible steps in advancing these recommendations in the coming months. 

GHTC was also encouraged to see the G20 articulate the need for strengthening local and regional health product manufacturing capacities and cooperation, as well as sustainable global and regional R&D networks, to facilitate better access to health technologies in lower- and middle-income countries. 

Insufficient urgency to mobilize against AMR and “the big three” 

While it was noteworthy to have global health R&D reflected throughout the final communique from G20 leaders, unfortunately the declaration also fell short in several areas. For instance, while GHTC was pleased to see that antimicrobial resistance (AMR) was elevated as part of pandemic preparedness, it was disappointing that countries failed to specify commitments and plans for addressing AMR, including planned investments to strengthen the pipeline of new tools to combat this growing health threat.  

Similarly, enduring health challenges such as tuberculosis, malaria, HIV, and neglected tropical diseases did not receive a single mention, reinforcing the perception that they have fallen further off global leaders’ radars, even as new data confirms that the COVID-19 pandemic has eroded hard-won progress in these areas. Continued neglect of these pandemics is a recipe for increased backsliding and puts the goal of universal health coverage at risk. Investment in developing new tools to combat these long-standing threats is key to achieving broad health goals endorsed by the G20 in recent years.  

A promising vision must be backed by greater commitment and accountability 

It was refreshing that this year’s declaration highlighted the importance of global health R&D in several areas, especially in relation to pandemic preparedness, and underscored that R&D investments and prioritization must continue to be a focus of national, regional, and global bodies to combat emerging and ongoing health threats. However, the declaration was light on tangible commitments and failed to address some of the world’s leading and most persistent health threats. To realize the vision of this declaration and the G20’s health goals more broadly, we call on leaders to make specific pledges and be more accountable to the principles outlined in the communique.