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Group of 20 health ministers today finished their first joint table top exercise to simulate the outbreak of a new deadly viral pandemic in “Anycountry” and passed a seven-page final resolution on pandemic preparedness and antimicrobial resistance. Non-governmental experts and health organizations welcomed the first ever meeting of health ministers in the G20 format, but see a risk of framing the debate from a global North security perspective. And despite a call of urgency with regard to antimicrobial resistance, the G20 could not agree to include the de-linking of the cost of investment in R&D from the price of medical products.

It was the first meeting of the G20 health ministers since the start of the G20 format 19 years ago. German Chancellor Angela Merkel in her welcoming speech said the Berlin health policy meeting was the only of the G20 ministers’ meeting she chose to attend in the run-up to the G20 Summit 7-8 July in Hamburg.

The event website and Berlin Declaration is here.

Support for CEPI and Funding Mechanisms

Help for the countries struck by Ebola in 2013 was “too late, too slow and too uncoordinated,” Merkel acknowledged in he remarks. “It would be cynical to not learn from this,” the German Chancellor said, adding, “when we have the next outbreak of such a disease, we face the question: have we done enough to prevent it? And we just hear that there are new Ebola cases in Congo.”

The World Health Organization, according to WHO Director-General Margaret Chan, “is currently monitoring 36 outbreaks in sub-Saharan Africa. The causes of these outbreaks range from cholera in countries devastated by famine and armed conflict, to the Democratic Republic of Congo’s eighth Ebola outbreak confirmed earlier this month.”

Chan pointed to problems still to be solved after the 2013 Ebola outbreak. “During the outbreak, WHO acquired extensive experience in facilitating R&D for new medical products, but poor coordination lost too much time,” she said. The WHO’s 2016 R&D blueprint discussions set in motion the establishment of the Coalition for Epidemic Preparedness Innovations (CEPI), a program that Merkel asked in her speech that G20 ministers support.

Merkel also called for additional financial efforts from the G20 for the health care systems in the poorest countries of the Global South and for new mechanisms to help countries struck by epidemic outbreaks, namely the WHO “Contingency Fund for Emergencies” (CFE) and the World Bank’s “Pandemic Emergency Financing Facility” (PEF).

The CFE especially needs more money, Merkel said, and acknowledged that there is “no free lunch” for the health ministers. A success of the German initiative to put health on top of the G20 agenda, observers said, is that Argentina confirmed health will be further discussed next year when Argentina takes over the G20 presidency.

Last Minute Cuts and Bolder Steps Not Taken

Civil society organisations had welcomed the focus on health during the G20, but in first reactions said there were some disappointing cuts in the declaration. Katie Bertram, head of advocacy/policy for Save the Children in Germany in a personal tweet from the closure of the meeting noted some weaker language in particular on the WHO role, which was not a great signal ahead of next week’s annual World Health Assembly, and what she called a disappointing migrant health cut.

Other cut-outs concern more cautious language with regard to affordability and accessibility of drugs and vaccinations developed by the new R&D mechanisms. While CEPI is lauded, instead of underscoring “the importance that countries ensure that products emerging from such R&D efforts become affordable and accessible to all people in need” – which was proposed in an earlier draft -, the final language only reminds that the new products should “become accessible to all people in need.” The mentioning of “market failure” also was not sustained, the sharing of data and samples now will happen “in accordance with national law”.

Also lost in the final version was the much-debated concept of “de-linking the cost of investment in research and development on antimicrobial resistance from the price and volume of sales so as to facilitate equitable and affordable access to new medicine, diagnostic tools, vaccines and other results to be gained through R&D.” Brazil had made a proposal to use this agreed UN language to acknowledge alternatives to what is mainly R&D incentivized by patent and sales numbers.

Yet there has been, as observers had pointed out before the final round of discussions of the ministers, strong objections, especially from the United States. The German Minister of Health, Hermann Groehe, in an interview with Reuters earlier this week even suggested that “ways to foster research could include patent terms to reward pharmaceuticals companies that developed new antibiotics and also various forms of public-private partnership in which companies would be paid a premium for new antibiotics.”

“To have delinkage mentioned in the text would have been very promising,” said Marco Alves, coordinator of the Access Campaign of Médecins Sans Frontières (MSF, Doctors Without Borders), Germany. Potentially longer patent terms on the other hand would go in the wrong direction.

Alves nevertheless told Intellectual Property Watch yesterday that he saw progress in global health politics. “There is a dynamic. It is stunning that all of a sudden half a billion US dollars were pledged to CEPI. Germany is a big sponsor. Compare this to the fact that it has taken several years for the German government to allocate 50 million for the much needed research of neglected diseases in a PDP budget-line.”

Certainly, according to Alves, there is much that still had to be tackled by the G20, even on the promising projects: “The IP regime and access-policies for CEPI for example are still unclear.”

Anne Jung, expert at medico international and coordinator of Germany’s Platform on Global Health, also welcomed the inclusion of global health on the G20 agenda, applauding the German government’s support for strengthening the WHO, which now has to be reconfirmed during the WHA next week.

But not only there is a need to better fund the WHO to enable it to do its job in guiding action in cases of outbreaks of pandemics, she said, “There is also a need that WHO members, including some members represented at the G20 table, adhere to the binding rules of the WHO, for example with regard to travel restriction. Inadequate travel restrictions have caused economic havoc in countries like Sierra Leone. Countries like for example the UK should have followed the rules of WHO here.”

The German platform also would have welcomed stronger language presented in earlier drafts on the relation of health and social inequality. But that language, too, vanished, causing the NGOs to warn that the G20 health discussions must not risk seeing global health security only as something essential for “security” in the global North.

“There is this risk,” warned Jung. Alves reasoned: “High prices, and the gap in research – these two problems hurt the global South for many years. Now these problems have reached the global North, too, with high prices for cancer or hepatitis C drugs for example. Plus the dry research and development pipeline for new antibiotics, combined with the emergence of resistant strains. It is just two sides of the same coin. The negative effects of how the innovation system is currently organised and incentivized.”

The Association Research Based Pharmaceutical Companies (VFA) called the Berlin Declaration an “important step to allow G20 states to act more coordinated, and more effective in future epidemic outbreaks.” In a press release after the closure of the Health Minister conference VFA also applauded the Ministers’ acknowledgment of the “value of public-private partnerships for the development of important vaccines and drugs that are not commercially viable.” VFA member companies have already begun to develop vaccines against eight of the 11 communicable diseases and vaccines that have been prioritized by the WHO, for example the Lassa fever and Zika, it said.

Separately, the declaration also states: “We underscore the importance that products emerging from such R&D efforts become accessible to all people in need. In regard to sample and data sharing, we recognize the importance of the WHO global influenza surveillance and response system and Pandemic Influenza Preparedness (PIP) framework, as well as the global initiative on sharing all influenza data (GISAID).

And the declaration commits to broaden the voluntary financial support for ongoing initiatives, such as the Global Antibiotic Research and Development Partnership (GARDP), the Drugs for Neglected Diseases initiative (DNDi), UNITAID, the Joint Programming Initiative on AMR (JPIAMR), Combating Antibiotic Resistance Bacteria Biopharmaceutical Accelerator (CARB-X), Innovative Medicines Initiative (IMI), and the TB Alliance for new anti-tuberculosis medicines. The health ministers also called on other countries, philanthropic organisation, academia, and the private sector to support those initiatives also.

Catherine Saez contributed to this story.