Last Tuesday we organised the meeting Retos en salud global: pandemias, cambio climático y políticas públicas [Challenges in global health: pandemics, climate change and public policies, in English] in Madrid, where we brought together members of the government and experts from society to discuss and reflect on these challenges and threats to health that our society is facing. This is always from a gender perspective and considering the social determinants of health.
As Vanessa López, director of Salud por Derecho, highlighted in her opening remarks at the event, the challenges remain significant: “Almost half of the global population lacks guaranteed access to healthcare. Each year, 2.5 million people die from AIDS, tuberculosis and malaria. Furthermore, climate change is causing temperatures to rise and extreme weather events to become more frequent. These changes have a significant impact on our health, with an increase in heat-related deaths and an uptick in diseases such as malaria.”
The inaugural speaker at the event was Javier Padilla, Secretary of State for Health. He highlighted the pivotal moment we are currently experiencing in global health, particularly in the wake of the pandemic: “It is imperative that our actions be more measured and have a greater sense of direction.” He highlighted that the Ministry of Health’s objective is to maintain consistency between domestic and foreign policies, with universality as a guiding principle. This approach ensures that these policies’ benefits reach the entire population, with particular focus on those who need it most.
Padilla was insistent on the connection between climate change and health: “The Ministry of Ecological Transition should be the first port of call for climate change, followed by the Ministry of Health.” Spain should assume a leadership position on climate change issues and gender gaps, or at the very least, play an important role in changing the European position and creating bridging positions between the people involved, as is the case with the failed Pandemic Treaty.
He concluded by emphasising the necessity of maintaining consistency in health policies regardless of changes in government: “It is necessary to establish a framework for the strategies and alliances between different actors. It is imperative that the framework be acceptable to most of the parliamentary spectrum. The policies must be justifiable from a moral standpoint, yet they must also align with the country’s geopolitical interests. This will ensure that subsequent governments are able to support these global health policies.”
Françoise Vanni, Head of External Relations and Communications for the Global Fund to fight HIV/AIDS, tuberculosis (TB) and malaria, started her address by expressing gratitude to Spain for its continued collaboration in the fight against pandemics over the years. She also highlighted Spain’s pivotal role and its contributions to addressing the remaining challenges.
She then proceeded to examine the model of success employed by the Global Fund, emphasising inclusivity’s pivotal role: “It is challenging to develop a model that incorporates civil society and the most affected communities, with equity and north-south balance. A lot of organisations have enquired as to the methodology employed.”
In her challenges review, Vanni considered the three pandemics. For HIV, the challenge is to prevent new infections: “To prevent the further spread of these infections, which primarily affect women and adolescents, it is necessary to adopt a multi-sectoral and partnership approach. This should involve working on issues of equity, empowerment, local partnerships, education, and combating gender-based violence.” Furthermore, she highlighted that the current political and social climate is complex due to the enactment of legislation in numerous countries that contravenes human rights and the rights of LGTBQ people.
On tuberculosis, Vanni welcomed the fact that the ground lost to COVID-19 has been made up, and that the systems and networks put in place beforehand have served to bring it back to those levels. She acknowledged the situation’s devastation, which was particularly challenging. The challenge is to address antimicrobial resistance and resistant tuberculosis as part of this problem: “The potential for the spread of drug-resistant tuberculosis (DR-TB) in Malawi is a matter of concern for all. No one is safe until we are all safe”.
With malaria, there has been encouraging signs of innovative progress. Vaccines are currently in the final stages of research and development, while new insecticide-resistant mosquito nets are being developed. The challenge is undoubtedly climate change, which is changing mosquito behaviours, increasing their biting seasons and driving them to higher latitudes. Vanni stated that: “71% of the funds are allocated to countries most affected by climate change.”
Regarding funding, she emphasised that the challenge is inextricably linked to political will. It is therefore vital to maintain the global health agenda and combat diseases, avoiding fatigue and complacency: “Millions of people are still dying, and we are far from reaching the necessary targets.” The economic crisis and conflicts present significant challenges to funding, particularly in countries most affected by inflation, debt and other economic issues. The objective is to maintain and increase funding, while improving the efficiency of health spending to save more lives for every dollar spent. “This year, a total of $2 billion was invested, with a particular focus on health systems, workers, laboratories, epidemiological surveillance, supply chains and the digitisation of health information.” The objective is for countries to enhance their capabilities in the context of current and future health challenges.
Héctor Tejero, the Spanish Government’s Minister of Health’s Cabinet official responsible for Health and Climate Change, began his speech in a clear and concise manner. “It is becoming increasingly evident that the climate crisis is a significant public health concern.” While the focus has traditionally been on ecosystems, scientific evidence now indicates that climate change represents the most significant threat to human health.
In Spain, the effects of extreme heat are particularly damaging to vulnerable individuals, resulting in thousands of premature deaths and exacerbating existing illnesses. Furthermore, climate change is responsible for some adverse effects, including floods, fires and air pollution. In addition, it has an impact on the social determinants of health, with a negative effect on many people’s quality of life and wellbeing. “One example is food insecurity. In Europe, there are 80 million people experiencing serious insecurity (in Spain, five million), which is a key factor in people’s poor health, especially children.”
It is of the utmost importance to Tejero that the impacts of his work are researched and communicated effectively to influence public policies at both the national and local level. In addition to low- and middle-income countries, Spain is particularly vulnerable to climate change within the EU. This raises questions about how healthy systems will be adapted: “It is crucial to raise awareness of these risks and work on adaptation and mitigation, including reducing fossil fuel usage. This is an area where the WHO resolution has fallen short.”
The event was followed by a presentation by Elizabet Diago, coordinator of ISGlobal’s Preparedness, Response, Recovery and Resilience Hub. Ms. Diago provided an update on the latest developments regarding the Pandemic Treaty, which the WHO has been negotiating for years. The treaty is designed to improve coordination in the response to future pandemics. “The agreement has been superseded by a new agreement, which can be further diluted,” he said, following the failure of the previous agreement during the last World Health Assembly.
She identified four main obstacles. The first issue concerns the equitable resource distribution. The second is related to intellectual property and patent barriers to promoting access to vaccines, medicines and other health technologies. The third is about transparency and the use of epidemiological and genetic data on pathogens, as some countries believe there are security and privacy risks to their national sovereignty. The fourth and final issue is about the financing and sustainability of the Treaty, because there are no established funding mechanisms in the agreement that say where the money is going to go.
“There has been a stalemate between countries that advocate for equity and North-South technology transfer, with negotiations postponed for another year.” However, he noted that uncertainty remains high, given the potential for political changes, such as the possibility of Trump being elected, to further complicate matters.
Elizabet also discussed the potential risks posed by climate change, deforestation and biodiversity loss. These factors could lead to the emergence of pathogens previously unknown to us: “It is imperative that we reinforce the terms of global surveillance by facilitating information exchange between countries. It is counterproductive to have this information and not share it.” He also emphasised the necessity of developing rapid response capabilities within health systems to enable the identification, isolation and reporting of incidents in a timely manner, as well as the importance of strengthening the health infrastructure and capacity in hospitals, primary care and laboratories. Finally, it is crucial to emphasise the importance of education and communication, particularly in the current climate of misinformation and information overload. “The infodemic is causing significant harm.”
In conclusion, Ángela León Cáceres, executive director of Women4GlobalFund, presented the women’s agenda in the context of the Global Fund and the fight against pandemics: “We must address the issue of gender-based violence, which has not been discussed in the context of the pandemic,” she began. “This is an issue that requires a joint response. We have not yet received an effective and efficient response. The combined impact of migration and climate crises is placing many populations, particularly women’s groups, at significant risk.”
Ms. León highlighted the growing prevalence of anti-rights and anti-gender policies, particularly in Latin America. This phenomenon is evident even in countries that were once at the vanguard of social investment, such as Argentina and Brazil, where public investment is now being scaled back. “Two days ago, the Ministry of Women’s Affairs in Argentina was closed, despite the fact that violence against women is on the rise.” In other countries, such as Ecuador and Peru, proposed and passed legislation criminalising people with diseases such as HIV is often enacted without accountability or monitoring mechanisms. Furthermore, he stated that civil society’s role has been significantly reduced. “It is inevitable that such policies will pose significant risks to the treatment of diseases, particularly for women.”
Latin America and the Caribbean is the most unequal region in the world, with women representing the most vulnerable population, including those most at risk from climate change. Lacking a political will to address gender equality, for Ángela León, means the most effective approach is to embed gender equality within a social justice framework, and to integrate it into investments and policies: “We are currently 140 years behind schedule in our efforts to achieve the SDGs. This is a clear indication that we are not allocating sufficient attention and resources.”
In her remarks, León highlighted the Global Fund’s participatory model as a key contribution: “Your model is the most effective in the industry. To be able to consult with actors on decisions that are fair to their health. There are challenges, but it is important to recognise that no governance system is without flaws.” These challenges require more than rhetoric; they demand real implementation, monitoring, and the ability to measure the quantitative and qualitative factors on the impact of gender equality and human rights initiatives. This includes sustained investment in infrastructure, training, and civil society participation in the three pandemics, as well as in the other pandemic: that of gender-based violence.
Prior to the question and answer session, Raquel González from MSF and Ana Trevoux from Friends of the Global Fund Europe were able to participate. Raquel discussed the significant challenges and importance of reaching populations in complex contexts, such as those in countries experiencing conflict and displacement. Anna presented the latest report from her organisation on new malaria vaccines.
