World Health Summit in Berlin: central public health management and access to abortion in the Universal Healthcare System

Ordo Iuris

From 16 to 18 October 2022, the World Health Summit took place in Berlin with the aim of bringing together global health leaders and private stakeholders from all sectors to discuss the challenges of future health threats and find solutions for enhancing global health in order to strengthen international cooperation. The World Health Summit 2022 is the first Summit to be hosted together with the World Health Organization, under the patronage of the Chancellor Olaf Scholz and the President of the Republic of France Emmanuel Macron. As states in the welcome messages of the two political leaders, the main goal of the Summit is to reflect on the interdependency of climate change, food systems, digital transformation, peace and global health in order to consider human, animal and environmental health as fundamentally interrelated and, as France particularly underlined, to continue to support access to health care and services, including comprehensive sexual and reproductive health and rights for women and girls.

The Ordo Iuris Institute for Legal Culture was involved in following and participating in selected panels on sexual and reproductive rights, financing and strengthening health systems, pandemic preparedness and response, global health communication and digital transformation for health.

In each of these panels, political figures, representatives of major donors (e.g. international financial institutions, global stakeholders, philanthropists) and members of the World Health Organisation discussed the priorities and future approaches to be taken to address health challenges. Equity, solidarity, leadership and sustainability were just some of the key words that dominated the discussions held in Berlin with the stated aim of strengthening global health systems. The main objective of creating an efficient system of health cooperation and solidarity between states to strengthen scientific knowledge and counter disease threats is an issue that should be addressed in order to rapidly tackle challenges of an international nature. However, the digital transformation for health, the increasingly central role of supranational bodies and agencies, together with the involvement of global private actors in the provision of public health services emerged as major themes of the forum, showing the goal of a progressive trend towards centralised governance to tackle future health challenges. Moreover, the idea of centralising governance that emerged from the summit should not only exist politically between global and national authorities, but consequently also strengthen the role of digital giants and large donors.. In this framework, topics still debated in several countries, such as, for example, mass vaccination or access to contraception and abortion, were not the subject of discussion, but rather starting points to talk about how to implement on a global scale access to these kinds of services that should be universally guaranteed in public health crisis without any debate on their efficiency or health benefits for women and girls.

Focusing on the topic of so-called sexual and reproductive rights (SRHR), the speakers involved in the discussion hosted by the WHS reflected on the integration of comprehensive SRHR services into universal health coverage reforms,. Natalia Kamen, executive director of the United Nations Population Fund, pointed out that the State of World Population report published by her agency shows that half of the world's pregnancies are unplanned and unwanted, pointing to 'women's choice' as the solution to this. On the other hand, Bärbel Kofler, German Federal Ministry for Economic Cooperation and Development, explained that Germany's priorities in advancing the agenda item linking SRHR to Universal Health Coverage are based on two levels: on the one hand, strengthening bilateral agreements with countries that need financial support to implement this plan, and on the other hand, funding multilateral funds such as organisations like Planned Parenthood. At the forum it emerged that universal access to sexual and reproductive health and rights is a key component in the implementation of the Sustainable Development Goals. Limited access to such services, due to several factors, including religious and cultural constructs related to contraceptive use, gender inequality, lack of affordability and other barriers, are the new obstacles to be tackled to address the urgency of investing equitably and sustainably in health and wellbeing, according to the intersecting global vision presented.

Regarding the global commitment to strengthen and finance health systems in the context of the response to Covid-19, the World Health Summit session devoted to this topic strongly emphasised the role played by public-private actors, such as the Gavi Vaccine Alliance, in supporting  primary health care, receiving funding from public institutions and distributing mass vaccines. The key role of actors like this has been described as a leadership role for the future of health policies and a key part of epidemic control, especially in developing countries, without however reflecting on the influence that non-state actors like the Bill and Melinda Gates Fundation, which pledged USD 750 million to the creation of Gavi in 1999, or the Rockefeller Foundation exert on these entities when they fund them with millions of dollars. The issues of independence and transparency of the involvement of large private financiers in the management of public health were not addressed in the ensuing debates, where instead the desire to guarantee these actors room for action in fostering access to health services in concert with national public institutions was reaffirmed. We should bear in mind that these entities want to have a direct impact on the rights and freedoms of individuals.

The debate between members of twelve different international parliamentary assemblies and networks and the deputy director of the World Health Organisation renewed and strongly emphasised the need to work together to sign a legally binding anti-pandemic treaty in order to tackle future outbreaks that risk developing into pandemics and establish a system of instruments that can bring greater coordination and cooperation to communities. It is worth to mention, that Mariam Jashi, a former member of the Georgian Parliament, raised issues against the political manipulation of the pandemic and the unscientifically based policy measures witnessed in many cases. However, the debate did not address the many concerns from countries and civil society about the risks of centralisation of powers around the WHO and the consequent devolution of competences from nation states to supranational bodies. The WHO, in fact, was unanimously presented as the main coordinating authority in international health. In line with these positions, the President of the European Council, Charles Michael, stated in his speech that: "The WHO is at the heart of our system of international law, it is the guiding and coordinating authority to address global health challenges. The European Union is determined to play a leading role in an inclusive process to strengthen the WHO especially in preparedness for and response to health emergencies, which is why we have launched the idea of an international treaty on pandemics". Within this framework, attention was also drawn to the importance of taking human rights and gender equality into account when drafting the treaty.

In conclusion, although several sessions of the World Health Summit reflected on the importance of strengthening  national health systems and enhancing the capacities and tools of local communities, the main discussions focused on the idea of strengthening global health cooperation, which, while taking into account local communities and national parliaments, should only be considered more effective if it is led at the global level by the WHO at the health policy level. In this landscape, the role of non-state actors and large philanthropic donors, such as the Bill and Melinda Gates Fundation, acting on a global scale, has been further strengthened in the discussion on the implementation and support of health policies of WHO member states and, especially, developing countries. Within these discussions, however, no doubts were raised about the promotion of access to abortion and contraception for women and adolescents.  Instead, the need to include SRHR (under which the right to abortion is indicated in many documents prepared by WHO) in Universal Health Coverage resounded, even though the issue of access to abortion continues to be debated or limited in many countries.

The health policy model promoted in the WHS is that of a centralisation of ever greater competences, ranging from the provision of services such as vaccinations, to scientific study and research, from national to international institutions where funding from member states competes with funding from private philanthropic organisations which have made clear their commitment to promoting abortion among sexual and reproductive rights.

Veronica Turetta – analyst in Ordo Iuris Center for Fundamental Rights