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Analysis

The G20 Discovers Global Health at Brisbane

John Kirton, Co-director, G20 Research Group
November 15, 2014

The G20's Brisbane Summit has gotten off to a very strong start with big, bold innovative action on a broader agenda beyond hard-core economics and on an issue it has never before taken up. The first communiqué released by the leaders at their first formal session on the afternoon of Saturday, November 15, 2014, was "The G20 Leaders' Brisbane Statement on Ebola." It was the first time the G20 issued a directly addressed a health issue in a separate statement in its own right and, indeed, addressed a major health crisis devastating human life and the economy of vulnerable countries at the time. This one separate statement on health from the first nine G20 summits compares with the four ones issued by the G7/8 during its first 40 summits. The one-page document with 600 words referred once to the G20's distinctive core mission of making globalization work for the benefit of all. It made five references to the G20's secondary mission of generating economic growth. It contained 34 specific, future-oriented, measurable, politically obligatory commitments — more than any G7 or G8 summit has ever done save for the 60 at St. Petersburg in 2006 and 43 at Heiligendamm in 2007 (see Appendix A). It also made nine references to seven outside international institutions: the World Health Organization (WHO), the United Nations, the World Bank and the International Monetary Fund (IMF), each with two references, and the World Health Assembly, the African Union and the Economic Community of West African States with one each (see Appendix B). Notable was the robust presence of the IMF, directed by G20 leaders to become an institution for direct global health governance for the first time.

Standing out from the statement were several steps that showed that the G20 had now become a direct global health governor itself in a broad way. The statement spoke of preventing such a crisis in the future rather than simply responding to the current one. It spoke simply of Ebola itself but more generally of an Ebola-like crisis that could come. In a clear sign of the initiative of the United Kingdom lying this statement, it included a commitment to fight antimicrobial resistance, an initiative pioneered by the UK in the G7/G8. It mobilized a wide array of financial and other instruments including debt relief, grants and concessional loans in the cause. Even more broadly, it specifically spoke of acting to assist "other vulnerable regions" and to strengthen health systems as a whole and to help ensure the delivery of this commitments it added an accountability mechanism by mandating "interested" G20 members to "report progress and announce a time frame by May 2015 at the World Health Assembly." This points to what would be first ever G20 health ministers' meeting, taking place at the World Health Assembly as the BRICS health ministers now routinely do. Notably all G20 members committed to "full implementation of the WHO International Health Regulations," a commitment that could lead Australia and Canada to reverse their IHR-consistent Ebola-catalyzed travel bans.

To be sure, some things that could easily be done were missing from the statement. One was a commitment to reduce or write off all the debt of the three West African countries at the epicentre of Ebola epidemic; another was a commitment to fully fund the amount that the WHO, UN and World Bank have said is already required to control the epidemic, with proportional contributions from all G20 members. Here one recalls that a few hours before the statement was issued, the leader of one G20 member — President Barack Obama of the United States —  announced a $3 billion contribution to the Green Climate Fund. Yet another was a specific commitment to have all G20 health ministers meet at the World Health Assembly or indeed on their own. And another was to indicate how this G8 innovation could be institutionalized through the inclusion of its relevant components in the post-2015 Millennium Development Goals. Also absent, as Oxfam quickly noted, was a specific reference to the "UN target of 70 per cent of cases being treated and 70% of burials being conducted safely by 1 December."

Appendix A: G20 Brisbane Ebola Statement Commitments (34)

2014-1: We fully support the UN Mission for Ebola Emergency Response's ongoing work to harness capacity to stop the outbreak,

2014-2: [We fully support the UN Mission for Ebola Emergency Response's ongoing work to] treat the infected,

2014-3: [We fully support the UN Mission for Ebola Emergency Response's ongoing work to] ensure essential services,

2014-4: [We fully support the UN Mission for Ebola Emergency Response's ongoing work to]preserve stability

2014-5: [We fully support the UN Mission for Ebola Emergency Response's ongoing work to] prevent further outbreaks and urge that it act swiftly to achieve these objectives.

2014-6: G20 members are committed to do what is necessary to ensure the international effort can extinguish the outbreak

2014-7: [G20 members are committed to do what is necessary to ensure the international effort can] address its medium-term economic costs

2014-8: [G20 members are committed to do what is necessary to ensure the international effort can address its] humanitarian costs.

2014-9: We will work through bilateral [channels]

2014-10: [We will work through] regional [channels]

2014-11: [We will work through] multilateral channels,

2014-12: [We will work] in partnership with non-governmental stakeholders.

2014-13: We will share our experiences of successfully fighting Ebola with our partners, including to promote safe conditions and training for health care and relief workers.

2014-14: We will work to expedite the effective and targeted disbursement of funds [balancing between emergency and longer-term needs.]

2014-15: [We will work to expedite the effective and targeted disbursement of] other assistance, balancing between emergency and longer-term needs.

2014-16: We invite those governments that have yet to do so to join in providing financial contributions,

2014-17: [We invite those governments that have yet to do so to join in providing] appropriately qualified and trained medical teams and personnel, medical and protective equipment, and medicines and treatments.

2014-18: G20 members recommit to full implementation of the WHO's International Health Regulations (IHR).

2014-19: To this end, and in the context of our broader efforts to strengthen health systems globally, we commit to support others to implement the IHR

2014-20: [To this end, and in the context of our broader efforts to strengthen health systems globally, we commit to support others to] build capacity to prevent, [to infectious diseases like Ebola.]

2014-21: [To this end, and in the context of our broader efforts to strengthen health systems globally, we commit to support others to] detect [to infectious diseases like Ebola.]

2014-22: [To this end, and in the context of our broader efforts to strengthen health systems globally, we commit to support others to] report early [to infectious diseases like Ebola.]

2014-23: [To this end, and in the context of our broader efforts to strengthen health systems globally, we commit to support others to] rapidly respond to infectious diseases like Ebola.

2014-24: We also commit to fight anti-microbial resistance.

2014-25: [Interested G20 members] will report progress [by May 2015 at the World Health Assembly.]

2014-26: [Interested G20 members] announce a time frame by May 2015 at the World Health Assembly.

2014-27: We invite all countries to join us in mobilising resources to strengthen national, [preparedness against the threat posed by infectious diseases to global health and strong, sustainable and balanced growth for all]

2014-28: [We invite all countries to join us in mobilising resources to strengthen] regional [preparedness against the threat posed by infectious diseases to global health and strong, sustainable and balanced growth for all.]

2014-29: [We invite all countries to join us in mobilising resources to strengthen] global preparedness against the threat posed by infectious diseases to global health and strong, sustainable and balanced growth for all.

2014-30: We invite all countries to join us in mobilising resources to strengthen national, [preparedness against the threat posed by infectious diseases to] [strong, sustainable and balanced growth for all]

2014-31: [We invite all countries to join us in mobilising resources to strengthen] regional [preparedness against the threat posed by infectious diseases to] [strong, sustainable and balanced growth for all.]

2014-32: [We invite all countries to join us in mobilising resources to strengthen] global preparedness against the threat posed by infectious diseases to] strong, sustainable and balanced growth for all.

2014-33: We will remain vigilant

2014-34: [We will remain] responsive.

Appendix B: Development of Global Governance in the G20 Leaders' Brisbane Statement on Ebola

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