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Analysis

The G20 Joint Finance and Health Ministers Meeting Statement:
An Important Brick on the Road to Riyadh

Lauren Millar, G20 Research Group
December 3, 2020

I am grateful for the data and analysis provided by members of the G7 and G20 Research Groups.

On September 17, 2020, the G20 health and finance ministers met virtually and endorsed a joint statement. This document strongly suggested that the leaders' summit on November 21-22 would focus largely on the COVID-19 pandemic and how the world's 20 largest economies would balance, and in some cases merge, the priorities of a global health response with a robust economic recovery.

Joint Health and Finance Ministerial Meetings

Only once before have finance and health ministers held a joint ministerial meeting prior to a G20 summit. That first meeting took place in June 2019 in Osaka, Japan, where the G20 ministers confirmed their commitment to a document named the "G20 Shared Understanding," which focused on the importance and impact of universal health coverage and financing in developing countries for sustainable and inclusive growth.

While the Osaka meeting was not a response to a global pandemic, such as SARS or Ebola, it did highlight the need for an interconnected approach to health and economic policy, particularly in the developing world. In 2020, the need for synergistic economic and health policy has never been greater. The global response to the COVID-19 pandemic requires interconnectedness between health and economic policy, especially with full recovery projected as being years away. One could expect this joint pre-summit meeting between finance and health ministers to become institutionalized in the years to come.

A full joint statement was released at the end of the September health and finance ministers meeting. This result was different from the meetings of environment ministers on September 16 and the agriculture and water ministers on September 12, for which the G20 Saudi secretariat issued press releases. When the sole outcome document from a meeting is a press release that makes little reference to any collectively agreed commitments, it can be assumed that agreement among all parties could not be reached.

Thus the current joint statement shows that the health and finance ministers were able to reach agreement at their meeting. This greatly increases the likelihood of G20 members' compliance on related issues with the similar commitments made at the Riyadh Summit itself.

The meeting of G20 health ministers in April 2020 resulted in only one commitment, which was to meet again. In contrast, the meeting of finance ministers and central bank governors in March produced six commitments, all related to health.

These six commitments were fewer than the number produced by G20 finance ministers in previous years, such as 28 commitments from the July 2016 Chengdu meeting, 28 from the 2017 Baden Baden meeting and 30 produced at the June 2019 Fukuoka meeting. Nonetheless, those six commitments suggest that the merging of health and economic policy that occurred with the joint September meeting led to more agreement among the members. John Kirton, director of the G20 Research Group, suggested after the April health ministers meeting, with its single commitment to meet again, that there seemed "little chance that the health professionals in the G20 Health Working Group can ignite a bottom-up process of needed action that will convince their political ministerial masters to act."

It is possible that the decision to include finance ministers, largely regarded as among the most powerful ministers in any cabinet, spurred the G20 members into action in commitment making and potentially compliance.

Silos and Synergies

The 2020 joint statement contained 16 commitments (see Appendix A). All were agreed to by all 20 members. Nine commitments were on health alone, five were on health and related explicitly to finance, and two were on health and referred to multilateral entities. Therefore, nine commitments can be viewed as "siloed" because they addressed only health. Seven commitments can be seen as "synergistic," integrating health and economic actions into a single commitment. This creates a silo-synergy ratio of 56%.

Further research should be conducted to evaluate whether compliance is higher with commitments that operate in a silo of just one policy area compared to synergies, with combined policy fields that seek multidisciplinary, collaborative solutions.

The Extraordinary Summit of March 26, 2020

The health and finance ministers' statement represents a continuation of the 47 commitments made at the G20 Extraordinary Summit, held virtually on March 26, 2020. Those commitments focused overwhelmingly on health, COVID-19 and economic recovery. A team of G20 Research Group analysts and its partners analyzed 11 of the 47 commitments (20 of which were on health) and found short-term compliance to be relatively high.

Since the September joint statement flows from the Extraordinary Summit commitments, and given that high compliance, G20 compliance with the Extraordinary Summit commitments and health and finance ministerial commitments will likely reach higher levels in the coming months.

Finance and health, given the challenges stemming from the COVID-19 pandemic across the developed and developing world, have becoming a unifying force for the G20. This stands in contrast to the continuing divisive discussions on climate change, environment and water, seen at the relevant ministers' meetings a few days before the September meeting of health and finance ministers.

International Law and Multilateral Institutions

The joint finance and health statement reaffirms the G20's "commitment to full compliance with the International Health Regulations (IHR 2005), to improve their implementation and to the continued sharing of timely, transparent and standardized data and information including on health measures and the effectiveness of non-pharmaceutical interventions." This clear commitment to a hard legal mechanism with a specific purpose — to improve implementation, transparency and effectiveness — may draw more attention and create a greater sense of responsibility and accountability from G20 members, increasing the probability of compliance.

Further, the joint statement also recognized the gaps in pandemic preparedness of the World Health Organization (WHO). It notably stated that "we acknowledge the important role of the United Nations' system and agencies, including the WHO, while considering the ongoing evaluations and the need to strengthen its overall effectiveness."

This reference to the WHO is a 180-degree turn from the April health minister meeting and the March meeting of finance ministers and central bank governors, where neither outcome document made any mention of the WHO. This direct reference to the WHO might indicate, since the United States approved the release of this statement, a shift in approach from the Trump administration to demanding and accepting reforms to the WHO rather than a complete retreat, repudiation and withdrawal.

The Road to Riyadh

Overall, this joint statement was a key brick on the road to Riyadh. It clearly positioned the summit to focus on health and global economic recovery in the wake of the COVID-19 pandemic. The near even split between siloed and synergistic commitments highlights a continuance from the Japan's G20 2019 presidency, which first merged health and economics in policy discussions. Furthermore, the continuation and adaption of commitments made at the G20's Extraordinary Summit strongly suggested that further compliance could be expected at the Riyadh Summit, all while reinforcing global "hard law" institutions.

As expected, at the Riyadh Summit itself, held virtually on November 21-22, 2020, the leaders focus on global health and economic stability in the wake of the COVID-19 pandemic. However, in his opening remarks at the summit, WHO director general Tedros Adhanom Ghebreyesus called for strong commitments to be made, such as ensuring vaccines are allocated fairly as public global goods, recommending the full implementation of IHR 2015, and addressing the vulnerabilities and inequalities at the root of the pandemic, these were only tangentially addressed in the commitments. As John Kirton wrote, at best the summit accomplished "just enough to hold out hope that the world get through its immediate crises of COVID-19 [and] economic recession"; however, it was largely short on substance and enforceable commitments.

This was the last summit attended by U.S. president Donald Trump. President Elect Joe Biden has already signalled his plans to, on his first day in office, reverse the United States' withdrawal from the WHO, which was set to be finalized in July 2021. Time will tell whether a United States re-engaged in global health policy, and supportive of the WHO, will lead to improved compliance and the inclusion of more "hard law" commitments at future G20 summits.

Health, in particular global health governance, is a multidimensional subject that requires input from and collaboration in multiple policy areas, especially the economic and fiscal policy fields. The unprecedented cross-border economic and health challenges that have arisen out of the global COVID-19 pandemic require a multidisciplinary approach. This is largely unprecedented within the G20, which paid inconsistent attention to health-related issues from 2008 to 2018.

The year 2020 has demonstrated how intertwined health and economic issues are and the need for a collaboration. The global health threat of COVID-19 has badly damaged confidence and stability in the global economy. The Riyadh Summit was an opportunity for the G20 to highlight its role not only as a crisis management forum, but also as a means for creating multidisciplinary approaches to complex problems, while supporting and engaging collaboration with multilateral global organizations such as the WHO. While steps were taken in that direction, the commitments made point to more interim solutions for the current crisis, and fall short on presenting a broader vision, with tangible commitments, for creating a better, more equitable global health system for the future.

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Appendix A: Finance and Health Ministers Commitments, September 17, 2020 ↩

Commitments

1. We will continue to use all available policy tools to safeguard people's lives, jobs and incomes, support the global economic recovery, and enhance the resilience of health and financial systems, while safeguarding against downside risks. (Health and economy, financial regulation)
2. We remain committed to investing in an effective response to the COVID-19 pandemic to bring the spread of the virus under control and prevent further transmission; thereby minimizing the economic and social disruption while reinforcing our support for returning to strong, sustainable, balanced and inclusive growth. (health with; related to social, macroeconomic policy)
3. We…encourage joint efforts including further voluntary contributions to relevant initiatives, organizations and financing platforms. (Health only)
4. We ask Multilateral Development Banks (MDBs) to swiftly consider ways to strengthen the financial support for countries access to COVID-19 tools. (health with; related to development)
5. We reiterate our commitment to respond promptly to the evolving health and socio-economic situations and drive forward international economic cooperation as we navigate this crisis and look ahead to a strong, sustainable, balanced and inclusive global economic recovery. (health and; macroeconomics).
6. We will reflect the outcomes of today's meeting in the updated G20 Action Plan that will be presented at the G20 Finance ministers and Central Bank Governors' meeting in October 2020 and to the G20 leaders' Summit in November 2020.
7. We call on International organizations (IOs), notably the IMF and OECD, to continue to integrate pandemic data in elaborating different scenarios for the economic impact of the health crisis going forward." (health with; macroeconomic policy related)
8. We will intensify our efforts to support pandemic surveillance and epidemic intelligence, strengthen health systems capabilities, and support platforms to accelerate research and development, to proactively identify and address new and reemerging infectious pathogens. (health only)
9. We reaffirm our commitment to full compliance with the International Health Regulations (IHR 2005), to improve their implementation and to the continued sharing of timely, transparent and standardized data and information including on health measures and the effectiveness of non-pharmaceutical interventions. (health only)
10. We encourage innovative ways of capturing and sharing user- and decision-friendly information. (health only)
11. We reemphasize our commitment to the G20 Shared Understanding on the Importance of Universal Health Coverage (UHC) Financing in Developing Countries to improve the resilience, prevention, detection, preparedness and response of health systems through protecting and investing in public health.
12. We will continue to address the disproportionate economic and social impact of the [COVID-19] crisis on women, young people, and the most vulnerable segments of society. (health and economy, social, gender, youth, vulnerable)
13. Therefore, we will work together to lay the foundation for targeted actions to help respond to the most immediate challenges posed by the COVID-19 pandemic and ensure that the world is better pre[pared to curb the impact of future health-related crises in line with the One Health Approach. (health only)
14. This includes delivering on previous G20 commitments to tackle antimicrobial resistance. (health only)
15. We will integrate the economic risks of pandemics, drug resistant infectious diseases, non-communicable diseases and high-impact tail risks more systematically into the G20's global risk monitoring and preparedness." (health and economy)
16. We will with the support of relevant IOs, build on key findings, lessons learned and propose recommendations to address existing gaps in global pandemic preparedness and response ahead of the G20 Leader's Summit in November 2020. (health only)

Compiled by John Kirton, September 18, 2020

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Lauren Millar is senior advisor and team lead on global health law and policy at the Global Governance Program, based at the Munk School of Global Affairs and Public Policy at Trinity College in the University of Toronto. She received her J.D. from the University of Ottawa Faculty of Law (exchange at the University of Hong Kong) and her Honours B.A. with High Distinction from Trinity College at the University of Toronto. Lauren is an alumna of the Ontario Legislature Internship Programme and was a Canadian Constitution Foundation Fellow. She has worked in politics, in the government relations department of one of Canada's largest banks and as a litigation associate at a national law firm. Lauren was a researcher with the G8 and G20 Research Groups from 2010 to 2013, and was a member of the field teams for the 2011, 2012 and 2013 summits.

The views and analysis reflected in this article are solely those of the author.