Every day in our medical operations, Médecins Sans Frontières (MSF) faces numerous barriers to providing medical care and dignity to people in need.  We therefore welcome the decision of the G20 to place ‘Global Health’ on its agenda.  We call on G20 states to put the welfare of sick and wounded people wherever they live at the core of their concerns, rather than focus on the perceived security threats presented by epidemics and other medical problems.  We believe the G20 states should pay particular attention to three priority areas.

Attacks on medical facilities

From Yemen to Syria, and from South Sudan to Afghanistan and beyond, health facilities are being looted, burnt and bombed by state and non-state parties to conflicts. Attacks on civilian medical facilities, including direct shelling and air strikes on hospitals and clinics by states, appear in some contexts to be a deliberate strategy of war. These attacks have resulted in the deaths of thousands of civilians, including patients, doctors and nurses. And they have been depriving affected populations of basic health services where they are most needed.

One year ago, the UN Security Council unanimously supported UN Security Council Resolution 2286 on the protection of the medical mission. But on the ground nothing has changed. At the G20 you are discussing health system strengthening but you should talk about how to put a stop to the deliberate destruction of health systems. There can be no more waiting. We call on the G20 to ensure that Resolution 2286 is translated into concrete measures in war zones that pave the way for stopping attacks on facilities and on people whose responsibility is to treat the wounded and sick.  

Emergency preparedness and response

When the Ebola outbreak in West Africa was declared in 2014, only a handful of governments and organisations, including MSF, responded.  Being prepared for such emergencies is essential but not sufficient. Preparedness serves no purpose if there is no response when thousands die or fall sick. Additionally, preparing for emergencies should not be limited to infectious diseases identified as threats by a distorting security lens alone.

The G20 should ensure that the World Health Organization (WHO) is given the responsibility and necessary political support for putting the welfare of affected communities – rather than the perceived security threats to powerful states – at the core of outbreak response, and that the necessary resources are mobilised and deployed in close cooperation with national authorities.  Countries must have incentives to transparently and promptly declare outbreaks to WHO so as to ensure a coordinated and efficient response.

Research and development (R&D) efforts can no longer ignore the diseases that predominantly affect the countries, and often poor and marginalised communities, we work for.  We urge you to support recent efforts at WHO and through the Coalition for Epidemic Preparedness Innovations (CEPI) to address these gaps.  And we urge you to ensure that the results of such R&D efforts will be affordable and available to all countries and people in need.

Antimicrobial resistance and drug-resistant tuberculosis

We welcome the commitments made in the UN High Level Declaration on Antimicrobial Resistance (AMR), which was agreed by all governments last September.  MSF is concerned that G20 states are backtracking on hard-fought commitments to ensure the response to AMR is truly global, patient-driven, and adapted to the needs of all health systems, especially in low-resource settings.  The G20 states must ensure public investment into the development of effective medicines, vaccines, and diagnostic tools results in products that are affordable and accessible to all people who need them. This can only be achieved by ‘de-linking’ R&D costs from the price and sales volume of end products, which is very different than de-linking return on investment from volumes, which would result in expensive medicines.  We also urge G20 governments to avoid policies that undermine or restrict access to antibiotics for neglected populations.

It is essential that the G20 states particularly focus on drug-resistant tuberculosis, which accounted for more than one third of all deaths caused by antimicrobial resistance in 2015.  To do so, MSF urges support for closing diagnostic and treatment access gaps, and implementing best practices and policies recommended by WHO.  MSF also calls on G20 governments to provide political and financial support for developing affordable, short-course regimens for all forms of TB, including the 3Ps (Push, Pull, Pool) R&D Initiative.

We expect that G20 states will continue the current focus on health under the presidency of Argentina and beyond.  The health challenges the world faces demand change that will require your attention, resources, and leadership.

Best regards

Joanne Liu

International President – Médecins Sans Frontières