The world is changing — our approach to health must change, too

The world seems to be spinning faster each day.

Already-strained health systems are contending with an accelerating pace of new outbreaks of cholera, Marburg virus and an unidentified virus in Burundi, while an uptick of avian flu is fueling concerns of another pandemic. The world is inching closer to the climate precipice, with a stark United Nations report punctuated by the continued fallout from devastating floods in Pakistan and early, intense wildfires in Spain. Nuclear tensions are flaring, natural disasters like the devastating earthquakes that affected Turkey and Syria are straining international resources and the gathering economic storm clouds make responses even more challenging.

This polycrisis presents the chance to chart a more inclusive and humane path.

So, 2023 represents a pivotal opportunity to either course correct or resign ourselves to the dire consequences of these compounding and complex crises. In September, the United Nations (UN) will host a Sustainable Development Goal (SDG) Summit, high-level meetings on tuberculosis (TB), pandemic preparedness and universal health coverage. A few months later, countries will gather for a critical UN climate change conference, COP28.

To leverage these meetings to deliver real solutions that drive impact, we must accept that the world is changing. Old policies dressed in new buzzwords are not enough. New approaches and policies must be grounded in science and evidence, designed with equity at their core and enable access for all to improve health and well-being for people and planet.

First, science. The rapid development of safe and effective COVID-19 vaccines, continued innovation in HIV treatment and prevention and other advances show what modern science is capable of achieving with the right resourcing and focus. But as recent experience shows, we still need to move faster and reach further to ensure the latest science benefits everyone, everywhere and in a timely manner.

In late 2022, plans came together to test multiple Sudan ebolavirus vaccines in response to an outbreak in Uganda, but statistically significant data could not be collected before the welcome end of the outbreak. This is clear evidence that newer, faster approaches are needed to quickly evaluate vaccine candidates in the face of potential pandemic threats, and that the research and development (R&D) ecosystem needs ambitious and transformative change to deliver for people in need.

Good science must also inform evidence-based decision-making that addresses the realities in front of us. From heeding scientists’ warnings on our dwindling window for effective climate action, to enacting human rights-based policies and laws that lead to better health outcomes, following the science is the smart and right thing to do.

We’ve seen this dynamic play out in the fight against HIV/AIDS. Evidence affirms that decriminalization leads to better outcomes, and countries that follow this evidence report progress against HIV/AIDS. Conversely, countries that ignore the evidence and pursue punitive laws and policies are unable to drive progress toward the targets needed to end AIDS as a public health threat by 2030.

Next, equity. Crises disproportionately and consistently impact certain populations more severely, and policies must be designed with an equity-first lens to account for this reality and ensure that no one is left behind.

Failure to do so can be devastating. Women, who are more likely to work in the informal economy, bore the brunt of job losses during COVID-19, exacerbating economic inequality and the gender gap in food insecurity. In response to the pandemic, governments enacted thousands of social support measures, many of which excluded people living with HIV and other key populations at higher risk of HIV from accessing services. Two years later, a stark new report warns that progress against HIV/AIDS is faltering, with key populations accounting for more than two of every three new cases of HIV globally. If we leave people behind, the world falls behind.

Finally, access. From inadequate funding and a shortfall of 10 million health workers to the epidemic of excessive criminalization and unaffordable services, structural and social barriers prevent people from accessing the care they need. Removing punitive laws and empowering community leadership and community health workers is key enabling access to essential health services and universal health coverage.

In Zimbabwe, following a multi-stakeholder government-led assessment of the legal environment that meaningfully engaged people living with HIV, other key populations and partners, parliamentarians advanced and advocated for the repeal of a law criminalizing HIV transmission in the country. The decriminalization of HIV can help boost Zimbabwe’s HIV response, which is on track to achieving the global goals and targets. Scaling this kind of approach to essential to expanding access and equity toward ending the AIDS pandemic by 2030.

The stakes this year are higher than they have ever been. The world has a historic opportunity to marshal science, equity and access to deliver the sea change that is needed to get back on track for the SDGs and achieve health and well-being for all. Complacency, the status quo and tinkering around the edges simply won’t do.

Mandeep Dhaliwal is the director of the HIV and Health Group for the United Nations Development Programme.