The Drugs for Neglected Diseases initiative (DNDi) was honoured to attend the G20 Health Ministers meeting on 18 and 19 August in Gandhinagar, India.

‘DNDi welcomes G20 nations’ commitment to “build more resilient, equitable, sustainable and inclusive health systems equipped to address ongoing global health challenges and future public health emergencies, with equitable access to safe, effective, quality-assured and affordable vaccines, therapeutics, diagnostics, and other medical countermeasures”’, said DNDi Executive Director, Dr Luis Pizarro following the release of the G20 Health Ministers’ Meeting Outcome Document. ‘To fully deliver on these commitments, DNDi urges the G20 to make operationalizing equity a central focus of its cooperation across pandemic preparedness and response, climate and health, and digital health innovation.’

In the area of Health emergencies prevention, preparedness, and response (PPR):

• DNDi welcomes the G20’s support for a successful outcome of the Inter-Governmental Negotiating Body for a legally binding WHO international instrument on PPR. All countries must have a role in shaping the framework for future pandemics.
• G20 countries currently conduct and fund the overwhelming majority of the world’s R&D. This should be leveraged to ensure access to the fruits of publicly funded research for all – including by attaching conditions on R&D funding to ensure affordability, access, and equity.
• When considering therapeutics, several issues must be addressed to ensure innovation and access:
  • R&D for new therapeutics must be seen as a critical element of PPR and must be financed as such. Tomorrow’s health emergencies may not look like COVID-19, and the G20 should ensure attention to the entire suite of health tools. In addition to vaccines and increased manufacturing, therapeutics and diagnostics will also be critical – as we have seen for HIV.
  • G20 support for developing new treatments before new crises hit is key. We can only get to the sprint of the race to develop new health tools by running the marathon before emergencies hit.
  • DNDi supports the G20’s focus on regional R&D and manufacturing networks – and the ‘network of networks’ approach. However, different approaches are needed for different health tools. For PPR, the potential classes and nature of treatment modalities required for therapeutics are diverse – including antivirals, antibacterials, biologics, and small molecules – as is the geographical location of expertise across technologies and stages of R&D. We support an inclusive approach that brings together geo-diverse organizations, potentially in a therapeutic alliance.

DNDi welcomes the G20’s focus on the impact of climate change on health:

• For many climate-sensitive diseases, underinvestment in medical R&D results in a lack of simple and effective tools for prevention, diagnosis, and treatment that can be easily integrated into already overburdened health systems. We urge the G20 to go further in prioritizing action to ensure availability of and equitable access to tools to diagnose and treat climate-sensitive diseases, which are vital to building resilient communities and health systems.
• We encourage the Brazilian Government to maintain a focus on climate and health as a priority area for its December 2023-November 2024 G20 presidency, including a review of the actions needed to ensure R&D and equitable access for new health tools to prevent, diagnose, and treat climate-sensitive diseases as part of efforts to build climate-resilient health systems.

DNDi commends the G20 for examining ‘the potential for innovative technologies, including the use of the Internet of Things, big data analytics, artificial intelligence, and machine learning, to support people’s health needs and achieve the goal of UHC’ – and for committing to support the WHO’s efforts to establish a Global Initiative on Digital Health:

• Digital technologies hold great promise to accelerate the development of simple and effective new tools that are needed to help control and eliminate neglected diseases, but their promise is not guaranteed to be realized – especially for the most neglected populations.
• DNDi urges G20 leaders to ensure that successful technologies are not locked away for only certain populations’ benefit. We also urge action to ensure that data used to train AI models is representative of diverse populations and medical conditions to avoid perpetuating existing data biases, including those related to age, ethnicity, and gender.
• Delivering on the G20 ambitions and ensuring that digital technologies are truly transformative for all requires investment to generate missing data in neglected areas and policies that encourage the creation of digital public goods.