Questionnaire

The COVID-19-pandemic has not only claimed millions of lives and caused immense economic damage. It has also set back realizing health as a human right for all by years. More than half of all people worldwide do not currently have access to adequate and affordable health care systems. In the wake of the pandemic, access to self-determined family planning and other sexual and reproductive health and rights services, immunization programs, and efforts to combat neglected tropical diseases and HIV, tuberculosis and malaria have suffered significant setbacks. The number of deaths due to antibiotic resistance will increase drastically without coordinated efforts to address this issue. Girls and women are particularly affected by the secondary consequences of the pandemic. At the same time, the pandemic has relentlessly exposed the vulnerability of the poorest– they not only bear the greatest personal risks, they also lack any adequate social protection. These negative effects are further exacerbated by climate change as well as the current food and energy crisis.

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The COVID-19 pandemic has not been defeated worldwide. No one is permanently safe until everyone is safe. Global solidarity in a pandemic is not only a humanitarian imperative, it is also an essential means of self-protection. We must also remain prepared for scenarios in which more aggressive viral variants lead to infection, death, and renewed socioeconomic consequences. 

To end the COVID-19 pandemic, the global community must proactively manage the future of the Access to COVID-19 Tools Accelerator (ACT-A) and invest in expanding and building local pharmaceutical production in all regions of the world. Inequalities in access to COVID-19 countermeasures must be eliminated and – for instance as regards the use of new medicines and vaccines –prevented from the outset. 

But also beyond the current pandemic, the global health architecture must be set up in a more effective way to better address potential future disease outbreaks. A prerequisite for achieving the SDGs and for better combating all diseases is a functional global health architecture whose actors efficiently coordinate their strategic orientation and resource allocation. The Global Action Plan (GAP), co-initiated by Germany, plays an important role here and should be revived, incorporating the experiences of ACT-A, to counter the fragmentation in the health sector.  Intersectoral exchange should be strengthened. In particular, WHO must be further strengthened in its coordinating and normative role, including financially.

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The pandemic has highlighted the dangers of zoonotic infectious agents and the risks of an exclusively reactive approach. Scientific studies show that the next pandemic is certain to come – the only question is how and when it will occur. In addition, for years we have been in the midst of a “silent” pandemic of antimicrobial resistance that urgently needs to be tackled. The rising world population and the destruction of natural habitats are increasing the risks still further. 

Pandemic prevention and preparedness have so far been neglected. In view of the high risks of future infectious agents and the possible loss of many human lives, prevention approaches urgently need to be developed and expanded. In fact, prevention and preparedness are more effective and less costly than response. 

With the help of the One Health approach, the interrelationships between human and animal health and the environment can be taken into account, and preventive measures can be taken. This way infections can be prevented from arising in the first place, and health systems are better prepared for outbreaks. In addition, more support is needed for the development of integrated surveillance and early detection systems, international cross-sectoral data sharing on infectious outbreaks and pathogens, and laboratory diagnostics.

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Achieving universal health coverage (UHC) is an overarching goal of German development cooperation in this sector. Access to quality health services for all sections of the population and providing poor and vulnerable people with protection against health expenses that are a threat to their livelihoods are central in this regard. It is therefore also important to create a stable financial basis in partner countries themselves and introduce comprehensive health insurance.

To achieve UHC, health systems must be expanded and strengthened. The WHO model for health systems, which also informs the main approaches of the German Development Cooperation, has six building blocks (health personnel, services, financing, information systems, drugs and medical devices, and governance). The complex and dynamic challenges in the field of global health (e.g., climate change, food crises, gender inequity, social inequalities) require that the understanding of health systems and approaches to strengthening them — also beyond the WHO building blocks — be expanded to include linkages with other sectors (e.g., in the context of Health in all Policies, One Health, population development, climate, gender, digitalization, etc.).  

The pandemic has also shown that primary health care is of paramount importance in health crises, in order to be able to respond efficiently on the front line while providing reliable access to basic health services for all population groups, especially mothers, newborns and children. Digital technologies have the potential to accelerate the development towards universal health coverage, enable equitable primary health care for all, and contribute to greater (global) health security. Smart investments for pandemic response and preparedness not only help manage the pandemic, they also ensure that systems are better prepared for future health crises. Strengthening the resilience of health systems to crises is essential and is pursued as a fundamental approach in health programs. Mindful of climate change, this also means that future health systems should be climate resilient, low carbon and sustainable.

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The sexual and reproductive health and self-determination of girls and women in all their diversity is an essential prerequisite for the equal participation of all people in social, economic and political life. When girls and women are healthy and can make self-determined decisions about the timing of pregnancies, this also benefits their further educational and employment opportunities.

In order for people to realize their rights in this area, crisis resilience and the provision of quality services must be further strengthened and expanded. This includes, in particular, maternal-child health and self-determined family planning. Furthermore, in addition to capacity building of health workers, menstrual hygiene and sexuality education, this area of intervention will also address health financing and reducing social and financial barriers.

Access to birth registration plays an essential role in making entitlement to health and social services possible in the first place. Population policy approaches are therefore dedicated to building the civil registration system and promoting the use of population data, which is essential, among other things, for development planning. In addition, efforts are to be made to identify population trends and promote policy dialogue with a view to harnessing the potential from the development of the population and thus reap a demographic dividend, for example.

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Crises such as the COVID-19 pandemic, natural disasters or the current food price crisis show how important it is for countries to have effective social protection systems. Tackling the causes of these crises is one thing – getting through them well another. In the pandemic, the welfare states in the Global North have shown how they can specifically protect people from poverty. In the Global South, on the other hand, most people are on their own – only half of the world’s population has access to social protection.

Social protection strengthens social justice and enables social and economic participation. In this way, it protects against instability and political disruption. We must therefore systematically promote the establishment and expansion of social protection systems and the realization of the human right to social protection. There are therefore plans to expand the bilateral and multilateral commitment to social protection within German development cooperation.

We are guided by the UN Sustainable Development Goal of establishing national social protection systems for all by 2030 (SDG target 1.3). With our international partners, we want to support partner countries in achieving access to social protection for up to one billion more people by 2025 in order to safeguard them against poverty and crises.

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Finally, we have a couple of brief cross-cutting questions for you:

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