Four Pillars Part 2: Multilateral Support

The COVID-19 pandemic brought to light many of the cracks in the existing global health infrastructure. At the same time, it demonstrated the benefits of multilateral organizations — driving cross-country collaboration, leveraging technical leadership and expertise, and supporting under-resourced health systems. Without the coordinating power of the World Health Organization (WHO), there would have been far more incoherence of efforts, duplication, and waste. While not perfect nor without missteps, we could not have reached this point in the pandemic without organizations like WHO, Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, and UNICEF. Through their collective expertise and coordinating power, the world was able to stand up the ACT Accelerator and, through it, COVAX. As a result, 5.17 billion people — nearly 70% of the world’s population — have received vaccines to date.*

While COVID-19 is a daily reminder of the value multilateral organizations provide, that value is far from assured without continued support. To operate effectively, multilaterals require ongoing partnership and resources from the U.S. and other countries. Yet, recent budget decisions show cause for concern. The failure to pass the COVID funding package, as well as the anemic resources directed toward global health in the Presidents FY23 budget proposal, are worrisome to say the least. But these decisions are just the latest in an ongoing trend. As this community is painfully aware, global health funding — which represents less than 1% of the overall U.S. budget — has been flat lined for years, despite the vast, unmet need.

In addition, U.S. support for health multilateral organizations is critical to leveraging support from other countries and to facilitating cross-country collaboration. This is not to suggest it is solely the U.S.’s responsibility Multilateral institutions are a collective resource in helping to protect the health of the world’s citizens; they require collective support to accomplish shared global health goals. Countries around the world must step up to increase funding, enact equitable and inclusive policies, and ensure access to care through these mechanisms. The past several years has been a poignant reminder of how vital they are to safeguarding the world against disease.

By leveraging the support of donors like the U.S., multilateral institutions protect the world against public health threats and help countries prevent, treat, and protect their citizens. But the decisions made through these entities must not solely be left to donors. Without the involvement of civil society, global health decisions are little more than a “best guess.” It is civil society organizations (CSOs) that are, in overused parlance, where the rubber meets the road. Throughout the COVID-19 pandemic, CSOs have played a critical role in addressing and advocating for the needs of minority and marginalized populations. Yet, they continue to be left out of crucial policy-making discussions surrounding the response. To truly deliver on the promise of multilateral organizations, CSOs must not just be at the table, they should be taking the lead as strategies are discussed.

Multilaterals institutions are imperfect, but the old cliché rings true: “Perfect is the enemy of good.” These organizations provide an inordinate amount of good for the world. They can and should strive to continually improve operations and outcomes through structural changes and, where needed, reforms. And it is our job to keep them accountable. But this can be done on a parallel track to their ongoing work of sharing information across countries and regions, advancing innovation to accelerate the elimination and eradication of diseases, and contributing to new solutions and health improvements.

Multilateral organizations possess different strengths and networks and can serve as meaningful partners to advance efforts toward improved outcomes. As we attempt to move past the worst pandemic in nearly a century, global health will require a new level of global cooperation. We will need to not only move past COVID-19, but also regain lost ground in other health areas in order to meet shared global goals. Without continued U.S. financial and technical support for multilateral organizations, none of this will be possible.

*https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html

All the best,
Elisha Dunn-Georgiou