6. Global Health Diplomacy

This episode of Healthy Cities in the SDG Era takes a different approach in thinking about the Sustainable Development Goals, by zooming out from a focus on specific SDGs, to talking about global health diplomacy, a process which is linked to many of the Goals.

Professor Ilona Kickbusch is the founder and chair of the Global Health Centre of the Graduate Institute of International and Development Studies, Geneva. Previously, she served as the head of the global health division of Yale University and held various positions at the World Health Organization. In 2016, Prof. Kickbusch was awarded the Cross of the Order of Merit of the Federal Republic of Germany in recognition of her significant contributions to shaping the field of global health with her practical and theoretical expertise. Currently, she is undertaking responsibilities in several distinguished boards and commissions such as the Lancet FT Commission Governing Health Futures – Growing up in a digital world, UHC 2030 and Global Preparedness Monitoring Board.

Dr. Srikanth Kondreddy is an Investigator at the Bruyère Research Institute, University of Ottawa, and a Senior Fellow at the WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Ottawa. He also works with UN agencies and he contributes to Think 20 (T20), a policy engagement group of the G20, and has contributed to projects such as the T20 Task Force on "COVID-19 - Multidisciplinary Approaches to Complex Problems". He has research and teaching interests in global health policy, governance, and diplomacy. He is currently researching on global health governance, pandemic preparedness and response, global health security, international health regulations, and international cooperation in health.

CREDITS: This podcast is co-hosted by Dr. Erica Di Ruggiero, Director of the Centre for Global Health, and Ophelia Michaelides, Manager of the Centre for Global Health, at the Dalla Lana School of Public Health, University of Toronto, and produced by Elizabeth Loftus. Audio editing is by Anwaar Baobeid. Music is produced by Julien Fortier and Patrick May. It is made with the support of the School of Cities at the University of Toronto. 

Transcript

Ophelia Michaelides [00:00:07] I'm Ophelia Michaelides and this is Healthy Cities in the SDG era, a podcast about the Sustainable Development Goals and how research conducted by faculty and students at the University of Toronto is helping to achieve them. In this episode, we're excited to take a different approach to thinking about the Sustainable Development Goals by zooming out from a focus on specific SDGs to talking about global health diplomacy, a process which is linked to many of the goals. Diplomacy is the art and science of conducting negotiations between countries. While diplomacy has been carried out around the world for centuries, global health diplomacy is a relatively new term, which has been described as the practices by which multiple actors attempt to coordinate and orchestrate global policy solutions to improve global health. Global health diplomacy is an interdisciplinary field involving many actors from diverse sectors, including foreign policy, trade, environment, labor and many more. To ultimately shape and influence health on a global scale. At the core of global health diplomacy are health issues that transcend national boundaries and require global agreements, instruments and alliances to be addressed successfully and sustainably through joint action. COVID 19 is an example of a global health challenge that requires international cooperation, among many other challenges such as climate change, migration and widening health inequities. That COVID 19 occurred at a time of marked political division and nationalism has certainly had an impact on COVID 19, the ability to spread, and the inequitable distribution of COVID 19 vaccines between and within countries. In this episode, we aim to unpack the topic of global health diplomacy as it relates to the SDGs. Our first discussion with Dr. Ilona Kickbusch will focus on the impact that global health diplomacy has had in the formation of the Sustainable Development Goals, the role of city diplomacy in achieving the SDGs, as well as the impact that geopolitical power shifts are having on multilateral institutions such as the World Health Organization. Our second discussion with Dr. Srikanth Kondreddy will focus on the issues of vaccine diplomacy and how countries, including Canada, are navigating vaccine diplomacy discourses. We'll also talk about the international health regulations in advancing global health agendas, including the SDGs. 

Ophelia Michaelides [00:02:37] Professor Kickbusch is the founder and chair of the Global Health Center of the Graduate Institute of International and Development Studies in Geneva. Previously, she served as the head of the Global Health Division of Yale University and has held various positions at the W.H.O.. In 2016, Professor Kickbusch was awarded the Cross of the Order of Merit of the Federal Republic of Germany in recognition of her significant contributions to shaping the field of global health. With her practical and theoretical expertise. Currently she is undertaking responsibilities and several distinguished boards and commissions such as the Lancet and Financial Times Commission on Governing Health Futures. Growing Up in a Digital World, UHC 2030 and Global Preparedness Monitoring Board. 

Ophelia Michaelides [00:03:23] Welcome. Illona, it's such a pleasure to have you on the show. In today's episode, we are exploring health, diplomacy and the way in which it is practiced in order to generate sustainable and equitable outcomes as set forth by the SDGs. I first wanted to start it off by recognizing the increasingly integral role of health in foreign policy agendas and at global negotiation tables. One of one may argue that the adoption of the SDGs themselves back in 2015 is one of the reasons for these developments. However, I was hoping that we could take a step back in time for just a moment and explore how the SDGs came about in the first place. So my question to you is what was the role of global health diplomacy in the creation of the SDGs, and were there any enabling factors to this process? 

Illona Kickbusch [00:04:18] Well, first of all, Ophelia, thank you very much for inviting me to discuss these really exciting questions. You know, how much I'm committed to, you know, health, diplomacy and everything that comes with it. I think before we actually hone in on global health diplomacy, it's important to see the extent to which the SDG negotiation process actually changed the way we negotiate at the global level. It was really a conceptual and political breakthrough. One was clearly, see that if we look back to the Millennium Development Goals, they were basically constructive. And I consciously use that word within the United Nations. They were built on recommendations that had come from major U.N. conferences and were then more or less presented to the member states and not really fully adopted, just sort of accepted. And the SDGs were really negotiated not only by countries, but by many, many other actors. And we saw through the negotiation process that what we called the new multilateralism actually was was really tight. And of course, before there has always been the involvement of NGOs, of some business representatives, etc.. But here it was really part of the process, since we can see over the last 15 years that all other U.N. negotiation processes and here we come to global health diplomacy, you know, the negotiation on the NCD agreements, the UHC resolutions that were adopted, etc., they were all built on this multi-stakeholder model. And there's another element to this that is this ACG negotiation basically changed the role of diplomats because, you know, before that, the these type of negotiations were in closed decision making processes and this time around, which was created, was so-called open working groups. The diplomats were really involved not just in negotiating the goals, but actually in trying to develop them. And that was also the opportunity then for diplomats with a health brief to continuously ensure that health issues were also part of other SDGs. And so, you know, initially health people said, my God, you know, this is stages and we only have one. Whereas, you know, when we had eight MDGs, we had three. And but actually one could see that health through this diplomatic process has really influenced nearly every other SDG and at least know some people calculate this and say at least 14 are important here. But really a breakthrough and absolutely important for the determinants of health. 

Ophelia Michaelides [00:07:41] Mm hmm. 

Ophelia Michaelides [00:07:43] The SDG negotiation process sounds incredibly impressive in its inclusivity, its wide range of stakeholders, and the reach to all these various stakeholders. And, of course, its focus on partnerships, which, again, is is part of our conversation today as SDG 17. One interesting development from this expansion of stakeholders has been the inclusion of cities in global discussions. Mayors are increasingly representing their cities on the world stage and helping shape the implementation of international agreements. So my question to you, Lorna, is how has city. Diplomacy changed since the SDG negotiations? And what role can cities play in achieving the SDGs? 

Illona Kickbusch [00:08:30] Well, with the SDGs, of course, we have an SDG that focuses on cities. If I remember correctly, it's number 11. 

Ophelia Michaelides [00:08:38] That's true 

Illona Kickbusch [00:08:39] And that's. So what we have here and this is really, you know, also in conceptual terms, a breakthrough. It's the intersection of cities with global governance. We see that very clearly. So cities are engaged in shaping global governance and shaping the priorities of global governance. And, you know, being integral to the SDGs, being named as important implementers is, of course critical. And that's the second dimension. Cities help implement global agreements. And so at first instance, we've seen that particularly in relation to the environment and the C40 cities, the cities, you know, that got really active both before and after the Paris Agreement. We have mayors movements and actually now in the wake and the process of the corona pandemic, what we see is that many cities are turning to new models in terms of the build back better. So so there's an enormous amount of activity going on that some people call global urban governance. I'm proud to say that to last, not least to my initiative in the 1980s, W.H.O. was one of the first organizations to actually work with cities officially. And we started the W.H.O. Healthy Cities Movement, which is still ongoing in many parts of the world. And again, you know, the city diplomacy, just like the SDGs, is a multisectoral diplomacy. And so health diplomacy both in the SDGs, as we discussed earlier and in terms of cities and urban implementation, is always intersectoral. And of course, right now the intersections we see in particular are between health and all the social determinants and health and all the environmental determinants. And so climate change and health has become, you know, an absolute priority and is central in terms of, you know, the CO2 outputs of cities, city transport policies, cycling policies that intersect, you know, with real health policies. And cities have also been thinking about new types of economic models. And so we have a new development called Donut Cities, which look at circular economy at the city level. So many of us hope that in the follow up to the pandemic that we will see a lot of innovation in cities, because we also now see what parts of cities don't function because they were totally dependent on a commercialized model. You know, some of the walking streets and all this type of stuff and it doesn't work anymore if you don't have consumption and they're not made for living. And so we're coming back to cities for well-being and not only cities for environment, health or whatever, but integration. Well-Being, cities. Donut cities. 

Ophelia Michaelides [00:12:14] Mm hmm. 

Ophelia Michaelides [00:12:15] It's it's quite fascinating to hear of these type of transformative initiatives at the city scale, certainly. I also wanted to ask you, diplomacy is facing some very significant challenges during the COVID 19 pandemic, which you mentioned as well, threw out some of your comments. And there are certainly some new political and economic realities. There have been notable geopolitical power shifts in the world and even the questioning of the role of multilateral institutions such as the W.H.O. as a pioneer in the field. Ilona, I am curious to know, you know, of course looking at your crystal ball, what do you see as the greatest challenges facing global health diplomacy at this point in time? And and how is this affecting the process and our progress towards the SDGs? 

Illona Kickbusch [00:13:09] Well, there's a lot to be said here. First of all, COVID 19 has clearly endangered the achievement of the SDGs. We know many more people have fallen into poverty. Many of the poverty gains actually made with the MDGs are being lost, many of the health goals will not be able to be achieved even if we put an enormous effort into it. So definitely COVID 19 is influencing, you know, partly the optimism we had at one point because we were successful with a number of the SDGs. So that's a worrying point, really. The second worrying point is, of course, that we see and it's it's a paradox in the way the SDGs call on us to be very integrative, to be multi-sectoral, to, you know, really work in that circle that they show. But at the same time, our international organizations are built to serve in a sort of issue focused way. You know, W.H.O. is health and UNEP is environment, and FAO is food. And so at present, one really has to be creating also this intersectoral thinking and working between various parts of the UN system. So that in itself is a challenge and we see that now also in trying to address a pandemic that so many parts of of the system need to work together. Just think now of the role of the development banks in trying to ensure that countries can either find out the direct response or are able to find out, you know, getting their economies back on track. But on top of that, then we have a decoupling in geopolitical terms that was really taken forward during the Trump administration in the United States and the new leadership in China. So there is a geopolitical competition, quite clearly between the United States and between China. Now, in the past, such geopolitical divisions didn't quite make it into health. I mean, there would still be, you know, some conflict over how you define should the health system be financed through taxes or private or whatever. But in general, you know, that you need collective action on a number of global health challenges was not questioned. And our ultimate example, of course, is the USSR and the United States and many Western countries working together to eradicate smallpox. So that was a big joint effort. And of course, what one would have hoped, but which wasn't possible because of this geopolitical standoff that when we faced COVID 19, what we would have needed is collective action is to say, you know, we're going to put everything. That's where we differ, trade and ideology and everything behind us. We're not going to call something a Chinese virus and throw blame around or. Right. We are going to say it will help every single person, every single nation state on this globe if we work together. And that's what we did not do. And so despite the fact of W.H.O. creating systems, you know, like COVAX to distribute vaccines, the United States did not join that. Uh China wasn't clear whether it would and how. And what we're seeing right now is, of course, what has been termed, on the one hand, vaccine nationalism, that many of the Western countries, the wealthy countries, are focusing on financing vaccines for their own population and leaving everyone else behind despite COVAX. But on the other hand, twisting very interesting developments of China and India and Russia have both. Also, all three have developed vaccines and they are again now using them for national interests, are using them geopolitically and are making them available partly very cheaply, partly for free to neighboring countries, to countries who they want in their political alliance, for example, China along the Belt and Road Initiative to take an example, India, a whole number of neighbors. So we have this decoupling and the biggest challenge right now, and we hope it will be possible because the United States has come back into multilateralism, that at the G20 meetings, the G7 meetings, the W.H.O. meetings, etc., that we can actually bring this effort together. Also, looking at at other blocs or alliances like the BRICS countries, which has, you know, three of the vaccine producers as partners or within the Shanghai Cooperation, which brings China and Russia together with a whole number of countries. So it's a big geopolitical challenge. W.H.O. is trying to master it. And we hope that that, you know, despite all other conflicts of a political nature, we will be able to come together to really, really fight this virus. Otherwise, we we're lost. 

Ophelia Michaelides [00:19:18] Mm hmm. 

Ophelia Michaelides [00:19:20] Well, the the sounds like the political ecosystem, no doubt is is no doubt complex and dynamic and very diverse for a global health diplomats to navigate. That's no doubt. Illona, I want to thank you for sharing your thoughts with us today. Here's hoping that we can continue to collectively promote and respond to the health of people around the world. On behalf of the Center for Global Health, I want to thank you for joining us today and stay well. 

Illona Kickbusch [00:19:51] Thank you, Ophelia. Thanks very much for having me. And stay well, too, over there in Canada. 

Ophelia Michaelides [00:20:04] Dr. Srikanth Kondreddy is an investigator at the Bruyere Research Institute at the University of Ottawa and a senior fellow at the W.H.O. Collaborating Center for Knowledge, Translation and Health Technology Assessment and Health Equity. He also works with U.N. agencies, and he contributes to think 20 or T20, a policy engagement group of the G20, and contributes to projects such as the T20 Task Force on COVID 19 multidisciplinary approaches to Complex Problems. He has research and teaching interests in global health policy, governance and diplomacy. He is currently researching on global health governance, pandemic preparedness and response. Global health security. International health regulations. And international cooperation in health. 

Ophelia Michaelides [00:20:48] Welcomes Srikanth to the show. Lovely to have you with us. I wanted to acknowledge that we are having this conversation during a pandemic, and I think it's safe to say that COVID 19 has radically shaped and disrupted much of our thinking towards global health. It has changed so much of the global political landscape and the way health diplomacy is practiced. As we speak, one of the defining issues we are grappling with as a global community is around ensuring equitable access to COVID 19 vaccines. Vaccine equity is challenged by rising vaccine nationalism. And so my first question to you is how will actors engaging in global health diplomacy be able to promote collective action and global solidarity to ensure people around the world receive a COVID 19 vaccine? 

Srikanth Kondreddy [00:21:42] Thank you for having me on this podcast. Thanks for discussion too. Yes, your recommendation where we are in the middle of a pandemic, so we are not sure when it's going to be over. So the only the hope is that we have vaccines because South Korea are struggling for almost one year. We are at the stage of having our vaccines. And now now it's it's the question of whether these vaccines are accessible to everyone or not. So that's where we are at this stage. So in this context, the vaccine equity is one thing that is is very puzzling at this point in time and when it comes to vaccine equity. So I would like to bring up on two conceptual things here. As you mentioned, those things in the question itself only. So vaccine nationalism. And the second one is vaccine multilateralism. I go by what they mean and then I'll go into the details of it. So as you mentioned, the vaccination is some it's an absolute kind of a threat to the equity part of it. What do we mean by vaccination is? So when a country procures the required number of doses, making it restricted access to the other countries. So that's when the vaccine nationalism comes into and ensuring the required doses for the population of that particular country by depriving the supply of vaccines to other countries. So this is one thing which is really, really struggling point at this point in time. So we have seen this. So the vaccine nationalism discourse has has been very evident. So particularly from the high income countries. So for example, the European Union countries, you see Canada, UK and Japan. So they all have had some kind of action and vaccine nationalisms. So which means that they want it to be procured at the priority required doses. I would say more than the required doses, which is which is making it difficult for the low income countries, people to have access to those those valuable lifesaving health technologies, vaccines in this point in time. So on the contrary, there are few countries which are looking at vaccine multilateralism, which means it's a kind of making sure while while making sure vaccines are available for their own population. So they're also trying to make sure that these vaccines are shared to the required countries, those people, those countries which which are in an absolute mood of it. So as when it comes to vaccine equity, it's the global solidarity that comes into picture. There needs to be lots of cooperation between countries, so then only we can make it accessible to everyone in that context. So vaccine nationalism is really, really a disturbing factor and an antidote for vaccination nationalism is vaccine multilateralism. Here, I would like to give a case context here. For example, India, which is one of the world's largest supplier of vaccines and is also at the forefront of global vaccine supply at this point in time. So if you if you look at the some of the factual data and so India produces almost 60% of vaccines, vaccine supply are producing 60%, and they make it available to the global supply chains. And then India also runs the world's largest immunization program, which means by population, it's one of the largest country and then which has almost 1.3 billion population, which means phenomenal amount of volume of drugs that are needed to vaccinate within the country while recognizing the importance of vaccinating population within the country. The Indian government is also providing required supplies to nearby countries. So that means that Bangladesh, Nepal, Maldives, these kinds of countries recently, as we have seen recently, that they have been in government, have supply agreed to supply 2 million doses to Bangladesh and they also supplied 2 million doses to Brazil. That way it is going to it is expanding and it is supporting whomsoever is in need of those vaccines. And that way they are living up to the point of a global solidarity and embracing vaccine multilateralism. There are some strategic advantages here by doing this. What are the strategic advantages? So one thing is that the Indian government is making a [...] living up to the point of global solidarity by supplying vaccines free of cost and when needed exports also to other countries. So that claim they are ensuring some kind of regional balance is there. Actually, if you look at the geopolitical sense, India is, you know, in such and such a geographic region, which they have a not China, which was they have a very bitter fight previously on the western side to have a Pakistan which they have a difficult situations to be the country for the last seven seven decades or so. So there is a [...] a strategically in a geopolitical sense, that is a misbalance between [..] between powers like India and China in that region, South Asia region. So by providing these vaccines and then make making these vaccines available to South Asian countries, for example, Bangladesh, Sri Lanka, Myanmar, Nepal, all these countries, they're trying to realign the geopolitical pattern there as as we have seen that in recent times. But China brings extensively under credit and all initiated this and we are initiating through this initiative. The Chinese government has been very instrumental in building infrastructure in Sri Lanka and Nepal and these countries. So on the contrary, India didn't get a chance to align those things. So by doing this vaccine diplomacy, if you go there trying to realign this of the geopolitical equations to challenge the powers there actually in terms of the Chinese geopolitical aggression there. So those kinds of things. So there is vaccine, I would say. So vaccines are very timely as much of it is serving the purpose of the global solidarity because also from the geopolitical interests of India. So that is how the vaccine diplomacy is making a significant part for the government of India in integrating this. 

Ophelia Michaelides [00:29:06] Mm hmm. 

Ophelia Michaelides [00:29:07] Absolutely fascinating to hear of the very significant power shifts in the geopolitical arena when it comes to vaccine diplomacy. It begs the next question in my mind, how well positioned are countries like Canada to approach the the various diplomatic challenges related to vaccine diplomacy, as you began mentioning? And, you know, what role will the vaccine equity discourse play in other fora that perhaps don't traditionally have a health focus, but where health is discussed, such as the G7 or the G20, for example. 

Srikanth Kondreddy [00:29:45] Canada is [...] I guess we all know that Canada [..] it's one of the high income countries and it's part of a geo political forums. For example, the G7 and G20 are part of it. So certainly Canada has a huge role to play in vaccine equity and then vaccine diplomacy for sure. But in recent times, as we have seen, that there is some kind of a disturbance with Canada's approach. There was a proposal by India and then South Africa to requesting a lay off of the acquiring vaccines and technologies. When this proposal was put forward. Canada blocked such an initiative there. So that is one thing which was really troubling something for the vaccine diplomacy and then making sure vaccines, vaccine equity, for example. But eventually so I mean when that thing happened [...] So there was some kind of resistance both in academia and in civil society within Canada, to reconsider Canada's position on this understanding, to unblock that kind of move. So that way I think there is there seem to be some kind of realignment. And and then Canada is kind of it seems to me that they're supporting this proposal, not blocking it anymore. So that way so that the credits are getting back to the diplomacy space where they have the contributing. And also, as we know, that Canada is part of the global COVAX and COVAX facility, the COVAX facility is which is a WHO facility. GAVI is part of it and CEPI is part of it. So all this I mean I mean, the goal of this vaccine facility is to make sure the vaccines are viable in a low-income countries as well as the high-income countries. So by joining the COVAX facility, so again, Canada's is actually playing a role. So they have Canada also contributed nearly $440 million to this vaccine facility. And and they have made a specific pledge of millions for this COVAX facility in order to supply these required vaccines to deliver in many countries. So that one thing so there was a bit of criticism also of Canada's approach to vaccine procurement, as we have seen in the newspapers and the debates and discourses that that Canada had preordered almost nearly 410 million approximately doses so far for countries cooperation of that document in population. So which means that for each individual, for each kind of inclusion would create a citizen as well as the recipient would get at least ten times the doses. So which is absolutely not necessarily right. So they were the ideal situation is that there should be two doses per person. So I mean in that sense, so there's a lot of procurement priorities by Canada government. So that's one thing which some critics say that that wouldn't have been the case by it's kind of hoarding the available supplies that is also restricts the possibility of getting those vaccines by other countries I mean, especially making orders for the pharmaceutical manufacturers to get those vaccines. But yeah, there's a reality that reports are there that say that Canada had [..] had preordered agreements with seven pharmaceutical industries, I mean, arrangements to procure almost 410 million doses. So those are the things which are a bit constraining factors. But then by being part of COVAX facility, so that's where they have contributed to vaccine multilateralism rather than sticking to the vaccine nationalism. So that way it is so contributing to the vaccine part of diplomacy part, and then making sure the supply of these vaccines. When it comes to the G7 and G20 forums, so these are the of Canada being a member in those forums. So there's always a scope for government of Canada or Canada to negotiate and to to discuss, to negotiate with other high income countries on making sure these these vaccines are equitably supplied, accessible to everyone. 

Ophelia Michaelides [00:34:47] Absolutely. So we've been talking a lot about, you know, where global health diplomacy is discussed. But I also want to touch upon on some of the key global health instruments that help promote global health cooperation, particularly as it relates to the control of infectious diseases. We know that one of these instruments is the international health regulations, which is a legal instrument that governs how countries collectively prevent, promote and provide public health responses to the international spread of diseases such as COVID 19. And we know that they've certainly been in the limelight in the past few months. And as they relate to the COVID 19 pandemic, and if they're adequate in dealing with global crises, such as the one we're living in right now. So my question to you is, what do you think the role of the international health regulations play in advancing global health agendas, including the SDGs? 

Srikanth Kondreddy [00:35:53] As we know that international regulations is one of the two legal frameworks that we have in in the WHO. And the other being the framework condition, tobacco control, and the other things like [..] that is for controlling tobacco and then consumption. And the international health regulations is in the context of infectious diseases and like ensuring global health security. So it's a it's a key governing framework. IHR is a key governing framework for global health security. So it has a lot of history, actually. So it starts from Paris particularly. I mean, 1857 onwards. That's the story. When we we if we were to look back retrospectively the context of international relations. So international scientific nations that was developed in 19- ah 1857, that kind of thing. So after that gave us subsequent revisions to this recognition scientific regulations, which became international health regulations. And then in 1983, there were significant revisions again. And then after that, after pandemic. So there was again a revision into this international regulation. So that is how we have we have got a really designed international health regulations, which we often call as soon as ten regulations, international regulations that we that came into effect in 2005 and such was the particular distribution. And as we are heading back now, it can be another tipping point from these revisions, because there are international legal scholars and international global health governance and scholars who were not quite sure how of written off these regulations at this point in time or prior, probably as we have some kind of a surplus in these pandemics. And probably so the discourse would focus more on attribution of IHR. So that's one thing to to to get into the some of the technicalities of international regulations to utilize IHR 2005 because the revised regulations came into force in 2005. And then there was an expectation that each member state that 193 member states and Europe on these regulations to regulate nations. So which means so they are they are obligated to fulfill certain requirements, a compliance of compliance and requirements, as IHR says I mean IHR has so at least eight court capacities and another five other capacities which which put together the packing capacities and eight eight court capacities absolutely must fight for ensuring health security and pandemic preparedness in the country. So, for example, this eight court capacity to intensify our range from our legislations, special focal point surveillance laboratories, miscommunications and all these things as of now, what we see a pre-pandemic times. So that was the time out before pandemic and also pandemic. The fact is fact remains to be the same that many countries are to develop these these capacities in their respective nations. They are trying to build these capacities to the facilities, but somehow these core capacities are to be established in each and every single nation as high income countries. They are being able to put these capacities in place. There was, for example, some of the African countries, they're still struggling to have peace and good capacities in the international context, trying to build it. Often there is this lack of lack of resources, lack of technology and those kinds of things, which mean them not being able to bring those capacities, which again its a lot of cooperation and commercial cooperation between those capacities in this context. As I said, when 93 countries are part of this financial framework, but two third of them are to bring these capacities. That's where we're at it. And then after this pandemic and then the attention, it's much more in responding to the pandemic than looking back at those capacities. So that is how they've been the has been in the focus. But certainly it's a guiding framework for the global health security and pandemic preparedness and response. But certainly there is going to be a possible revision as we move forward. So when it comes to either China and India and excluding other global agendas, including institutions, if we see the Sustainable Development Goals key point to date, which specifically talks about strengthening capacities in a national context, especially in developing countries for pandemic preparedness, for public health risks and key point by point one, it specifically emphasizes strengthening IHR core capacities. 

Ophelia Michaelides [00:41:19] Yes. 

Srikanth Kondreddy [00:41:20] So that where there is a lot of relevance and very significant role for IHR in [..] in the sustainable goals for sure. And that's again the other part of, for example, 3.8 of SDG 3, so which talks about universal health coverage. I see some kind of relevance for Asia in universal health calling also. So in all these things, in these agendas. So the one of the key interlinking practices of the workforce and one of the key core capacity varieties of IHR human workforce. Hthe uman workforce is also a key, essential element for remotely headquarters. 

Srikanth Kondreddy [00:42:04] Yes. 

Srikanth Kondreddy [00:42:05] And it helps us to start strengthening our lives. So so those kinds of things are for sure there is a risk role for international regulations and in promoting or making sure this is some kind of relevance for the agenda's global health agendas. 

Ophelia Michaelides [00:42:26] Mm hmm. 

Ophelia Michaelides [00:42:27] And we'll see what the IHR Review committee comes out with. Certainly. 

Srikanth Kondreddy [00:42:33] Yeah. So it's going to be yeah, there will be interesting discussions once this pandemic gets over. There will be multiple divisions, as I believe you have. How to revise it to make it fit for the next public health emergency? 

Ophelia Michaelides [00:42:53] Yes. Fingers crossed. That doesn't happen any time soon. 

Srikanth Kondreddy [00:42:57] Hopefully not. 

Ophelia Michaelides [00:42:57] If everything works as as we discuss. Srikanth, thank you for your wealth of knowledge and for illuminating so many pressing issues that we are facing right now. On behalf of the Center for Global Health, I want to thank you for your time and give the last word over to you. 

Srikanth Kondreddy [00:43:17] Thanks for that Ophelia.  And then I have just a quick point. So as now, we are in the last phase of the sustainable development agenda. Time yet as we are hoping to achieve these things by the Sustainable Development Agenda by 2030. And then secondly, the pandemic had a [...] halt to this achievement. I mean the progress and and as we know there is  an emphasis in the sustainable development goals that is SDG 17 building partnerships for sustainable development. 

Srikanth Kondreddy [00:43:53] Yes. 

Srikanth Kondreddy [00:43:53] So again, there is hope and these partnerships are really very essential for making sure these vaccines available, vaccine equity and all these things. And these partnerships are also really essential for pandemic recovery. And then getting ready for the next public health emergencies. And again, there is this to this point lately, forums, for example, the G20 has a vital role in establishing this these partnerships. And we last year, in 2020, the G20 summit was held in Saudi Arabia. And this is this year, the G20 summit is going to have a is going to take place in Italy. [incoherent] And so there is an opportunity to build these partnerships as we know that G20 is a powerful bloc, broad forum for both developing countries. So there is of this opportunity for these countries to negotiate and discuss multiple common issues, including pandemic recovery. But this opportunity for these G20 also to engage with developing countries are committing to make them part of these G20 discourses so that we can have some kind of arrangements for sustainable partnerships when we achieve sustainable developmental goals. 

Ophelia Michaelides [00:45:28] Thank you for outlining the importance of multilateralism in the times we're living in and moving forward. And I know there's many challenges facing multilateralism at the moment, but there's certainly many, many forum, many discussions to be had. Srikanth, thank you again. Really appreciate your time with us and stay well. 

Srikanth Kondreddy [00:45:51] Thank you so much. Thank you Ophelia

Ophelia Michaelides [00:45:59] As highlighted by both of our speakers this episode, the SDGs are unprecedented and engaging all 193 United Nations Member States in negotiating and creating a bold blueprint to leaving no one behind. However, the real world implementation of the SDGs requires equitable, respectful and peaceful relations between countries a reality which the COVID 19 pandemic has brought to the forefront, particularly in the face of rising vaccine nationalism, calling for greater vaccine diplomacy. As we have heard in this series before, the COVID 19 pandemic has set back progress towards the SDGs. And so it is important to bring the stages back to the forefront as we rebuild from the pandemic. 

Ophelia Michaelides [00:46:43] Healthy cities in the SDG era is made with the support of the School of Cities at the University of Toronto, whose mission is to bring urban focused researchers, educators, students, practitioners and the public together to explore and address complex urban challenges. 

Ophelia Michaelides [00:47:02] We would love to hear your thoughts on healthy cities in the SDG era. If you enjoyed this episode, please rate, subscribe and share. To help others find this series, you can find healthy cities in the SDG era on Spotify, Apple Podcasts and the Dalla Lana School of Public Health's YouTube page, as well as our Center for Global Health website. On our next episode, we'll look at Zero Hunger. Thank you for tuning in and we look forward to speaking soon. Take good care.