Brazil should use its G20 leadership to support public health preparedness

Leveraging the power of the G20 for universal health access and pandemic preparedness

As Brazil takes on the presidency of the G20 in 2024, it has a unique opportunity to advance the global health agenda and advocate for public health systems as a vital element of universal health coverage. The country’s own pioneering public healthcare system, the Sistema Único de Saúde (SUS), stands as a beacon of democratic resistance and a model for how to build resilient, community-based primary care.

By invoking the principles of decolonization, Brazil can challenge the prevailing narratives that frame healthcare through a market-driven lens. Instead, the country should use its G20 leadership to champion the universal right to health and the critical role of public health institutes in pandemic preparedness and response.

Decolonizing global health through the SUS

The SUS was formed during Brazil’s redemocratization process, enshrining the principle of health as a citizenship right. Despite its limitations, it represents a decolonial project that centers equity, justice, and community empowerment in healthcare.

The SUS contrasts radically with the market-driven, fiscally austere approaches often prescribed to the global South by wealthy countries and international institutions. It departs from the limited “universal health coverage” models that restrict services for disadvantaged groups, instead recognizing the universal right to comprehensive care.

The SUS’s decentralized, participatory structure, with deliberative bodies comprising government officials, service providers, health professionals, and users, exemplifies decolonial governance. Its primary care-focused “family health strategy” operates through community-based, multidisciplinary teams – the largest public healthcare program of its kind globally.

This localized, people-centered approach has enabled the SUS to play a vital role in Brazil’s pandemic response, identifying and supporting vulnerable communities, and integrating health and nutrition services. The SUS’s strengths during COVID-19 underscore its potential as a model for building resilient, equitable public health systems in the global South.

Advocating for universal access and pandemic preparedness at the G20

As the 2024 G20 president, Brazil should leverage this platform to advocate for universal access to health and public health systems as essential elements of pandemic preparedness and response.

The country can draw attention to the SUS’s legacy of advancing health surveillance, immunization, pharmaceutical assistance, and other public health capabilities. By positioning the SUS as a decolonial project, Brazil can challenge the dominant narratives that frame healthcare through a market-centric lens and promote a vision of health as a universal right.

Importantly, Brazil should use its G20 leadership to ensure that hunger and food insecurity are addressed as integral parts of the global health agenda. The SUS’s integration of nutrition policies demonstrates how public health systems can play a crucial role in tackling the social determinants of health, especially in crisis situations.

Furthermore, Brazil should advocate for strengthening national public health institutes (NPHIs) as key actors in pandemic preparedness and response. The country can draw on its experience hosting the International Association of National Public Health Institutes (IANPHI) and supporting the development of NPHIs in Africa to position these institutions as vital components of resilient health systems.

Opportunities for international cooperation and capacity-building

As the G20 president, Brazil can leverage its relationships with global health partners to facilitate international cooperation and capacity-building for public health systems. This could include:

• Sharing the SUS model: Promoting the SUS as a case study for countries in the global South to learn from and adapt, highlighting its strengths in primary care, community engagement, and integration of social determinants of health.

• Supporting NPHI development: Building on Brazil’s experience with IANPHI, championing initiatives to strengthen NPHIs in G20 countries and beyond, equipping them with the necessary resources and technical expertise to play a central role in pandemic preparedness.

• Fostering South-South cooperation: Leveraging Brazil’s strong ties with the global South to facilitate knowledge-sharing, joint research, and capacity-building programs that empower countries to develop resilient, equitable public health systems.

• Securing sustained financing: Advocating for the G20 to provide reliable, long-term funding for public health systems and pandemic preparedness, moving away from the cycle of crisis-driven, short-term responses.

By positioning public health as a fundamental component of universal health coverage and pandemic readiness, Brazil can use its G20 presidency to advance a transformative agenda that challenges the prevailing market-driven narratives and centers the experiences and needs of the global South.

Strengthening national public health institutes for pandemic preparedness

National public health institutes (NPHIs) play a crucial role in pandemic preparedness and response, acting as the scientific, technological, and operational backbone of national health systems. As the 2024 G20 president, Brazil has an opportunity to leverage this platform to strengthen the capacity and coordination of NPHIs globally.

The vital role of NPHIs in health emergencies

NPHIs are responsible for detecting, investigating, and responding to disease outbreaks and public health emergencies. They serve as the primary interface between governments, the public, and the global health community, providing essential functions such as:

• Surveillance and early warning: Monitoring disease trends, detecting emerging threats, and triggering rapid response mechanisms.
• Laboratory diagnostics: Conducting testing, analysis, and quality assurance for infectious agents and other health hazards.
• Epidemiological investigation: Tracing disease transmission patterns, identifying risk factors, and informing evidence-based interventions.
• Emergency coordination: Mobilizing resources, coordinating multiagency responses, and managing public communication during crises.
• Research and innovation: Driving scientific discovery, evaluating new technologies, and translating research into public health practice.

During the COVID-19 pandemic, NPHIs in many countries have been at the forefront of the response, leveraging their expertise and agility to support their governments’ efforts. However, the pandemic has also exposed the varying capacities and coordination challenges faced by these institutions across the global South.

Strengthening NPHIs through the G20 platform

As the 2024 G20 president, Brazil can use this platform to champion the crucial role of NPHIs in pandemic preparedness and response, and mobilize support for building their institutional capacity. Key priorities could include:

1. Promoting NPHI networking and knowledge-sharing: Facilitate the exchange of best practices, technical expertise, and lessons learned among NPHIs in G20 countries and beyond. This could involve organizing conferences, facilitating twinning programs, and establishing regional NPHI networks.

2. Enhancing NPHI capabilities: Support NPHIs in developing robust surveillance systems, strengthening laboratory infrastructure, improving data management, and bolstering emergency response capabilities. This could include targeted technical assistance, capacity-building programs, and access to innovative tools and technologies.

3. Strengthening NPHI coordination: Improve the integration of NPHIs into national and global health security frameworks, ensuring seamless collaboration with other government agencies, the private sector, and international organizations during emergencies.

4. Securing sustainable financing: Advocate for the G20 to establish dedicated funding mechanisms to support the long-term institutional development and operational readiness of NPHIs, moving beyond short-term, crisis-driven investments.

5. Fostering South-South cooperation: Leverage Brazil’s experience in supporting the development of NPHIs in Africa and other regions of the global South to facilitate peer-to-peer learning, technology transfer, and collaborative research initiatives.

By positioning NPHIs as central actors in pandemic preparedness and response, Brazil can use its G20 presidency to drive a transformative agenda that strengthens public health systems, fosters international cooperation, and enhances global health security.

Integrating nutrition and food security into the global health agenda

Hunger and food insecurity are inextricably linked to public health, as malnutrition weakens immune systems and exacerbates the impacts of disease outbreaks. The COVID-19 pandemic has further exacerbated these challenges, with the number of people facing chronic hunger expected to rise sharply.

As the 2024 G20 president, Brazil has an opportunity to ensure that nutrition and food security are firmly integrated into the global health agenda, drawing on its own experience in tackling hunger and its innovative approaches within the SUS.

The crucial role of nutrition in pandemic response

The COVID-19 pandemic has underscored the vital importance of nutrition in maintaining population health and resilience. Malnutrition, both undernutrition and overnutrition, can increase the severity of COVID-19 symptoms and the risk of adverse outcomes.

Furthermore, the social and economic disruptions caused by the pandemic have had a devastating impact on food systems, supply chains, and household food security, especially for the most vulnerable communities. This has led to a surge in hunger and malnutrition, which can further undermine the effectiveness of public health measures and the ability of individuals and communities to cope with the crisis.

The SUS’s holistic approach to public health, which integrates nutrition policies and community-based interventions, provides a model for how national health systems can play a pivotal role in addressing these intersections between nutrition, food security, and pandemic response.

Positioning nutrition and food security on the G20 health agenda

As the 2024 G20 president, Brazil should leverage this platform to elevate nutrition and food security as essential components of the global health agenda. Key priorities could include:

1. Advocating for the integration of nutrition into pandemic preparedness and response: Encourage G20 countries to incorporate nutrition-sensitive interventions, such as food assistance, nutrition counseling, and community-based food production, into their national pandemic plans and health emergency responses.

2. Championing the role of public health systems in addressing food insecurity: Highlight how the SUS’s decentralized, community-based approach has enabled it to identify and support vulnerable populations facing food insecurity during the COVID-19 crisis, and advocate for other countries to emulate this model.

3. Securing sustained financing for nutrition and food security programs: Urge the G20 to allocate dedicated, long-term funding for initiatives that address the underlying drivers of malnutrition and food insecurity, as part of building resilient, equitable health systems.

4. Fostering international cooperation and knowledge-sharing: Facilitate the exchange of best practices, innovative approaches, and technical expertise among G20 countries and beyond, enabling the scale-up of successful nutrition and food security programs.

5. Connecting nutrition to the broader sustainable development agenda: Emphasize the interlinkages between nutrition, food security, environmental sustainability, and other Sustainable Development Goals, and call for a comprehensive, multisectoral approach to addressing these challenges.

By placing nutrition and food security at the heart of the global health agenda, Brazil can use its G20 presidency to drive a transformative, equity-focused response to the COVID-19 pandemic and future health emergencies.

Conclusion: Seizing the opportunity for global health leadership

As the 2024 G20 president, Brazil has a unique opportunity to leverage this platform to advance a bold, decolonial vision for global health. By championing the SUS as a model for universal health access and pandemic preparedness, the country can challenge the prevailing market-driven narratives and promote public health systems as vital components of resilient, equitable societies.

Furthermore, Brazil can use its G20 leadership to strengthen the capacity and coordination of national public health institutes globally, ensuring these institutions are equipped to detect, investigate, and respond to health emergencies. Integrating nutrition and food security into the global health agenda will also be crucial, as the country draws on its own experience in tackling hunger and malnutrition.

Through these strategic interventions, Brazil can position itself as a global health leader, championing the universal right to health, the centrality of public health systems, and the importance of addressing the social determinants of health. This vision, grounded in the principles of decolonization and South-South cooperation, has the potential to catalyze transformative change in the global health landscape.

By seizing the opportunities presented by its G20 presidency, Brazil can solidify its legacy as a champion of health equity and pandemic preparedness, inspiring other countries in the global South to follow its lead. The stakes are high, but the potential rewards are immense – a healthier, more resilient world for all.