As we enter the third decade of the 21st century the world has been shaken at its economic, political, and social core by a series of convergent and interrelated events - the COVID-19 pandemic, the growing impact of climate change, and the rapidly growing economic inequalities between and within nations. They have led to calls for re-thinking the future of human societies in ways that will result in a fairer, healthier, and more sustainable world.
The 2022 PMAC theme – “The World We Want: Actions Towards a Sustainable, Fairer and Healthier Society”, aims to take a long view by focusing on the ‘mega trends’ that will shape the rest of this century and the complex interplay between them, including how they are already reshaping our global health landscape. PMAC 2022 will consider how the experience of the COVID-19 pandemic is impacting the geopolitics of global health, implications of key shifts in the makeup of the world’s population, the opportunity gains and threats of exponential technological change, and that most urgent of ticking clocks the imminent and evolving threats to global health and wellbeing posed by climate change.
While in the summer of 2021 some rich countries have had access to vaccines with robust immunization programs and are near to achieving herd immunity (Israel, Canada, UK, US), the story is completely different for the vast majority of the world’s population. In low- and middle-income countries (LMIC), fewer than 1 percent have been vaccinated with little expectation that vaccine coverage will be widely available through 2022. In the absence of widespread vaccination coverage SARS-CoV-2 variants will remain a significant threat to those gains already achieved. The issue of equitable access to COVID-19 vaccines and treatment technologies is crucial and poses massive questions for the global community about equitable provision of access to health care and the conditions for health and wellbeing.
The role of political leadership has emerged as vital in determining pandemic responses. COVID-19 is unlikely to be the last pandemic or health crisis that the world faces, especially as deforestation, biodiversity loss, and climate change increase the risk of further spillover of zoonotic diseases. Therefore, this pandemic should serve as an inflection point for the international community to cast aside what the World Health Organization (WHO) has called the “the panic then forget” cycle, which has been emblematic of previous international responses to global health emergencies. Preparing for the next pandemic requires building the systems, capacities and partnerships that can better anticipate, prevent and respond to emergent threats. Ultimately, multi-sectoral approaches are needed to address the challenges of epidemics and pandemics. These should include addressing the root causes of spill-overs and spread – inclusive of environmental degradation and sustainable agriculture, and in parallel intensifying investments in robust and resilient health systems and conditions of everyday that support health.
The human-created and destructive impacts on many of the environmental systems on which human health and life depend can be characterized by ecological ‘overshoot’, in which population demands on ecosystem resources exceeds the capacity for resource regeneration, with climate change posing the most immediately critical health-related threat. As one example, particulate air pollution (associated with fossil fuel consumption and greenhouse gas emissions) is responsible for three times as many deaths annually as HIV, malaria, and tuberculosis combined. Despite 25 years of efforts to implement the United Nations Framework Convention on Climate Change (UNFCCC), through its two agreements and one protocol, CO2 emissions continue to increase rather than stabilize or decline. The election of US President Biden has given a boost to efforts to establish more ambitious carbon reduction targets but a secure climate future is far from assured. Unless the UN Climate Change conference in Glasgow in October-November 2021 (COP26) leads to a global agreement to reduce global warming to 1.5 degree in order to reach global zero emissions by 2050, the climate scientists are warning of the high probability of a planet that is increasing inhospitable for human and most eco-systems. Given the urgency of action on climate change, a quarter century of slow or no substantial prevention or mitigation attests to crises in effective global governance, with concern that the slow decline in multilateralism will worsen the situation.
Over the course of the remainder of this century, the dual threats posed by emerging infectious diseases and climate change will continue to increase, driven to a large extent by ongoing demographic trends and their impact on global ecosystems. Further exacerbating the consequences of these trends are persistent social and economic inequalities that shift the burden of their impact on the economically disenfranchised, displaced populations and people living with pre-existing conditions.
Complicating the ability of nations to mount an effective response to COVID-19 pandemic and climate change has been the erosion of support over the past decade for multilateral institutions and partnerships, a growing mistrust between citizens and their leaders, and the rise of “anti-science”. We need to thoughtfully examine the causes underlying these trends, including the expanding impact of social media, if we are to develop new strategies to re-invigorate our commitment to multilateral partnerships, build more trustful relationships between governments and their citizens, and re-affirm the centrality of evidence-based solutions to future threats.
There are competing views of what our world could look like in 2100. Should the ambitious Sustainable Development Goals and the Paris Climate Accords be achieved, some predict a world in which we are; already winning the battle against climate change by reducing CO2 levels down, where embracing sustainable agriculture and renewable energy reverses the disruptive impact on the ecosystem reducing the threats of future pandemics, where urban design favors cities that are walkable ensuring air pollution levels are under control and where alternative environment friendly transit public transit is available. A world where a circular economy is flourishing, reducing the burden on global resources, and a new kind of global economy takes root, with an overhaul of economic policy to consider broader societal impacts rather than GDP alone. A world where old age care starts when you’re young with a life-course perspective and precision medicine is accessible to everyone, not just the rich. A world where citizen participation in policy making and institutional governance is enhanced and welcomed as an essential step to more democratic and representative governance in local, national and global fora and institutions. Where the ubiquity of technology empowers human minds across the globe, where digitech helps close the gender and wealth gap.
Across most of these alternatives of a virtuous future is an acknowledgment that global governance and favorable geopolitics is a crucial enabler – that the global challenges facing humanity are transnational in nature and trans institutional in solution, where no single government or international organization or other form of institution acting alone can solve the problems described. Global foresight needs to inform global-scale decision-making in order for global governance to keep up with global interdependence.
In that spirit, and in the race to identify ever-increasing ways to improve the human condition despite the ever-increasing complexity and scale of global challenges, PMAC 2022 aims to convene futurists, academics and experts from the fields of global governance, international relations, demography, nutrition, political economy, climate, and technology alongside private sector and global health experts, to take a long view. In so doing, PMAC 2022 is a curtain raiser for future years and future PMACs, that will delve more singularly into megatrends raised here, to ensure the global health vision and global health community use these megatrends to inform and shape possible alternatives for global transformation for health and equity through the 21st century - For the World We Want.