PMAC 2022

The World We Want: Actions Towards a Sustainable, Fairer and Healthier Society



26 - 29 January 2023
Centara Grand at Central World, Bangkok, Thailand

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.

Preparing for Future Pandemics

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.

Environmental Degradation, Global Warming and the Ensuing Climate Crisis

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.

The Way Forward

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.

 

PMAC 2022: The World We Want

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.

Slide for more sub-themes

Sub-theme 1 Concept Note   The World We Want: Megatrends and Futuristic Point of Views


The world has been shaken at its economic, political, and social core by the COVID-19 pandemic. The impact of the pandemic has led to calls for re-thinking the future of human societies in ways that will result in a fairer, healthier, and more sustainable world. Recognizing that the pandemic is not the only crisis facing humankind, other mega trends equally as important to consider in any rethinking of future directions are:

  • Rapidly growing economic inequities within and between countries
  • A pandemic of non-communicable diseases
  • Population, migration and refugees
  • Advocacy of new approaches to economics
  • Changing geopolitical relations, decline of multilaterialism, and increased risks of regional and international conflicts
  • Growing technology inequalities
  • The need for strengthened health systems

Together these mega-trends have created an unstable world which is more open to health and other crises.

Agreed Goals for the Future

The world has also adopted seventeen goals – The Sustainable Development Goals (SDGs) – which have given us a vision of where the world should be by 2030. The 17 SDGs are:

  1. No poverty
  2. Zero Hunger
  3. Good Health and wellbeing
  4. Quality Education
  5. Gender Equality
  6. Clean Water and Sanitation
  7. Affordable and Clean Energy
  8. Decent work and Economic Growth
  9. Industry Innovation and Infrastructure
  10. Reducing Inequality
  11. Sustainable Cities and Communities
  12. Responsible consumption
  13. Climate Action
  14. Life below Water
  15. Life on Land
  16. Peace, Justice and Strong Institutions
  17. Partnerships for the Goals

Further to these goals the United Nations has also endorsed the goal of Universal Health Coverage (UHC) which include:

  • equity in access to health services – those who need the services should get them, not only those who can pay for them;
  • that the quality of health services is good enough to improve the health of those receiving services; and
  • financial-risk protection – ensuring that the cost of using care does not put people at risk of financial hardship.

Many also envisage that UHC will only be achieved through the provision of public services based on comprehensive primary health care1. In addition, there is some agreement (the Paris Accord) that global warming must be kept below two degrees Celsius compared to pre-industrial levels. While there is some denialism regarding climate change there is primarily a strong and growing consensus on the target and the need for strong action to achieve it.

 

               

Background to the megatrends that will be covered in this sub-theme

This section summarizes the relevance of sub-themes 2 & 3 as they are an important backdrops to envisaging the world we want in the future. 

Handling Future Pandemics

While in May 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 in many LMIC. In India, Brazil and the Philippines in May 2021 the pandemic was raging and new variants emerging. 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. The role of political leadership has emerged as vital in determining pandemic responses. There is also evidence that the pandemic has led to an increase in gender-based violence. The pandemic has underlined the importance of strong public health systems which are free at the point of use.

Environmental degradation, Global warming and the ensuing climate crisis Increased risk of pandemics A trend that underpins all the others is the human-created and destructive impacts on many of the environmental systems on which human health and life depend. This is characterized by ecological ‘overshoot’, in which population demand on ecosystem resources exceeds the capacity for resource regeneration, with climate change posing the most immediately critical health-related issue. 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 stabilize or decline. The commitment of the European Union and 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.  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. The recent G7 meeting in the UK did make some commitments to climate action but commentators2 have seen the commitments as not going far enough. Other multilateral meetings happening in 2021 are G20 (Saudi Arabia, November 2021), and OECD (tax reform) and the COP26 in Glasgow (November 2021). While Climate change is the focus of sub-theme 2 addressing this crisis is critical to the ability to achieve the vison in this sub-theme.

Objectives

  • Examine- from different perspectives – how the vision of a healthy, fair and sustainable world can be achieved for current and future generations
  • Examine the varying theoretical and ideological base underpinning these perspectives
  • Outline the most likely pathways to achieving the vision over the next decades

Sub-theme 2 Concept Note   The World We Want: Scaling up Efforts to Address Climate Crisis and Building Forward Greener


The converging crises of climate, ecology, environment and health are megatrends that present current and future threats to our planet and population. There is a need for multisectoral and interdisciplinary collaboration between countries and actors and a need to unite in political solutions. Joint accelerated efforts to tackle the climate crisis and recover from the COVID-19 pandemic are crucial. Measures taken to address both of these public health crises must be examined carefully, given their strong connection.

Many governments and actors are already leading the way, with leadership focusing on green transitions, including the European Union, governments committing to zero net carbon including China and, and President Biden has proposed a $2 trillion climate plan to phase down fossil fuels.However, more action is urgently needed to assure a more promising outlook. During the first half of 2020, the level of carbon dioxide in the air exceeded 410 ppm, the highest levels in 3 million years, as pointed out by a new multi-agency report launched in September by UN Secretary-General.

PMAC 2022 should send positive signals to further scale up efforts tackle the converging health and climate crisis with engagement of youth, vulnerable groups, private sector via innovation and inspirations. We suggest involving politicians and decision-makers on high levels, stimulating discussions to generate agreements for the way forward regarding climate, ecology, and environment for optimal health outcomes. Youth and groups representing the most vulnerable in the converging crises of climate change, environmental degradation and health will also be involved in these discussions. Our activities aim to build momentum, mobilize support and advocate for the megatrends discussed at PMAC.

Objectives

The world is in a situation where there is an increased openness for transformation due to the pandemic, where clear goals need to be set, and key activities need to be prioritised. In this, PMAC can be a strong voice addressing the converging global crises and how to take bold actions for humanity and planet – emphasising that human health is dependent on the planet's health.

The objectives for sub-theme 2 are:

  • Discuss actions to address the converging crises of climate, biodiversity, environment and health.
  • Mobilise political and private sector support and momentum for action-oriented collaboration between countries and actors to synergise in political solutions and mechanisms. This should also include creating accountability for investing greener in the recovery post-COVID-19 and mobilising resources for "building forward better".
  • Engage youth and vulnerable groups in the converging crises of climate change, environmental degradation and health in these discussions, and create a platform for them to express what they need from today's leaders.
  • Leverage the momentum and impacts from COP26 (before PMAC) and contribute to Stockholm +50 in June 2022 (after PMAC).

Sub-theme 3 Concept Note   Learning from the COVID-19 Pandemic to Better Prepare for Tomorrow’s Challenges


The ongoing COVID-19 pandemic has laid bare our collective weaknesses in being able to effectively respond to the emergence of a highly contagious and lethal microbial threat.  Despite extraordinary advances over the past century in science and in global health standards, we still live in a world where the threat of an infectious agent can emerge anytime and anyplace without warning and spread rapidly to every community and every household without regard to national borders.

Importantly, COVID-19 is not the first pandemic due to an emergent pathogen from wildlife of this century and is unlikely to be the last. Over the last 20 years a number of high impact pathogens have emerged or re-emerged. These include emergence of diseases due to three new coronaviruses (CoV), namely Severe Acute Respiratory Syndrome (SARS) in 2003; Middle East Respiratory Syndrome (MERS) in 2012; and the ongoing COVID-19 pandemic, a number of highly pathogenic influenza A viruses (e.g. H5N1 in 2003; H7N9 in 2013; and the H1N1 pandemic of 2009), the Zika virus as a global health emergency in 2016, and the continuing rise and spread of Ebola in West and Central Africa since 2013.

All these emergent pathogens have jumped from transmission among non-human animals to transmission among humans.  Over the course of the remainder of this century, the likely frequency of epidemics and pandemics will continue to increase, driven mainly by demographic trends, including urbanization, and environmental degradation, climate change, persistent social and economic inequalities, and globalized trade and travel.

While upgrading of the health security apparatus over the last decade has been welcomed, COVID-19 underscores that the existing legislation, processes, and institutional arrangements such as the International Health Regulations (IHR) and Global Health Security Agenda (GHSA) are insufficient for early warnings and in preventing impacts of events such as those caused by SARS COV-2.  Some countries that were assessed to be well prepared using various indexes and metrics, performed poorly in containment and mitigation during the COVID-19 pandemic. Clearly, there are other components of health emergency risk management and an effective response that have not been well characterized. 

The experience of the COVID-19 pandemic, yet again underscores that new efforts are needed to craft global strategies, policies and regulatory frameworks that improve our collective capacities to prevent, as well as rapidly detect and respond to threats.  The COVID-19 pandemic, has heightened the sensitivity of the global community to devastating socio-political and economic damage to the planet. This is an opportunity to capitalize on a growing international discussion among political and global health leaders on the need to address future emerging threats to leverage political and financial support, as well as build out its organizational and operational architecture. Making good use of the additional energy in the system will be essential if we are to learn the lessons that we have failed to learn before. We must capitalize on this to guide both near-term and longer term future investments in pandemic preparedness and to expand work to understand new pathogens and where they come from before there are widespread outbreaks.

               

Objectives

  1. Characterize and understand the factors that led to the inadequate global preparedness for and response to COVID-19, leading to direct and indirect impacts, in order to answer “how can we be better prepared to prevent and mitigate the impacts of any future pandemic threat?”
  2. Characterize and understand the strengths and weaknesses in the design and implementation of: the global regulatory framework and conventions, such as the IHRs and the SDGs; the global health architecture; international funding mechanisms etc., in preparing the world for COVID-19 and identify how they might be improved to make them more effective for future emerging threats?
  3. Understand how current mega-trends are likely to impact the emergence and spread of future infectious disease threats and identify actions to make the world’s social, political and economic systems better able to cope with these changing dynamics.

               

PMAC 2022 International Organizing Committee

Name - Surname Position Organization Role
Dr. Vicharn Panich Chair, International Award Committee Prince Mahidol Award Foundation, Thailand Chair
Ms. Henrietta H. Fore Executive Director United Nations Children's Fund, USA Co-Chair
Ms. Winnie Byanyima Executive Director Joint United Nations Programme on HIV/AIDS, Switzerland Co-Chair
Dr. Naoko Yamamoto Assistant Director-General for Universal Health Coverage and Health Systems Cluster World Health Organization, Switzerland Co-Chair
Dr. Juan Pablo Uribe Global Director for Health Nutrition and Population The World Bank, USA Co-Chair
Mr. Haoliang Xu Assistant Secretary General and Director of the Bureau for Policy and Programme United Nations Development Programme, USA Co-Chair
Dr. Osamu Kunii Head, Strategy, Investment and Impact Division (SIID) The Global Fund to Fight AIDS, Tuberculosis and Malaria, Switzerland Co-Chair
Mr. Tomoya Yoshida Deputy Director General, Human Development Department Japan International Cooperation Agency, Japan Co-Chair
Dr. Jennifer Adams Senior Deputy Assistant Administrator, Bureau for Global Health United States Agency for International Development, USA Co-Chair
Dr. Barbara J. Stoll President China Medical Board, USA Co-Chair
Dr. Naveen Rao Senior Vice President & Senior Advisor to the President, Health Initiative The Rockefeller Foundation, USA Co-Chair
Dr. David Harper Senior Consulting Fellow, Global Health Programme Chatham House, United Kingdom Co-Chair
Dr. Rintaro Mori Regional Adviser (Population Ageing and Sustainable Development) United Nations Population Fund, Thailand Member
Dr. Peter Friberg Co-founder and Director Swedish Institute for Global Health Transformation, Sweden Member
Dr. David Wilson Senior Program Officer in Decision Sciences Bill & Melinda Gates Foundation, USA Member
Dr. Teo Yik Ying Dean, Saw Swee Hock School of Public Health National University of Singapore, Singapore Member
Dr. Ashley McKimm Director of Partnership Development British Medical Journal, United Kingdom Member
Dr. Timothy Mastro Chief Science Officer FHI 360, USA Member
Ms. Bridget Lloyd Global Coordinator People's Health Movement, South Africa Member
Mr. Thani Thongphakdi Permanent Secretary Ministry of Foreign Affairs, Thailand Member
Dr. Kiattibhoom Vongrachit Permanent Secretary Ministry of Public Health, Thailand Member
Dr. Supat Vanichakarn Secretary General Prince Mahidol Award Foundation, Thailand Member
Dr. Jadej Thammatach-aree Secretary General National Health Security Office, Thailand Member
Dr. Nopporn Cheanklin Director Health Systems Research Institute, Thailand Member
Dr. Supreda Adulyanon Chief Executive Officer Thai Health Promotion Foundation, Thailand Member
Dr. Banchong Mahaisavariya President Mahidol University, Thailand Member
Dr. Prasit Watanapa Dean, Faculty of Medicine Siriraj Hospital Mahidol University, Thailand Member
Dr. Piyamitr Sritara Dean, Faculty of Medicine Ramathibodi Hospital Mahidol University, Thailand Member
Dr. Suwit Wibulpolprasert Vice Chair International Health Policy Program Foundation and Health Intervention and Technology Assessment Foundation, Thailand Member
Dr. Viroj Tangcharoensathien Senior Advisor International Health Policy Program, Thailand Member
Dr. Walaiporn Patcharanarumol Director, Global Health Division Ministry of Public Health, Thailand Member & Joint Secretary
Mr. Gerardo Zamora-Monge Executive Officer, Office of Assistant Director-General, Division of UHC/Healthier Populations World Health Organization, Switzerland Member & Joint Secretary
Dr. Toomas Palu Advisor in Global Health The World Bank, Switzerland Member & Joint Secretary
Mr. Hakan Bjorkman Regional Health Advisor/Team Leader ai, Asia and the Pacific United Nations Development Programme, Thailand Member & Joint Secretary
Ms. Debora Comini Deputy Regional Director, East Asia and the Pacific Regional Office United Nations Children's Fund, Thailand Member & Joint Secretary
Mr. Taoufik Bakkali Regional Director ai, Regional Support Team Asia and the Pacific Joint United Nations Programme on HIV/AIDS, Thailand Member & Joint Secretary
Dr. Scott Stewart  Senior Health Economist, Bureau for Global Health United States Agency for International Development, USA Member & Joint Secretary
Mr. Tatsuya Ashida Director, Human Development Department Japan International Cooperation Agency, Japan Member & Joint Secretary
Dr. Le Nhan Phuong CMB SE Asia Regional Representative China Medical Board, Thailand Member & Joint Secretary
Mr. John Spangler Director, Communications, Policy and Advocacy The Rockefeller Foundation, USA Member & Joint Secretary
Dr. Thananya Boonyasirinant Deputy Dean for Academic Affairs Faculty of Medicine Siriraj Hospital, Mahidol University, Thaland Member & Joint Secretary
Dr. Churnrurtai Kanchanachitra Professor Institute for Population and Social Research, Mahidol University, Thailand Member & Joint Secretary