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

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.