Munich, Germany — Diplomacy and foreign policy prescribe health as a critical component that impacts economic prosperity, global development, and security. Policy decisions in these areas directly influence health outcomes and the spread of disease.
"I've come to understand that nearly every facet of our lives, including global health, is intertwined with both global and local politics. When we fail to unite to tackle shared challenges, everyone suffers. Ending HIV and AIDS is a global problem that requires concerted efforts. All countries need to work together just as with the other global issues such as climate change and biodiversity loss" said Helen Clark, the former Prime Minister of New Zealand and a prominent advocate for structural reform in global and public health at the 25th International AIDS Conference, speaking on Global Health as a Matter of Global Politics.
We now live in an era of multiple crises
Clark called for the critical need for solutions to poverty, inequality, and persistent conflicts. She said: "It deeply concerns me that the global peace and security architecture is in shreds and unable to end major conflicts like the land war in Europe, the war in Gaza, and repression across the Occupied Palestinian Territories, as well as numerous other conflicts from Myanmar to the Horn of Africa, the Sahel, and beyond."
"We now live in an era of multiple crises, where long-standing issues have resurfaced, and new challenges have emerged. These crises are overwhelming our ability to respond, compounded by escalating tensions between East and West and deepening divides between North and South."
She said that "these conditions complicate collective action on our shared challenges. While there is much focus on shared values in Western countries, shared interests often receive less attention. Ineffective engagement across political and regional lines undermines our capacity to address global challenges, including health. With the rise of far-right governments and an increase polarisation, even the COVID-19 pandemic was inadequately managed, with stark disparities in access between high-income and lower-income countries. This is not a new issue for the HIV-AIDS community.
"Efforts to improve pandemic preparedness and response have struggled, and the outcome of these negotiations remains uncertain. At least we have made some progress with international health regulations."
People with HIV and AIDS can now live long lives with medication and advancements in treatment and understanding.
But "despite notable progress" Clark said HIV and AIDS remains a public health threat, having killed more than 42 million people "and continuing to take more each year".
The climate crisis, as well as conflict, poses the most significant and immediate threat to global health, with far-reaching consequences
"The therapeutic and preventive tools to end AIDS exist, but not only are they not equally available to all, but as well, stigma, discrimination, criminalization, and human rights abuses are playing key roles in stopping the end of AIDS. This is intolerable," she said. "The cluster of challenges our world is now facing, this so-called poly-crisis, has compounding impacts, including on our efforts to end HIV-AIDS."
The climate crisis, as well as conflict, poses the most significant and immediate threat to global health, with far-reaching consequences.
"In any conflict or major disaster, essentials like access to food, water, shelter, and essential treatments are at risk. People living with HIV may not have access to their medications, and treatments for cancer and other illnesses are also disrupted."
Debt Crisis Cripples Global Health Recovery
The additional burden imposed by the Covid-19 pandemic, referencing the Economist Intelligence Unit's estimate of 28.5 million excess deaths and severe economic repercussions means that "developing countries are grappling with the worst debt crisis in history, with about half their budgets dedicated to servicing debt," according to a recent study by Debt Relief International.
The severe impact of debt on over 100 countries means they are "struggling to manage their debts, resulting in cuts to health, education, social protection, and climate change investments," according to The Guardian. Clark also referenced Winnie Byanyima's remarks on the debt crisis, highlighting its relevance to the conference's discussions. She pointed out that "the pandemic exacerbated poverty and hunger, increased the number of children out of school and unvaccinated," and said that WHO data shows stalled progress in reducing maternal deaths and slowing survival gains for newborns and young children.
"We've seen stalled progress on reducing maternal deaths for the last eight years, and the survival gains for newborns and young children have lost pace."
Clark said the daunting challenge of meeting SDG goals by 2030, with only "17% of the targets on track with six years remaining." While acknowledging that "money is not everything, it always helps," she criticized the scarcity of funds for global health initiatives and highlighted how this scarcity affects the fight against HIV and AIDS. She said that many traditional donors are "still working to address the fiscal deficits accrued during the COVID pandemic", warning that some countries have elected or might elect far-right governments that "show little interest in global solidarity".
Global Crises Hamstring Efforts to End HIV and AIDS
As major humanitarian crises consume significant portions of official development assistance budgets, funding for WHO and UNAIDS is "extremely tight," she said. And observed that donor governments can use OECD rules to offset some costs related to informal migration. She pointed out the additional strain from informal migration, driven by conflict, poverty, and climate-induced displacement.
She criticized the previous UK government for allocating around half of its bilateral aid Budget domestically and noted that traditional donors are increasing their defense spending. "Every dollar spent on defense is a dollar not spent on health and sustainable development," she said, emphasizing the lack of effort in conflict resolution.
Describing the current global environment as a "perfect storm", Clark said these factors hinder efforts to end HIV and AIDS and other critical issues. She also expressed concern over the rise of the anti-rights movement, which she said has "a very adverse impact on sexual and reproductive health and rights."
Clark said that "criminalization always obstructs effective public health responses", as does the denial of comprehensive sex education. She added that the HIV and AIDS pandemic is rooted in inequality and marginalization, and effective responses have involved rights-based approaches, community engagement, universal health coverage, and campaigns against stigma.
prisons globally are overwhelmed due to these misguided policies
However, she warned that "civic space is under pressure in many places," and "many have been left behind," including people who use drugs. She criticized the UN's drug conventions for their role in perpetuating human rights abuses and contributing to problems in the war on drugs. "The victims of the more than half a century-long war on drugs, mandated by the UN's drug conventions, bear heavy responsibility for widespread human rights abuses, deaths, displacement, and over-incarceration," she said.
"These troubling conventions are used by states, both authoritarian and supposedly democratic, to criminalize people who use drugs and to oppose harm reduction efforts that would save lives," she said.
According to Clark, prisons globally are overwhelmed due to these misguided policies, and high HIV rates are linked to repressive measures and inadequate harm reduction.
She urged the global movement to end HIV and AIDS to recognize that many others are facing similar pressures. "We must build solidarity across movements and advocate for new approaches to secure access to global common goods. The fight against HIV and AIDS is strengthened by a coalition of communities working together towards a healthy, equitable, and sustainable future."
"Women, young people, LGBTQI+, Indigenous people, health, environmental and peace activists, anti-poverty and labour rights campaigners, and more. These and more must be part of a broad coalition to build a better world. We have to build solidarity across movements," she said.
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Let us not see a repeat of the recent inability to access COVID-19 vaccines, therapeutics, and diagnostics
"We need new champions to bring the fight against HIV and AIDS back up the political agenda. We have major battles to fight to uphold human rights and gain equitable access to services and treatments. There are scientific breakthroughs in fighting HIV and AIDS which need to be accessible now by populations everywhere, like these twice-yearly injectable antiretroviral medications, said Clark.
"Let us not see a repeat of the recent inability to access COVID-19 vaccines, therapeutics, and diagnostics with the innovations that can help end AIDS," said Clark. "That would be reprehensible."
"For me, the ideal would be TRIPS waivers for life-saving innovations which can stop pandemics. But, to date, these have been as unobtainable for the HIV and AIDS pandemic as they were for COVID-19.
"As we know from experience, that was not able to be obtained for the HIV and AIDS pandemic and certainly not for COVID-19. So there must continue to be concerted pressure on and negotiations with the pharmaceutical industry to increase the supply of innovative treatments and bring down unit costs. And sharing innovation through WHO's medicines patent pool to allow genuine, generic licensing to flourish would be a very important step which many of us have put our aim to call for."
Clark called for a renewed focus on prevention, universal health coverage, and prioritizing HIV and AIDS within that framework. She said, "Ending AIDS as a public health threat and a danger to individual wellbeing is not a distant dream but a realistic and achievable goal. Everyone here, and everyone you represent, has a critical role in making this vision a reality."
"We do not live in the best of times, but we cannot give up on challenges like ending AIDS. Lives and wellbeing depend on it," she said.
