Thembeni Mkingofa, a woman living with HIV, visits the PMTCT section of the Makhume District Hospital, Zimbabwe. She has three children - 14, 10 and 2 who are all HIV negative. This is her fourth pregnancy. Her husband is also on HIV treatment. Here she is pictured with her two-year-old daughter, Hilda Chakiryizira. 5 November 2019. Credit: UNAIDS/C. Matonhodze

By Winnie Byanyima and Sir Michael Marmot
BRASILIA, Brazil, Jun 5 2023 (IPS)

The COVID-19 crisis has shone a light on the danger of pandemics; social crises have shone a light on the danger of inequalities. And the reality is that outbreaks become the pandemics they do because of inequality. The good news is that both can be overcome – if they are confronted as one.

Scientific and medical breakthroughs in the treatment and prevention of HIV should have brought us to the point of ending AIDS. Tragically, however, although the number of new HIV infections is falling fast in many countries, it is still rising in dozens of countries and the goal of ending AIDS by 2030 is in danger.

The reason: economic and social inequalities within countries and between them increase people’s risk of acquiring disease and block access to life-saving services.

Letting inequality grow is driving pandemics and prolonging emergencies that drain economies and health systems. This makes all of us vulnerable to the next pandemic, while placing entire countries and communities of people in harm’s way.

In too much of the world we see policy approaches which leave inequalities to widen, and even, in some cases, deliberately exacerbate inequalities.

On a global level when wealthy countries quickly invest billions in their own medical and social response, while leaving other countries so burdened by debt they have no fiscal space to do so, that undermines the world’s capacity to fight AIDS and pandemics.

During COVID-19 while wealthy countries poured in billions to protect their economies, reduce economic and social hardship and fight the pandemic, almost half of all developing countries cut health spending and about 70% cut spending on education.

Shanenire Ndiweni, has a consultation to receive pre-exposure prophylaxis at the Centre for Sexual Health and HIV/AIDS Research Zimbabwe (CeSHHAR Zimbabwe) clinic, Mutare, Zimbabwe, 6 November 2019. Credit: UNAIDS/C. Matonhodze

Viruses do not respect borders, so when the vaccines, drugs, and tests intended to stop those viruses go to powerful countries in excess, while other countries have little or nothing and are held back from producing medicines themselves, that perpetuates pandemics everywhere.

Similarly, social and economic conditions that perpetuate pandemics in low- and middle-income countries present a global threat. Much as with COVID-19 the same has happened with the MPox virus.

In recent years twice as many people have died of MPox in the Democratic Republic of Congo as the entire rest of the world combined but, as of today, zero vaccines for MPox had been delivered to the DRC.

Social and legal determinants that make people vulnerable to pandemics must be tackled. Globally almost 5,000 young women and girls become infected with HIV every week. Dismantling barriers to sexual and reproductive health and rights services, investing in girls’ education, and combating gender-based violence to remove gender inequity is key to ending the AIDS pandemic and protecting women’s health.

Laws that criminalize and marginalize LGBT communities, sex workers and people who use drugs weaken public health approaches and prolong pandemics such as HIV. In sub-Saharan African countries where same sex relations are criminalized, HIV prevalence is five times higher among gay men and men who have sex with men than in countries where same sex relations are not criminalized.

Even within countries that are making substantial progress against HIV, advances may not be shared equally. Here in Brazil for example, HIV infections are falling dramatically among the white population as access to treatment is widened and new prevention tools such as PrEP are rolled out.

That shows what can be achieved; but HIV infections among the black population in Brazil are still on the rise. A similar story runs in the United States where gay white people are more likely to have access to good health care than gay black people.

We emphasize that it is not only access to health care that perpetuates these inequalities, but the social determinants that increase the risk of infection.

To overcome inequalities in accessing essential services, communities must be empowered to demand their rights. The AIDS movement is one of the best examples of how groups of people experiencing intersecting inequalities can unite to overcome them, leading to millions of lives being saved.

Successive Commissions on Social Determinants of Health have brought together evidence on how the conditions in which people are born, grow, live, work and age are powerful influences on health equity.

To bring together these two strands of knowledge over the coming months we will be convening global experts from academia, government, civil society, international development and the creative arts to build a Global Council to advance evidence-based solutions to the inequalities which drive AIDS and other pandemics.

The council will unite experts from disparate fields of economics, epidemiology, law, and politics and will include ministers, mayors, and former heads of state, researchers and clinicians, health security experts, community leaders and human rights activists.

The work of the Global Council will harness essential evidence for policymakers. It will elevate political attention to the need for action. Most crucially, it will help equip the advocacy of the frontline communities fighting for their lives, with what they need to shift policies and power.

Appropriately, the Global Council is launching in Brazil. Whilst Brazil has exemplified the challenges of intersecting inequalities, Brazil’s social movements have been pioneers in confronting them, and Brazil’s new government under President Lula has committed to tackle inequalities in Brazil and worldwide.

To fight tomorrow’s pandemics, we need inequality-busting approaches to today’s pandemics. The world’s leaders now face a clear choice: stand by whilst the dangers mount or come together to tackle inequalities for a world that is not only fairer, but safer too.

Winnie Byanyima is the Executive Director of UNAIDS and an Under-Secretary-General of the United Nations. Before joining UNAIDS, she served as Executive Director of Oxfam International, a confederation of 20 civil society organizations working in more than 90 countries worldwide, empowering people to create a future that is secure, just and free from poverty.

They will launch the Global Council on Inequalities, HIV and pandemics in Brazil on June 5. The authors are founder members of the Global Council on Inequality, AIDS and Pandemics and are in Brazil for its announcement.

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Efforts to reinforce and leverage the infrastructure built to end AIDS can optimize the health impact and sustainability of the response to COVID-19. Zimbabwe, November 2019. Credit: UNAIDS/Cynthia Matonhodzes

By Winnie Byanyima
GENEVA, Sep 15 2022 (IPS)

Next week, taking place alongside the UN General Assembly, President Biden hosts a financing summit in New York of such importance that it will determine if millions of people live, will shape the world around us for years to come and will set the future direction of global health. At least $18 billion is needed to fund the work of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

A successful replenishment of the Global Fund will help strengthen the fight against three of today’s deadliest diseases and build more resilient national health systems capable of withstanding tomorrow’s shocks.

The funding needs are particularly urgent in the wake of the COVID-19 pandemic which caused such severe disruption to the delivery of essential healthcare, including HIV treatment, prevention and care services.

The latest data from UNAIDS has revealed a global faltering response to HIV, compounded by a continued decline in resources. Around 650 000 people died of AIDS-related illnesses last year, with tuberculosis remaining a major cause of death among people living with HIV.

There were also 1.5 million new HIV infections—over one million more than the global target set. New infections fell by only 3.6% between 2020-2021, the smallest annual decline since 2016. New infections increased in 38 countries.

Infections continue to occur disproportionately among young women and adolescent girls aged 15—24, with a new infection every two minutes. The gendered HIV impact, particularly for young African women and girls, has taken place amidst severe disruption to HIV treatment and prevention services, millions of girls forced out of school, and spikes in teenage pregnancies and gender-based violence.

In sub-Saharan Africa, adolescent girls and young women are three times as likely to acquire HIV as adolescent boys and young men. Vulnerable groups of people worldwide such as gay men and other men who have sex with men have also been disproportionately affected during service interruptions.

If we don’t more effectively prevent young people from getting HIV now, especially young women and adolescent girls, there will be millions more infections and deaths and the resources needed to end AIDS will increase further.

Stigma and discrimination that drives the epidemic among marginalized and criminalized groups of people must be tackled, including through law reform. And there must be bolder action to ensure that children living with HIV receive antiretroviral therapy as a matter of course—currently just half of HIV positive children are on life-saving treatment.

Giving young people the chance to live requires investment. But international solidarity in the fight against HIV and other global health threats has been fraying. At a time when global leadership and an increase of funding is most needed, too many high-income countries are cutting back aid, and resources for global health are under serious threat.

In 2021, international resources available for HIV were 6% lower than in 2010. Overseas development assistance for HIV from bilateral donors other than the United States of America has plummeted by 57% over the last decade. The HIV response in low- and middle-income countries is US$8 billion short of the amount needed by 2025.

Furthermore, global trade rules are obstructing low- and middle-income countries’ production of pandemic-ending medicines, including new and emerging long-acting HIV medicines, and keeping prices unaffordably high.

The United States has already pledged $6 billion to the 7th Global Fund Replenishment but this is contingent on other donors stepping up to fully achieve the $18 billion target. Since it was created in 2001, the Global Fund has saved millions of lives by reducing the impact of HIV, tuberculosis, and malaria. It must be fully funded to carry out its work—and its partners too.

Recognizing the complementarity between the work of the Global Fund and UNAIDS, the US has also raised its contribution to UNAIDS by $5 million for 2022. UNAIDS is on the ground in countries collecting the data that shapes the HIV response, helping advance the removal of harmful laws and policies and the end of HIV-related stigma and discrimination, and generating an enabling environment where investments can be most effective. Its work is key to maximizing the effectiveness of national programmes financed by the Global Fund.

Member States of the United Nations have made a commitment to achieve the 2030 Sustainable Development Agenda to deliver health and well-being for all, to achieve universal health coverage, and to build a more prosperous, equitable and sustainable world.

We can end AIDS. If we succeed – and the data is clear that we can – it will save millions of lives, be a pivotal moment for a healthier, more secure planet, and be a triumph of international cooperation.

But the investment is needed today. Let’s fight for what counts.

Winnie Byanyima is Executive Director of UNAIDS and Under-Secretary-General of the United Nations.

Footnote: US President Joe Biden will host the Global Fund’s Seventh Replenishment Conference on September 21 in New York City. Founded in 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria is described as a unique financing mechanism that relies on a dynamic partnership among governments, the private sector, and civil society to fight HIV/AIDS, tuberculosis (TB), and malaria in ways that contribute to strengthening health systems.

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The UN commemorated World Aids Day on 30 November. Credit: UNAIDS

By Winnie Byanyima
GENEVA, Dec 1 2021 (IPS)

This week I called out to the world to warn them that inequalities are making us all unsafe. I noted starkly our new analysis that we face millions of additional AIDS deaths – 7.7 million in the next decade alone – as well continued devastation from pandemics, unless leaders address the inequalities which drive them. We have to treat this threat as an emergency, as a red alert.

To end AIDS, we need to act with far more urgency to tackle these inequalities. And it’s not just AIDS. All pandemics take root in, and widen, the fissures of society. The world’s failure to address marginalization and unequal power is also driving the COVID crisis and leaving us unprepared for the pandemics of tomorrow. We need all leaders to work boldly and together to tackle the inequalities which endanger us all.

To tackle inequalities requires leaders to take these courageous steps:

● Support community-led and people-centred infrastructure
● Ensure equitable access to medicines, vaccines and health technologies
● Strengthen human rights, to build trust and tackle pandemics
● Elevate essential workers and provide them with the resources and tools they need
● Ensure people-centred data systems that highlight inequalities.

At the United Nations General Assembly High-Level Meeting on HIV/AIDS in June this year, member states adopted a bold new plan to end the AIDS epidemic, including new targets for 2025.

We are seeing around the world examples of the transformative impact of tackling inequalities – with some people and some countries making progress against AIDS that many had believed impossible. These prove that it can be done, and guide us in what we need to take to scale worldwide to end AIDS.

On my recent visit to Senegal, I saw the power of leadership in driving down new HIV infections. In Dakar I met with the inspirational Mariama Ba Thiam, a peer educator at a harm reduction programme for people who inject drugs.

The programme helps them protect their health and to secure economic independence. Mariama’s approach works because it starts by considering the whole person, connecting the medical with the social. It rejects the failed punitive and stigmatizing approaches taken by so many, and it instead respects the dignity of every person.

It succeeds because it involves frontline communities in service provision and in leadership, and because it recognizes that access to the treatments grounded in the best science is a human right and a public good. We know what success looks like, and it looks like Mariama. Thousands of Mariamas worldwide have shown the way by walking it.

But in too many cases we are not only not moving fast enough to end the inequalities which drive pandemics, and are moving in the wrong direction – tech monopolies instead of tech sharing, donor withdrawal instead of global solidarity, austerity instead of investment, clampdowns on marginalised communities instead of repeals of outdated laws.

Six in seven new HIV infections among adolescents in sub-Saharan Africa are occurring among girls. Gay men and other men who have sex with men, sex workers, and people who use drugs face 25-35 greater risk of acquiring HIV worldwide.

Progress in AIDS, which was already off track, is now under even greater strain as the Covid crisis continues to rage, disrupting HIV prevention and treatment services, schooling, violence-prevention programmes, and more. Harm reduction services for people who use drugs were disrupted in nearly two thirds (65%) of 130 countries surveyed in 2020.

We have reached a fork in the road. The choice for leaders to make on inequalities is between bold action and half-measures. The data is clear: it is being too gradual that is the unaffordable choice.

Leaders need to turn this moment of crisis into a moment of transformation. Ending these inequalities fast is what needs to be reflected in every leader’s policy programme and every country’s budget.

If we take on the inequalities which hold back progress, we can deliver on the promise to end AIDS by 2030. It is in our hands. But if we don’t act to end inequalities, we will all pay the price.

Inequalities kill. Every minute that passes, we are losing a precious life to AIDS, and widening inequality is putting us ever more in danger. We don’t have time.

Winnie Byanyima is Executive Director of UNAIDS and Under-Secretary-General of the United Nations

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A woman is vaccinated against COVID-19 in the indigenous community of Concordia, Colombia. Meanwhile, UN Secretary-General Antonio Guterres repeated his call for the G20 to establish a Task Force “able to deal with the pharmaceutical companies and other key stakeholders”, which would address equitable vaccine distribution through the COVAX global initiative. Credit: WHO/Nadege Mazars

By Winnie Byanyima
GENEVA, May 27 2021 (IPS)

In this time of intersecting crises – the Covid crisis, the HIV crisis, the inequality crisis, and more – progress on all these crises is being blocked by another crisis: finance.

Right now, most of the world’s countries are facing brutal financial constraints, during a raging pandemic, and during the biggest crisis since World War II. The majority of countries look set to slash investment in essential public services. Such austerity would be literally fatal.

As world leaders exchange proposals for joint financial action for recovery in the build-up to the series of G7 and G20 meetings fast approaching, they need to break free from the discredited and damaging financing model that is choking social and economic recovery.

It’s important to acknowledge, of course, the vital initial steps towards recovery that world leaders, including the G20 finance ministers, and the IMF council, have taken, including at the recent Spring Meetings of the World Bank and IMF. But the scale of the financial measures taken is dwarfed by the scale of need.

Put simply, if leaders do not go much further, fast, to find and allocate the finances required, the effects will include the return of levels of deprivation that we had thought we had defeated, and spiraling social and political catastrophe.

To be clear, this is not a counsel of despair, but a call to leaders to make a wiser choice, and to the public to press them to do so. The really good news is this: if the will is there, we can find the money.

On debt, leaders have agreed to extend the Debt Suspension Initiative; but they have done so only until the end of this year, and private creditors have again been merely invited to collaborate.

As a result, repayments over $30bn are set to flow from the poorest nations to banks, investments funds, Governments and multilateral banks in 2021. Only the IMF among those has announced debt relief to 28 countries.

Cancelling debt repayments of the poorest nations is essential, and vulnerable middle-income countries need approaches that allow for cancellation too.

No debt service payments should be made or asked for until the investments necessary for achieving the UN Sustainable Development Goal on health are secured.

Indebted poor countries must not be pushed into new debts to pay for vaccine imports, but should rather be allowed to produce their own at much lower cost.

The very welcome statements from key leaders on a patent waiver need to be turned into a formal decision urgently, reinforced by technology sharing by companies through the WHO.

Cervical cancer is the most common cancer among women living with HIV. The likelihood that a woman living with HIV will develop invasive cervical cancer is up to five times higher than for a woman who is not living with HIV. The overall risk of HIV acquisition among women is doubled when they have had a human papillomavirus (HPV) infection. Credit: UNAIDS

On aid by traditional donors, OECD figures report a small increase overall of barely $10 billion, a drop in the ocean compared to the $17 trillion that rich countries have used to support themselves.

No agreement has been reached on expanding ODA now when it is most needed. All developed countries should honour the pledge of at least 0.7%. A pandemic is the most damaging time to back away.

Emerging countries with a strong financial capacity must step up too with their own upgraded contributions.

On Special Drawing Rights (SDRs), the IMF currency, a historical issuance of the equivalent of $650bn has been reached. But only 3.3% of those resources, $22bn, are set to flow to Sub Saharan Africa, the region most in need. Indeed, the amounts that low-income countries are set to receive through the SDR issuance are smaller than the unsuspended external debt repayments scheduled for 2021.

There is an active discussion about rich countries reallocating perhaps 10% or so of their own share of SDRs. But a strong case has been made that rich countries should reallocate the majority of their own SDRs to low and low middle-income countries.

That would indeed represent the largest ever financing for development operation; but that scale of action is what our current scale of crisis requires.

Of course, what countries most need is to grow their own domestic resourcing. Right now, we lose a nurse’s yearly salary to tax havens every second.

World leaders’ dialogue on tax evasion has been rightly acknowledged as historic, with proposals to establish a minimum global corporate tax, something that would enable billions in public investment across countries, seriously reducing extreme inequality.

An agreement will be under discussion soon at the G20 and with the OECD. Leaders need urgently to move from discussion to agreement and action.

We need a compact that includes taxation on excess profits, wealth, and negative climate impacts, invested to fund the scrapping of user fees and the expansion of health and education so that they are finally experienced as universal rights.

Global pandemic preparedness, stability and prosperity all require us to fight inequality.

Gordon Brown´s proposal for G7 countries to immediately share the burden of the $60 billion needed in funding for vaccines and vital medical supplies, diagnostics and medical oxygen is both essential and achievable – now.

It would kickstart recovery for every country and could help set the world on a pathway to a new approach to global financing.

Now is the moment to consign to the dustbin old worn-out ideas that we can’t afford to overcome our crises. The reality is that we can’t afford not to.

The Covid-19 crisis has seen a transfer of wealth from workers to billionaires of almost $4 trillion. This moment could, like other crises before, become a moment for rebuilding a fairer world – but only if we seize it.

Achieving a more equal world is essential for our health. The financing solutions are there. The principal challenge is not technical, it is courage.

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Excerpt:

High school graduation, Accra, Ghana, 2013. Credit: United Nations

By Winnie Byanyima
GENEVA, Apr 8 2021 (IPS)

Leaders at this year’s World Bank/IMF Spring Meetings (April 5-11) will determine how best to recover from one of the biggest crises the institutions have faced since their founding in 1944—COVID-19’s impact and its economic aftermath.

Given the need to fund treatment and vaccines, there is pressure to scale back funding for social provisions. But doing so would prove a catastrophic—and costly—mistake. Instead, leaders must boldly finance a more equal world.

The issue isn’t just that COVID’s impact is unequal; it’s that inequalities, especially gender inequality, hamper an effective recovery. They undermine the world’s readiness for future pandemics and shocks, and block achievement of the United Nations’ Sustainable Development Goals.

It is one thing to call for these inequalities to be addressed—and another to allocate funding to rectify them. We must invest in rights for them to be actualized.

COVID-19 has dramatically widened gaps between women and men in wealth, income, access to services, the burden of unpaid care, status and power. Pre-pandemic, 132 million girls were out of school.

Twenty million more secondary school-aged girls could be out of school post-pandemic. Many will not go back, putting them at greater risk for violence, HIV, teenage pregnancy, child marriage, poor health and poverty.

Because of COVID-19, two and a half million more girls are at risk of child marriage in the next five years and rates of violence against women and girls have precipitously increased. In the pandemic, women bear the brunt of job losses and comprise the majority of frontline health workers, many of whom are under-protected and under-paid.

Gender inequality is not only wrong—it is dangerous and weakens us all. It drives the spread of COVID-19 while threatening progress against AIDS and other pandemics. It depresses economic potential too: economies and nations only flourish when women can. Recovery strategies to pandemics cannot be gender blind or gender neutral. They must overturn the inequalities that hold women back.

COVID-19 lays bare social inequality says UN chief, as COVAX doses top 36 million. Mali begins its vaccination programme against COVID-19 with Fanta Siby, Minister for Health, the first to be inoculated. Credit: UNICEF/Seyba Keïta

Prior to COVID-19, many economies and societies were weakened by insufficient investments in health, education and social protection. The COVID-19 crisis revealed the pre-existing lack of resilience in many parts of our economies and societies. Finding the financing to fight inequality in the recovery from COVID-19 is essential.

How can world leaders finance an equal economic recovery from COVID-19?

Issuing Special Drawing Rights (SDRs) will help. A range of G20, emerging and developing nations support them. An agreement to secure $500 billion in SDRs, under discussion, could allow up to $25 billion to flow to the central banks of African nations.

Preferable would be securing up to $650 billion, the cap that requires U.S. Congressional approval. Should wealthy nations share even half of their proportional issuance with developing nations, SDRs could powerfully undergird vital investments.

Cancelling debt is critical. A large share of low and middle-income countries’ budgets pays off debt. This is especially the case in Sub-Saharan Africa where government debt increased to an estimated 70 percent of GDP in 2020.

Building back better after COVID-19 requires ensuring that no debt service payments be made, or forced, until investments necessary for achieving the UN SDG on health are secured.

Countries need to increase domestic revenues. The economic impacts of COVID-19 make this challenging short term. But policy changes can lay the path to domestic resource mobilization in days to come.

Three areas requiring policy change that could increase domestic resources are: 1) protecting against international tax evasion (through the G20-OECD-led processes) by setting a global, minimum corporate tax rate affecting all geographies/all companies, including digital ones, 2) establishing emergency tax measures such as taxes on wealth or excess profits in times of crisis and 3) designing progressive tax systems at the local and regional levels for both capital and income.

These new sources of funding can help eliminate user fees and boost investments in health and education.

User fees are a grave injustice—they tax the sick and increase mortality and morbidity while exacerbating poverty and inequities. No new mother should be chained to her hospital bed for not having the money to pay for her child’s birth.

Charging for healthcare not only hurts those affected; the spillover costs of ill health drain economic potential. Health crises won’t be stopped if some people can’t afford testing or treatment. Publicly provided healthcare is the most efficient and effective form of provision—it’s not an unaffordable burden but a smart investment.

Ensuring girls’ education and empowerment is vital to recovery. The gains from girls’ schooling are multiple, proven, and profound—from helping to prevent child marriages and teenage pregnancies and reducing violence and HIV infections, to increasing future earnings and strengthening economic growth.

Crises are a reckoning: they show us what is broken—and what needs to be fixed. Achieving a more equal world is not only a moral imperative—it will make the world more resilient to pandemics and makes us all healthier, safer and more prosperous. We can’t afford not to do it.

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Excerpt:

Kansiime and her daughters arrive at the Mbarara Hospital. The three family members all live with HIV and go to the clinic regularly to collect their medication. "When I go to hospital, I am surrounded by other women who have come for treatment. We are there for the same reason,” Kansiime says. “This has helped me overcome stigma and given me strength." Credit: UNICEF/UNI211907/Schermbrucker

By Winnie Byanyima
GENEVA, Apr 2 2020 (IPS)

The multi-layered crisis of the Coronavirus epidemic has been a dramatic shock to everyone. But, to communities affected by HIV and AIDS, the crisis has not only brought a further shock to already vulnerable people, it has brought other reactions too – a troubling sense of déjà vu, and a passionate, empathetic, fierce solidarity with all those affected by Coronavirus.

No two pandemics are the same. All require a specific, tailored, response. But we also have a duty, when dangerous, unjust and unsustainable structural weaknesses are exposed by one pandemic, left unresolved, and then jeopardize the fight against a second pandemic, to ensure that we don’t wait for the third.

Everyone involved in the fight against AIDS is determined to do everything we can to support all those affected by the Coronavirus epidemic. We are by your side. We waited years for many of the breakthroughs we fought for, and we are still waiting for many others; we refuse to let leaders make you wait in this new crisis as they have made us wait. The time to fix the rips in our social fabric is now.

The HIV community has joined the emergency response in solidarity with those affected, and has joined too in insisting that leaders recognize that healthcare is a public good – that the health of each of us depends on the health of all of us.

Winnie Byanyima

Healthcare must be provided to all, free of charge, funded by public revenue. Quality health care is a human right, not a privilege, and should never depend on how much money you have in your pocket.

Governments must provide publicly funded health care for all people, through progressive tax systems in which everyone, including the super-rich and large corporations, pay their fair share. Public health systems must deliver services that reach people most in need.

As part of this, governments must support services which are community-led AND publicly-funded. Cutting-edge medicines and health care must be delivered affordably and to scale, to everyone no matter where they live.

User fees are false economy and a grave injustice – they are a tax on the sick that increases mortality and morbidity, and exacerbates poverty and inequities.

Decades of experience have shown that these charges deter people, especially low-income households, from using the health services they need, deepen poverty, and are highly inefficient and regressive ways to finance health care.

Their most obscene incarnation sees, in several countries, hospital wards turned into debtors’ prisons of patients chained to their beds until their families sell assets or borrow from money-lenders to release their loved-ones.

Even in other, more “moderate”, incarnations user fees see families bankrupted or left landless and powerless by the costs of care, and people left to die because they can’t afford the fees. Three people every second are pushed into extreme poverty from paying for healthcare.

Charging for healthcare does not only hurt those directly affected – it puts all of us at risk. Covid-19 won’t be stopped if some people can’t afford testing or treatment.

As (former UN Secretary-General) Ban Ki-Moon noted in January, before this epidemic exploded: “Out-of-pocket health spending has been rising, meaning that more people are being impoverished because of health costs.

This not only undermines achieving universal health care, it is also a threat to global health security. High private health spending also inhibits progress towards other Sustainable Development Goals including eliminating poverty, reducing inequality and achieving gender equality.”

Dr. Denis Nansera, a paediatrician, examines Kansiime Ruth, 25, and her daughters aged 1 and 4 years, at the Mbarara Regional Referral Hospital in Mbarara District, Western Region, Uganda on 20 August 2019. “A good number of mothers used to fall out of antenatal care. But with (medical advancements), we see a huge reduction in the time taken to diagnose a child, and time taken to get child on medication,” Dr. Nansera says. Credit: UNICEF/UNI211885/Schermbrucker

After the horrors of World War II, several European countries and Japan introduced universal health care. After the financial and AIDS crises hit, Thailand did. All these universal health coverage (UHC) reforms delivered massive health and economic benefits to the people.

Now, in this crisis, leaders across the world have an opportunity to build the health systems that were always needed, and which now cannot be delayed any longer.

Countries don’t have to be rich to provide free health care for all – as Sri Lanka has long shown. And the impact from removing fees is proven and profound. Jamaica saw improved access to health services among children and teenagers after it changed its policy on user fees in 2007, with the poorest people benefiting the most.

Sierra Leone showed that even in fragile settings, fee removals, properly planned and implemented, improve health systems and protect the vulnerable.

But globally the pace of progress is much too slow, and the impact of the Covid-19 pandemic is testimony that financial leaders have underestimated the economic risks of low investments in equitable health.

In addressing the current crisis, one major practical action that leaders can implement immediately is to launch truly universal, publicly-financed health care reforms to cover their entire population – not only for Covid-19 services but for all services.

This would cost around 1-2% GDP in the short-term, not enormous compared with some of the massive fiscal stimuluses already being planned.

The international community too has a profound moral obligation, and collective self-interest, in backing the expansion of universal healthcare by supporting moratoriums on debt repayments to free up resources of developing countries to invest in their healthcare systems.

As the UN Secretary-General has urged leaders to remember, “we are only as strong as the weakest health system in our interconnected world.”

Bilateral donors and international financial institutions including the World Bank and IMF should also offer grants – not loans – to address the social and economic impacts of the pandemic on the poor and most vulnerable groups, including informal sector workers and marginalized populations.

Most low-income countries are already highly-indebted; it is immoral to push them to take more loans to fight an existential threat that the whole world is facing. A broad and equitable debt relief process is urgently needed not only to respond to the Covid-19 crisis but to shorten the recovery period and create conditions for growth.

Before Coronavirus hit, defenders of the unfair and unsustainable status quo in health claimed that the current patchwork, fragmented and wealth-based system worked just fine. But the damage of that system has now been exposed to everybody. Health for all is central to resolving this pandemic.

The best time to provide health for all has already passed. And the second-best time is now.

*Winnie Byanyima was appointed as the Executive Director of UNAIDS by the United Nations Secretary-General on 14 August 2019 assumed her functions as UNAIDS Executive Director on 1 November 2019. She was Executive Director of Oxfam International since 2013. Prior to that, she served for seven years as the Director of Gender and Development at the United Nations Development Programme.

Excerpt:

Winnie Byanyima, Executive Director of Oxfam with UN Secretary-General Ban Ki-moon. Credit: UN Photo/Evan Schneider.

By Winnie Byanyima
Oxford, UNITED KINGDOM, Aug 3 2016 (IPS)

The process for arguably the top political job on the planet is well underway.  And the time is right for a woman and a feminist to take the helm.

The United Nations (UN) Security Council is continuing its consideration of candidates for the next UN Secretary-General, with the next “straw poll” due to take place on Friday August 5th.

Backed by public debates and online campaigns, this selection process for the Secretary-General has been the most transparent and accessible yet – driven in part by tireless efforts from civil society.

But the decision to appoint essentially rests with the Security Council’s five permanent members in what has been, since 1946, a remarkably secretive selection procedure, one which has given us three Europeans, two Africans, two Asians and one Latin American – all men – in 70 years.

This process has never produced a female secretary general.

In 2006 the Secretary-General selection process included only one woman in seven candidates. This time round, half the current candidates are women. There is no shortage of talent. Yet the initial signs are not promising. The Security Council’s first straw poll on July 21^st saw only one woman among the top five.

The long selection process ahead must reverse this. The absurd male monopoly on the UN’s top job must come to an end. The next Secretary-General must be both a woman and a feminist, with the determination and leadership to promote women’s rights and gender equality.

Growing up as an activist under an oppressive dictatorship in Uganda, the UN was a friend to those of us who fought our way to freedom, as it was for the millions that joined decolonization struggles in the African continent. Today, the Sustainable Development Goals (SDGs) and Paris Climate Agreement agreed in 2015 are testament to the UN’s global role and reach, and a legacy of Ban Ki-moon’s outstanding leadership.

Yet the UN is failing to meet its founding tenets to “save succeeding generations from the scourge of war” and uphold human rights for those who are powerless. For the UN’s new leader, reversing this sounds near-impossible amidst protracted conflicts, a lack of respect for international humanitarian law and a massive global displacement crisis.

Fulfilling the pledge to “leave no one behind” is perhaps the biggest political challenge. The new Secretary-General must grapple with the spiralling crisis of extreme economic inequality that keeps people poor, undermines economic growth and threatens the health of democracies. And a low carbon pathway will not happen without strong UN leadership to drive drastic reductions from the richest in our societies, whose lifestyles are responsible for the majority of them.

Choosing a woman goes far beyond symbolism and political correctness. The discrimination of women and girls goes to the core of any and all analyses of the world’s economic, political and environmental problems.

A feminist woman Secretary-General will, by definition and action, ensure gender equality is put at the heart of peace, security and development. In doing so, she will truly champion the UN’s core values of human rights, equality and justice.

Such an appointment – far too long in coming – would fulfil promises given by world leaders 21 years ago at the historic UN Fourth World Conference on Women in Beijing to nominate more women to senior posts in the UN. In the past decade, women have filled less than a quarter of senior roles at the organization, according to UN Women. Shockingly, as recently as last year women made up less than 17 percent of Under- and Assistant Secretary-General appointments.  

A new feminist UN Secretary General will ensure that more women serve as heads of UN agencies, peacekeeping missions, diplomatic envoys, and senior mediators who collectively can strengthen the global peace and security agenda. Without women’s equal access to positions of decision-making power and a clear process to get there, gender equality, global security and peace will never be realized.

And it will take a woman feminist Secretary-General to advance the bold, comprehensive women’s human rights agenda in intergovernmental fora that is needed to address the multiple and intertwined challenges facing us in the 21^st century. Only a woman feminist Secretary-General can ensure financial support reaches women’s rights movements – proven to have made progress on addressing the challenges of violence against women and girls, climate change, conflict and economic inequality. They can ensure that feminist and civil society movements are not just observers in policymaking, but active and equal participants.

She should, too, boost international efforts to empower women economically – thus strengthening national economies and prosperity for all – and tackling the harmful social norms that trap women in poverty and powerlessness.

The new Secretary-General must also reimagine the role of the UN in a world radically different to the one it was set up to serve and be bold in leading its reform.

The UN must be made more inclusive, accountable, democratic, effective, and reflective of a world in which political and economic power has shifted. And the UN must be able to protect its unique role as a genuinely multilateral institution that acts in the interests of all people and all countries. Integrity must not be undermined by the influence of private sector actors and their money.

The Security Council, particularly the five permanent members, must choose change and progress over continuity. They must have the foresight to ensure they listen to the voices of the public and select the Secretary-General that the world and the UN needs today: a woman and a feminist.

Excerpt:

The richest 66 people have the same amount of wealth as the bottom half of humanity. Credit: Bigstock/IPS

By Winnie Byanyima
NEW YORK, Jun 17 2014 (IPS)

Two major injustices – inequality and climate change – are threatening to undermine the efforts of millions of people to escape poverty and hunger.

By concentrating wealth and power in the hands of a few, inequality robs the poorest people of the support they need to improve their lives. And as climate change devastates crops and livelihoods, it undoes poor people’s efforts to feed their families.

But an historic opportunity is on the horizon as the sun sets on the Millennium Development Goals (MDGs). Right now the United Nations is in the midst of a heated debate about the new set of Sustainable Development Goals. This new framework for global development could end poverty and save the planet.

Laudable progress has been made under the MDGs, which are set to expire next year. The goal to halve extreme poverty has been met – an achievement to celebrate. The MDGs have inspired a common purpose and ambition, and there have been many development successes over the last 14 years.

Yet the twin challenges of inequality and climate change have not been adequately tackled – and Oxfam fears the same mistake will be made again. If we are to create a fairer, healthier world, the new Sustainable Development Goals must be ambitious, and backed up by strong action on climate change.

Recently, Oxfam revealed that the world’s 85 richest people have as much wealth as the poorest 3.5 billion. That figure was recently revised. Now the richest 66 have the same as the bottom half of humanity. If the global community fails to curb the widening gap, a host of related economic and social problems will ensue, including the undermining of efforts to eradicate poverty. We can only lift up those at the bottom if we tackle the extreme wealth at the top.

At the same time, climate change is threatening to undo progress made in confronting poverty over the last decade. More than 800 million people are at risk of hunger. Through its devastating impact on crops and livelihoods, climate change is predicted to increase that number by as much as 20 percent by 2050.

It’s up to the U.N. Framework Convention on Climate Change to set the global framework for climate action. But the Sustainable Development Goals offer the opportunity to complement this and go further, dealing with climate change in the context of poverty alleviation and sustainable development. Action on climate change – in the framework of development after 2015 – could create significant political momentum, and increase ambition for a strong global climate deal.

For these reasons, Oxfam has released a paper on addressing inequality and climate change in the post-2015 framework.

Regarding inequality, we propose goals that eradicate extreme economic inequality, eradicate extreme poverty, achieve gender equality and realise women’s rights, and achieve universal health coverage and education through strong public services.

To address climate change, we propose dedicated goals on climate change and energy, food and hunger, water, and risk, as well as integrating targets on climate throughout the framework. These measures can help ensure development consistent with limiting global warming to 1.5 degrees Celsius.

The U.N. working group on the Sustainable Development Goals has released a ‘Zero Draft’ containing many proposed goals and targets Oxfam would welcome – including standalone goals on inequality and climate change. As the number of goals and targets are reduced and refined in the process of agreeing a new post-2015 development framework, it is essential that these remain.

There’s also room for targets that are much more ambitious than those currently proposed.

In the inequality goal, we must be bolder. Oxfam backs the target proposed by former Chief Economist to the World Bank and Nobel Prize winner Joseph Stiglitz to reduce income inequality so that the income of the top 10 percent is no more than that of the bottom 40 percent.

Since the world is already on track to end one-dollar-per-day poverty, we must set the bar higher and eradicate two-dollar-per-day poverty. We must commit to achieving universal health coverage and universal education, provided through well-funded public services. Finally, the proposed climate goal should include targets to limit global warming to 1.5 degrees Celsius and promote low carbon sustainable development.

If we get it right, a bold new framework for global development next year, together with agreement at the U.N. climate talks in Paris, could provide the impetus for a transition to a more equal world – a world without the scourge of poverty and climate change.

This would transform millions of lives. So let us embrace the new beginning the Sustainable Development Goals offer.

*Winnie Byanyima is the executive director of Oxfam International

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