Reporting back from the tuberculosis, universal health coverage and pandemic prevention, preparedness and response multistakeholder hearings in New York.
We made our way to New York to attend the multistakeholder hearings on the fight Against Tuberculosis (TB), Pandemic Prevention, Preparedness and Response (PPPR), and Universal Health Coverage (UHC). The three hearings took place over two days on May 8th and 9th, with each lasting half a day.
All three hearings had the same structure – after opening remarks by the Office of the President of the General Assembly, two panels on two different themes with 4 participants each took place, with about half an hour dedicated after each panels to questions and remarks from the room. Finally after the panels and Q&A, the co-facilitators of the high level meeting made closing remarks (you can find the full programs here). A number of side events took place in New York alongside the hearings, and advocates used the opportunity to secure meetings with country delegations to the United Nations.
These are not the first health multistakeholder hearings held at the UN, and two in fact are follow-up on earlier High Level Meetings – there were a TB HLM in 2018 and a UHC HLM in 2019 – and things on the whole went as expected for these types of events. All parties (country missions, the Office of the President of the UNGA, Panel members from civil society, academia, and/or technical agencies) reiterated their beliefs in the urgency of addressing health issues in the light of the damage done by COVID-19, the importance to use that opportunity to build back better and foster equity and people-centered solutions. Across all three HLMs, the apparent alignment on display was striking, as was the use of civil society- and community-centric language.
Whether this support was substantive is a different matter. Unlike for other HLMs, where a day or more was dedicated to the multistakeholder hearings (MSH), each of the three only had 3 hours. Kudos to the facilitators and participants, the meetings ran mostly on time – but the compressed agenda meant that less time was available for remarks and questions from the floor, and nowhere near everyone in the rooms had a chance to speak. This was less of a problem for the TB MSH, where the remarks made were focused and coordinated, thanks in large part to the work done by Stop TB and the Civil Society Engagement Hub ahead of the meeting. For the PPPR and UHC MSHs though, the broader themes and more diverse groups represented led to more disjointed discussions and remarks.
Who could speak at the hearing was also an issue worth mentioning, as participants could not register in advance to be given the floor, and had to indicate interest on the spot, on the basis of which meeting organizers gave speaking slots. Participants were not told that they were going to be able to speak until it was their turn, leading to much fumbling and some less structured remarks than they should have been.
This bleeds into the broader access issues, which have been discussed extensively on the TB engagement hub calls – confirmation for meeting participants came late, and left little time to secure visas. Since COVID-19, the clogging of immigration proceeding has made it impossible in many countries to secure visa appointments less than months away, which skewed participation to the multistakeholder hearings heavily towards people with stronger passport, or with existing visas. There were also logistics issues on the day and reports of participants’ badges not coming through on time for them to attend the hearings. All these issues are real barriers to participation; the meeting conveners cannot be held responsible for the state of the U.S. immigration system, but can for not taking it into account in their management of the meeting’s logistics.
We have worked on an open letter to the President of the General Assembly to address some of these issues ahead of the high level meetings themselves in September – you can read the letter here and sign onto it here.
The TB MSH
The TB MSH was notable for the size and dynamism of civil society and community engagement during and around the meeting. The Stop TB Partnership ran several side events in the lead up to the meeting and worked to ensure wide representation; the impact of which was obvious in the room. Vulnerable communities were represented on both panels, and remarks from the floor were well aligned with the Stop TB Key Ask document, visible throughout the room in the hands of delegates.
You can see our full live tweeting of the event in this thread.
Since then the first draft of the Political Declaration was leaked. There are some upsides – the document is short-ish and concise-ish (as far as Political Declarations go) – but overall the draft is a significant step back from the 2018 declaration. No numerical targets are included for TB diagnosis, treatment, prevention and funding, human rights and community-centered language is watered down or absent, commitments on the roll-out of innovation and R&D are missing, and there is no accountability framework. We have heard that the first round of negotiation has somewhat strengthened the document, but there is still a long way to go.
The PPPR MSH
The discussions during the MSH on PPPR focused on COVID-19 and its aftermath as much as it did on future pandemics, reflecting on the shortfalls in the lead up to 2020 and during the response. In its recorded opening remarks, Dr. Tedros shared its concerns that reforms of global institutions undertaken in the wake of the pandemic had been disconnected and piecemeal, and that he hoped for a roadmap for better coordination as an outcome of the HLM.
On the panels and in the room there was a larger representation of academia and organizations working through a health security lens, leading to a very different tone to the discussions, more technical and more disjointed. As the PPPR HLM was the only one for which there was no formal civil society engagement mechanism (no equivalent to the CS hub for TB or CSEM for UHC), representation from civil society and community was more sparse, especially from low and middle income countries – though for the same reason and thanks to good time keeping a larger share of people in the room were given a chance to talk.
The UHC MSH
The MSH on UHC came last and were well attended, with strong civil society representation in part thanks to the work of CSEM, in the audience and on the panels. The topic being broader, the discussions and interventions touched on a broad range of issues, and because of the way interventions were allocated, it was not as easy to keep track of key asks and objectives.
Reflecting in part the challenge of its broader reach, the draft of the Political Declaration is by far the longest and touches on a broad range of issues. It does, unlike the first draft of the TB political declaration, build on the last UHC HLM, and feels overall like a step forward, with numbered targets and objectives throughout. There is still a lot of room for improvement. There is welcome language around equity and vulnerable groups, but these good intentions are not yet fully reflected in the draft’s targets.
You can read the zero draft of the UHC Political Declaration here – noting that in a good step towards more transparency, the draft has been made public by the Office of the President of the General Assembly.