Intended for healthcare professionals


Global health security and universal health coverage: from fragmented aspirations to ambitious commitments

BMJ 2023; 381 doi: (Published 09 May 2023) Cite this as: BMJ 2023;381:p1029
  1. Katri Bertram, founding partner and senior global health consultant1,
  2. Arush Lal, commissioner, former vice chair, and doctoral candidate234
  1. 1Partners for Impact
  2. 2Chatham House Commission for Universal Health
  3. 3Women in Global Health
  4. 4London School of Economics and Political Science
  1. @KatriBertram@Arush Lal

To achieve global health security and universal health coverage, stakeholders must commit to integrated and actionable steps rather than vague end goals, write Katri Bertram and Arush Lal

As leaders of the G7 meet in Japan in May, and representatives from 194 countries convene at the World Health Assembly in Geneva directly after, we are likely to see communiqués and resolution texts reiterating long standing commitments to advance global health security and universal health coverage.

Building on cross cutting health targets that all United Nations member states adopted through the sustainable development goals (SDGs) in 2015,1 these commitments are more important than ever, as the covid-19 pandemic has shown. Lack of progress on global health security, defined as “the capacities [needed] to prevent, detect, and respond to infectious disease threats,”2 continues to leave all countries vulnerable to public health emergencies. Lack of progress on universal health coverage, which ensures “all people have access to the full range of quality health services they need, when and where they need them, without financial hardship,”3 continues to leave millions of people globally unable to afford essential health services.

Repeated resolutions in past years from G74 and G205 and, more recently, negotiations for the Pandemic Accord6 and preparations for the 2023 UN high level meetings on health, leave us concerned that global health stakeholders are confusing actionable commitments with aspirational end goals. The latter, such as the most recent G20 call to build “towards achieving and sustaining universal health coverage under the SDGs,”5 are rarely backed up by policy change or concrete resources. This means that we see little meaningful progress.

Global health security and universal health coverage should not be viewed solely as end goals, but rather as interlinked frameworks requiring specific policy changes and backed by tangible investments.

Both health security and universal health coverage are delivered at the community level through the same health system. But policy makers and donors have neglected to tackle these jointly. At the domestic level, health systems that are both resilient to public health crises and avoid high out-of-pocket payments remain out of reach in all countries.7 Internationally, development assistance for health continues to prioritise select countries, diseases, or population specific interventions.8 The result is that global health security and universal health coverage are not receiving the coherent, actionable interventions and financial attention that they urgently require.

We commend important progress made on better aligning both concepts, such as the zero draft of the Pandemic Accord that advances pandemic preparedness and response with “a view to achieving universal health coverage.” But we think that countries must meaningfully reflect on whether the repetitive process used to negotiate landmark resolutions is translating into measurable progress or if it simply recycles language used in previous commitments. Is the chronic characterisation of global health security and universal health coverage as aspirational end goals resulting in little more than empty lip service? Are repeated commitments providing false cover for policy makers unable to tangibly advance these goals at a national level?

All countries must commit to actionable steps to strengthen health systems necessary for both health security and universal health coverage—particularly prioritising the community health workforce, resilient health services, and social and financial protection. Meanwhile, donor countries, international organisations, and funding organisations must support this joint approach—through strengthened country health systems, guided by integrated approaches like WHO’s Health Emergencies Preparedness and Response framework9 and joint review mechanisms like the Universal Health and Preparedness Review. We otherwise risk continuing with business as usual, which history shows will result in vast health equity gaps, weak protection from health threats, and millions of people unable to access and afford the health services and products they need.

As health ministers and heads of state meet in May and again at the UN General Assembly in September, we call on all countries and global health stakeholders to recommit to global health security and universal health coverage jointly,10 as interlinked frameworks that require specific policy change. All communiqués and resolution texts should specify which policy steps are being taken to deliver on these commitments, with clear milestones that are updated to reflect recent lessons. All global health funding and implementing entities need to prioritise collectively and sustainably strengthening country health systems and complementing domestic financing for health. Accountability can be strengthened through transparent reporting, budgeting, and inclusive decision making.

We remain optimistic that health for all can become a reality—the alternative is unacceptable. But progress will not stem from recycled commitments. Countries and global health stakeholders must take concrete, actionable steps to advance global health security and universal health coverage at all levels of health systems. This means moving beyond hollow promises and vague end goals towards interlinked policy reforms backed by tangible, timely investments that meet the moment.


  • Provenance and peer review: Not commissioned, not externally peer reviewed.

  • Competing interests: none.