Initial Response of the Delegation of the Civil-7 Global Health Working Groupon the G7 Leaders Communique (the Section on Global Health) and“G7 Hiroshima Vision for Equitable Access to Medical Countermeasures”
May 20, 2023
At the G7 Hiroshima Summit, held on Ujina Island in southern Hiroshima from May 19 to 21, the G7’sLeaders Communique, whose 33rd to 35th paragraphs were devoted to global health, and the "G7Hiroshima Vision for Equitable Access to Medical Countermeasures" were released on May 20. The Civil7 Global Health Working Group would first like to commend the G7 Leaders for adopting a communiquéthat touches on global health in a comprehensive and exhaustive manner at the G7 Hiroshima Summit,
following the G7 Health Ministers' Meeting held in Nagasaki one week before the Hiroshima Summit. We
would then like to draw your attention to the following points.

1. Equitable Access to Medicines for Infectious Disease Crisis (MCM)
The "G7 Hiroshima Vision for Equitable Access to Medical Countermeasures" (hereinafter referred to as
the "MCM Vision") clearly states that the G7 will strive to establish an "end-to-end" global MCM ecosystem
and achieve equitable access to MCMs, taking lessons from the COVID-19 outbreak. It also explicitly
recognizes that countries that have experienced inequitable access to MCM have a leading role indesigning their own response to the pandemic. However, the next paragraph defines this "ecosystem" asrelying solely on "voluntary cooperation.” Herein lies a major pitfall.
In our experiences of COVID-19, the transfer of technology and inexpensive distribution of vaccines andother medicines developed with massive public funds to developing countries are left to the "voluntarycooperation" of pharmaceutical companies in developed countries that hold intellectual property rights.
This issue, combined with the "vaccine nationalism" of developed countries that hoarded huge amountsof vaccines, impeded the achievement of "equitable access" for all countries including to the Global South.
As a result, the "comprehensive waiver of intellectual property rights related to COVID-19" was proposedat the World Trade Organization (WTO) by up to 65 countries as co-sponsors. In addition, technology
transferring and sharing to the Global South, and strengthening the manufacturing capacity of MCM atthe regional level, were recognized as the biggest common agendas for "pandemic preparedness andresponse,"
which the G7 also recognized. The Global South does not seek "charity" from the Global
North. What they seek is the right and agency to protect the health of their own people from pandemics,
through technology sharing and strengthened manufacturing capacity. If the G7 is to extol the "leadingrole" of each country including the Global South in designing national level responses and ownership in
pandemic preparedness, the "end-to-end" MCM ecosystem must include more active technology transferand technology sharing mechanisms, including comprehensive waiver of intellectual property rights, atleast for those MCMs developed with public funds, to make them global public goods.
Equitable access to medicines and the MCM ecosystem are currently being discussed in the negotiationsof the WHO CA++ and the amendment of the International Health Regulations, as well as in the WHOand G20 negotiations to create a successor framework to the ACT Accelerator, which was organized
during the COVID-19 pandemic. The G7 should not limit the basis of this "ecosystem" to "voluntarycooperation." On the other hand, paragraph 35 of the Communiqué states that the G7 will establish the"MCM Delivery Partnership for Equitable Access (MCDP)" based on this MCM Vision. The G7 needs toclarify the details of this "partnership" as soon as possible. The same paragraph also pledges that the G7will work with development finance providers "this summer" on concrete measures to ensure the financial
liquidity of international organizations to provide MCM at an early stage in the health crisis. This also

needs clarified, including in relation to the G20 Finance and Health Ministers' Meeting and the G20 Health
Ministers' Meeting to be held in August.

2. Global Health Architecture and UHC
Paragraph 33 of the G7 Hiroshima Communiqué mainly describes the global health architecture. Whilethe comprehensive and exhaustive description is commendable, it seems that the content is either areaffirmation of previous commitments or a pledge without sufficient specificity. The document also
postpones and shows a lack of commitment in "surge financing" measures in the event of a pandemic. It
is unfortunate that the G7 Hiroshima Summit was held in mid-May, more than a month earlier than last
year's G7 Summit, leaving an insufficient preparation period to formulate multilateral shared initiatives ina sustainable and predictable manner, even for the G7. Given the importance of the G7 in shaping global
issues, we must ensure that the date of the G7 Leaders' Summit allows for sufficient maturation ofinitiatives. We must also ensure clarifications of processes of initiatives following the summit. On the otherhand, we commend the inclusion at the end of the paragraph that recognizes the role of civil society inhealth, and we reaffirm our commitment to work with the G7 for a healthier future for all.
Paragraph 34 of the G7 Hiroshima Leaders' Communiqué primarily discusses Universal Health Coverage(UHC). Compared to the Nagasaki G7 Health Ministers' Communiqué and the G7 Global Plan of Action
for the UHC Action Agenda released at the same time, the Hiroshima Communiqué seems to be asetback to the perspective of health as a human right and the "leave no one behind" principle of UHC
that focuses on the most vulnerable communities. Additionally, there are no mentions of genderinequalities in accessing health services. While statements of ending AIDS, TB, and malaria and the 7th
replenishment of the Global Fund (Global Fund to Fight AIDS, TB, and Malaria) are commendable, as inthe Nagasaki G7 Health Ministers' Communiqué, there are insufficient descriptions of NonCommunicable Diseases (NCDs) or Neglected Tropical Diseases (NTDs). There is also a serious andtotal absence of issues that urgently need to be addressed, including the need to promote comprehensive
sexual education, and the mental health of young people. The statement that the G7 will make a "total
financial contribution of $48 billion" to achieve UHC has various challenges such as the absence of its
timeframe, the inclusion of the private sector in the specified pledge amount, and the ambiguity of theG7’s renewed financial contributions. Concerning the G7’s financial contributions, pledges must be moretransparent and responsible. In the last part of paragraph 35, we commend the detailed discussion arounddementia, and call for more active multilateral policy and financial mobilization toward increased equitable
access to medicines, health and care related to aging, in light of the current accelerated aging of theworld population.
Ends