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TO THE EDITOR — The world is facing unprecedented global challenges that pose existential-level threats to the survival of humanity and the planet. Despite the enormity of these challenges,

world leaders have failed to rise to the occasion. Instead, we have observed increasingly nationalistic, siloed responses that undermine much needed approaches centred around global

solidarity. We write as a collective of young global health scholars and professionals who recognize the urgency of the challenges we face and the limited time we have to address them. We

call on G7 and G20 leaders to act on commitments made and to strengthen global governance to address three interconnected challenges of our time: the COVID-19 pandemic, antimicrobial

resistance and the climate crisis. The COVID-19 pandemic has caused 15 million excess deaths between January 2020 and December 2021, with 53% of these occurring in lower-middle-income

countries1. At the current rate, the global goal of vaccinating 70% of the world’s population by September 2022 will not be achieved, leaving behind low-income and lower-middle-income

countries2. To successfully course correct, it is important to recognize and learn from mistakes in preparedness and response. For example, over the last three years, high-income countries

(HICs) created inequities by hoarding vaccines and providing insufficient funding to COVAX while also having bi-lateral deals with manufacturers2. HICs have also continued perpetuating these

inequities by donating nearly expired vaccines and blocking or watering down the Trade-Related Aspects of Intellectual Property Rights (TRIPS) waiver aimed at strengthening regional

manufacturing of COVID-19 tools2. It is imperative that relevant G7 and G20 countries take responsibility for current failures and commit to a more equitable governance structure where the

priorities of all countries are considered equally in health crises. This recognition of responsibility is central to both current response strengthening and sustainable future pandemic

preparedness efforts. HICs must support the temporary TRIPS waiver for all COVID-19 tools and the strengthening of regional manufacturing capacity of vaccines, diagnostics and therapeutic

agents. Relevant G7 and G20 countries also need to fulfill existing commitments on vaccine donations, prioritize support for required service delivery strengthening in low- and middle-income

countries (LMICs) and support multilateral mechanisms such as the Access to COVID-19 Tools Accelerator2. While we welcome the 2022 G7 health ministers’ re-commitments related to COVID-19,

they need to be honored and built upon. Considering the challenge of antimicrobial resistance, in 2019 alone an estimated 4.95 million deaths were associated with bacterial antimicrobial

resistance3. If current trends continue, cumulative economic costs are estimated at US$100 trillion by 2050, which could result in a major economic crisis3,4. As one of the World Health

Organization’s top ten threats to global health, antimicrobial resistance is likely to lead to enormous loss of life and to severely cripple national health systems. Since 2015,

antimicrobial resistance has consistently been featured on the G7 and G20 health agendas, appearing in a total of 116 commitments so far. However, most of these commitments have been ‘merely

ideas’ — statements upholding or supporting a principle, action or commitment5. Although surveillance and stewardship objectives of the Global Action Plan on antimicrobial resistance have

been priority commitments, more proactive approaches such as improving sanitation or health infrastructure remain underutilized5. At the last G7 summit, commitments focused on strengthening

the global supply chain for antimicrobials, including incentivizing antimicrobial research and development (R&D) and expanding manufacturing capacities worldwide. However, commitments

did not prioritize equitable access to new or alternative antimicrobials worldwide as global public goods5. At the global level, improving antimicrobial resistance responses requires G7 and

G20 countries to mobilize political and financial capital to strengthen multilateral efforts (including the Global Leaders Group on Antimicrobial Resistance and the Global Antimicrobial

Resistance R&D Hub) to advance all objectives. To further strengthen the global agenda, G7 and G20 need to acknowledge the limitations of working with the pharmaceutical industry, as the

development of new antibiotics may generate limited profits, and prioritize commitments to publicly financed primary healthcare, infection prevention and control, healthcare workforce

training and laboratory capacity5. At the national level, G7 and G20 commitments must recognize the required governance and technical capacities to effectively tackle antimicrobial

resistance and move towards more comprehensive, preventive approaches that strengthen underlying health systems. The climate crisis is the most immediate threat to the world’s ecosystem, and

yet the 1.5 ºC threshold set in the Paris Climate Agreement is likely to be missed6. India and Pakistan recorded the hottest March in 122 years, causing power outages, wheat crop failures,

forest fires, wildfires and floods7. Despite global agreements, G7 and G20 countries, particularly countries with high CO2 emissions, have not made meaningful progress to address the climate

crisis. This has led to the United Nations Secretary General calling the latest report by the Intergovernmental Panel on Climate Change a “file of shame”8. Although recent statements from

the G7 indicate a commitment to climate crisis targets, including maximizing synergy within the G7 development track and setting up a global early warning system within the next five years,

similar statements have been made before without meaningful action9. For instance, the financing targets set in 2009 by HICs to mobilize US$100 billion by 2020 are now expected to be

achieved in 2023 (ref. 10). Financing is required to achieve the COP26 (The 26th Conference of the Parties) goals of accelerating the phase-out of coal, curtailing deforestation, speeding up

switching to electric vehicles and encouraging investment in renewables6. Urgent action is required to reach global targets that were collectively agreed upon. G7 and G20 leaders must

fulfill their global financial commitments on climate financing in order to reach global targets. G20 countries with the highest emission levels need to improve their Nationally Determined

Contributions to reduce emissions and deliver on their commitments. The voices of vulnerable communities, such as climate migrants, refugees and indigenous populations, as well as their

agendas must be prioritized nationally and globally. Rhetoric without sustained political action and financial commitments will lead to irreversible loss of human and planetary life, as well

as economic damage. The inactions of the G7 and the G20 as collective bodies reinforce colonial structures and agendas where the lives of people in less wealthy nations continue to be

undervalued. Given their power and resources, G7 and G20 leaders have a responsibility to deliver on global commitments to address these health crises with a sense of urgency. These

challenges also call for a shift in global governance, from a model that is led by a select few towards one that puts solidarity and equity at the center. As the next generation of global

health leaders, we will hold the leaders of today accountable to their commitments and keep pushing for changes to our broken global health governance system. REFERENCES * World Health

Organization. https://www.who.int/news/item/05-05-2022-14.9-million-excess-deaths-were-associated-with-the-covid-19-pandemic-in-2020-and-2021 (2022). * Yamey, G. et al. _BMJ_ 376, e070650

(2022). Article  Google Scholar  * Murray, C. J. et al. _The Lancet_ 399, 629–655 (2022). Article  CAS  Google Scholar  * The World Bank.

https://www.worldbank.org/en/news/press-release/2016/09/18/by-2050-drug-resistant-infections-could-cause-global-economic-damage-on-par-with-2008-financial-crisis (2016). * Tejpar, S. et al.

_BMJ Glob. Health_ 7, e008159 (2022). Article  Google Scholar  * _Climate Change 2022: Impacts, Adaptation and Vulnerability_. https://www.ipcc.ch/report/ar6/wg2/ (IPCC, 2022). * Jain, Y. et

al. _BMJ_ 377, o1207 (2022). Article  Google Scholar  * CBS News. https://www.cbsnews.com/news/climate-change-un-report-governments-business-lying-efforts/ (2022). * G7 Foreign Ministers.

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(2021). Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada

Shashika Bandara * Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Prativa Baral & Daniel Krugman * Trent/Fleming School of

Nursing, Trent University, Ontario, Canada Anshumi Joshi * Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK Joy Muhia * Faculty of Health Systems

and Behavioural Sciences, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore Afifah Rahman-Shepherd * Public and Global Health Program, Tampere

University, Tampere, Finland Praju Adhikari * Global Health Corps, Kigali, Rwanda Alice Bayingana * Division of Global Surgery, University of Cape Town, Cape Town, South Africa Hloni

Bookholane * Global Health Direct Matriculation Program, Johns Hopkins University, Baltimore, MD, USA Yara Changyit-Levin * School of Nursing, Midwifery and Health Systems, University

College Dublin, Dublin, Ireland Sara Dada * Programme for Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA Rohini Dutta * Kabul University of Medical Sciences,

Kabul, Afghanistan Mohammad Yasir Essar * University of Witswatersrand, Johannesburg, South Africa Nelson Aghogho Evaborhene * Department of Epidemiology, School of Public Health, University

of Washington, Seattle, WA, USA Ramya Kumar * International Working Group for Health Systems Strengthening, New York, NY, USA Malvikha Manoj * University of Global Health Equity, Kigali,

Rwanda Kedest Mathewos * University of Minnesota Medical School, Minneapolis, MN, USA Nehemiah Olson * School of Clinical Medicine, University of Cambridge, Cambridge, UK Rhiannon Osborne *

One Health Research Group, Facultad de Medicina, Universidad de las Américas, Quito, Ecuador Daniel Romero-Alvarez * Saw Swee Hock School of Public Health, Singapore, Singapore Zaw Myo Tun *

The International Digital Health & AI Research Collaborative (I-DAIR), Global Health Centre, Geneva Graduate Institute, Geneva, Switzerland Brian Li Han Wong Authors * Shashika Bandara

View author publications You can also search for this author inPubMed Google Scholar * Prativa Baral View author publications You can also search for this author inPubMed Google Scholar *

Anshumi Joshi View author publications You can also search for this author inPubMed Google Scholar * Joy Muhia View author publications You can also search for this author inPubMed Google

Scholar * Afifah Rahman-Shepherd View author publications You can also search for this author inPubMed Google Scholar * Praju Adhikari View author publications You can also search for this

author inPubMed Google Scholar * Alice Bayingana View author publications You can also search for this author inPubMed Google Scholar * Hloni Bookholane View author publications You can also

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Scholar CORRESPONDING AUTHOR Correspondence to Shashika Bandara. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no competing interests. RIGHTS AND PERMISSIONS Reprints and

permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Bandara, S., Baral, P., Joshi, A. _et al._ Open Letter to G7 and G20 leaders: resolve global crises to secure our future. _Nat Med_ 28,

1974–1975 (2022). https://doi.org/10.1038/s41591-022-01944-7 Download citation * Published: 15 August 2022 * Issue Date: October 2022 * DOI: https://doi.org/10.1038/s41591-022-01944-7 SHARE

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