2nd Meeting, Social Forum 2026

Sound check for capturing. One, two, three. One, two, three. Can you hear me? Thank you very much. All good for us. Good afternoon, colleagues. Welcome back. I hope you had a good lunch break. As promised, we'll continue with the previous speaking list, but I should warn you that we only have 15 minutes, and there is no way that we can accommodate more than 50 plus speakers within 15 minutes. So in order to make this inclusive and balanced, we have decided to take four states and two civil society organizations within this hopefully 15 minutes. So I now give the floor to India. India has the floor, followed by Iran, of course.

Thank you, Mr. Chair. Right to health and right to development are indivisible and foundational to human dignity. Rising debt burdens and liquidity constraints, as described by the panel, severely limit the capacity of many Global South countries to deliver adequate healthcare. Mr. Chair, Yet, states retain the primary responsibility for progressive realization of the right to health. India meets this obligation through Ayushman Bharat, the world's largest publicly funded health assurance scheme. It provides 500,000 Indian rupees annual coverage to close to 5 million vulnerable citizens and has already enabled more than 130 million hospitalizations. This is powerfully complemented by the Ayushman Bharat Digital Mission, which has generated nearly 930 million digital health identities, ensuring continuity of care and a robust digital health ecosystem. Guided by the civilizational principle of Vasudhaiva Kutumbakam, the world is one family, India actively advances South-South cooperation. As the pharmacy of the world, our Vaccine Maitri initiative delivered critical medical supplies globally. Through the ITEC program, we continue to build healthcare capacity across developing nations. When international health financing is shrinking, we call upon the international community to urgently revitalize equitable development financing and translate shared responsibility into concrete action. Only through genuine solidarity and strengthened international cooperation can highest attainable standard of physical and mental health become a lived reality for all. I thank you, Chair.

Thank you. I now give the floor to Iran, followed by Venezuela.

Thank you, Mr. Chair. The decline in international health financing threatens both the right to health and the right to development. For developing countries, unpredictable funding can disrupt essential services, weaken health systems, and reverse hard-won development gains. The response must be guided by international solidarity and effective cooperation with full respect for national ownership and priorities. In this regard, we would like to highlight three points. First, the primary responsibility of states for their people's health must be supported by effective international cooperation. Developing countries need sustained, adequate, and predictable financing to maintain essential services and build reliance public health system. International assistance should support national identified need, and strengthen lasting capacity. Second, addressing the health financing gap also requires removing obstacles that prevent countries from using their own resources. Unilateral coercive measures, restrictions on financial Transaction and other compliance can obstruct payments for medicine, medical equipment, and essential health services. Iran's experience under underscores the importance of addressing these barriers. Humanitarian exemptions must translate into effective access in practice, including through functioning payment channels. Discussion on mobilizing resources for health should therefore also address restrictions that impede their transfer and use. Third, South-South and triangular cooperation can support the exchange of knowledge, training of health professional, and development of local production capacities. This partnership deserve greater financial and technical supports. They should complement North-South cooperation and the fulfillment of existing development assistance commitments. Mr. Chair, the right to development provides a framework for translating solidarity into practical cooperation.

We encourage this forum to identify

Please conclude. Okay, in that case, I give the floor to Venezuela, followed by Algeria.

Chair Rapporteur, firstly, we join others in expressing our condolences and solidarity with the Spanish people following the tragic rail accident which occurred in Spain. Venezuela reiterates that the enjoyment of the highest attainable standard of physical and mental health is a fundamental right In order to achieve this, we need sustained national efforts as well as effective international cooperation based on shared responsibility and solidarity. We're concerned to see a cut in international funding for health, particularly because of the consequences on developing countries. Their health systems face budgetary restrictions and structural difficulty which restricts access to basic services. Venezuela thinks it's absolutely vital to promote Sustainable, predictable and accessible funding which responds to national priorities, respects national sovereignty and contributes to strengthening national health systems without preconditions. Thus, we think it's vital to strengthen South-South and triangular cooperation through the exchange of good practices, knowledge and technology, as well as developing national practices in order to narrow inequalities in accessing health. Venezuela faces obstacles in accessing medicines and equipment. This affects the working of our health system and compromises the effective enjoyment of the right to health. We reiterate that there is a strong link between the rights to health and development. They require an enabling international environment based on equity, cooperation and solidarity. Venezuela makes a call for revitalizing international cooperation and ensuring fairer distribution of resources in order to put the well-being of people at the heart of health policies. Thank you very much, Chair.

Thank you. I now give the floor to Algeria.

I thank you, Mr. Chair.

Allow me to begin by.

Expressing Algeria's deepest condolences to the government and people of Spain, and our sympathy to the families of the victims. From a right to development perspective, States need sufficient policy and fiscal space to realize the right to health, as affirmed in Article 2, paragraph 3 of the Declaration on the Right to Development. That space is eroded by the no repatriation of funds of illicit origin. As resolution 14/4 recognized, illicit financial flows deprive countries of resources needed to realize economic, social, and cultural rights, including for us, the right to physical and mental health. As coordinator of the African Group on Health, Algeria considers the right to health a priority. It is constitutionally guaranteed and public care has been free since 1974.

Algeria ranked first in Africa on the WHO UHC Service Coverage Index in 2019.

We call on States holding such assets to speed up legal assistance and strengthen transparency, and on partners to treat asset return as.

Part of fiscal space.

I thank you, Mr. Chair.

Thank you. I now give the floor to Policy and Economic Alliance, Caring of Earth. You have the floor. Is peace in the room? That doesn't seem to be the case. Then I'll give the floor to Al-Had. You have the floor.

Mr. Chairman, rapporteur, Excellencies, I would like to thank you for organizing this forum. And I would like to speak about the suspension of work with Palestinians and the difficulties in accessing health care as a result. There are 5.9 people who are affected by this phenomenon. Basic medication has been stopped and there have been threats against persons who suffer from chronic diseases such as diabetes and others. The cancer treatments as well have been less available. Similarly, there is staff and medication which is in shortage, and this has an effect on women and children. There is medical equipment which is not well maintained, and again, that has an effect on their supply. So withdrawing funds in this fashion has undermined the health of Palestinians. The international organizations should provide sustained financial support while guaranteeing the non-politicization of assistance in the health system in Palestine.

Thank you. I now give the floor to Women's Federation for World Peace International.

Distinguished Chair, Excellencies, and fellow delegates, a country may meet its financial targets while its people lose access to essential healthcare. Can we genuinely call that a successful agreement? When international financing conditions restrict public sector recruitment or healthcare expenditure, the consequences extend far beyond government budgets. A government may meet its fiscal targets by restricting healthcare recruitment, but at what cost to communities already struggling to access essential care? The IMF already recognizes social spending floors as a means of protecting essential services during financial adjustment. So why should we stop at protecting expenditure rather than ensuring that people can challenge decisions affecting their right to health? I propose three safeguards grounded in the right to development. First, meaningful participation. Independently selected youth and community representatives, particularly women, persons with disability, gender violence women, marginalized groups, and frontline healthcare workers should have a formal role in reviewing financing conditions before agreements are signed. Governments and lenders must then publicly demonstrate how their input has shaped the final decisions. Participation must carry influence, not merely provide consultation. Second, measurable safeguards. Financing agreements must protect essential healthcare budgets and staffing with regular assessments of their impact on marginalized communities. Success should be measured not only by fiscal targets achieved, but by people's continued access to healthcare. Third, shared accountability. Where conditions demonstrably undermine access to essential health care, affected communities should have access to an independent review process, with clear procedures for governments and financing partners to reconsider those conditions. Because ultimately, if people must live with the consequences of financial agreements, they deserve a voice in determining their terms. I thank you.

Thank you. That was the last speaker that we could accommodate, and I thank you for your understanding. We are now beginning our second panel entitled Securing Sufficient Policy and Fiscal Space to Enable Countries to Meet Their Health-Related Human Rights Obligations. I would like to welcome the distinct panelists and I'm also pleased to introduce Ms. Pia Obrey, Chief of the Right to Development Section at OHCHR, who will be moderating the panel. Please join us in the podium.

Another panelist is still joining so that I can accommodate the name plates.

Yeah, sure.

Thank you, Mr. Chair. May I first call, please, the panelists to the podium? Her Excellency Ambassador Cecilia Kiku Ishitani from Brazil, Serge Joyouk Amga from the Expert Mechanism on the Right to Development, Evelyn Opondo from ICRW Africa, Caroline Dohmann from Human Rights Economics, and Uju Mabel Onyeze from Africa CDC. Please join us on the podium. Mr. Chair, Excellencies, distinguished panelists, colleagues, and friends, it is my pleasure to moderate the second thematic session of the Social Forum on securing sufficient policy and fiscal space to enable countries to meet their health-related human rights obligations. This morning, we discussed the sharp decline in international health financing. This afternoon, we turn to a closely related question, not only how much financing is available, but on what terms. As aid declines and debt servicing obligations rise, many countries face growing constraints in designing and implementing health policies aligned with their national priorities and human rights obligations. Conditions attached to financing can play a significant role. Deficit reduction targets, austerity measures, and wage bill ceilings can limit the resources available for health. Requirements related to privatization or user fees can hinder access to services, especially for people in vulnerable situations. In 2022, three out of four people among the poorest segments of the population experienced financial hardship from health costs, compared with fewer than one in 25 among the richest. And the design of assistance matters too. Earmarking for specific diseases, tied aid, And certain donor restrictions can fragment health systems, weaken local capacities, and affect services for marginalized populations. Together, these factors can constrain national ownership, the ability of countries to set their own health priorities. Yet states remain accountable to their people for realizing the right to health, which is why financing arrangements should enable them to meet their human rights obligations rather than stand in the way. The declaration on the right to development offers a clear framework. It recognizes the duty of states to formulate national development policies, which requires sufficient policy and fiscal space. It also sets out the duty of states to cooperate in eliminating obstacles to development, saying that international cooperation should support nationally owned health strategies and strengthen, rather than constrain, national capacities and decision making. Our panel today brings together a wide range of expert perspectives, and I will introduce the panelists as they speak. I'll ask each panelist to keep to seven minutes, and we'll start with our first speaker. Our first speaker is Her Excellency Ambassador Cecilia Kiku Ishitani, the Deputy Permanent Representative of Brazil, who will speak about strengthening national ownership and policy space for health through international cooperation. Madam, you have the floor.

Thank you. Excellencies, distinguished participants, colleagues, and friends, Brazil welcomes this opportunity to discuss how international cooperation can support the realization of the right to health. Our experience is grounded in a fundamental principle: health is a universal right and a responsibility of the state. This principle is enshrined in our 1988 constitution and implemented through our unified health system, the Sistema Único de Saúde, known as SUS. The SUS provides healthcare free of charge from primary care and vaccination to highly specialized treatments for a population of more than 200 million people. Its creation was part of Brazil's return to democracy, supported by strong social mobilization. Universal health care expresses a political commitment to equality, social inclusion, and human rights. It also requires action on the social determinants of health, including safe water, sanitation, adequate housing, food, and decent work. Social participation is equally essential. Communities must have a voice in defining priorities and holding public institutions accountable. Distinguished participants, building a sustaining And sustaining a universal public health system requires more than financial resources. It requires strong public institutions, long-term investment, and the ability to define national priorities according to the needs of the population. For Brazil, national ownership means preserving the capacity to formulate and implement public health policies, including decisions on resource allocation, procurement, research, innovation, and access to medicines. Fiscal constraints, debt burdens, and unequal access to health technologies can severely limit this capacity, particularly in developing countries. International cooperation should help countries overcome these constraints rather than create new dependencies or restrict their policy choices. This means moving beyond traditional models of assistance towards partnerships based on solidarity, mutual benefit, technology transfer, and sustainable national capacities. Preserving policy autonomy and strengthening international cooperation are mutually reinforcing objectives. Cooperation succeeds when it expands countries' ability to fulfill the right to health. Financing of the SUS is shared among federal, state, and municipal governments with constitutional minimum spending requirement to protect public's resources for health. In 2024, Brazil total health expenditure, public and private, reached 10.13% of GDP. Yet spending per person was only 38% of the OECD average, illustrating the challenge of financing universal health care. How resources are allocated matters alongside how much is invested. Better coordination of care, procurement, and price negotiation can help resources go further and improve access. Equity requires addressing inequalities both between and within countries, allocating resources according to different needs, including those of indigenous and underserved communities. We anchor access in our generic drugs law, stimulating competitive domestic production. We support innovation and intellectual property rights while exercising flexibilities of international agreements to ensure affordable access to life-saving therapies. We established a centralized price negotiation committee to deal with pharmaceutical industries and modernize our supply chain logistics. And we actively champion multilateral purchasing mechanisms, expanding the use of PAHO's revolving and strategic funds to pull regional demand and negotiate fair prices for high cost therapies. Colleagues. An important dimension of policy autonomy is local and regional production of medicine, vaccines, diagnostics, and other essential health technologies. The COVID-19 pandemic exposed the vulnerabilities associated with concentrated manufacturing capacity and unequal access. Stronger local and regional capacities can improve supply security and contribute to more affordable and sustainable access. Public institutions, such as Fiocruz, help connect research, technological development, production, and training to the need of the SUS. A concrete example is regional cooperation on training professionals in vaccine and diagnostic development and production. The lesson is clear. International cooperation is most effective when it goes beyond supplying finished products and contributes to transferring knowledge, technology, and productive capabilities. This understanding informed the Global Coalition for Local and Regional Production, Innovation, and Equitable Access, promoting during Brazil's G20 presidency in 2024, and formally established in Geneva last year. The coalition seeks to strengthen production innovation and expand access to essential health technologies, particularly in developing countries, with attention to neglected diseases and populations in vulnerable situations. Its purpose connects directly with our discussion, enabling countries to develop the capacities needed to respond to their own public health priorities. Colleagues, Brazil's long-standing commitment to South-South cooperation follows the same principles: solidarity, respect for national priorities, and the exchange of experiences among developing countries. Our approach emphasizes institutional strengthening and the sharing of public policies and technologies that can be adapted to different national context. The lasting contribution of cooperation lies in strengthening country's ability to sustain services, develop their workforce, and make their own public health decisions. I will share some concrete examples. One particularly successful example is Brazil's international cooperation on human milk banks. This model combines relatively low-cost technologies, professional training, and public health policies to improve neonatal nutrition and care. Through cooperation, coordinating by the Brazilian Cooperation Agency and Fiocruz, Brazil has supported the development of human milk banks across Latin America, the Caribbean, Africa, and beyond. This initiative demonstrates that sharing political knowledge and strengthening local institutions can generate significant and sustainable health benefits. Across the community of Portuguese language countries, CPLP, Brazil champions structuring health cooperation. Rather than relying on short-term donations, we partner with national health ministries to build enduring institutional capacity. Cooperation with Mozambique, for instance, combined support for pharmaceutical manufacturing with professional training and institutional development. In Angola, a bilateral health workforce training program has already enabled 347 participants to complete their training and take up roles in the country's health services. These experiences demonstrate how cooperation can build lasting capacities, strengthen national institutions, and expand countries' ability to respond to their population's needs. Brazil's experience with HIV/AIDS provides a further lesson. Universal access to treatment requires coordinated public policies, including procurement, access to affordable medicines, and international cooperation supported by meaningful civil society participation. These experiences bring us to the central question of how cooperation can support universal health system under fiscal constraints. From Brazil perspective, three elements are particularly important. First, preserve national policy space. International financial arrangement should respect nationally defined health priorities and avoid conditions that undermine essential public services or restrict access to health technologies. Second, investing in sustainable capacities. Technology transfer, local and regional production, professional training, and institutional strengthening can generate lasting benefits and help countries make better use of limited resources. Third and last, Lastly, strengthening international solidarity. Developing countries need more equitable access to financing, knowledge, and technologies, as well as meaningful participation in decisions that shape global health governance. International cooperation should complement sustainable domestic public financing for health. Countries must also have sufficient fiscal space to fulfill their human rights obligations and progressively realize the right to health. Brazil's experience with the SUS shows that universal health care depends on strong public institutions, sustained political commitment, and the ability to respond to nationally determined priorities. The constitutional guarantee of minimum health expenditure, the commitment to universal access, and the scale of Brazil's health spending demonstrate that financing the right to health requires both legal protection and sustained public action. International cooperation can make a decisive contribution when it is strengthening these foundations. therefore, should be to enable countries to build resilient, equitable, and sustained health systems of their own, translating international solidarity into the effective enjoyment of the universal right to health. I thank you.

Thank you very much, Ambassador. Our next speaker is Professor Serge Joyoucamgar, who is a member of the Expert Mechanism on the Right to Development, for your perspective, please.

Thank you very much, Chair. Your Excellencies, distinguished delegates, it's my pleasure to speak before you this afternoon. And I would like to thank the organizers of the forum for the opportunity to share my reflection on these critical issues dealing with the self-determination and policy space, a right to development perspective on health financing. I would like to start by pointing out that Article 25 of the UN Declaration on Human Rights clearly integrates the right to health into adequate standard of living. It says, "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age, or other lack of livelihood in circumstances beyond his control. It shows you the multi-dimension of the right to adequate standard of living, including the right to health. The UN Charter also highlight the equal sovereignty of states. Article 55 and 56 of the same charter calls on the international community to join hands, working together to improve the standard of living everywhere in the world. This call, of course, needless to say, is reiterated by Article 6 of the UN Declaration on the Right to Development. This entails financial resources needed to finance the right to health and the right to development. This means development cooperation should support national ownership, meaningful participation, accountability, and policy autonomy as regards the right to health and the right to development. However, the resources needed to secure this right are not accessible to the countries or people that need them most. The global public health debt reached a record of 102 trillion dollars in 2024. Developing countries accounted for less than a third of that debt, yet paid about a trillion dollars in interest in that year alone. 46 developing countries now spend more on interest than on either health or education. As correctly observed by President Ruto of Kenya in his statement recently in New York, he said, behind this number lies a simple reality. Hospitals compete with the creditors. The classroom and the right to development compete with debt services, and too often the creditor is paid first. Many people enter hospital without bed or medicines. When debt service displaces investment in health and other basic needs, the right to health and the right to development are violated. The current international health financing systems reflect the violation of the right to self-determination and the shrinking of policy space in emerging economy. In this regard, national efforts are hindered by the international financial system. The country that most needs capital frequently pay the highest price to obtain it. Developing countries have recently borrowed at a rate two to four times higher on average than the developed nations. While there is finance, the questions are who can access it? At what price, for how long, and under what assessment risk? Developing countries know the cost of that assessment. Sovereign credit rating shapes perception of risk, the interest countries pay, and even the volume of finance available to them. A UNDP study highlight that African nation could save up to $74.5 billion in sovereign credit rating, relied on objective evidence-based assessment rather than subjective criteria. It's very important to note the gravity of the problem. Ruto said, "We cannot build a fair global economy if the nations with the greatest development need face the higher cost of development financing." Now, what should be the solution? The solution, I will now be drilling into the right to development approach. Here, I argue that to resolve this problems, the right to development discourse and framework should guide the international financing system. In this perspective, we need to ensure that the right to participation of beneficiary of health services is considered and really taken seriously. People on the ground should not experience discrimination in the allocation of resources. In this context, it's important to consult with the population on what is their priority in terms of health care services. Secondly, the international cooperation should be informed by the needs of the people. Here we reiterate the right to equal sovereignty of states not to be discriminated in the sharing or allocation of resources. We need to respect national priorities of countries. The equal participation and decision making of developing countries is critical to impact financing on the right to health. A cooperation in which we don't have partnership between the rider and the horse, but a fair partnership informed by the need to protect the right to health and the right to development. I thank you.

Thank you very much, professor. Our next speaker is Ms. Evelyn Opondo, Executive Director of the International Center for Research on Women Africa, and she will look at fiscal and policy conditionalities through a gender and human rights lens. You have the floor.

Thank you. It's my pleasure to be speaking with you all this afternoon. Now, most important health decisions are actually made outside the health sector. These decisions are made in budgets, in financing agreements, and in policy choices. The WHO reports that in 2023, 260,000 women died during pregnancy and following pregnancy and childbirth. Approximately 92% of those deaths were in lower middle income countries. And importantly, most of those deaths could have been prevented. Now, the three delays model attempts to answer why the many deaths are still occurring. It shows that That health outcomes are shaped not only by clinical care, but by the systems, by resources, and by public investments, which determine whether health is available, accessible, and equitable. Our health outcomes reveal the cumulative choices that we make as a people about gender equality, about infrastructure, about public investment, about education, social protection, and about governance. Now, when we look at the first delay, the question is, why is it that several people delay in making the decision to go into a health facility? The question is, Can they afford transport to those health facilities? Do they have information that they trust? Can they take away time from their work or from their caregiving responsibilities in order to attend to those services? Can they make decisions about their own bodies or about their health? When funding cuts reduce service availability, or when policy restrictions limit information and choice, we see that costs, distance, stigma, and practical barriers to care increase, especially for women, girls, and marginalized communities. The common thread here is that access to care depends on the information that we share and give on social protection, on economic opportunity, gender equality, and bodily autonomy. The first delay is therefore a gender equality issue, it's a human rights issue, and it's a development issue. The second delay. Once a woman or a person decides that now they want to go into the health facility, the question is, can they physically get to the services when they need it? When roads are impassable because the roads are so bad, that's a transport issue. When floods isolate communities, that's a climate resilience issue. When rural facilities are far apart, that's a public investment issue. When transport costs are unaffordable, that's an economic justice issue. For many girls and women, particularly in rural communities and humanitarian setting, distance becomes exclusion, and exclusion finally becomes health outcome. Therefore, Investment in infrastructure, in transport, in resilience, in local service delivery, all of these are investments in the right to health. The third delay, once a person gets into the facility, they've already taken themselves there, the question then becomes, are there enough nurses and midwives? Are the medicines available? Are equipment functioning? Is care respectful and free from discrimination? Are the facilities adequately resourced? We've heard from morning, across most of Africa, governments are expected to expand universal health coverage, reduce maternal mortality, strengthen preparedness for health emergencies, respond to climate related health impacts, and address the growing burdens of disease. Yet, even the previous speaker has just spoken to the debt, the burden, the fiscal burden on African governments. More than 40% of African countries spend more on debt servicing than on their health budgets. And Africa's debt we've heard from morning is over $650 billion. And at the same time, we are expecting our governments to operate within expenditure ceilings, within fiscal consolidation frameworks, hiring restrictions, and other conditionalities that limit resources for public investment. Ladies and gentlemen, the consequence is clear. It means health worker shortages, it means stockouts, it means under-resourced primary health care systems, it means delayed investment in prevention. Of course, all these fiscal constraints are not gender neutral. When public services weaken, the burden does not disappear. It shifts mostly to women and girls. Women absorb additional unpaid care responsibilities. Women stretch household budgets. Women postpone seeking care for themselves because they're responding to everybody else. And we see girls leaving school because they need to support the caregiving responsibilities within the families. And when you see community health programs are reduced, women provide the care that is lost. When social protection systems weaken, women compensate for those gaps. Importantly, policy is also of great value for us to consider here. Even when resources exist, policy choices will determine if people can fully exercise their right to health. Policy restrictions constrain what services and information people can access. Health care services depends not only on whether services exist, but also on the policies that determine who can access Under what conditions can they access, and with what degree of autonomy? And we've seen a lot of adolescents denied services because of age-related barriers. And therefore, when evidence becomes politicized, policy making becomes vulnerable to ideology and not evidence. A rights-based approach requires that adequate fiscal space and policy space Therefore, resources to deliver services and the freedom to provide those services are evidence informed, and in fact, that they are rights affirming. We have heard from morning about the need for us to make sure that those that are most affected are on the table in the making of policies. And in fact, this means that we are protecting civic space, we are promoting local evidence, and we are promoting meaningful participation. In conclusion, I want to propose three priorities. to ensure that we entrench gender within the fiscal and policy discussions. One, we need to make sure that we place gender equality and human rights at the center of fiscal decision making. We need to assess gender and human rights implications before major fiscal reforms and not after the fact. We need to measure equity and rights outcomes and not just physical targets. Secondly, we need to protect essential investment. We need to protect, to safeguard health. We need to safeguard social protection and care systems, especially during times of fiscal adjustments. We need to make sure that we treat primary health care and prevention and community health programs as investments rather than expenditure. And finally, we need to strengthen participation and accountability. The fundamental challenge here isn't simply how to finance health, but is to ensure that fiscal and policy decisions expand rather than constrain our ability to live healthy, dignified, and productive lives. Thank you.

Thank you very much. Our next speaker is Ms. Caroline Dommen, who's the Director of Human Rights Economics, and will speak about trade policies and related conditionalities. You have the floor.

Thank you, Chair, and thank you for this opportunity to discuss this very important topic. So, yeah, I want to talk about how trade and trade agreements affect the underlying conditions for the realization of the right to health. We often think of trade policy and health policy as separate. Often they're dealt with by very separate ministries, but they are linked in many ways that previous speakers have already touched on. For instance, trade-related intellectual property standards affect access to medicines and to vaccines. Trade rules restrict the policy space for sanitary standards. Trade rules limit fiscal space, for instance, through trade commitments that have over the years progressively reduced import tariffs. and corporate taxes, meaning that governments are less able to mobilize resources and then to devote maximum available resources to the realization of the right to health. Also, trade and trade agreements affect what food is available in countries markets and how it's produced. Now, each of these topics in itself would be, you know, we could discuss probably for the whole of this session, but I just want to focus briefly on one aspect, the latter one, about food and agriculture trade rules as a determinant, sorry, food as a determinant of the right to health, and food and agriculture trade rules impacts on the right to health. My remarks are based, to a large extent, on work I've been leading, developing an entirely new set of rules to govern global food and agriculture trade, which really puts human rights at its center, and which I, if I have time, will mention more about later. So first of all, I want to describe just a couple of the ways that the trading system shapes what food is available and the health impact of that, before turning to how human rights tools, impact assessment and other tools, can be used to create a global food system that really fosters healthy outcomes. So trade, we know, can improve food security, enabling food to move from where it's produced to where it's needed. And for many countries, as probably many of you know better than I do, this is essential. Switzerland, my country, for instance, imports half the calories that are consumed here. So international trade, food trade, is welcome. It also enables food prices to fall and improving access for consumers. And studies have shown that agricultural trade openness has, on average, a positive net impact on food security, measured as dietary energy supply adequacy. But we know that quantity is not quality, right? And this is a key part of the health dimension. Dietary diversity is important for the adequate provision of nutrients and human health. And as natural conditions don't allow for the production of all foods everywhere, trade is important as a means to diverse diets. And while trade organization data shows that increases in trade in fruit and vegetables have occurred since agriculture trade liberalization has been underway. So it's not just about agriculture, sorry, alcohol or tobacco or ultra processed food. It's also about healthy foods. So the international, the centerpiece of international food trade regulation is the World Trade Organization's Agreement on Agriculture, which was adopted 30 years ago. And since then, the volumes of international food trade have increased dramatically. I think the latest figure I've seen is over 350%. And so we would think health outcomes have improved, right? Sadly, no. Over the same period, health outcomes have declined with increased incidents of diet-related diseases like diabetes, cardiovascular diseases, and so on. And this isn't just because more food crosses borders. Rather, it's a consequence of the profound changes that trade liberalization and related rules have ushered in to the food system. And some of the channels through which this has happened is that it's the more value-added trade is in the processed goods, and therefore has led to more trade in ultra-processed products, which we know have adverse health impacts. Also, the fact that markets are now globalized facilitate the emergence of large, vertically integrated companies who can realize vast economic gains, leading to a vicious, or perhaps for them, virtuous cycle of increasing power, corporate power, and therefore an increased power of these companies to determine what's sold, what's produced, and what's consumed. So, yes, to move on. So increased international trade has increased the composition quality and nutritional value, therefore, and relative prices of food available in local markets. And diets worldwide are now much more likely to include animal sourced food and horticultural products than in the past, as well as more processed food and carbonated sugar drinks. And what is striking in the context of our discussion today is that many companies who sought to restrict the less healthy foods through their trade import rules, have been faced with intense campaigns by the advocates of the private companies who really exert immense power to limit the positive, healthy regulations regarding food. And so nothing in current trade rules enables consideration of health value of the agricultural goods traded. Another health aspect is that the international trading system enables and amplifies environmental harms. And I probably don't need here to describe how environmental harm has health impact, but we really know that agriculture, food production, and trade account for over a quarter of global greenhouse gas emissions, 70% of global freshwater withdrawals. And as we know, export-oriented agriculture is typically intensive with high chemical inputs, with all sorts of harms for workers' health as well. So the current international trade system ignores these types of externalities, and countries are extremely limited in how they can regulate trade on environmental grounds. And extreme competitive pressures limit producers' ability to improve standards because of the costs and competition pressures. And within the World Trade Organization, which is really at the center of agricultural food, sorry, agricultural and food trade rules, there's been some talks to try and reflect the environmental impacts, but these are extremely limited. First of all, the whole system is stalled. You know, basically since this agreement on agriculture was adopted in 1995, almost immediately, talks began in the WTO to reform and improve these rules, and, you know, 30 years on, They're increasingly stuck. But even if they were to move forward, the proposals on the table don't go nearly far enough as needed to regulate the food, the global food system in a way that would promote the right to health. So faced with this, what would the response be? What could one do? I was asked to speak about tools such as human rights impact assessments, which I think can go some way to help. But basically, the scale and the systemic structural system is so entrenched that I think that something much more fundamental is needed. And this is where our initiative on reimagining agricultural trade rules comes in. And we really think that it's necessary to rethink the system from first principles. that it's necessary to be bold enough to advocate for fundamental reform. And this is what we've done, and we've published a model treaty on agriculture trade for sustainable food systems. And it really has the right to food and human rights at its heart. And it seeks to move beyond a regime that prioritizes trade liberalization to one grounded in human rights and sustainable food systems. Amongst the main novelties it introduces, let me just mention on a couple. It's based on human rights and values, principles. It measures success not by GDP or by increases in trade volumes, but by wellbeing outcomes, including health. And it limits, it puts strict limits on corporate power, which are now entirely absent from the international trade and international governance system as a whole. So we reflect a vision of inclusive, sustainable priority. And I really, you know, as a recommendation, perhaps instead of a recommendation, a call to the people present today, to really call out the current international trading system for the harms that it enables, that it facilitates, and to be bold enough to call for the system to be rethought from first principles. We know that the current trading system is not working, and it's collapsing as the world experiences climate crises, geopolitical crises, economic crises. And I think whether we work in governments or academia, whether we represent a social movement, a private company, or a UN entity, we must be realistic and bold enough to call for the change that we really know is needed. And thank you for this opportunity to reflect on these questions.

Thank you very much, Caroline, for that. Our final speaker will be Ms. Uju Mabel Onyes, who's the Principal Technical Officer of the Public Financial Management and Lusaka Agenda Division of the Africa Center for Disease Control and Prevention, bringing the perspective from the African region on public financial management and the alignment of external financing with national priorities. You have the floor.

Thank you, Chair. Hello, everyone. I would like to start by saying something we've heard quite a bit today. Health is not just a privilege, it's a human right. And I think this is something that we're all familiar with in this room and at the panel. And that's something that countries as well are very familiar with, and they're doing their best to achieve the highest attainable healthcare for their population using whatever resources are available, including international cooperation. So this is where also universal health coverage comes into play, giving your population the access to quality healthcare services without exposing them to any sort of financial hardships to achieve it. Just like my fellow panelists were speaking about the different barriers to care, and one of the things that shouldn't be on the table is really one of the financial barriers. Nobody should not want to get to a facility because they cannot afford to. And this is something lots of countries are working on. So one of the things that I want to talk about today is really around financial ODA, financial assistance, and USACA agenda, as well as public financial management. Another issue is really not about how much external financing comes into Africa, but it's what the financing is doing to our health systems. Is it strengthening it, or is it further fragmenting them? One of the tools that's used to put aside money for health and other sectors is known as earmarking. So earmarking ring-fences resources for health. It targets specific diseases, protects specific populations, especially the vulnerable. And really, while it's a great tool, what really matters is who earmarks these funds. Countries like Ghana, for example, Gabon, Nigeria, to mention a few, have done really great work using levies and statutory funds to cover vulnerable populations in the countries, such as, for example, children, pregnant women, the elderly, and the poorest of the population, which has really helped to close some of these gaps that the people face. But the question is, how do we earmark? Are we earmarking outside of the national systems? This is something that could weaken the health system as opposed to strengthen it. In each of these cases, the government that I mentioned around Gabon, Nigeria, and some of the others, the earmark is set by government, it's approved by parliament, and it's visible in the budget and accountable to citizens as well as civil society. But even then, it only works with strong public financial management. Earmarks can be eroded, and ring-fenced money can actually sit unused if it's not released, tracked, and accounted for. So earmarking alone is not just enough. I also want to talk about vertical program financing. This is something that has been around for decades, where we have funding for specific disease programs that run outside of national systems and really just focus on one specific disease program as opposed to the health system as a whole. There's no doubt that this is something that was used, has been used for years, looking at the fights for HIV, like against HIV over the years, and it saved thousands, if not millions of lives. So we cannot not say that, yes, this is something that has worked. We cannot acknowledge that it's not worked. But looking at this from the sustainability lens, are these programs that are building their health systems? or to be able to stand on their own, or these programs that will suffer once the funding for this, that will make the health system suffer once this funding is withdrawn. When money flows outside of the government systems, priorities follow the funders, not the national plan. The money cannot move to where the need is greatest, and vertical funding is often not in the budget. And most times the Ministry of Finance doesn't even know this money exists in the country, in their budget. They're not aware. So they can't plan for it. It can't be overseen by parliament, and it's not accountable to citizens. Most times, it often stresses an already weak health care system. We have parallel plans. We have parallel accounting, procurement, multiple procurement processes. Reporting bypasses the national systems. Instead of strengthening it, it's able to report back, even to the point where you can have multiple health care workers in the same facility with the same qualifications, doing the same jobs, having different salaries depending on which donor is funding them. Basically increasing inequities in the system. And all of this money, everything I'm talking about, often sits outside of the government budget. Until the shock lands with no notice, as we saw, was it last year? It feels like five years ago. Like we saw last year what happened with the sudden aid freeze. It was sudden. There was no time to plan a transition. And when the money stopped, many services stopped along with it. Had more of this financing been on budget, through strengthening government systems, with the exit managed as a planned transition, countries would probably have been able to survive and move through that, the shock that we saw, a bit more softly than what we've seen as the reality. So the question is not really whether to fund priority programs and protect vulnerable groups. We must do that. It is whether we can do this within strong national systems. where they are visible and accountable, or whether we're going to them outside, where they disappear, and the gains, the hard-fought gains, are lost when the funder leaves the system. So I'm going to take us now to the SACA agenda. We've heard about this a bit. People have talked about the SACA agenda today. The Human Rights Commissioner mentioned it. A couple of my panelists as well have mentioned it in previous sessions. This is where it comes into play. The Lusaka Agenda sets how the global health initiatives need to change the way they work in Africa and on the continent, so that they strengthen national systems rather than run alongside them. It does this through five shifts, and each one speaks directly to the problem of fragmentation. I'm going to touch on them really quickly in the issues of time, but there's primary strengthening primary health care, sustainable domestic financing. There's equity, which is something that's really fundamental to human rights, ensuring that governments and partners work jointly to reach those who are left behind. The strategic and operational coherence, where there is one plan, one budget, and one report, and one national plan that every partner aligns behind, one budget where all the health financing is pooled, both internal and external, is visible, and one national reporting framework for reporting results to avoid administrative burnout. So countries are really working hard to build this within the national compact and national plans, and making it a prerequisite for engagement by any partners. And we really are supporting them as they push this through. And then the fifth is around continental capacity to develop health products, conduct research, and regional manufacturing. So that countries are less exposed to supply shocks, just as we saw during the COVID-19 pandemic, where some countries were affected disproportionately, excuse my English, than others. And so we're trying to build a system where Africa develops its own research, its own product, its own supply commodities that is used for Africans. So the current secretariat for the Lusaka Agenda is within the Africa CDC, and we're working very strongly with the member states on developing, and we recently developed an accountability framework, the Lusaka Agenda Monitoring and Accountability Framework, and a scorecard, which we are using to hold both governments and partners accountable to these promises that they've made through the Lusaka Agenda and Africa Health Sovereignty Agenda. But none of this works without strong public financial management underneath. That is the focus of the PFM and the LA division at the Africa CDC. We're working with governments to strengthen how they plan, how they budget, how they spend, and how they account for their health resources, so national systems are strong enough for partners to use and transparent enough for them to trust. Because fiscal space is not just about how much money a country has, but how well they spend it. We often talk about increased resource mobilization for health, but the reality is that a lot of the resources that currently exist in these countries aren't even being spent efficiently. At the end of the budgeting cycle, you find that there's more money left in the account, and this always affects the next budgeting cycle, because no finance minister wants to give you money when you didn't spend what he gave you last year. So we really We need to work with governments, strengthen their capacity to be able to predict where the money is coming from, to be able to work, to strengthen, to budget, to implement, to work, basically use that money for the population. This is also shaped by debt and the cost of borrowing. Domestic effort is essential, but international cooperation has to address that too. Lusaka Agenda protects fiscal space by making external financing visible and predictable, so it can be planned alongside domestic resources, planning transitions jointly and gradually, especially for health workers and essential commodities. Finally, we're not against protecting health priority programs. We are for designing and delivering them efficiently and sustainably inside national budgets. approved by parliament, backed by policy, with strong government public financial management capacity that allows civil society and citizens to follow the money. Because health sovereignty is not about turning away from international cooperation. No, it's not. It's about making sure that cooperation strengthens the state's ability to meet its obligation to the people. And the one plan, one budget, one report is how we're going to make that happen. Thank you.

Thank you very much to you, but and to all of our panelists for what were really rich and insightful presentations. Thank you. I now have the pleasure of handing the floor back to the chair rapporteur who will chair the interactive dialogue. Over to you.

Thank you, Ms. Aubrey, for your moderation, and to our esteemed speakers for sharing their expert perspectives and experiences. Before I open the floor for an interactive dialogue, I kindly ask all speakers to keep their remarks focused and to respect the allotted speaking time so that the remaining speakers can also get an opportunity to share their views. The floor is now open, and I will give the floor to League of Arab States.

Thank you, Chair. Good afternoon, distinguished delegates. Before I begin, I would like to express my deepest condolences to the families and loved ones of the victims of the tragic train accident in Spain. My thoughts are with everyone affected, those who have been injured, and the emergency responders. First of all, I would like to thank the previous speakers for their insightful remarks and valuable contributions to the discussions. Thank you also for giving me the floor. One day, we will leave this room. The microphones will be switched off. The speeches will be forgotten. But somewhere in the world, someone will still be waiting to receive medical care. And on that day, It will not be our intentions that matter, it will be the consequences of our decisions. We are gathered here to discuss the right to health. We talk about funding, cooperation, public policy, and technology. These are essential issues, but I would like us to remember one thing. Behind every statistics, there is a human life. Behind every funding cut, A health care service may close. Behind every inaccessible medicine, there is someone waiting. And behind every conflict, there are families still hoping to live, to receive medical care, and to rebuild their future. The right to health is internationally recognized, yet access to health care remains deeply unequal across countries. With that in mind, I would like to ask: how can countries maintain sufficient budgetary autonomy to prioritize public health care while ensuring that international cooperation helps them fulfill their human rights obligations? Thank you very much.

Thank you. I now give the floor to Cuba, followed by Egypt. Cuba has the floor.

Thank you very much, Chair Rapporteur. I would like to congratulate you on being appointed as the Chair Rapporteur of the Social Forum and wish you every success in this role. Chair Rapporteur, the Cuban Constitution enshrines the right of everyone to have access to high-quality, free public health care. On an average, my country devotes 21% of the state budget to keep its over 2,000 health centers running and ensuring the employment, the jobs of over 200,000 health workers, and this is despite the huge difficulties caused by the economic and financial blockade imposed by the United States. Nevertheless, for over 60 years, our public health policies have recorded indicators on the same level as the most developed countries. In 2025, life expectancy reached 81 for women and 76 for men. The collective punishment imposed by the United States for achieving political aims has failed to undermine the indicators. Nevertheless, These measures are an attack on the lives of Cubans. Over 340 children and adolescents are diagnosed with cancer every year. Their treatment requires equipment run on electricity, but because of the American measures, The chances of survival have been cut by 20% for these victims of illnesses. This is unacceptable. This trampling of rights leaves the world a less safe place. We will never fall silent, and we will never stop our efforts to promote the right of Cuban people to health, even in the most difficult times. Thank you very much, Chair.

Thank you, Cuba. I now give the floor to Egypt, followed by Eritrea.

Thank you, Mr. Chairman Rapporteur. We present our condolences to the Spanish Government following the accident yesterday. We welcome the discussions held today. In this interdependent world, we cannot set aside the right to health and its connection with the international economic situation, which has a direct impact on States' capacities to invest in fundamental services, especially health services. These challenges are first exacerbated due to the current situation relating to international cooperation between countries. where priorities rarely attached to health on the international agenda. These developments come at the same time where we see crises multiplying in the world and we see their detrimental impact on states' abilities to invest in basic services relating to human rights. Moreover, The debt and the debt servicing are challenges which worsen the situation. 3.7 billion people live in countries today which are obliged to spend public resources on servicing the debt instead of health. We need international cooperation based on access to vaccines, to medical treatments and technological advances, in particular in a time of pandemics and health emergencies. For this purpose, we need to facilitate investment by states into health services and ensure the right to health. Thank you.

Thank you, Egypt. I now give the floor to Eritrea, followed by Malaysia.

Mr. Chair, The realization of the right to health requires not only adequate resources, but also sufficient policies and fiscal space for States to determine their own national priorities. For Eritrea, national ownership is fundamental. Development strategies must respond to the specific circumstances, priorities, and needs of each society. International cooperation should strengthen this capacity, not substitute for it or constrain national decision-making. Financing arrangements that impose excessive conditionalities, restrict policy choice, or divert resources from nationally determined priorities can undermine sustainable development. Eritrea’s own development approach is rooted in social justice, self-reliance, and inclusive national development. In health, this has translated into sustained investments in primary and community-based health care, prevention, maternal and child health, and services reaching rural and remote communities. At the international level, Greater attention must also be given to structural constraints facing developing countries. Unsustainable debt burdens, unequal access to financing, and unilateral coercive measures can significantly reduce the fiscal policies available to the states. Eritrea would like to ask the distinguished panelists: How can international financial institutions and development partners better support developing countries in strengthening their economic foundations and expanding their capacity to finance their own development, in line with their national priorities and development strategy? I thank you.

Thank you, Eritrea. I now give the floor to Malaysia, followed by Sri Lanka.

Mr. Chair, Malaysia welcomes this discussion and thanks the panelists for their insights. Malaysia believes that realizing the rights to health and to development requires sufficient policy and fiscal space to pursue nationally determined health priorities. As a dedicated WHO member, we continue to support the WHO's efforts and initiatives to strengthen our collective health security. Our national healthcare architecture is systematically underpinned by the principles of equity, universal accessibility, and a resolute commitment to social inclusivity, thereby ensuring that no segment of the population is marginalised. In the recently tabled Budget 2027, The government proposed to increase the Ministry of Health's allocation by 2.5% to almost US$12 billion to ensure our primary healthcare system has the capacity to continue focusing on promotive, preventive, curative, and rehabilitative services. This commitment underscores the importance of sustained investment in public services and the national health ecosystem. Mr. Chair, policy space enables preventive action. Our key national initiatives include free Tdap vaccination for all pregnant women, alongside the nationwide implementation of the WHO Integrated Care for Older People framework to support healthy ageing. Additionally, Malaysia is increasing the sugar-sweetened beverage tax to 20% and implementing the front-of-pack labelling scheme to proactively combat metabolic and non-communicable diseases. Community-based prevention and outreach programmes complement these efforts. Malaysia reaffirms its commitment to universal health coverage and the 2030 Agenda. We continue to advance towards SDG 3 to ensure that high-quality, essential healthcare remains accessible and affordable for all. We wish to also stress that when implementing global frameworks, it is vital to adapt to each member state's unique context and capacities. Obligations should be balanced and practical to avoid overburdening countries or undermining their sovereignty and priorities. I thank you.

Thank you. I now give the floor to Sri Lanka, followed by UNDP.

Chair, rapporteur, we thank the panelists for their valuable comments on ensuring sufficient policy and fiscal space to advance the right to health and development. While our country has restored macroeconomic stability following the recent economic crisis, vulnerabilities arise from debt, external shocks, and pressures. Global trade policy and impact of El Niño continue to be important concerns. Sri Lanka has consistently emphasized that strong political commitment, sound governance, equitable health financing reforms, and sustainable investment in primary health care are essential for resilient and people-centered health systems. At the same time, we highlight that national development circumstances differ for each country. A one-size-fits-all approach cannot adequately address the diverse challenges confronting different developing countries. International financing and development cooperation must therefore support national ownership and enable countries to determine their development priorities. Sri Lanka re-iterates its call for a fairer rules governing debt and development finance, meaningful reform of the international financial architecture, and strengthened international cooperation. We reaffirm that fiscal sustainability and the continued provision of accessible, quality health care must advance together, ensuring that no one is left behind. Thank you.

Thank you, Sri Lanka. I now give the floor to UNDP, followed by Association AIDES.

Chair, the right to health is a foundation of human development, dignity, and resilience. Yet billions of people lack access to essential health services, and UNDP's 2026 Global Multidimensional Poverty Index report, which was just launched, showed that for the first time since 2010, it's increasing. Drawing on our work in over 130 countries, let me share some lessons. First, as external assistance declines and debt servicing pressures rise, countries need to mobilize and better use all available resources. Through integrated national financing frameworks, UNDP helps align public, private, domestic, and international financing and country-led plans and development priorities. And through our equinomics work, we help ensure that fiscal choices advance gender equality, an issue that was raised by many on the panel. Health taxes are also an important to consider in this conversation, as they can both mobilize revenue and address the commercial determinants of health. Second, laws, regulation, and inclusive governance shape health, and UNDP supports rights-based legal and policy environments, so stigma and punitive laws do not prevent access to HIV and health services, and that laws and regulations, as we have heard, including those addressing the determinants of health, can create and protect the healthy environments. Third, sustaining health gains requires resilient systems that can deliver innovation equitably. Climate shocks and crises threaten essential services, but we see how investments in clean energy and digital systems can help protect continuity of care. Similarly, breakthroughs in health technologies offer great promise, yet access remains deeply unequal. UNDP works to help build equity and into innovation from the outset, working with developers, funders, governments, and communities to ensure research responds to people's needs and thus affordability and access are built into design and funding. We also support countries to preserve and use their policy space under international law to expand access to affordable, quality-assured health technologies, including through local and regional production, technology transfer, and South-South and triangular cooperation. Thank you.

Thank you, UNDP. I now give the floor to Asociación AIDES, followed by Consortium for Youth-Led Development.

Gracias, Presidente.

Thank you, Chair Rapporteur. Human rights are universal. When the right to health becomes a means for geopolitical pressure, The American blockade has been compounded by the energy siege. This undermines the functioning of hospitals and prevents basic supplies reaching the Cuban people, as the Cuban delegation has just said. We call once again on the American Government to lift the unilateral coercive measures. When there's no energy in a hospital, coercion becomes a direct threat to life. At the same time, the rise of far-right movements, hate speech and autocratic practices in Latin America are to the benefit of corporate interests. And so we see state repression and the denial of people's sovereignty. These are attacks on human rights. We just recall here that no power is above international law, and there are no peoples of first or second class. So we propose that we must evaluate the effects on health of unilateral coercive measures and ensure medical and energy supplies throughout the world. So we call on interested states and organizations to take part in our initiative, which we launched over a year ago in various places, to promote the decolonization of human rights, promote the human dignity of people. We'd like to take the last few seconds to present our sincere condolences to the people and government of Spain for the tragic rail accident which occurred yesterday. Thank you, Chair Rapporteur.

Thank you. Thank you. I now give the floor to the Consortium for Youth-led Development, followed by Al-Haq.

Distinguished delegates, Excellencies, colleagues, ladies and gentlemen, The question is not only how to mobilize more resources for health, but how to ensure that financing helps countries fulfill their human rights obligations. We need to make sure that countries have both the financial resources and the freedom to decide how to best meet their people's healthcare needs. International cooperation is essential. However, funding should strengthen health systems and support countries’ own decisions. I would emphasize three priorities: First, financing agreements should be transparent, subject to human rights impact assessments, and include safeguards for access to essential services. Second, affected communities, civil society, and health workers must meaningfully participate in health budgeting and priority setting, not merely be consulted after these decisions are made. Third, international partners should provide predictable and flexible financing aligned with national priorities, improving services and supporting long-term self-reliance. The right to development reminds us that people must be active participants in development and that international cooperation should help create the conditions for human rights to be realized. My question to the panel is: What concrete accountability mechanisms can ensure that conditions attached to international health financing respect human rights, protect marginalized populations, and preserve meaningful national ownership? I thank you.

Thank you. I now give the floor to Alha, followed by Mukhtar Khan.

Thank you, Mr. Chair. I would like also to thank the panelists. I would like to share three experiences from reality with regard to restrictions in the health sector and the impact on people in terms of enjoyment of the right to health. First, the health sector, especially in Gaza, that is witnessing genocide. perpetrated by the Israeli occupation, is witnessing a collapse of the health sector, and this has an impact on the Palestinian citizens. There is also the collapse of the health sector in the West Bank because the Israeli occupation withholds the clearing funds.

This is the revenues of tax.

It is to the tune of $1 billion as of 2026. This would threaten the further collapse of the health sector in the occupied Palestinian territories, and withholding these funds has impacted the health personnel and pharmaceuticals.

We have stores that are empty.

197 pharmaceuticals have depleted in the occupied Palestinian territories. The other example is related to the political conditionalities when it comes to providing finance to the Palestinian Authority, things to do with institutional reform, But what is clear now that they go beyond institutional reform, but are linked to issues related to Palestinian identity. The last issue we would like to share with you are the limits imposed on the health health organizations, whether international organizations or policy organizations. These restrictions have led to sanctions depriving funding needed to finance health programs in marginalized areas. Thank you.

Thank you. I now give the floor to Mukta Kahan, followed by Walker Foundation.

Mr. Chair and distinguished delegates, I speak as someone raised in the global south and now living in the global north. My perspective has been shaped by my work with UN development agencies, global media, the US Department of State, and health care agencies. Much of my early experience came from reporting on conflict-affected Pashtun communities in Pakistan and Afghanistan. I witnessed how years of conflict and poverty deprived common people of basic health care. I see similar structural crises in Palestine, where prolonged conflict and damaged health infrastructure leave families struggling to access essential services. This is part of a global crisis now. The WHO and World Bank report that 4.5 billion people lack full coverage for essential health services. Behind this figure are real people. To protect them, we must examine how debt servicing obligations and macroeconomic conditionalities restrict national policy space. When international financial institutions impose rigid austerity measures and public sector wage ceilings, they freeze a state's capacity to fund public health. Furthermore, structural barriers like user fees and privatization widen the dignity gap. I urge international financial institutions to protect essential health budgets and expand unconditional fiscal space. Poor families should not have to choose between medical treatment and basic necessities. For Pashtun communities in Pakistan and Afghanistan, and for families in Palestine, commitments must translate into functioning clinics and protected public financing. Health care must depend on human need, not geography or wealth. Thank you.

Thank you. I now give the floor to WAKAT Foundation, followed by Federation of Hazara Council of Australia.

Thank you. Thank you, Mr. Chair. My name is Mohammad Mirzai. I'm representing the Federation of the Hazara Council of Australia. I'm originally from Afghanistan. As you know, Afghanistan has different ethnicities. Unfortunately, it's the only country who didn't integrate it.

Excuse me?

Integrated, so.

Excuse me. There was a speaker before that. Work Hard Foundation is not in the room. That doesn't seem to. So please continue.

So, sorry, actually, I'm from Afghanistan. As you know that Afghanistan has multi-ethnicities who unfortunately the only country who didn't integrate it. And this is the reason that we have one for many years. After August 2021, when Taliban, they returned back for the second time in power, and after the President Trump stopped US aid, and for that reason, 80% of the health system in Afghanistan was stopped. And that war, it cost a lot for a lot of Afghans. And with result that we had million of refugees in Pakistan and in Iran, and we don't have the whole The health facility in Afghanistan is zero, and for this reason, many people who are passing away with very simple disease. And we don't have, for example, we don't have any real doctors, expert doctors. They had to escape Afghanistan, and they moved in other countries. And we don't have many childrens, they are, they couldn't do vaccine, and many nurses, all of them, they had to escape the countries. And. With the result that we have a lot of refugees in Iran and Pakistan for they started to deport these people back to Afghanistan. And I really request from all of these countries, all of these international organizations who have representatives here to start to focus on Afghanistan and to help again, for example, like WHO is here, for example, UNDP is here, and many other countries who had project for health in Afghanistan. Thank you so much.

Thank you. I now call WHO Academy, followed by Institute Diplomatic Public.

Thank you, Chair. It's a pleasure to deliver this statement on behalf of the WHO Academy. The right to health ultimately depends on people. So when we discuss fiscal space and the right to health, we must also consider the people, the health and care workers, the unpaid work, as well as all of those needed to make that right a reality. Across many countries, Workforce shortages are often the consequence of constrained fiscal space, public sector employment restrictions, and the historical undervaluation of care work. Much of this work is performed by women. The health and care workforce is a productive investment that generates health gains, supports economic participation, and creates decent work and contributes to gender equality in a sector where 67% of the paid employees are women. Yet, there is an important tension in the way health systems are financed. Austerity and fiscal consolidation can constrain government's ability to recruit and retain health and care workers. And external financing is often easier to mobilize for commodities, infrastructure, or for time-limited programs than for the recurrent costs of workforce that are needed to deliver and sustain health and care services. We can therefore find ourselves financing the inputs around health services while constraining investment in the people that are required to actually provide it. From a right to development perspective, countries need sufficient policy space to invest in their health and care workforce according to national priorities. Development cooperation and financing arrangements should strengthen, rather than constrain, the ability of governments to recruit, retain, and fairly remunerate health and care workers. Ultimately, investment in a health and care workforce sits at the intersection of rights to health, decent work, and development, and should sit at the center of advancing all of three of these together. Thank you, Chair.

Thank you. I now give the floor to Institute Diplomatic Public.

Thank you, Chair. Thank you, your Excellencies, distinguished ladies and gentlemen. My name is Professor Ngozi Frank Okoye, and I'm attending as a delegate of Institute of Diplomatic Public. I am also a mentor to over 500 women, and I'm talking from their experiences, majority of them from the Global South. I would like to draw attention to an issue that affects the health, dignity, and everyday lives of women and girls across the world: period poverty and the affordability of menstrual products. Although progress has been made in providing free menstrual products in certain public facilities and institutions, access to these products can still depend on where a woman or girl lives and whether she can afford to buy them herself. Menstruation is a recurring biological reality, yet the products needed to manage it safely and with dignity remain an ongoing expense. No woman or girl should have to choose between purchasing essential menstrual products and meeting other basic needs. We must therefore look beyond limited access points and ask how we can make essential products consistently affordable and accessible wherever they are needed, as a right to health. My question to the panelists is this: how can governments, international organizations, the private sector, and civil society work together to establish sustainable financing measures, including subsidies, reduced prices, free provision for those most in need, so that no woman or girl is denied dignity, health, or participation in education and daily life because she cannot afford menstrual products? I thank you.

Thank you. Now, International Organization for the Development of Diplomatic Relations will take the floor via video message. Thank you.

The right to health is the right to dignity. Mr. Chair, Excellencies, Delegates, Ladies and gentlemen, it is an honor to present this forum on one of the fundamental principles of human dignity: the right to health. Health must never be a privilege determined by poverty, gender, social status, or place of birth. Health is a fundamental human right. Yet millions of people, especially women and children, still lack access to essential healthcare, medicines, and adequate nutrition. As Deputy President of the International Organization for the Development of Diplomatic Relations, I firmly believe that international solidarity must translate into concrete action. No woman should have to choose between feeding her children and receiving medical treatment. No child should suffer because of poverty or conflict. No nation should be left alone in protecting the health of its people. It is therefore essential to ensure sufficient political and fiscal space for countries to fulfill their human rights obligations relating to health. International cooperation must strengthen healthcare systems and ensure equitable access to medical advices, because there can be no sustainable development without health, and no true health without dignity, equality, and peace. Today I wish to leave you one message: Humanity cannot call itself truly developed while millions are denied the right to live in health and dignity. Let us transform solidarity into responsibility, and responsibility into action, because the right to health knows no border, and neither should our solidarity.

Thank you.

I now give the floor to Manusha and Tam Tang Foundation, followed by Bring Back Green Foundation.

Thank you, Chair. Oh, sorry.

Hello.

I had an abortion in Thailand when abortion was partially legal and government funded. Yet, because no public abortion services was available in my city at that time, I had to travel 300 kilometers round trip to access the care. I was also pressured to use contraception as the condition of receiving the service. Although abortion itself was free, I still had to take time off work and pay for the transportation and accommodation. My experience alongside thousands of women show that legal recognition and public funding means little if people cannot access services in practice without additional cost or coercion. In Thailand, abortion has been partially legalized, but still criminalized. There are still too few public hospitals to provide services to many people who still need them. The burden falls on private clinics and the civil society organizations to fill the gap. However, private clinic, private care can be expensive for abortion seekers to pay out of their pocket, and civil society cannot substitute for a functioning public health system. People continue People continue to face financial barriers, long distance stigma, and refusal by healthcare provider, even they are legally entitled to care. Abortion is healthcare. Right to health requires political commitment, adequate funding, and services that people can actually access. The right to health requires more than legal recognition. It requires government to ensure that healthcare is available, affordable, accessible, and provided with dignity. We call on states to provide the full spectrum of SRHR, from contraception, sex education, to safe abortion, miscarriage, and post-abortion care. Allocate sufficient funding for free SRHR care, including through public hospitals. We urge the states to remove criminal laws that obstruct access and protect fiscal space, investing in the care for all. We urge the government to also remove coercive requirements, including mandatory contraception or sterilization, and respect every person's right to make decisions about their own body, address stigma and discrimination that lead to service denial, and ensure that conscientious objection do not obstruct timely access to care. We need rights backed by resources and policy backed by political commitment and effective implementation. Thank you.

Thank you. I now give the floor Bring Back Green Foundation, followed by Solar Optimist International.

Honorable Chair, distinguished delegates, ladies and gentlemen. My name is Hana El-Khayy. I stand before you today as a young Egyptian woman to address an issue that continues to threaten the health, dignity, and future of millions of girls: female genital mutilation, or FGM. FGM involves the partial or total removal of external female genitalia for non-medical reasons. It has no health benefits and can cause severe physical and psychological harm. It is a violation of human rights, and no tradition or social expectation should come before a girl's safety and dignity. At least 200 million girls and women across 30 countries in Africa, the Middle East, and Asia have undergone FGM, usually before the age of 15, before they can understand its consequences or decide about their own bodies. This is a shared challenge, and no single country faces it alone. For example, Egypt has criminalized FGM and introduced public awareness campaigns and national initiatives, which represent important steps forward. However, the practice remains a challenge because of deeply rooted social norms, misconceptions about tradition, and fears surrounding social acceptance and marriage. To achieve lasting change, we must go beyond legislation and address the beliefs and pressures that allow FGM to continue across generations. Another critical concern is the role of healthcare professionals. Approximately 74% of women who have undergone FGM were cut by medical professionals. Medical involvement does not make FGM safe or acceptable. Ending FGM is essential to achieving the Sustainable Development Goals, particularly SDG5 on gender equality, SDG3 on good health and well-being, SDG4 on quality education. As a young Egyptian advocate, I believe sustainable change must begin at the community level through a bottom-up approach. Our approach must also be inclusive. Young people must be active participants in designing and implementing solutions. Progress must be measured not only by the number of campaigns conducted, but also by changing attitude, improved access to protection, and the prevention of FGM. Honorable delegates, as an Egyptian, I envision a future where no girl must choose between her health and her community's expectations. No tradition should come before a girl's safety, and no social expectation should come before her dignity. Let us work together to ensure that the next generation inherits a future defined by dignity, equality, health, and opportunity. I thank you.

Thank you. I now give the floor to Soroptimist International, followed by Juventa Foundation.

Distinguished delegates, excellencies, ladies and gentlemen, I speak on behalf of Soroptimist International, a global network of women and girls in more than 100 countries. Today, 3.7 billion people live in countries that spend more on interest than on health or education, while development assistance for health is at its lowest over 15 years. Women bear the heaviest burden. They make up 70% of the health and care workforce and provide most unpaid care. When health services are cut, they pay twice: through their work and through their own health. Through our clubs worldwide, we see these gaps every day and we work locally on women's health, education, and empowerment. So we bring this experience here because policies and financing decisions must translate into actual improvements in people's lives. For this reason, we call for two actions. First, put people at the center of fiscal decisions by including health and gender impact assessments in financing agreements and protecting a minimum level of health spending. Second, align development support with nationally owned health plans, building on the Lusaka agenda and give women organizations in civil society a real voice in the budget decisions that follow. Soroptimist International stands ready to work with governments, international institutions, and civil society to turn these commitments into actions. I thank you.

Thank you. I now give the floor to Juventa Foundation, followed by United States Council of Organizations.

Thank you, Chair, for the recognition. Our country should never choose between repaying its debts and protecting the health of its people. Yet across the world, governments are being forced to make precisely that choice. When debt repayments take priority over public hospitals, when sternness limits the number of healthcare workers, and when people must pay the fees they cannot afford to see a doctor, we must ask ourselves, what is development worth if people cannot afford to survive? I speak on the behalf of the Uenda Foundation with simple conviction. Health is a human right and not a privilege negotiated to financial agreements. International assistance should empower nations, not dictate their priorities. Aid that comes with conditions that weakens public healthcare, restricts national decision making, or excludes marginalized communities risks contradicting the very purpose of development cooperation. Accountability matters, and so does responsible spending. But fiscal discipline cannot become an excuse for human suffering. A balanced budget means little if the people it is meant for to serve are left behind. We cannot build a healthy society on unhealthy compromises, and that is why we must advocate for certain fundamental changes. Protecting the national autonomy. Countries must have fiscal space to invest in hospitals, medicines, healthcare workers, and preventive care according to the people's need, rather than being forced into one-size-fits-all solutions. Secondly, reforming international health finances. Assistance must be transparent, flexible, and aligned with nationally determined priorities. Funding should strengthen entire health systems, not create fragmented programs that disappear when donor priorities change. Putting people at the center of decision-making: communities, civil societies, and marginalized populations must have a meaningful voice in how health budgets are designed and implemented. Participation cannot be a ceremonial gesture after the decisions have already been made. Debt is a financial obligation. The protection of human life is a human rights obligation. One must never be used to erase the other. Thank you, Chair.

Thank you. I now give the floor to the United States Council of Organizations, followed by Anwar Mahmud. United States Council of Organizations doesn't seem to be in the room. So we will move on to Anwar Mahmoud. You have the floor.

Thank you, Chair, Excellencies. My name is Anwar Mahmoud, an international human rights consultant. And today I would like to take this time to highlight some disparities that exist in mental health diagnosis and treatment. In the Global South, mental illness is too often suffered in silence. untreated, unfunded, and unseen. Last year, the WHO reported that more than 1 billion people live with a mental health condition. Yet governments spend on average just 2% of their health budget on mental health. High-income countries spend $65 per person. low-income countries spend 4 cents. In low and middle-income countries, about 80% of the people with a mental disorder receive no treatment at all. This session asks why countries are not meeting their health obligations, and mental health services exemplify this gap clearly. Austerity often means psychologically and the community health workers are never hired. Donors earmark funds for specific disease, and mental health is rarely one of them. Governments are left with no fiscal space to build the care their people need. Some people say AI will fill the gap. I urge caution. About 80% of the people studied in living psychological journals came from the Western countries, which represents only 12% of the world's population. AI trained on that knowledge carries the same blind spots and biases. In many of our communities, distress is expressed through faith and close-knit family. Most AI models are simply not exposed to their knowns.

Please conclude.

AI for the South must be built with the South on the data governed by their communities. So I ask three things. First, protect mental health spending from austerity conditions. Second, let countries set their own health priorities. Third, fund locally built, culturally grounded cares. I thank you.

Thank you. I now give the floor to Workart Foundation.

Distinguished Chair, delegates, I have the honor to deliver this statement for Workart Foundation at the request of its trustee and CEO, Dr. Huzaifa Korakiewala. The foundation's mobile health units bring diagnostics and free medicines to people's doorsteps. reaching more than 49 million patients since 2008 across states. Its free dialysis centers respond to hard reality. As international health financing declines, community-based health models offer a practical path. They are holistic, treating the whole person through prevention, primary care, and sanitation together. They are local, decentralized, Regional manufacturing of medicines shortens supply chains, lowers costs, and protects communities when global supply is disrupted. Such models grow through partnership among governments, communities, civil society, and responsible private actors, and are the kind of experience South-South cooperation can share. Three points merit attention. First, protect domestic financing and invest in primary and community care. Second, support regional manufacturing and shared training, data, and technical exchange among Global South countries. Third, treat civil society as a full partner because it reaches people that public systems alone cannot. The right to health cannot depend on the level of aid. It must rest on solidarity, shared responsibility, and local ownership. Thank you so much.

Thank you. I now give the floor to Rivia Durani. followed by Kera, or to be a star.

Excellencies, distinguished delegates, my name is Rabia Durrani and I'm a law student from Pakistan.

I rise to address a critical structural gap in our global architecture, the systematic paralysis of cross-border medical access for vulnerable populations in conflict-impacted zones across the Global South. Traditional international frameworks treat health as an isolated domestic metric. However, when geopolitical volatility fractures, regional supply chains, local health infrastructures collapse. To transition from passive rhetoric actionable to international corporation, I submit two concrete legal mechanisms before this panel. First, the hard-coded establishment of automated medical visa green channels. Sovereign states must enter a binding legal accord that completely insulates medical transit from generic immigration blockades. Secondly, the structural harmonization of digital telehealth networks. We must bridge the healthcare disparity by legally authorizing certified medical practitioners to practice digitally. The realization of the right to health requires us to dismantle the Westphalian borders, that restrict medical deployment. We do not need more non-binding declarations. We require enforceable, cross-border legal corridors that protect human life above sovereign politics.

I thank you.

Thank you. I now give the floor to Kaira Farah to Ben Benstar, followed by our last speaker on the list, APG 23.

Good afternoon, everybody. Thank you, Chair, for giving me the floor. I'm the founder of United to Help People Without a Voice, and I'm honored here, be here today to be joined by COSI MEX, which is the largest NGO partnership in Mexico. Our delegation here today represents different causes, but we have the same goal, which is to promote public health, prevention, and the well-being of our communities. I want to talk to you about public health from a different perspective. What happens before someone requires medical care? In Mexico, we face a situation which cannot be trivialized, and this is the large number of stray dogs and cats. We've been working with different municipalities and town halls and seen how this problem affects public health. There are excrements in public areas, there are many animals which haven't been vaccinated, children get bitten. as do other people, and there is a lack of control, which means that the problem proliferates generation by generation. This is why we have a new 3R problem, which is rescue, recovery, and return. We return and sterilize and use responsible adoption, but we know that there are many areas which can't afford to provide these services, so that's why we have itinerant services which allow us to provide these services free of charge or at low cost for the communities most in need. Our preventive activities of having itinerant services will require public policies and funding mechanisms which enable us to sustain these practices over time and take them to the communities most in need. We wanted you to know about this situation in Mexico, But we have a model and the experience to change this situation. It's not just about redressing the problem of animals being abandoned, but also curing a public health issue. Thank you.

Thank you. I now give the floor to APG 23.

Three thanks to the panelists for their insightful remarks.

As external aid declines and debt servicing obligation increase, developing countries face severe constraints in fulfilling their human rights obligations and implementing health policies. aligned with national priorities and people needs. Eight conditionalities, macroeconomic conditions, and austerity measures imposed by international financial institutions severely restrict the policy choices and fiscal resources needed for ensuring health, education, and social protection, disproportionately impacting vulnerable groups and further increasing inequality in access to basic services. Ensuring adequate policy and fiscal spaces is not just a technical issue.

It makes the difference for people's lives.

When we accept that 3.4 billion people live in countries obliged to spend more in servicing debt than on health or education, or when we allow the straining of fragile systems, critical shortages in essential medicines, disruption to life-saving immunization programs, then we are compromising the right to life, dignity, and security. If we want to address and overcome such injustice, we have to adopt the transformational perspective of the right to development, which calls for tackling the root socio-economic inequities through a radical shift of the global economic, financial, tax, trade, and development architecture and their governance. Indeed, while states bear primary domestic obligation to protect human rights, the realization of the right to health as well as the human rights requires effective international cooperation and solidarity. We have a question for Dr. Kamga. Which kind of systemic reframing of the global economic governance would you suggest in order to achieve the fiscal and debt justice needed for ensuring universal health coverage and social protection floors? Thank you.

Thank you. So we have now exhausted the list of speakers. I now give the floor back to the moderator for their final remarks. To stay on schedule, I would appreciate if you can do that in six minutes.

Well, I won't need to take six minutes. Thank you, Mr. Chair. But I wondered whether I could ask our panelists to take 30 seconds or less to respond to some of these excellent interventions.

Okay, 30 seconds, I will simply say if we apply the right to development framework that I recommend here, it will give the opportunity to not only consider local reality, But it will also pave the way to resolve the asymmetry of powers between countries. In fact, we should move away from the theory of help, development assistance for healthcare, to a theory of human right. Health should be received as a human right and not as a matter of charity, because if we stay in charity framework, we will still have these differences of treatment, but if it's an entitlement as provided for by the right to development framework, it will lead to equitable partnership that will take into account sovereign equality of states, and that will be very useful. Thank you.

Thank you. Madam Ambassador, you have the floor.

Thank you so much for the opportunity of engaging today. I think it was very useful hearing all your inputs and comments. I think that they are so valuable. And I think that one important element to bear in mind is that the right to health cannot depend on the level of aid. So this is why South-South cooperation is so fundamental, and also always focusing the right to health from the lenses of human rights. and is essential so that we really have in mind what the priorities are, so that the limited resources, as we see that nowadays, they can be channeled to the right priorities, having in mind the sovereignty and what really makes sense for every country, because, as it was mentioned by the former From Sri Lanka, I thank you for your comments. There's no solution, there's no one-size-fits-all solution. So I think that is so fundamental to have this in mind. And again, thank you so much for the opportunity of engaging in this very insightful debate today, Pia. Thank you. It.

Was a pleasure. Thank you. Caroline, may I come to you for 30 seconds of reflections?

Thank you. Yes, it's been very interesting to hear the different experiences and suggestions of the people in the room. Many challenges, many difficult issues that need to be resolved, but I've also heard many proposals and suggestions and possibilities. And I really echo the views of those who've directed our attention to addressing the root causes of these issues. And what I've also heard very strongly, and which I think is very important to take away, is the ongoing importance and value and relevance of a human rights lens to addressing these issues, centering the equity, justice, participation, and last but not least, international solidarity.

Thank you very much for that. And Evelyn, please.

Thank you. A lot has been said, and in 30 seconds, what I can reiterate is a decolonial approach to aid and to support. We have since morning had about unnecessary restrictions, particularly on African countries and in the global south countries. And we are saying we deserve dignity, and even when the support comes, the support should be such that it promotes our our health and our dignity as human beings. Thank you.

Very good. Thank you very much. And finally, Mabel, your turn.

Thank you. So 30 seconds. Really just reiterating that health is really not a privilege, it's a human right, and we should treat that way in every room we're in. The same child, just like a former panelist said, a child born in Geneva should have the same access to healthcare as a child born in the South of Sudan and all over the world. Number two, I want to talk about Lusaka agenda. We're really committed to strengthening national systems and addressing the fragmentations that currently exist in how health systems are structured, how ODA is implemented, and we're really committed to working really hand in hand with the country governments and member states to ensure that they strengthen their systems. Number three, public financial management. I really want to harp on the importance of strengthening the government's ability to budget for, to plan, and to execute its own budget. And that's also something that we're really working hard to support the member countries within member states in Africa to do, and really looking forward to all your support. The lady from UNDP was really great hearing some of the awesome work you've done as well. I'll definitely have a chat with you after the meeting, and thank you so much for all the interesting context, interesting comments, and thank you.

Thank you very much to all of our panelists and the participants for what I thought was a very rich, expert, constructive, and above all, disciplined panel today. And with that, I'd like to hand back to the chair. Thank you.

Thank you. I would like to thank Ms. Aubry for the deliberations, the speakers for their excellent presentations. and to you all for the rich discussion. We will take a five-minute break to ready the podium for our next panel, and thank you. So, the five minutes is up, so I kindly invite delegates to take their seats.

Important announcement.

Message.

Important.

Delegates, please take your seats so that we may begin our third panel discussion. In the interest of time, we will go straight to the third expert discussion on equitable access to medicines, vaccines, medical equipment, and health products. I would like to invite distinguished panelists and moderator to the podium if they haven't done so far. We don't have. Okay. Okay, I would like to welcome the distinct panelists and thank you for being with us today. And it's my pleasure to introduce Ms. Judith Ruth San Juan, Independent Advisor on Innovation and Access to Medicines and Health Technologies, who will be moderating the panel. Ms. Ruth, you have the floor.

Now, yes. Good afternoon, good evening. Thank you to the Chairperson to the Human Rights Council and to the Office of the United Nations Human Rights Commission team for the invitation. It's really a true honor to be here. I know you all must be very tired, you had a very long day, but I promise you, this is gonna be worthy. You're gonna be hearing two of the most senior, intellectually inspiring, and public health committed experts in the field of access to medicines. I personally have learned so much from both of them, and I think it's gonna be worthy for you to stay a little bit longer today and to hear them, both of them. Dr. Maria Angela Simao, as you all know, is the United Nations Special Rapporteur on the right to physical and mental health. She's a Brazilian physician and public health expert. She has more than four decades of experience in health policy, health systems, and equitable access to medicines. She previously served as the WHO Assistant Director General for Access to Medicines and Health Products, and has held senior leadership positions at UNAIDS and directed Brazil National HIV/AIDS and Viral Hepatitis Program. She most recently served as Brazil's Secretary of Health and Environmental Surveillance. So she has worked for the government, she has worked for the UN system. She's not only a thinker, but she's also a doer and somebody who transform ideas into policy change. Professor Carlos Correa is Executive Director of the South Centre, a leading international authority on intellectual property, international trade, technology, innovation, and public health. An Argentinian lawyer and economist with a doctorate in law, he previously advised the Argentinian government and directed the Center for Interdisciplinary Studies on Industrial Property and Economics at the University of Buenos Aires. He has served from major international expert bodies, including the WHO Commission on Intellectual Property Rights and the UN Secretary General High Level Panel on Access to Medicines. And he is basically the first, I'm a lawyer, so I have to say any lawyer in the field of public health working on access to medicines have learned everything they know from Carlos Correa, have read their books, and basically we're here because of him. So it's really truly inspiring and an honor for me to be moderating this discussion. You're all human rights experts, I am not. I'm a practitioner of access to medicines and innovation, but I can tell you how useful and important is the work that you do every day to ensure that the right to health, the right to development, and the right to ensure the benefits of scientific knowledge are seen as key components of the struggle for inequity on access to medicines. You all know very well that the COVID-19 pandemic exposed deep inequities in access to vaccines, medical innovations, and essential equipment. especially for countries considered low and middle-income countries. But the inequity is broader and deeper, and it impacts all countries, including middle-income countries and high-income countries, and all health needs and priorities beyond pandemics, including access to treatments for cancer and other non-communicable diseases, and innovation gaps for pediatrics, women's health, and antibiotics, to name three examples. Equitable access to medicines and other health technologies, or the lack of, is a key element for the realization of the right to health, development, and scientific progress. As I hope we will all understand today in the conversation that we're going to have, the causes, the barriers, and the challenges are deeply structural. And the panel, I hope this conversation that we're going to have today will complement the panel Tomorrow morning, where we will go a little bit deeper on some of the issues. I think the organizers have really thought very correctly about the importance of first understanding the structural challenge, the legal challenges, the economic challenges, and the structural causes. And then tomorrow morning in a panel, we will go a little bit deeper on some of the potential solutions and strategies that are being put forward. So what's today's session? Today's session is to have a conversation with two of the world leading experts in this field and to go deeper into structural, legal, and human rights dimensions of access to medicines. This conversation aims to ask them, and I allow you to ask them, What are their opinions about how do we transform ideas and challenges into practical solutions that challenges the status quo? The format proposed is a series of questions and answers. We're going to try to make it very participative, include among the two speakers, the two experts, and then a time for the Q&A, for questions from you and for interactions with the room. I would like to ask the organizers to alert me, please, when the time for the Q&A has to start, and without further ado, I'm going to start with the first question. And if you allow me, my first question will not be technical, will be personal, because I do believe that change come not only from knowledge and technical expertise that our experts have, but also from public health commitments, from ethics, from principles. So I'm going to ask them, I'm going to ask, I'm going to call you Mariangela, if you allow me, Dr. Simao, I'm going to ask Mariangela to tell us what first drew you to the struggle for equitable access to medicines? What was a particular experience, a particular issue that really made you the commitment expert that you are? Thank you.

Thank you, Judith. I'm going to speak in English because Portuguese is not an official language, but, you know. But, you know, I thought about your question, and actually, i think of two moments in my life where I When I was very young and I started working as a pediatrician in my hometown, which is in the south of Brazil, we had problems because the Brazilian constitution establishes that the right to health, you know, and that there is a right to health and that the state has to provide the means. for it, you know? And this means that you have to provide access to medicines and everything else. And we had problems in my hometown, and then I worked for the state government with establishing how to how did we manage the high-cost medicines, you know, because Small number of patients, you know, with government having to buy, you pay high prices, right? And the second, so this was the first time we start working on lists that showed what, so that we are not bound to what was the pharmaceutical industry interest, right? But what was, at the time, what was evidence-based that it was a better medicine than whatever was in the market. And then I became, later on, many years after, I became the HIV and hepatitis director in Brazil. And then, I think the HIV response is the best example, you know, on access to medicines and to diagnostics and everything becoming a reality because there was civil society movement, you know, and there is a lot that could be learned from the HIV movement, so these two. But all the time, the problem is, what's a fair price? And how do you make this affordable? Because Brazil has a universal health coverage, a universal health access system. And then, what's a fair price when you have to buy?

Thank you, Mariangela. Mariangela. Carlos, I'm gonna call you for it's intimidating for me to be here with my mentor, so I'm gonna use the first name. I hope that's okay.

I'm just going to joke, you know, 'cause when you say experience, you mean old, older people. Yeah.

Thank you for the very kind introduction, as well as the generous invitation to take part in the forum. I started work on technology transfer when I was working at UNCTAD. This was when we were negotiating the international code on technology transfer. Regrettably, it failed. It was an attempt to set up a new economic order. But then back in my country, pharmaceutical patents weren't recognized. This is something which happens in a lot of developing countries, but in Switzerland, medicinal patents were only introduced in the 1970s. It was the same in France, Japan, Spain, and even later in Portugal. Well, I studied both economics and law, and when I was doing so, it was clear that there was very strong pressure on the Argentinian government to create a patent system in pharmaceutical products. This was despite the fact that it had been prohibited in law, as it was in France decades before. There was a powerful international lobby which wanted to change the country's rules in this area. Obviously, this had very significant impact on access to medicines because when you approve a patent, you award a monopoly. that increases prices and prevents public access, particularly of the most vulnerable and the poorest, to medicines. So that's why I'm closely involved in equity and access to medicines and intellectual property. Thank you.

Gracias. Thank you. So the way we frame these discussions around three rounds of questions. I will encourage to reflect on each other's responses and to comment, to basically also question, comment, and reflect on what other's response. So the first question is about the structural causes and responsibilities in providing for equitable access to medicines and health technologies. Mariangela, from a human rights perspective, from a right to health perspective, and your experience in both government and UN agencies, where do you see the most important structural causes and barriers to equitable access to medicines and vaccines and other health technologies today?

You know, this is a very current discussion, probably will be after I die, you know, because it was before I, maybe before I was born, there was not that much discussion because it was a long time ago. But now it's, now we have these negotiations at the World Health Assembly, the pathogens access and benefit sharing, everything else. And this is, I don't know the exact answer to that, you know, because I think the commercial interests at this time and the way we live, when we live, is they are founding, you know, it's, they conflict with member states' interests. And then it's very difficult to get across the barriers that are put because of that. So I mean, there are member states that have heavy manufacturing, pharmaceutical manufacturing. And then this become interest of the states, you know? But at the same time, all states here at the UN, they need to protect the right to health, right? Because this is mandated and it should. But in practice, that's not what we're seeing, you know? So I, when I, my past life, one of my past lives, you know, I, we used to have at WHO a fair pricing form, you know? And I used to talk about fair profits, and then someone who worked in the generic industry, he said, no, you should frame it differently. Call it sustainable investment and innovation. And then I'd like just to say something that the Minister of Health of Brazil, because I left the government a few months ago, right? So I still have a lot of, most of my life was spent in the Brazilian. health system, right? He said that innovation without access is not innovation, it's injustice. You know, I think this is something that's very important for this discussion. Thank you.

Carlos, you have deep expertise on intellectual property, trade, and wider economics and finance and global health frameworks. So which rules and practices more significantly impact access to medicines today? And Are existing tools, flexibilities and incentives inadequate, or are states failing to use the policy space that they have?

Well, as we know from the negotiations in the Uruguay round, one of the things that was approved was the TRIPS agreement, which established a rule which was celebrated by the international pharmaceutical industry. According to that rule, all members of the WTO had to grant patents on pharmaceutical products. So this meant that for some 55 developing countries had to introduce a legal monopoly on pharmaceutical products when patents don't stimulate innovation in pharmaceutical products in developing countries. Patents are just an opportunity for the monopolist to set prices. They're often too high to enable people whose life at risk, is at risk, to get treatment. So what I would say is that intellectual property and patents in particular, and the monopolies that they produce, push patients further away from access to medicine and compel states like Brazil to pay very high prices. So, the TRIPS agreement provides for certain flexibility, which some countries have applied partially. For example, last year, the South Center published a joint report with an organization from Boston in which we analyzed 15 middle-income countries. And what we found was whether or not there was compulsory survey of prices or not, and we found that all too often it wasn't foreseen in law. Now, we see that patents requests are analysed from the perspective of being an industrial application and innovation from the perspective of the major pharmaceutical companies, it's not just an issue of patenting the medicine, but patenting the hundreds of molecules to prevent generics entering the market and creating greater competition. So, the flexibility is to prevent the granting of patents, not for rewarding innovation and recovering investment, but just to avoid competition from generics. If I give you the Argentinian example, there are around 10,000 applications for patents in the pharmaceutical field in Argentina, they were subject to scientific analysis and only 9% of them were granted as a result. This meant that there is a market for generics outside the monopoly, and then There was an independent economic think tank which published a study which showed that Argentina was saving around $2.2 billion per year thanks to the fact that there was greater competition in pharmaceuticals. thanks to ensuring that patents were only granted when there was true justification for it.

Very clear, we heard very clear commercial determinants of health. We heard very clear the expectation for a high return on investment or high profitability of an investment that is both public and private in terms of health technologies. I'm also hearing very well the inadequacy of international trade regimes as applicable to health, as an incentive for innovation, but also both. It's not only what I'm hearing that you're saying, Carlos, is not only the rules, it's the applicability of the rules by member states. So what about access to capital and access to knowledge? I'm just trying to go a little bit deeper on the structural challenges. I think all the points you raised. Is there other structural challenges that a human rights framework or a human rights body should consider as we're looking at access to medicines.

I start and you come. You know, I heard, it's not the first time I hear Carlos Correa, right? Many of us have heard him several times. But, you know, I managed when I was in Brazil a long time ago to do, we managed at the government level to do a compulsory license for an HIV medicine. And applying the TRIPS flexibility is easier said than done, right? And what you're saying about creating the mechanisms and proving that it can be done, you know, that's important, I think. You know, that's because it's very complex. To actually, the tools exist that could be helpful, but countries need all of government approach is very hard. We had like 19 or 20 meetings to sort out the decision. It was during President Lula's second term, 2007, I think. And then internationally, what do you have? We also have, like, the TRIPS flexibilities that can be helpful or not, but we also have, it was discussed at the WHO, right? And very much there was a framework that was approved and a strategic. framework and everything, but then what happens? It's not funded, you know, and then you don't implement it, you know, so I mean that the legal and the normative structure exists for countries to apply, you know, and I think the civil society and other organizations that can help countries to understand how do you find the trail, because the trail is hidden, you know, it's not easy. And now we do have challenges now, and I think the two big challenges I see right now, for example, for HIV, the access to long-acting antiretrovirus, 'cause this is a problem in many countries, 'cause it's been like HIV, there's a lot of investment in new drugs, not so much in vaccines, it's complicated, it's very complicated, but there should be investment in vaccines, but actually, we need to keep people alive and well, I agree with that, but we need to think of a cure or we need to think of a vaccine that could help prevent new infections, right? But then you have this producer that produces a good medicine, which is a global public good, and puts the price very high, especially for upper middle income countries. So we have a, and the world is changing, right? There are more and more upper middle income countries that are subject, in small states as well. You know, even rich countries, they if they have a small market, they have problems. So I think there is space, legal space, to act, you know, but it's a complex issue. And just saying that, because HIV is the old pandemic, right? But now we had COVID very recently, and we committed the same mistakes again. You know, I said, if we are going to That's why it's so important the pathogen access and benefit sharing discussion that's happening at the World Health Assembly next year, because this is gonna frame what's gonna happen in terms of access in the next pandemic. And we all saw the disaster that was the COVID.

Of course, we could talk about the challenges much longer. Let's move, if you agree with me, to what are the solutions? What are the priority reforms? So let me ask you, Carlos, starting with you, what are the two, three most important changes at national or international level that would make the greatest difference at this moment? And I would like to put on the table, after COVID-19, we relearned that industrial policy is important for the human rights to health, that regional production, regional innovation, decentralization of knowledge and manufacturing capacity, it's an old concept, it's coming back. So I would like to ask you about priority reforms, and I would like to ask you about your thoughts specifically on this re-energization of industrial policy as a key element.

Thank you, Judith. First of all, I'd like to refer to Mariangela and what she was saying about compulsory licenses. It's often foreseen in legal frameworks, but perhaps not always appropriately. One of the things that developing countries have faced is that when they try to apply compulsory licenses, they face pressure from developed countries, particularly the United States. For example, if you read the most recent report special section 301, it's in the USDR report. This is where the US analyzes intellectual property regimes around the world, and in it says that compulsory licenses should only be used in extremely limited circumstances. What's the paradox? Which is the country which grants the largest number of compulsory licenses? That's the United States. That's the country which has granted the highest number of licenses. The European Union recently adopted regulation on a common obligatory license, so it's an accepted concept. So I think what we have to do is we have to adopt regulations on obligatory licenses on parallel imports. Too many countries have followed the European doctrine of consent in the importing country. So this means to say that exports are made under an obligatory license, but We should also fully apply patent laws, so patents are only granted when there is a justification for it, in order to avoid this system being abused by companies to prevent legitimate competition from generics. I think that one of the things which is really important is the removal of paragraph F of Article 31 of TRIPS, which states that obligatory licenses can only be granted for supplying local markets. But imagine, this led to the need for approval of two waivers in the WTO. Firstly, it was in the Doha round, in order to allow for a compulsory license to be granted for exports. This is so that other countries which don't have production capacity can receive the medicines. And then there was a waiver on patents, which was very late coming, but it was a way of trying to avoid the problems linked to obligatory licenses. So this is a step forward, but there's also a need to reform Article 66 of TRIPS so that we clearly see developed countries' obligations to transfer technology to less developed countries.

I think you mentioned, and Carlos in a way also mentioned, because I think the single most important thing at the moment, and it's not new, is diversify local and regional production. And that needs technology transfer, which is, yeah, but we also need to make sure that next time, 'cause this was a big problem during COVID, because there are many I'm not saying that every country has to produce something because it's not easy, it's complicated and it has lots of regulatory issues and so on, but, you know, but. At the time, with the COVID waiver and everything, we had problems with who was going to produce if you did a waiver. So we need to be better prepared. And I know G20 has an initiative for regional production and local production. And so I think that the developing world needs to really invest, and that needs investment. That's it.

Chairperson, do I have time for a follow-up, or should we go to the floor? We are yours. I know there's a list of speakers.

We are behind schedule, so.

So let's go to the floor. Yes.

Thank you, Ms. Ruiz, for your moderation, and to our esteemed speakers for their insightful reflections. I will now open the floor for an interactive dialogue. The first name on the list of speakers is Belarus, on behalf of a group of friends in defense of the UN Charter. You have the floor, and followed by Azerbaijan.

Mr. President, I have the honor to deliver the statement on behalf of the Group of Friends in Defense of the Charter of the United Nations. Our group reaffirms that equitable access to medicines, vaccines, medical equipment, and other essential health products is fundamental to the full realization of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. In this regard, we consider it important to continue strengthening national health system capacities, as well as promoting conditions that facilitate timely and non-discriminatory access to essential health products, in accordance with the needs and priorities of each country. We also underscore that unilateral coercive measures hinder access to medicines, medical equipment, health technologies, and essential services, generating negative consequences for the effective enjoyment of this fundamental right. Unilateral coercive measures undermine the right to health. We reiterate the importance of international cooperation based on solidarity, mutual respect, and shared benefit, contributing to overcoming existing inequalities and strengthening countries' capacities to ensure access to medicines and other essential health products. In conclusion, our group reaffirms its commitment to the promotion and protection of the right to health for all, based on the purpose and principles of the Charter of the United Nations, including the sovereign equality of States and international cooperation. Thank you.

Thank you. So I'll give the floor to Azerbaijan, followed by Russian Federation.

Thank you, Mr. Chair. Azerbaijan thanks the panelists for their insights and welcomes the focus of this session. Access to medicines and vaccines is shaped not only by health systems, but by trade rules, intellectual property regimes, export controls, and international financial architecture. It's at its core a question of the right to health and the right to development. The COVID-19 pandemic was the hardest test of this principle in our generation. It struck while Azerbaijan held the chairmanship of the Non-Aligned Movement. From the first weeks of the crisis, we saw it as our responsibility to give NAM member states a collective voice. In May 2020, at the initiative of the President Ilham Aliyev, Azerbaijan convened the online summit of the NAM Contact Group. group, united against COVID-19. The summit established a NAM task force and a database of member states' medical, social, and humanitarian needs, which the World Health Organization used to target support. On behalf of the movement, Azerbaijan initiated the special session of the UN General Assembly on COVID-19 at the level of heads of states and government, held in December 2020, with the support of more than 150 states, placing equitable access at the center of the global agenda. Here in Geneva, in March 2021, Azerbaijan, on behalf of NAM, put forwarded Human Rights Council resolution 46/14 on ensuring equitable, affordable, timely, and universal access for all countries to vaccines. Adopted by consensus, it called on states to remove unjustified obstacles to vaccine exports and facilitate their trade and distribution. A similar resolution followed in the General Assembly later that year. National Azerbaijan contributed 10 million US dollars to WHO and assisted more than bilaterally and through WHO. In March 2023, the NAM summit in Baku addressed post-pandemic recovery and proposed a UN high-level panel on global recovery from COVID-19. The lessons of the pandemic must now become commitments. The pandemic proved that no one is safe until everyone is safe. Azerbaijan remains committed to working with all partners to make equitable access to health products a reality for all. Thank you.

Thank you. I give the floor to Russia Federation, followed by Belarus.

Thank you, Mr. Chairman. The Russian Federation is convinced that ensuring equal access to vaccines and medical technologies must be an absolute priority of the international community. In this connection, we'd like to draw the attention to serious obstacles against the highest level of attainable standard of physical and medical health -- and mental health, excuse me. There are serious humanitarian concerns. consequences that come from that, and the interruption of supply chains impede access to medicines and medical technologies. There is an example in Cuba, Iran, and Venezuela where unilateral restrictions are impeding the access of the population to essential medical equipment. There is a particular concern with the excessive observance of sanctions, which even includes the removal of humanitarian assistance. The socially vulnerable segments of the population are most affected, including children and those with chronic diseases. Mr. Chairman, we recall that the right of everyone to the highest attainable standard of physical and mental health is a human right, and we believe that it is not acceptable that the interests of individual states are placed higher than the health of millions. We call for an end to measures which impede access to medicine. In this context, we would ask the experts what steps they foresee to put an end to unilateral coercive measures which impede access to medical equipment and health care. Thank you.

Thank you. I now give the floor to Belarus, followed by the Democratic Republic of the Congo.

Mr. Chairman, Belarus is of the view that equal access to medical equipment and medicines is a prerequisite for equal access to health care. And in this context, we are strengthening our production and our technical development to provide broader access to medicines and medical services, including in rural areas. In conditions where access to medical care is more difficult, we provide universal access to health care to medication, vaccinations, and medical equipment. However, we would note that the increase of sanctions by a group of states has a serious effect on medical components, and this affects the most vulnerable. Unilateral coercive measures also have a negative impact on the health of populations in Venezuela, Cuba, and other states. impediments make the purchase of pharmaceutical elements more difficult, as well as that of medical equipment, and this has a negative impact on the enjoyment of fundamental human rights, including the right to health. We are of the view that constructive international cooperation is an important prerequisite to ensure equal access to medical supplies and services. Thank you.

Thank you. I now give the floor to DEMU, followed by Maloka International. Is DEMU representative from them in the full room? That doesn't seem to be the case, so we'll go with Maloka International, followed by Abdul Samad. Maloka International doesn't seem to be in the room either. So, spiritual Science Research Foundation is in the room. Please go ahead.

Thank you, Chairman. Today we talk about solidarity, and that is not only a policy principle, it is one of the values that unite humanity. And it shares that by spiritual tradition, which call on us to practice tolerance, love, and mutual respect, and to see everyone as part of one human family. This is why we believe that no nation and no human can know true happiness when these values are abandoned. And when there is no solidarity, there is selfishness and greed. And when there is no tolerance and mutual respect, there is conflict and war. We live in the moment when health financings decline while military expenditure grows, and for health finance as well as medicine finance, if we continue in the same direction, we are setting the path towards global suffering rather than global health and well-being. As long as allocation for health medicine decrease, we must mobilize every resources society has. Spiritual organization are one such resource. Spiritual practice such as meditation and self-improvement practice that develop virtues and reduce selfishness, anger, and ego significantly improve mental health by building resilience, reducing stress, and restoring hope. These are low cost interventions and can reach more people and reduce burden on health system. We encourage states and international partners to recognize spiritual organization as partner of health system in the realization of the right to health, always grounded in human rights, respect for diversity and freedom of thoughts, conscious and religion. We have a choice to choose compassion and solidarity and work together towards health, peace, and prosperity. Thank you.

Thank you. I now give the floor to Karimi Ali Mardan.

Thank you. Thank you, Mr. Chair. My name is Ali Karimi. I was born in Afghanistan, and I am a master's student in sociology, social work, and social policy at the University of Fribourg. I work in a refugee residence in Bern, Switzerland, with young people aged 15 to 18. Many flee conflict, their wounds are invisible, sleepless nights, lost hope. Often, they cannot explain their pain to a doctor because no one speak their language. Health does not stop at borders, neither should solidarity. In Afghanistan, many clinics have closed as international funding has fallen. When it is cut, mothers, newborns, and girls pay the price. I have three proposals. First, health funding for countries like Afghanistan should be multi-year with protected support for mothers and newborns. Second, people fleeing conflict need health care and psychosocial support at borders. Host countries should not carry this alone. And third, those most affected should not only be discussed in room like this, they should be heard in them. And now, my question to the speakers, how can international cooperation ensure that the right to health reaches people living without legal documents and those waiting at borders? Thank you.

Thank you. I now give the floor to Abdul Samad.

Excellencies, esteemed delegates, ladies and gentlemen, it is an honor to address this United Nations Social Forum on equitable access to essential medicines, vaccines, medical equipment, and health products. Access to health care should never depend on income, nationality, or place of residence. It is a fundamental human right rooted in dignity and social justice. We must strengthen international cooperation, promote affordable health care, support technology transfer and local production, and ensure that underserved communities are not left behind. Distinguished delegates, medical progress matters only when its benefits reach to everyone. Let us work towards a world where healthcare is not a privilege for a few, but a right for all.

Thank you, Mr. Chairperson.

Thank you. I now give the floor to International Relations Students Association of McGill University.

Mr. Chair, Excellencies, distinguished delegates, my name is Catherine Dong, and I have the

honor of delivering the statement on behalf of the McGill Youth Advisory Delegation.

Menstruation is widely considered taboo, but if half of the world will experience it, why are we too shy to talk about it? Stigma around menstruation normalizes severe menstrual pain, contributing to the dismissal of symptoms and delay of diagnoses. Access to menstrual products is also unequal. Of the 2 billion women who menstruate worldwide, an estimated 500 million of them lacked access to adequate menstrual materials in 2024, according to the WHO.

Women and girls living in humanitarian

crises face particular barriers to accessing safe sanitation facilities, undermining their ability to manage menstruation safely, privately, and with dignity. My own mother lived through this.

Growing up in poverty, she had to make improvised pads out of toilet paper, which exposed her to infection risks

and leakage.

Girls may also miss school if they lack access to pads or if their schools lack adequate sanitary spaces.

We commend the Human Rights Council for recognizing menstrual health as a human right. Nonetheless, only around 40 countries have reported on their menstrual health management to the UN's Joint Monitoring Program.

It is time to advance menstrual equity.

Member states should adopt UNICEF's standards for menstrual health responsive spaces, transition to the 11th revision,

of the International Classification of Diseases, which recognizes premenstrual dysphoric disorder, and remove taxes on menstrual products. It is through these actions that women and girls like my mom can attain the highest attainable standard of physical and mental health. Thank you, Mr. Chair.

Thank you. That was the last speaker that we could accommodate. So, I will now give the floor back to the moderator for their final remarks. We have less than five minutes. Thank you.

Thank you, Chair. I would like to ask our two experts to, there's been direct questions to you, some three, I think I got three direct questions, and to use your final moments to respond to the questions and also to do a final recommendation for the Human Rights Council. If you had to choose one single recommendation moving forward, which one would it be?

I can start, right? And I'm not gonna respond to the questions directly because some of them are beyond my knowledge. But, you know, I think that we are talking about equitable access to medicines, health products in general, right? Vaccines, diagnostics, and so on. And this is probably the most actionable part of the right to health. You know, it's the access to health services, to healthcare, and the access to the products when people need them, not too years after, but when they need it. Because we can invest a lot on health promotion and so on, but people are sick, and people don't have access. I remember my time when I was in WHO, there was a discussion on access to epilepsy medication, because I don't remember now the number of people who did not have access to drugs that are long no intellectual property, no patents on them. So I think this is very actionable, and it's an essential part of the right to health, and there are different ways to achieve it. Thank you.

Well, I cannot really answer all the questions, but just let me address the question about United Nations measures. It is difficult to know what steps can be taken at the national level because we know that these measures continue to be applied. and even more leading to military aggression. But just in the area of health, I would like to highlight the case of Cuba that despite the blockade by the United States for more than 60 years, Cuba has developed a very vibrant pharmaceutical industry, has been able to produce a large number of products for local population, and also to export, in particular, has done a significant development in the area of biologicals, so this shows that despite these measures, It is possible to develop local manufacturing in pharmaceuticals to address the situation of the local people. Second comment, I just like to support Mariangela's comment on the need to have a good annex in PAPS for the pandemic agreement. Without an annex that would ensure actual equity, that would ensure mandatory provisions for beneficiary, the pandemic agreement will not be meaningful. in solving the next pandemic, if such is the case. So I think we encourage all here to support developing countries, the African group, the equity group, to continue a sustained position that should lead to an analysis which is meaningful. And finally, for a recommendation, I think will be important for this forum and those participating here, to look at means to reconcile human rights with other rights, including intellectual property. And I would like just to read very briefly a decision taken by the Andean Tribunal of Justice, which is the tribunal for the Andean community in Latin America, which in a decision taken April 26, the tribunal said, "The court states that it has the authority and responsibility to prioritize affordable access to essential medicines when commercial interests clash with public health. So I think it's a very important role, because you have the laws, and then you have the human rights. On the one hand, you have intellectual property rights and other rights on the other side, but they need to reconcile on the basis of considering that commercial rights need to be overridden when there is public health and human rights at stake.

Chairman, just as a conclusion, I was asked to summarize the main recommendations. I think it's unnecessary, but I think what I heard, and I really appreciate all the statements, that there is a consensus that this forum, that the human rights dimensions to the right to health and the attention to the specifically the issues of equitable access. have been essential in the past, continue to be relevant today, and are going to be a key strategy moving forward. Member states have choices to make. There clearly, we heard about legal and policy incoherence in international trade and international norms. ongoing negotiations, where we heard is that the human rights framework is an essential tool to guide these negotiations, to guide the implementation of international agreements, and then to ensure that appropriate reforms happen at both national and international level. Thank you.

Thank you, moderator. Thank you, panelists, and thank you all of you for such a rich discussion. I also thank the interpreters, technicians, and security personnel for their patience. Colleagues, this wraps up our interactive dialogue for today. We will convene tomorrow at 10:00 AM. I wish you all a pleasant evening. This meeting is adjourned.