The Lancet Commission on 21st-Century Global Health Threats

The world has lived through an extraordinary global health threat, the COVID-19 pandemic, leading to nearly 20 million deaths, staggering economic losses, a generational decline in human capital, and the first decline in global life expectancy since 1950 (the first year when UN estimates were published).1, 2, 3, 4 Another major threat, climate change, now has broad scientific, political, and social recognition.5, 6, 7 The spectre of nuclear confrontation has re-emerged as a serious threat during the ongoing Russian invasion of Ukraine. The three Cs—COVID-19, climate change, and conflict—highlight that the steady global health progress of the past 70 years will not necessarily continue in the next 70 years. But there are many other threats beyond the three Cs that threaten to undermine future global health progress, including rising antimicrobial resistance, increasing obesity, inverted population pyramids, eroding sexual and reproductive rights for women, food insecurity, and fraying multilateralism. How global health advances or retreats will depend crucially on the multiplicity of these threats and how they intersect.

The global community and many nations have launched commissions, task forces, and panels to draw lessons from the COVID-19 pandemic.7, 8, 9, 10, 11, 12 The Pan-European Commission on Health and Sustainable Development⁸ explored the post-pandemic world for Europe and made far-reaching recommendations based on a One Health lens. The Independent Panel for Pandemic Preparedness and Response¹¹ and the G20 High Level Independent Panel on Financing the Global Commons for Pandemic Preparedness and Response¹² called for the creation of new institutions and financing mechanisms to prepare the world for new pandemics and other threats. Multiple commissions, task forces, and panels have addressed climate change, including two Lancet Commissions, and the Intergovernmental Panel on Climate Change produces regular multistakeholder assessments.7, 8, 13, 14 These global convenings have been mirrored by multiple national reviews.15, 16, 17 Although there are high-profile initiatives for pandemics and climate change, other threats have received less widespread attention or have been debated largely in academic subdisciplines.

Governments, international organisations, and local communities will need to manage multiple threats at the same time. Many of these threats interact and lead to complex health, economic, social, and geopolitical consequences. Climate change, population growth, and political fragility may coincide leading to large-scale migration. Food systems can be designed to improve health, reduce poverty, and slow climate change, or the reverse. Specific and cross-cutting technologies and policies are needed to reduce the risk of emerging threats or to decrease the harms from threats as they unfold. The most important strategies for risk and harm reduction are unlikely to emerge if each threat is examined in isolation from the others.

We have established the Lancet Commission on 21st-Century Global Health Threats to examine the broad set of threats facing the world over the rest of the century. This long perspective is needed since threats such as climate change, food systems, antimicrobial resistance, or inverted population pyramids require many decades for actions to alter future trajectories. The Sustainable Development Goal focus on 2030 is an important motivator for immediate policy action, but a longer-term perspective is needed to fully assess and respond to emerging threats.

This Commission's work will be informed by diverse expertise. The Commission members are drawn from many distinct groups: current and former heads of state, intergovernmental organisation leaders, leaders of public health institutions, global health funders, global health thought leaders, and civil society and youth organisations. The Commission represents a diverse group with gender parity and regional balance so that many perspectives are brought to bear on finding cross-cutting tools and solutions for future threats. The Commission will meet over the next 2 years to assess the evidence produced by various working groups and will release its analysis and recommendations by the end of 2024.

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Beyond the Commission members, the Commission also seeks input from diverse individuals and institutions in every region of the world. We recognise that solutions for multiple threats facing communities require sound scientific analyses combined with understanding of local values, preferences, priorities, and perspectives. We make an open call for input to this Commission through the Commission's website and encourage evidence that can help us all find potential cross-cutting solutions for global health threats. We now have the analytic capabilities to harness the power of data from across multiple fields, galvanise global expertise with diverse perspectives, and identify for the world some of the most important priorities for the long term. The Lancet Commission on 21st-Century Global Health Threats will act as an independent voice to call attention to these priorities.

For the website of the Lancet Commission on 21st-Century Global Health Threats see https://www.globalhealththreatscommission.org