[Title] Chair's Statement of the 13th APEC High-Level Meeting on Health and the Economy

"Strengthening Health Systems for Pandemic Prevention, Preparedness and Response—Interconnection, Innovation, and Inclusion in Health and the Economy"

All APEC ministers responsible for health agreed to all paragraphs except for paragraphs 3 and 10.

1. The 13th Asia-Pacific Economic Cooperation (APEC) High-Level Meeting on Health and the Economy (HLM13) was convened in Seattle, Washington, in the United States, on August 6, 2023, under the theme "Strengthening Health Systems for Pandemic Prevention, Preparedness and Response (PPR)—Interconnections, Innovations, and Inclusion in Health and the Economy" to support the realization of the Putrajaya Vision 2040, including through the implementation of the Aotearoa Plan of Action, and in support of the Bangkok Goals on Bio-Circular-Green (BCG) Economy and the La Serena Roadmap for Women and Inclusive Growth. We, the Ministers of Health, welcomed the participation of the APEC Secretariat, the APEC Business Advisory Council (ABAC), the Association of Southeast Asian Nations (ASEAN), the Pacific Islands Forum (PIF), the Pacific Economic Cooperation Council (PECC).

2. We noted the interconnectedness of health and the economy was demonstrated by the COVID-19 pandemic, and we further committed to reinforcing our systems to prevent, prepare for, and respond to future pandemics and health emergencies, and to further strengthen the health workforce, acknowledging their tremendous contributions to protecting lives and safeguarding health. Sustainable health financing, innovative digital health solutions to increase access to, and delivery of, health services, readily available primary health care (PHC), and equitable models of care are all integral to healthy people and healthy economies.

3. As our Leaders highlighted last November, we have witnessed the war in Ukraine further adversely impact the global economy.There was a discussion on the issue. We reiterated our positions as expressed in other fora, including the UN Security Council and the UN General Assembly, which, in Resolution No. ES-11/1 dated 2 March 2022, as adopted by majority vote (141 votes for, 5 against, 35 abstentions, 12 absent) deplores in the strongest terms the aggression by the Russian Federation against Ukraine and demands its complete and unconditional withdrawal from the territory of Ukraine. Most members strongly condemned the war in Ukraine and stressed it is causing immense human suffering and exacerbating existing fragilities in the global economy - constraining growth, increasing inflation, disrupting supply chains, heightening energy and food insecurity, and elevating financial stability risks. There were other views and different assessments of the situation and sanctions. Recognizing that APEC is not the forum to resolve security issues, we acknowledge that security issues can have significant consequences for the global economy.*1*

4. We acknowledged that resilient health systems are important elements of equitable and sustainable health and access. We recognize that more intensive efforts are needed to address today's challenges to health systems, including climate change, extreme weather and natural disasters.

5. We recognized that the world needs to be more prepared for future pandemics and other health threats, including through enhanced investments in health security. We therefore recognized the importance of efforts as decided by the WHASS A2(5) to develop a new international instrument on pandemic prevention, preparedness and response and to strengthen the International Health Regulations (2005).

6. We stressed the need to continue efforts to promote equitable access to safe, effective, quality-assured, and affordable vaccines, therapeutics, and diagnostics, extensive immunization against COVID-19 as a global public good and to intensify work that enhances resilience and sustainability of medical supply chains. We support efforts to enhance supply chain connectivity, last mile delivery, and minimize supply chain disruptions. We encourage fostering open, secure, and resilient medical supply chains.

7. We acknowledged the impacts of COVID-19 on the medical supply chain, and that as the medical products industry has become more globalized and specialized, APEC economies endeavor to ensure that access to legitimate medical products is not disrupted. We underscored the value of strengthening regulatory and delivery systems in the region, as well as the need to ensure the appropriate organizational structure to continue APEC's critical work on regulatory cooperation and convergence in efforts to ensure access to safe, effective, and quality-assured medical products.

8. We recognize the threat of antimicrobial resistance (AMR) globally, and the associated mortality and economic costs which will continue to rise if mitigating actions are not taken, and we encourage economies to collaborate with all government sectors, academia, civil society, and the private sector to explorepush and pull incentives that promote investment in R&D of antimicrobials. We also strongly support efforts to preserve the antimicrobial pipeline and to maximize the effectiveness of existing antimicrobials through antimicrobial stewardship and to create robust surveillance of AMR.

9. We recognized that strengthening our economies' health systems is critical for economic recovery and that additional investment is needed for resilient, equitable, and sustainable health systems. We express our commitment to achieving UHC, including through health systems strengthening and, as a cornerstone, enhancing PHC to restore access to essential health services, and to strengthen health security.

10. We acknowledged the importance of both public and private sector solutions, and innovative health financing strategies, in ensuring sustainable, shock-resistant, equitable and quality health services, including for immunization, infectious diseases, non-communicable diseases (NCDs) including mental health conditions; maternal, newborn, child and adolescent health; and healthy ageing. Many ministers also stressed the importance of sexual and reproductive health and rights (SRHR).

11. We discussed the important role of, and contributions made by, strong PHC systems in the COVID-19 response and beyond. We discussed opportunities for PHC strengthening on pandemic preparedness including through digital health, immunization programs, and healthcare workforce strengthening. We recognized the importance of PHC in achieving UHC and accelerating progress, aligned with the 2030 Agenda for Sustainable Development.

12. We welcomed member economies' progress in implementing the APEC Action Plan on Vaccination Across the Life-Course, with continued efforts by economies and relevant stakeholders to capture the full societal and economic benefits of immunization, establish sustainable financing for immunization programs, improve data collection,bolster vaccine confidence, and address misinformation and disinformation.

13. We reaffirm that innovative initiatives including those related to digital health are critical to strengthening pandemic PPR and achieving UHC. We noted the innovations in and acceleration of the digital economy in the health sector and how these advances have increased equitable access to health care services for populations that are hard-to-reach and in vulnerable situations. While there has been rapid growth in digital health applications, telehealth services, and digital technologies, we also discussed the importance of health data privacy and security in the digital economy.

14. We acknowledged that the COVID-19 pandemic has had an impact on the physical and mental health of all our people, especially those living in vulnerable situations. We thus reaffirmed APEC's commitment to increasing health equity and addressing health-related barriers specific to women in the workforce, business, and entrepreneurship, such as improving workplace protections, health, and safety, and increasing health access and awareness.

15. We welcomed member economies' continued progress in implementing the APEC Roadmap to Promote Sustainable Economic Advancement for Women Through Cervical Cancer Prevention and Control as measured in the Status Report on Cervical Cancer Elimination in the APEC Region.

16. We acknowledged the disproportionate impact of COVID-19, including increased risk factors for violence against women and girls, and the unequal distribution of care work as a barrier to gender equality and women's equitable participation in our economies and in society. We further noted the importance of strengthening care infrastructure and supporting care providers as an integral part of health care and health systems, as both paid and unpaid care work is essential to the healthy functioning of our economies and societies.

17. We committed to strengthening our public-private sector partnerships and bringing other stakeholders including civil society and academia to build on past work and support the intersection of health and economy.

18. We look forward to the next APEC High-Level Meeting on Health and the Economy and related activities in the APEC forum of 2024 under Peru's host year.

{*1* Paragraph 3 of this document, taken from the APEC Bangkok Leaders' Declaration from November 19, 2022, was agreed to by all member economies except the People's Republic of China and the Russian Federation.}