Letter to the Minister of Development from the Stoltenberg Committee

Dear Minister of Development Åsmund Grøver Aukrust,

We thank you for the good discussions in the meeting with Committee Chair Camilla Stoltenberg and Committee Member Anne-Marie Helland on 25 February. As promised, we follow up with a letter with our updated reflections on “Norway can, Norway should: Take leadership to halve premature death by 2050”, given the dramatic changes of recent months in international work for global health.

We still stand behind all the recommendations in our report “Norway can, Norway should“. If anything, they're more relevant now than they were when the report was launched in November 2024. However, the changed situation makes us want to make some specific recommendations and perspectives that are particularly important in the time ahead.

At Norway renews Its leadership in global health is now more important to both the world and Norway than it was. We appreciate that the Minister of Development has in several cases put forward arguments for this, including in his response to Written question from Representative Ulstein (26.03.2025) on Norway's reaction to US aid cuts. In other contexts, the Minister for Development has also highlighted the importance of continued Norwegian value leadership at SRHR, in line with recommendation 1.4 in our report. Norway is probably one of the few countries that will be able to maintain and strengthen aid, and therefore has a special responsibility to take leadership in global health - and will have legitimacy for this.

We are pleased to see that the Minister of Development maintains the goal of At least one percent of aid despite an international trend of cuts in aid. At the same time, Norwegian aid funds are stretched ever thinner, and are particularly squeezed by increased support for Ukraine and increased refugee costs in Norway. One percent for aid is thus no guarantee that investments in global health will be sustained. It is furthermore important that new investments in global health security, directly in Norway's self-interest, do not come at the expense of investments in reducing health inequalities globally. This must happen by increasing the aid budget to more than one per cent of GNP. Some of the increase to support the management of common global challenges should also come from outside the aid budget.

Health safety is also preparedness

Investing in health systems in developing countries is not just a matter of solidarity and aid, but of investing in our own security. It's about global security and stability. We therefore thank the Minister of Development for pledging this in his Chronicles in Dagsavisen. We wrote a chronicle with similar messages, in NRK Utterance: After the fall of the United States, Norway should take over the leadership jersey on global health safety and preparedness which we hope you have read.

According to a Lancet commission this fall, there is a whopping 50 percent probability of a new pandemic with a higher mortality rate than covid-19 before 2050, and this was estimated until there were huge cuts made in global health from the US and others. The probability is even higher now. The director of the Africa CDC discussed the consequences of cuts in US health aid thus in a interview in Panorama:

“This means less money, less medicines and fewer health workers while increasing the number of disease outbreaks in the region. The consequence could be a new global pandemic.”

Norwegian preparedness is not enough

Investing in prevention and health preparedness globally is far cheaper than dealing with a global pandemic after it has spread. We therefore urge the Minister for Development to talk to his colleagues in the government about how Norway can invest more in global health security across different budgets, and outside aid budget. An example of inspiration is that increased defense budgets can also be used for research and development on health security, biological threats and their management through the development of medical countermeasures. Each year, the United States spends approximately $100 billion in research and development under the Department of Defense (DoD). Research into biosafety and health security should also be able to be a military investment. As mentioned, if Norway is to make a significant contribution to Norwegian, European and global health security, investments cannot be limited by the aid ceiling of one percent of GNI.

The world now needs a state leader who goes ahead and takes responsibility for global health. This also fits with Norway's comparative advantage; Støre is probably the prime minister in Europe with the most relevant experience in global health, both inside and outside politics. Norway as a country also has strong expertise and history. If there is one role Norway should play in international preparedness, it is therefore in health security. Controlling pandemics and epidemics is in everyone's interest.

At a time of extraordinarily squeezed budgets in many countries, there is a danger that increased investment in global health security is happening at the expense of investments in global health inequality. It's unfortunate, and it means sending the bill to the world's poorest. If there is a country that has the resources, knowledge and history to preserve its commitment to health inequality and overall health system strengthening, it is Norway.

Priorities in a new situation

The Minister of Development expressed in meeting with us that he wanted our input on how to succeed in health system strengthening. We refer here to recommendation 3.2 (p. 29) in”Norway can, Norway should“.

One of the health system measures that has become extra relevant since this fall is accessible and robust health data. One of the consequences of the cuts in the US is that government data, e.g. Demographic and Health Surveys, disappears—also data dealing with disease outbreaks and surveillance. Lack of health data means more steps in the wrong direction for global health security, research on global health and the health systems of developing countries. Here, too, Norway can make a difference.

Crises also create opportunities for change. One opportunity we now see is that the world can more quickly succeed in simplifying and reforming the global healthcare architecture in line with Lusaka Agenda (see mention in the report, page 15). Norway can continue the leadership we showed through the Lusaka Agenda and initiate coordination among the global health initiatives on how to respond to the crisis in a way that at the same time brings us closer to the Lusaka agenda. This is linked to the Committee's recommendations 1.2 and 5.3. When major donors to global health such as the United States and the United Kingdom cut their contributions, Norway gains increased influence and the opportunity to speed up reforms. For example, Norway could become the largest donor country to Gavi from 2026, from being number three today. This is also an opportunity for the Norwegian leadership to implement necessary reforms — for change to improve, and to get more out of pooling efforts and mechanisms to follow up at country level.

Now is the time, both for the sake of the world and Norway, to invest in global health inequality and global health security. Investment in global health concerns both the Minister of Development, the Minister of Health, the Secretary of State and the Prime Minister, and we hope to see funding and leadership from more than the Minister of Development going forward, including in the revised National Budget. Norway can, and should, do more.

We are happy to answer questions or ask for a meeting to shed further light on our input.

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sincerely

• Camilla Stoltenberg (Committee Chair), CEO of NORCE and Professor 2 at the Department of Global Health and Community Medicine at UiB
• Amanda Hylland Spjeldnaes, former head of the Norwegian People's Aid Solidarity Youth and representative of Norwegian youth in the World Health Assembly at WHO
• Anne-Marie HellandDirector of International Development at PwC
• Bent Hoie, State Administrator of Rogaland
• John-Arne Roettingen, CEO of Wellcome Trust
• Karoline M. Linde, CEO of Laerdal Global Health
• Lumbwe Chola, Associate Professor at UiO in Health Management and Health Economics
• Ole Frithjof Norheim, Professor of Ethics and Public Health in the Department of Global Health and Population Studies, Harvard T.H. Chan School of Public Health
• Ottar Maestad, researcher at CMI and head of the Development Learning Lab (DLL)

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