Abstract
Healthcare systems are facing unprecedented and multifaceted challenges due to emerging health risks and planetary pressures, including climate change, pollution and biodiversity loss. As these challenges transcend borders and involve numerous stakeholders, international collaborations with the space sector can drive innovation in global health by harnessing its diverse expertise, resources and experiences across countries and disciplines.
Collaborations and partnerships are essential in healthcare and global health, and such cooperation can lead to the development and dissemination of novel strategies, treatments and technologies. By pooling R&D efforts, countries can collectively accelerate the creation of new interventions, share best practices and utilise data to develop timely and cost-effective solutions that ultimately strengthen public health systems.
Global and public health initiatives often rely on international collaborations, and are frequently hampered by inconsistent cooperation, limited resource-sharing and uneven global participation. During the COVID-19 pandemic, the unequal distribution and availability of vaccines and health information revealed significant gaps in public health equity, raising to the forefront the critical need for more robust, coordinated efforts and cross-sectoral partnerships. 1
Global collaborations in space: a model for healthcare
Collaborations in space exploration have resulted in groundbreaking technological innovations, efficient problem-solving strategies and effective management practices.2,3 Healthcare leaders can draw valuable lessons from space’s successes and leverage its established partnerships, to enhance its approach in managing complex health challenges. 4 The space sector’s emphasis on international partnerships, data sharing and capacity building offers a model for global public health, where similar strategies can be employed to address pandemic preparedness, climate change-related health impacts and global health equity.
This commentary highlights several key areas where collaborative efforts in space have catalysed advancements for space exploration and advanced global health efforts on Earth. These examples offer a broad overview of the potential impacts, setting the stage for further in-depth exploration and innovation in healthcare service delivery. By bridging the space and health sectors, global health systems can be further empowered to contribute as an equal partner in discourse that aims to promptly address the diverse population health risks.
International collaborations in space exploration
Since the initial space race, international collaborations in space exploration have expanded, promoting knowledge sharing and driving economic growth. The ability to observe one-third of the Earth’s surface with just one satellite in orbit highlights the fact that space exploration has emerged as a frontier that extends beyond national boundaries. This global perspective underscores the necessity for nations to work together and unite in pursuit of shared goals, and one prominent example is the International Space Station (ISS). As a partnership involving NASA (USA), Roscosmos (Russia), ESA (Europe), JAXA (Japan) and CSA (Canada), the ISS serves as a home for astronauts and cosmonauts, as well as a microgravity research laboratory to conduct experiments and foster scientific cooperation among nations. Additionally, international collaboration has also led to astronauts from many other nations visit the ISS and have participated in various space-related research activities.
Similarly, multiple examples of space collaborations in outer space exist, including lunar activities with the Artemis Accords (initiated by the USA and currently signed by over 50 countries) or the International Lunar Research Station (initiated by China and currently signed on by around a dozen nations), both of which seek to advance scientific and technological cooperation. These collaborations offer developed and emerging/developing nations alike to contribute to space exploration and participate in research and development (R&D), which may not be feasible independently. Moreover, the private space sector has also become a key player in space exploration, with private companies like SpaceX and Blue Origin working in tandem with governmental agencies. Public–private partnerships (P3) have ushered in a new era, where innovative approaches, entrepreneurial spirit and governmental support intersect to drive advancements in space technology.
Complexities of international collaborations in space
International collaboration and cooperation within the space sector are not without their challenges. These challenges include addressing language barriers, cultural and political differences; inequalities in technical and financial conditions among nations; standards definition and regulatory compliance, among other factors. Furthermore, space-related activities are often driven by goals such as national security, the pursuit of technological supremacy, or the economic exploitation of outer space. These goals can hinder building trust, rapport and competition, and hence may cause hesitation or limit fruitful collaborations.
Despite these significant challenges, the space sector has progressively developed strategies and solutions to foster collaborations, recognising that for many spacefaring nations (including for emerging space nations), sustained cooperation is essential for their continued viability and advancement. The lack of boundaries in space already allows global collaboration and cooperation to pool resources and capabilities that can be leveraged for space-based research that can revolutionise healthcare. For example, a United States’ company could produce hardware that could be launched to the ISS by a European rocket, where an Emirati or Canadian astronaut could conduct experiments in Japan's science module.
As the space sector is becoming increasingly complex, technological advancements have unlocked new opportunities for the economic exploration of outer space, such as resource extraction (asteroid mining, lunar mining), space tourism, space labs and space-based manufacturing (products that can be marketed as being ‘made in space’), as well as the expansion of satellite applications to support a wide range of other economic activities. These possibilities have brought new actors into space – new countries and private investments – raising critical questions about sustainability, environmental impact and governance. These elements enable space initiatives to overcome national boundaries for cooperation. Using this approach for healthcare could transform global health and public health efforts led by organisations such as the World Health Organization (WHO) and United Nations (UN), since healthcare often faces challenges from political borders and differing regional policies, which can limit resource sharing and a coordinated response. Therefore, by considering a ‘borderless’ mindset and focusing on shared goals and mutual successes, we can foster a collaborative environment in healthcare that can be beneficial to developing and developed nations globally. Although this paradigm shift could enable healthcare to operate more openly, healthcare stakeholders should continue to develop solutions related to challenges in logistics, regulatory requirements and infrastructure.
Space for global health benefits – space for all
Beyond exploration, space-based collaborative initiatives have made significant contributions to public health and global health. The United Nations Platform for Space-based Information for Disaster Management and Emergency Response under the United Nations Office for Outer Space Affairs (UNOOSA) facilitates the access and utilisation of pertinent space-based data across developed and developing nations to aid their global emergency response efforts. Each year, UNOOSA convenes the Heads of National Disaster Authorities to share lessons learned and provide a platform for new international collaborations around space data. This information can help support decision-makers in their disaster preparedness and response efforts, as they monitor the impacts of climate change-related events on public health.
In December 2022, the UN General Assembly adopted a resolution emphasising the importance of space science and technology in promoting well-being for all ages. 5 The Space and Global Health (SGH) Network, guided by UNOOSA, encourages global collaboration and partnerships between public and private actors, enabling shared knowledge exchanges and accelerating the adoption of space-derived tools and services to address global health issues. 6 International collaborations among space agencies have also led to initiatives like the International Charter on Space and Major Disasters, supporting immediate relief efforts during disasters. 7 When a disaster occurs, any country – even if the country has no satellites of its own – can ‘activate’ the charter to receive free satellite images to support assessment, monitoring and the mitigation of the disaster. This collaborative system ensures that all nations can benefit from the application of space-based technologies in disaster scenarios.7,8 The Charter has so far been activated over 900 times to support disaster management in both developed and developing nations.
Furthermore, the participation of over 20 space agencies in the Space Agencies Leaders’ Summit at the 28th United Nations Climate Change Conference (COP28) highlights the collaborative nature of the space sector in addressing the human impacts of climate change. This collaborative approach is crucial for both developed and emerging/developing nations, emphasising shared responsibility for the sustainable and peaceful use of space and its health applications.
Navigating complexities and conflicts
Whether health leaders and decision-makers are addressing healthcare’s challenges or spacefaring nations are working together, collaborations can present differing national and international interests, geopolitical tensions, and technological disparities that can strain partnerships. Successfully navigating these complexities requires diplomatic finesse and a commitment to the common goal of advancing human understanding and technological prowess. These are areas where the space sector excels, as it recognises that the future of space exploration would be non-existent without such valuable collaborations and cooperation. As a result, despite today’s growing regional and international tensions, robust international space-related partnerships, such as the ISS and the Disaster Charter, continue to prosper and thrive worldwide.
Next steps
The collaborative spirit in space exploration demonstrates humanity’s ability to unite for a shared vision, with valuable lessons for public health policy, which emphasise the importance of collaboration, standardisation and innovation.
These examples highlight the need for shared goals, resource pooling and technology transfer, making participation accessible for many nations and partners. Similarly, international health collaborations, such as those led by the WHO, focus on equitable resource distribution and joint efforts to address global health crises. Although the collaboration involving space exploration may involve fewer stakeholders due to financial and technological barriers, other space initiatives like the Disaster Charter and the SGH Network demonstrate how these challenges are set aside to support global health. Thus, adapting the space collaborative approach to healthcare could further drive innovation and help bridge disparities, ensuring accessibility for low-resource nations.
Health systems can also benefit from adopting international partnerships, similar to those in the space sector, to effectively share knowledge and resources. Embracing open data sharing, equitable resource distribution and capacity-building initiatives can strengthen global public health, reflecting the strategies used in space programmes. Additionally, applying the space sector’s diplomatic strategies and leveraging the space sector’s established partnerships for managing global tensions and technological disparities can enhance international collaborations, leading to cost-effective interventions, timely medical technologies and actionable solutions to global challenges.
Similarly, strengthening collaborations between the health and space sectors can potentially revolutionise medical advancements and set new standards for health collaborations. Space technology has already been transforming healthcare, including advancing telemedicine, diagnostic imaging and remote monitoring. 2 By adopting a One Health lens, which focuses on close links between human, animal and environmental health, leaders can analyse and propose strategies on how to best apply space technologies to address existing gaps towards achieving the indicators of the 17 Sustainable Development Goals.9,10 By leveraging the space sector’s well-established international networks – where nations, governments, organisations and the private sector collaborate – healthcare systems, through enhanced collaboration and cooperation, can achieve unprecedented advancements, breaking barriers and reaching new frontiers for emerging health risks affecting the planet.
