{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T05:10:39Z","timestamp":1778908239609,"version":"3.51.4"},"reference-count":154,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["enviromicro-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microbial Biotechnology"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Despite unprecedented medical advances, global healthcare systems are failing to deliver universal, equitable and quality care. Many systems also have low resilience to surges in demand, are highly fragmented, or suffer from unsustainable funding models. The crisis of poor accessibility of healthcare services, which includes both lack of availability and unacceptably long waiting times, stems from systemic failures: inadequate provision of primary healthcare, suboptimal deployment of human and non\u2010human healthcare assets, metric\u2010 and profit\u2010centric models that exacerbate inequality, fragmented and siloed services, unsustainable costs and a reactive focus on treatment over prevention. Climate change and demographic shifts threaten to overwhelm already strained systems. In this discourse we argue that achieving the fundamental human right to healthcare requires a radical reconstitution of primary healthcare, centred on unlocking previously un\u2010 and under\u2010exploited resources, capacities and productivity, governed by the principle of \u2018Networked Agency with a Safety Net\u2019. We propose a holistic transformation that increases accessibility, resilience, integration, sustainability and, crucially, equity, centred on three synergistic pillars. First, a digital and patient\u2010agency revolution, designed to radically increase access to, and the productivity of, primary healthcare. This involves creating self\u2010care ecosystems such as Do\u2010It\u2010Yourself Digital Medical Centres and Home Clinics, supported by a National Clinical Informatics Centre. By enabling patients to manage routine care, this system frees highly trained healthcare professionals to focus on the complex clinical work that demands their full expertise. This enables and fosters patient empowerment while ensuring continuous clinical oversight (\n                    <jats:italic>to prevent any misunderstanding: clinical oversight means that all clinical recommendations\/decisions are made by healthcare professionals; patient agency involves inter alia implementing such recommendations\/decisions<\/jats:italic>\n                    ). Second, acceleration of the strategic exploitation of microbial technologies\u2014frugal, sustainable tools for diagnostics, prophylactics and therapies, including and especially mental health interventions, and environmental health (One Health). Third, a decisive shift towards disease prevention and health creation, integrating \u2018Health in All Policies\u2019, targeted comprehensive health education, and a comprehensive and systematic dismantling of healthcare accessibility barriers\u2014such as transport impediments\u2014and legacy forms of discrimination like restricted sexual\/reproductive healthcare and failure to adequately care for the most chronically underserved, including the ageing population. This model is inherently sustainable and designed to drastically reduce the healthcare sector's carbon footprint and environmental impact through service consolidation, transport\u2010oriented siting and green infrastructure. The measures constitute a technical upgrade and also a fundamental recasting of the primary healthcare system and mindset. This is also a moral imperative. Governments, while increasingly delegating service provision to commercial actors, hold a non\u2010delegable\n                    <jats:italic>duty of care<\/jats:italic>\n                    . Fulfilling this duty necessitates a covenant that transitions healthcare from a market commodity to a publicly\u2010accountable system sustainably designed for long\u2010term resilience, equity and dignity. The roadmap we provide\u2014encompassing governance, infrastructure, innovation and education\u2014charts a course from crisis to a sustainable future where universal access to quality healthcare can finally be realised.\n                  <\/jats:p>","DOI":"10.1111\/1751-7915.70345","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T04:15:42Z","timestamp":1776744942000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Manifesto for Universal Healthcare: Reconstituting Primary Care Through Digital Innovation, Microbial Technologies and Empowered Citizenship"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0066-4670","authenticated-orcid":false,"given":"Kenneth","family":"Timmis","sequence":"first","affiliation":[{"name":"Institute for Microbiology Technical University of Braunschweig  Braunschweig Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerard","family":"Clarke","sequence":"additional","affiliation":[{"name":"APC Microbiome Ireland, Department of Psychiatry and Neurobehavioral Sciences University College Cork  Cork Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8672-5429","authenticated-orcid":false,"given":"Mar\u00eda Francisca","family":"Colom","sequence":"additional","affiliation":[{"name":"Department of Plant Production and Microbiology, San Juan de Alicante, Institute for Sanitary and Biomedical Research of Alicante Miguel Hern\u00e1ndez University  Alicante Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7727-3363","authenticated-orcid":false,"given":"Zeynep Ceren","family":"Karahan","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, School of Medicine Ankara University  Ankara Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3516-6815","authenticated-orcid":false,"given":"Rachel","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Department of Architecture KU Leuven  Gent Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/jme.2010.038737"},{"key":"e_1_2_11_3_1","unstructured":"American Public Health Association.2025.\u201cPublic Health Code of Ethics.\u201dhttps:\/\/www.apha.org\/getcontentasset\/43d5fdee\u20104ccd\u2010427d\u201090db\u2010b1d585c880b0\/7ca0dc9d\u2010611d\u201046e2\u20109fd3\u201026a4c03ddcbb\/code_of_ethics.pdf?language=en."},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1751-7915.14224"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2023.100705"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(21)00260-7"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.4324\/9781315109053"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41746\u2010025\u201001598\u2010y"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(21)00207-2"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s43678\u2010021\u201000237\u20101"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocae006"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2019.1665402"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s41471\u2010022\u201000132\u20100"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00550-6"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1089\/109350703321908441"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2023.102180"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10198\u2010022\u201001464\u20108"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/1751-7915.13952"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/19490976.2024.2337312"},{"key":"e_1_2_11_20_1","unstructured":"British Medical Association.2022.\u201cBMA Covid Review 2. 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