The Global Response to the COVID-19 Pandemic
Last month I addressed the Otago University Public Health Summer School on the work of the Independent Panel on Pandemic Preparedness and Response (IPPPR) of which I am a Co-Chair. The speech covers the mandate, work, and observations of the Panel to date. It will report again in May. The text of the speech follows:
“The Global Response to the COVID-19 Pandemic”
Rt Hon Helen Clark, Co-Chair of The Independent Panel on Pandemic Preparedness and Response.
Address to University of Otago Public Health Summer School.
Wellington School of Medicine, 5.30 pm, Monday 1 February 2021.
Thank you for the invitation to speak to the Summer School on the global response to the pandemic.
Tonight, I will reflect on the dramatic events of the past year, and on the work of the Independent Panel on Pandemic Preparedness and Response which I am co-chairing at the request of the WHO Director General.
But, first, let’s cast our minds back to where we were a year ago – on 1 February 2020. Maybe many of you here were at the Public Health Summer School – or preparing to go to it. A pandemic was the last thing on our minds.
I was in Europe. I had traveled there via India where I attended that country’s flagship geopolitical dialogue, the Raisina Dialogue. I went on to Switzerland to be at the World Economic Forum in Davos; then to Oslo where the Extractive Industries Transparency Initiative, an organisation I chair, has its headquarters; and then to the United Kingdom.
I was aware from media reporting at the beginning of January that the WHO was requesting information from China about the emergence of pneumonia cases of unknown origin in Wuhan. Then, while in Davos, I was present at an impromptu briefing on 23 January after news came through that the Emergency Committee convened under the International Health Regulations had not taken a decision to declare the by then identified COVID-19 disease as a Public Health Emergency of International Concern (PHEIC) – the highest level of alert under the Regulations.
On 30 January when I was in the United Kingdom, a PHEIC was declared, and the media was reporting extensively on the crisis in Wuhan. It all seemed strangely distant, with remarkably little comment on the threat which a novel coronavirus could pose to the world at large.
In mid-February I returned to Geneva for the launch of a Lancet Commission Report at the WHO. We heard there that there was likely only to be a small window of opportunity to avoid a pandemic, but that that window was closing fast.
On 11 March, by which time the disease had been reported in more than 100 countries and Italy had imposed the first nationwide lockdown in Europe, the WHO characterized the disease as a pandemic. While the term has no legal meaning in the WHO lexicon, it does attract attention when used.
As the disease continued to spread exponentially, the World Health Assembly at its virtual meeting in May, deeply concerned by the pandemic, called on the WHO Director General with respect to COVID-19:
“to initiate, at the earliest appropriate moment, and in consultation with Member States,
- (1) a stepwise process of impartial, independent and comprehensive evaluation, including using existing mechanisms,
- (2) as appropriate, to review experience gained and lessons learned from the WHO-coordinated international health response to COVID-19 – including
- (i) the effectiveness of the mechanisms at WHO’s disposal;
- (ii) the functioning of the International Health Regulations (2005) and the status of implementation of the relevant recommendations of previous IHR Review Committees;
- (iii) WHO’s contribution to United Nations-wide efforts; and
- (iv) the actions of WHO and their timelines pertaining to the COVID-19 pandemic – and
- to make recommendations to improve capacity for global pandemic prevention, preparedness, and response.
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In July, the WHO Director- General, Dr Tedros Adhanom Ghebreyesus, approached me and the former President of Liberia, Ellen Johnson Sirleaf, inviting us to be co-chairs of the review. We agreed – and our roles have been consuming a good deal of our time ever since. Our first tasks were to establish a secretariat, define terms of reference, and assemble panellists. The full panel met for the first time in September, and will issue a substantive report to the World Health Assembly in May this year.
The review has the formal title of The Independent Panel for Pandemic Preparedness and Response, and has been organized around four themes:
- to learn from the management of previous pandemics and examine the status of the global health system prior to COVID-19,
- to draw up an authoritative chronology of the unfolding of this pandemic to help understand where responses could have been improved,
- to assess the direct and indirect impacts of the pandemic – on health systems, societies and economies, and
- to develop a vision for a strengthened international system which is better equipped for pandemic preparedness and response.
I characterise our task as being to distill lessons from what has happened, and make recommendations which if implemented could help avert such a catastrophe again.
In January, we presented a second report on progress to the WHO Executive Board. It was described by the New York Times as “both a bleak recounting of deadly missteps and an early blueprint for repairs”. The Times went on to say that: “The report describes one failure leading to another, from the “slow, cumbersome and indecisive” pandemic alert system, to the years of preparedness plans that failed to deliver, to the disjointed and even obstructive responses of national governments.”
Our report said that there have been failings in global and national capacities before and since the emergence of COVID-19, and that these contributed to a pandemic developing. There had, for example, been a wide lack of preparedness at the national level. We say that scores received in various preparedness assessments did not predict the success or otherwise of how countries handled the pandemic, and suggest that scoring methodologies may not have had sufficient regard to leadership and political factors which have played such an important role in the response to the pandemic. Let us remember that the 2019 Global Health Security Index placed the United States first out of 195 countries with a ranking of 83.5, the UK second with a ranking of 77.9, and New Zealand 35th with a ranking of 54.
Our Panel has looked at the reports of twelve previous commissions and panels which had reviewed gaps in pandemic responses. They made many worthwhile recommendations, many of which were never implemented – many no doubt because Member State agreement could not be reached, and/or because there wasn’t a big enough vision for the scale of reform required across the international system.
The development of the authoritative chronology of the emergence of COVID-19 is a critical part of our work, because from that we can discern where critical gaps and time delays were. The chronology will speak for itself. There are clearly things which needed to be done faster.
Our impression is that the WHO is underpowered and underfunded to do the job the world expects of it. It has no rights of access to inspect when and where there is a disease outbreak, and it does not have the power to enforce the International Health Regulations. It seems unduly restrained by the regulatory regime which Member States have approved. We think it should be able to act in a precautionary way.
A month went by from when Wuhan issued a public bulletin about the cluster of cases of pneumonia of unknown origin to when the WHO Emergency Committee agreed, at a second meeting, to support the declaration of a PHEIC. That was a month when case numbers were expanding in China and beyond its borders. This was not 2003 when air travel within and beyond China was a fraction of what it is today. It was 2020 with a highly globally connected world. In these circumstances, hours and days matter in curbing transmission of an infectious pathogen, and a precautionary approach by WHO is warranted. If there are barriers to that, they need to be removed. As well, the cautious approach in the International Health Regulations to measures restricting travel seems somewhat unrealistic in today’s circumstances.
What is surprising to the Panel is the relatively lacklustre response there was at the country level in the month of February to the declaration of the Public health Emergency of International Concern. To use an antipodean phrase, much of the world seemed to stand by like a stunned mullet. The declaration of a PHEIC is something to be taken very seriously – put simply, there was a disease to be contained. Collectively the world failed to do that.
The Panel observes that the geopolitical tensions of 2020 were not conducive to management of the pandemic. The contrasts with Ebola in 2014 are stark. In September 2014, the UN Security Council resolved to declare Ebola a threat to global peace and security, and to urge Member States to do whatever they could to overcome the threat. No such resolution has been agreed by the Security Council in the past year. Agreement was belatedly reached on supporting the Secretary-General’s call for parties to conflicts to cease hostilities in order to fight the pandemic – that call and that resolution appear to have fallen on deaf ears if the raging conflicts in a number of countries are any guide.
The pandemic has had profound economic and social consequences. Many health systems have lacked the resilience to deliver essential services, students all over the world have missed out on education, domestic violence has soared, jobs and livelihoods have disappeared, and whole economies and government revenues have suffered. When the Global Financial Crisis of 2007-2009 had profound spill over effects, the G20 representing 85 per cent of the world’s economy rallied the necessary resources for the International Financial Institutions to support countries in difficulty. There has not been a commensurate effort during this crisis, meaning that many countries will emerge from it in worse shape than they could have. This too is a by-product of global tensions.
The Panel concludes from its work to date that there must be fundamental and systemic change around the prevention of, preparation for, and responses to pandemics. Our May report will make recommendations to that effect. The global pandemic alert system is not fit for purpose – it is not delivering at the speed required. Financing of global preparedness and response must be seen as a global public good, and invested in accordingly. Global institutions need to be empowered and adequately funded. There need to be better co-ordination mechanisms across the international system.
This pandemic should be the kind of wake up call to global health that Chernobyl was to the international system governing nuclear materials. After Chernobyl, countries agreed to share information and experiences as never before, and the International Atomic Energy Agency’s (IAEA’s) nuclear safety mandate and its Safety Standards were strengthened. A new Convention on Nuclear Safety and an internally co-ordinated response system centred on the IAEA’s Incident and Emergency Centre was put in place.
That response to Chernobyl tells us that when the world faces an existential threat to health and safety, it is capable of acting. Member State Governments should not let down the world’s peoples by refusing to step up on pandemic preparedness and response now. The stakes are too high. Those who don’t learn the lessons of history are doomed to repeat them.
The Panel’s interim report also called for immediate action in two respects:
1. We said that the public health measures which can curb the pandemic needed to be rolled out comprehensively and consistently. Many lives continue to be lost and long-term health damage is being done to others while efforts to contain the disease are sub-optimal. Further these measures will need to continue as vaccines are rolled out, and one suspects that there will be an ongoing need for a number of them beyond rollout as the disease moves from a pandemic to endemic phase. Populations need to be sensitised to that.
2. We are appalled at the highly inequitable access to the vaccines against COVID-19. The pandemic has highlighted inequalities and inequities within and between countries. One would have hoped that the response to it could have an equity focus. We say that a world where the wealthy have access to coverage and the poor don’t is a world on the wrong footing – wrong because it’s unjust and wrong because it thwarts pandemic control. The longer transmission rages, the more variants develop, and the more challenging it becomes to contain the disease effectively.
Over the next three months, our Panel will continue to consolidate its evidence base, distil the lessons to be learned from what has worked and what hasn’t, and debate the recommendations we will make. We have been urged to be bold. We are want our recommendations to be actionable – mere exhortations for more leadership and co-operation won’t do, nice as it would be to see more of it. A new global framework is needed, with strengthened institutions, fit for purpose legal instruments, and adequate financing. What will be needed is Member State recognition that a reset is needed, and for the multilateral instinct which should kick in where there is a common threat to come to the fore. Our Panel will make its recommendations in good faith and in the hope that change will happen.
