World Health Organization Director General Tedros Adhanom Ghebreyesus was one of many world health leaders who spoke bluntly about the pandemic at annual meetings that end Tuesday. Commenting on the lack of priority of vaccines for poor countries, he said, “The world is facing a catastrophic moral failure.” Fabrice Coffrini / AFP via Getty Images Hide caption
Fabrice Coffrini / AFP via Getty Images
Fabrice Coffrini / AFP via Getty Images
How can we ensure that the world will never be so destroyed by another pandemic?
Health officials from around the world debated this question fiercely last week at the annual meeting of the World Health Organization’s Executive Council. The members, whose nine-day, largely virtual meeting ends Tuesday, have heard recommendations from four different bodies.
Some of these bodies are high-level, such as an independent advisory body set up by WHO to study pandemic preparedness and chaired by the former Liberian President – and Nobel Peace Prize Laureate. Ellen Johnson Sirleaf and former New Zealand Prime Minister Helen Clark.
Other committees are narrower, such as a committee of prominent scientists and health officials tasked with reviewing how the current regulatory system for international health emergencies worked during the pandemic.
Two more committees were set up before the coronavirus outbreak to more fully examine the WHO’s new emergency program and global pandemic preparedness and monitoring. Last week, two key WHO officials also weighed: Michael Ryanwho heads the emergency program and WHO Director General Tedros Adhanom Ghebreyesus.
While the conversations were far-reaching, common topics keep cropping up. Here are six of them:
Time for fundamental changes
The pandemic’s toll of more than 2 million reported deaths and global economic and social upheaval was not inevitable, many speakers said. It was the direct result, as former New Zealand Prime Minister Clark put it, “despite years of warnings that better preparation is necessary, not being adequately prepared for a pandemic threat”.
The hopeful side of this, at the very least, is that there are concrete steps that can be taken to prevent it from recurring if another deadly virus occurs. But the reformers repeatedly stressed that half measures would not be enough. As the co-chair of the Clark Committee, former Liberian President Sirleaf, put it, a “fundamental reset” of the world’s preparedness and response systems is now required.
The need for speed
Much of this rollback will be to significantly increase the pace at which individual nations and global organizations such as WHO assess incoming threats and take action. As Clark put it, “the international alert and response system has the characteristics of an analog system in the digital age.”
Many argued that the problem wasn’t so much a lack of data. Clark said, “Modern information systems [already] Collect signals of potential disease by searching hundreds of thousands of data points every day. “
Rather, the problem is that countries do not have the procedures to act quickly. One of the ideas discussed is the search for a way to feed the signals from local clinics and laboratories into a real-time tool that is available worldwide.
Also questionable: how can decision-making in response to the data be accelerated, including a revision of the WHO system for determining when an emerging disease is a “public health emergency”? It took the WHO four weeks to identify the coronavirus to take this step. And even then, said Clark, “too many countries have not acted quickly and decisively enough to apply the necessary and recommended public health measures.”
One solution is to create a medium alert that WHO can raise before reporting a full emergency, the chairman of one of the other review committees noted. Lothar Weiler, Head of the German Agency for Infectious Diseases, the Robert Koch Institute.
But Weiler added: “That is far from certain [this] This would lead to such earlier action. “A better option could be to use regular global and regional risk assessments to drive“ earlier and more targeted response measures at all levels. “Countries also need to develop clearer, pre-established steps for responding to international alerts, Weiler said.
While experts are still debating precise solutions, Weiler concluded, there is strong agreement on the goal: “It is clear that global preparedness, alert and response actions need to begin much earlier and more decisively than during COVID-19.”
Logistics is key … as is health workers
Mobilizing the whole world to respond to a global pandemic is not just about getting countries to act. It’s about making sure they have the physical means to respond: from diagnostic tests to treatments to vaccines. In other words, there is a huge logistical component that needs to be developed and distributed. When it came to that part, “everything collapsed in this COVID-19 pandemic,” said Mike Ryan, WHO director of emergencies.
“It wasn’t just a supply problem,” he explained. “There were manufacturing problems. There were raw material problems. There were distribution problems. There were error problems. There were competition problems between Member States.”
When it comes to preparing for the next major disease event, it will be critical to address each of these disruptions so that the supply chain and logistics system are far more resilient, Ryan said.
“It’s a much more complicated challenge,” he said. “And it’s going to be a comprehensive and, I can only say, complicated solution to make it work.”
A much larger global health emergency workforce that can be deployed quickly in an emergency is also needed, Ryan said. This is because a characteristic of this pandemic is that not all countries and regions within countries were affected at the same time. Some were unharmed in moments when others were badly hit. “And if they had got more help faster – if we could have moved [health workers] faster to these places – we could have saved more lives. “
Of course, to maintain a really robust disease detection and response system requires money. However, many speakers said that it is just as important to raise an adequate amount of funds to ensure that this flow of funding is reliable.
Felicity Harvey – Chair of a panel charged with the independent monitoring of WHO’s emergency program – said her committee had “repeatedly expressed concern about the lack of predictable and flexible EU funding [emergencies] Program.”
Sirleaf also raised the issue, saying: “If WHO is expected to raise funds on an ongoing basis because the estimated contributions to them remain low, it is at the expense of their ability to focus on pandemic preparedness and response. “
Ryan, the emergency program director, did not deny this. “I’ll tell you clearly,” he said. “There is a massive loophole in the rhetoric of funding [from donor countries] and the money we actually get. … My grandfather always said you get what you pay for. “
Inequality is a threat to everyone
The pandemic has not only made it clear how unequal the world is when it comes to health care. The world’s response is now actually deepening these inequalities, Liberia’s Sirleaf said.
Take vaccines, she said. “Tens of millions of doses of vaccine are already available in some of the richest countries. However, under current plans, vaccines will not be widely available in the African continent until 2022 or even 2023, for example.”
“It is unacceptable,” continued Sirleaf, “that wealthy countries can vaccinate 100% of their population, while poorer countries can get by on only 20%.”
Tedros, the head of the WHO, made a similar note. He noted that while WHO worked with other international organizations and governments to set up a system called COVAX for buying vaccines in bulk so that low- and middle-income countries could gain access, wealthy countries undercut COVAX has been. “Some countries and companies continue to prioritize bilateral deals, walking around COVAX, driving prices up and trying to jump to the top of the line.”
And he and other speakers ultimately said that this was also a problem for the rich countries. The appearance of variant strains of the coronavirus that may be more resistant to the vaccines in place is a reminder that as long as the coronavirus rages uncontrollably anywhere in the world, it is a potential threat anywhere in the world. In other words, Tedros said, “Not just this me-first approach [to vaccines] Leave the world’s poorest and most vulnerable people in danger, it’s self-destructive too. “
But Tedros and others argued that it wasn’t too late to move on to more justice. In particular, they advocate that wealthy nations who have signed upfront agreements with large pharmaceutical companies now donate some of these vaccine doses to COVAX.
“I must be blunt,” said Tedros. “The world is facing catastrophic moral failure.”
Why this pandemic might be the one that ultimately inspires action
Even as they made recommendations, many speakers seemed to consider how many previous efforts to prepare the world for pandemics have failed.
“With every new pandemic or other major health threat, there are many ratings that come with dozens of recommendations,” Sirleaf said. “They are almost too numerous to be counted and too few of them have been processed.”
Still, she expressed the hope that the scale of the crisis could make all the difference this time around. “This is a unique opportunity, given the severity of this crisis,” said Sirleaf, “to reset the system.”