Speech to Europe Meeting of the International Association of National Public Health Institutes
Rt Hon Helen Clark:
Address to International Association of National Public Health
Institutes Europe Annual Meeting on improving pandemic
preparedness and response in the aftermath of the COVID-19 pandemic.
Friday 21 April, 8.30 pm NZ.
Greetings from New Zealand to those of you gathered in Lisbon, and to everyone joining online, and thank you for the invitation to speak today.
Three years ago this month, Europe was at the epicentre of the COVID-19 pandemic, and the virus had spread to just about every country in our world.
The speed, scale, and severity of its spread caught many off-guard, despite years of warnings that such a pandemic could occur. The Global Health Security Index rankings proved to be a poor predictor of which countries were best prepared to address a health emergency.
As we are all aware, the toll of COVID-19 on human health and wellbeing, and on societies and economies at large, has been high. It seems likely that excess deaths during the pandemic exceed twenty million people. The hit to the global economy has been in the many trillions. All countries have been impacted, but those among low- and middle-income countries with less fiscal space have carried a particular burden. COVID-19 tore at the social fabric of our nations, and human development progress went into reverse across poverty eradication and other key indicators.
National Public Health Institutes – and their equivalents – have been on the frontlines of the pandemic, including in recommending public health measures which were not always understood or welcome. These have been a tough three years –and not an experience we would want to repeat.
In July 2020, the WHO Director-General announced that President Ellen Johnson Sirleaf and I would co-chair an independent, impartial, and comprehensive evaluation of the lessons learned from the international health response to COVID-19. This review had been requested by the World Health Assembly in May 2020. President Sirleaf and I then selected eleven others for what was titled the Independent Panel for Pandemic Preparedness and Response, established a Secretariat and went to work.
In May 2021, after consultations with experts around the world, multiple literature reviews, commissioning original research, and having dialogue with those working on the front-line and with civil society, we released our main report - titled “COVID-19: Make it the Last Pandemic.” We concluded that COVID-19 could be the last pandemic - if transformative changes were made to the international system for pandemic preparedness and response.
We recommended a package of measures encompassing:
- enhanced global political leadership, co-ordination, and accountability around PPR;
- dedicated pandemic preparedness financing, and a surge mechanism for funding a response phase;
- changes to international legal instruments to support faster and more effective action to stop a pandemic developing;
- an equitable, end-to end system for access to pandemic countermeasures, including to diagnostics, therapeutics and vaccines; and
- improvements to WHO’s financing and capacity.
President Sirleaf as Co-Chair drew on her experience of leadership during the Ebola outbreak in Liberia, Guinea and Sierra Leone from 2013-2016 which killed more than 11,300 people. That outbreak had also been the subject of high-level reviews.
In our report, we noted that “The shelves of storage rooms in the UN and national capitals are full of reports and reviews of previous health crises. Had their warnings been heeded, we would have avoided the catastrophe we are in… This time must be different.”
So, is it different?
There are processes underway which could make a real difference. For the most part, the areas the Independent Panel identified as needing change are being addressed, although not at speed and with optimal outcomes hard to reach.
On improving international rules: there are parallel efforts through different mechanisms to overhaul the International Health Regulations and to negotiate a “pandemic accord”.
Both sets of negotiations are timetabled to produce texts for agreement at the World Health Assembly in May 2024. This is not being done at the speed of lightning – compare this with the timeline for new international conventions on nuclear safety which were agreed within months of the Chernobyl nuclear accident. On the other hand, it took ten years to negotiate the recently agreed “High Seas Treaty” to better protect biodiversity in the world’s oceans – let’s hope that these current negotiations don’t come to rival that length.
Amendments to the International Health Regulations are being addressed by a Member State working group. For COVID-19, the lack of speed of reporting and lack of WHO authority were major problems. If countries can agree to more effective processes around reporting, transparency, investigation, and issuing global warnings, that would mark real progress.
In the IHR discussion, low- and middle-income countries are rightly concerned about equity and access to countermeasures. There is a view that if the pandemic accord were not to be successfully negotiated, such access must be captured in the IHRs.
On countermeasures in general, the accord and the IHR negotiations have de facto become the venues for defining elements of an equitable platform, but as yet, there does not appear to be enough emphasis on elaborating an ‘end-to-end’ approach.
Equity needs to begin with investment in research and development - all regions should have that capacity and the capacity to manufacture countermeasures. Never again will the Global South want to be left without access to essential commodities to fight a pandemic threat.
A number of former Independent Panel members have worked with experts to publish two Lancet comments this year elaborating what an equitable countermeasures ecosystem could look like. It should be based on openness, collaboration, and a global common goods model; and not on the secrecy, competition and profiteering which characterised the countermeasures response to COVID-19.
The WHO is currently working on what it terms an interim platform for pandemic countermeasures. It’s unclear as yet what this could look like. The emphasis should be on it being interim until an inclusive process has agreed on the principles for a new pre-negotiated ecosystem. If not, there is a risk that the interim platform will become the standing platform, and that business as usual along the lines of the inadequate ACT-A – the Access to COVID-19 Tools Accelerator – would prevail.
On Financing: Low- and middle-income countries need access to solidarity funding to maintain the surveillance, research and development, health workforce, and overall strengthened health systems required to identify and stop pandemic threats. The Independent Panel estimated that around $10 billion would need to be provided annually, and that up to $100 billion would be needed for emergency response when a pandemic threat materialised.
So far – just $1.6 billion has been committed to a new World Bank-hosted Pandemic Fund. This is woefully short of the needs, and given the toll of the full-blown COVID-19 pandemic, is out of step with reality. The Pandemic Fund has put out a call for proposals – but can only distribute $300 million as a first disbursement. An initial call for expressions of interest attracted preliminary proposals totalling several billion.
How to fix this? The Pandemic Fund hopes that by demonstrating results, more cash will flow in. But there are no guarantees. What is guaranteed is that the world will face more pandemic threats.
The Independent Panel recommended a global public investment model for new financing – whereby all countries contribute according to their means, and access funding according to their needs. An income-based formula is how the base programme of the WHO and the core and peacekeeping budgets of the UN are financed. There are also calls for the World Bank to make pandemic preparedness a core part of larger and faster lending at lower cost. Regional development banks must also play a role. Overall, current commitments in this space are not sufficient.
High Level Meeting at UNGA.
There is another opportunity this year to bring cohesion and higher ambition to pandemic preparedness and response – at the High-Level Meeting at the UN General Assembly in New York, scheduled for 20 September.
This meeting was recommended by the Independent Panel, because it believed that effective pandemic preparedness and response requires Head of State and Government-level leadership. One of the biggest gaps in the international response to COVID-19 was an absence of co-ordinated global leadership.
Put simply, the job which needed to be done was much bigger than the WHO had the mandate to muster. COVID-19’s impacts spread far beyond the health sector, and co-ordinated responses needed to be developed across economic and social policy and across the international system.
To fill the leadership gap at the global level, the Independent Panel and others have recommended establishing an inclusive council comprised of Heads of State and Government, and with civil society and private sector representation. It would work closely with relevant UN bodies - including WHO, and with the multilateral development banks
This council would not govern the global pandemic preparedness and response system, but it would work to ensure sustained commitment to it - between and during crises.
A new health crisis with potential global impact is arising every few years. From the time of SARS in 2003, we faced H1N1 influenza, concerns about MERS, Ebola in West Africa, Zika, Ebola again in the Democratic Republic of the Congo, COVID-19, and most recently mpox. The AIDS pandemic has been long-running. Each crisis has also been beset by poor access to vaccines and treatments – if they exist at all, or with access limited to wealthier countries.
After each crisis, the world moves on, neglecting again the need to be prepared. Then we return to panic mode when a new threat emerges. It’s time to break this cycle.
From the High-Level Meeting in September, we need a concise, action-oriented political declaration. It should commit countries to addressing political leadership, sustainable financing, equitable access to countermeasures, and a stronger, more independent WHO working in a co-ordinated multisectoral system with sensible rules around reporting, investigating, and stopping outbreaks before they become pandemics.
I am working with former Independent Panel members and others to advocate for this kind of declaration, so that the High-Level Meeting doesn’t end up as one more talk shop with an inconsequential outcome.
At National Public Health Institutes, you know far more than most the perils of lack of preparedness. Your own countries may already be well into the neglect phase of the panic and neglect cycle – with underinvestment in public health, including in ongoing surveillance and measures around COVID-19. Many countries also have an exhausted health workforce.
So, this is the time to rally, as hard as you can, to encourage national and local investments in preparedness and response. These should be based on lessons learned from the COVID-19 experience - ideally drawing on formal reviews of it.
It’s also time to rally for preparedness based on whole-of-government, and whole-of-society multisectoral approaches. We must be acutely aware of the impact COVID-19 had on the most vulnerable – whether they were the elderly, the sick, the disabled, or a range of marginalised communities. Preparedness planning must address the social determinants of health inequities, and provide for effective social protection, health system resilience, and continuity of education by whatever means.
National Public Health Institutes can also lead efforts to ensure that governments test preparedness, through simulation exercises.
It will be important to share lessons learned and best practice across international networks. Every country has experiences to share. Among low- and middle-income countries with recent experience of pandemic threats prior to COVID-19, there were lessons learned from those events which they could quickly draw on when faced with COVID-19.
And let’s not forget that COVID-19 itself is still infecting a great many people, and causing death and longer-term health issues, particularly among the most vulnerable. The SARS-CoV-2 virus has the capacity to surprise us again. Surveillance should be continued. Data must be shared. We must watch for and warn of any alarming changes. Public health measures should be calibrated to the level of risk at any given time. Vaccination schedules must be maintained. More buildings need better ventilation to reduce the risks of transmission of COVID-19 and other respiratory pathogens.
We should also collect and share information about the other impacts of COVID – on mental health and on adolescents and youth, for example. On long COVID, there is still much to learn. This continues to be a pandemic with sharp teeth and a long tail.
Thank you for giving me the opportunity to speak today. Knowing that you are collaborating and learning from one another offers great hope. I wish you the very best with the remainder of this conference, and with your continued work.