Progress six months after the report of the Independent Panel for Pandemic Preparedness and Response. This report was released at an open Chatham House event on 22 November 2021.
HE Ellen Johnson Sirleaf (in a pre-recorded video)
Thank you, Rob Yates and the team at Chatham House for hosting the release of our progress report today. Six months ago, Prime Minister Clark and I presented the main report of the Independent Panel for Pandemic Preparedness and Response to the World Health Assembly and the world at large.
Our report was the product of months of meticulous analysis of the international response to COVID-19. We were privileged to work with eleven distinguished leaders to deliver it.
We recommended a comprehensive package of reforms to ensure equity, to leadership and governance, to finance and legal instruments, and to strengthen WHO. Action on this package as a whole is vital to stop the current pandemic, and to stop a future health threat from devastating the world as COVID-19 has done.
We are encouraged to see some movement to address some of the major gaps exposed in global pandemic preparedness and response. There are conversations happening in many of the right places. But the world is not moving with the speed this moment requires.
In the past 6 months, 90 million more people have contracted COVID19, and more than 1.6 million people have died. Those are only the reported cases.
Waves of disease and death continue. The resolve to maintain protective measures is waning, vaccine coverage is uneven, and people in the poorest countries still have almost no access to vaccines at all.
The world is losing vital time against a virus that continues to thrive when we don’t work urgently together.
It is over a year since the first results showed that COVID-19 vaccines were effective against severe disease and death. Today over two-thirds of the entire population of high-income countries are fully vaccinated. This contrasts harshly with the situation for people in low-income countries – where an average of fewer than one in twenty has received a single dose.
Our Panel calculated there were at least one billion doses available to redistribute to low-income countries by 1 September this year. Yet while wealthy countries have made impressive public pledges, just 256 million redistributed doses have actually been delivered through COVAX as we recommended. This is compounded by inconsistent delivery, a lack of transparency and even dumping of nearly expired doses. These practices waste a vital opportunity to save lives.
WHO estimates that up to 180,000 health workers have died from COVID-19, while caring for us and our loved ones. Many of these people lived in countries without enough doctors and nurses to begin with. The idea that a poor health worker is unprotected while the healthy and wealthy receive booster doses should present a deep moral quandary. To this there is only one solution – vaccine equity.
Countries must also make use of the full range of tools available beyond vaccines to manage COVID-19. It’s a vaccines-plus strategy – and it includes equitable access to diagnostics and novel antivirals, in addition to masking, distancing and ventilation as the epidemiology demands.
COVID-19 has demonstrated the urgent need for leader-level multilateral action to respond to both the current pandemic and to prepare for the next health threat. These health emergencies extend well beyond the health sector – into finance, trade, labour, education – the list of affected sectors is long. Pandemic preparedness and response demands a whole-of-society approach. This is what we called for in our report.
Specifically, to catalyse change, we called for Heads of State and Government to attend a special session of the UN General Assembly. There, they would agree a political declaration that would provide a roadmap to end this pandemic and avert another. The Global Preparedness Monitoring Board has echoed our call for a summit at that level alongside many other international actors.
The Right Honourable Helen Clark
I would also like to thank Chatham House for hosting this important event.
With respect to the UN General Assembly which President Sirleaf just spoke about, let’s remember what the HIV experience taught us. The UNGA High-Level Meeting on HIV in 2001 was catalytic to the global response – and led to global leadership, accountability and eventually, equitable access to diagnostics and treatment – within a few years.
In the context of COVID-19, we can be even more ambitious: yes, a fire is burning, but we have the tools available now to put it out – if we have the will to do so.
Now – let me say some more about what has and hasn’t happened in the past six months, and about what needs to happen to end this pandemic and secure the future.
The Independent Panel urged that action should be taken on its recommendations as a package – in order to transform systems for pandemic preparedness and response.
The centrepiece of that package is the Global Health Threats Council – which must be led by Heads of State and Government. Ultimate responsibility within governments for pandemic preparedness and response lies with Presidents and Prime Ministers. They also have the gravitas at the global level to drive change.
We are encouraged by support for the concept of the Council from a number of quarters, including from the G20 High Level Independent Panel; and notably from United States President Biden and South African President Cyril Ramaphosa. Such a Council, if created now, could galvanise action on pressing issues like vaccine equity, and for working coherently towards reforms that would enable us to avert another devastating pandemic.
Agreement to form the Council should be one of the actions arising from a UN General Assembly political declaration, agreed by leaders at a UNGA summit. On convening such a summit, there are also many voices of support, including recently from the Global Preparedness Monitoring Board. We are encouraged by the traction being gained in New York in support of convening such a summit.
Let me also be clear – an authoritative, independent WHO is another essential part of a reform package. WHO represents the nerve centre of all health aspects of pandemic preparedness and response. It is the guider of plans, the eyes and ears on disease intelligence, and a first responder in health crises. We need a stronger WHO with true independence and the focus, the authority, and the reliable financing to do the job Member States expect of it, including rapid response to pandemic threats.
There are two WHO working groups addressing The Independent Panel’s recommendations and those of other reviews. We are glad to see movement on the prospect of new legal instruments in particular – with a Special Session of the World Health Assembly being convened next Monday focused on that. Change could include strengthening the International Health Regulations and creating a new pandemic treaty.
For those who haven’t already done so, I encourage a close reading of a Lancet article published ten days ago, which analysed our Panel’s chronology of how a localised disease outbreak became a pandemic, and made specific observations on where the International Health Regulations fell flat. The paper also pointed to areas where a treaty could fill current deadly gaps, including in the equitable supply of pandemic tools as global public goods.
We urge Member States as they meet at the WHA next week to have it as top of mind that the world is still mired in a global emergency, and that the need to act is urgent. Our message is: please, don’t get stuck on commas in committees while a pandemic rages, and a new health threat could arise anywhere, at anytime.
On financing: In our new report, we stress that governance without finance lacks teeth and finance without governance lacks accountability. Despite an emerging consensus on the need to raise new financing, to the tune of at least $10 billion a year for preparedness, agreement on a new financing mechanism has not yet been reached. On mobilising finance, G20 has yet to act with the decisiveness which characterised its response to the global financial crisis. Its decision in October to establish yet another taskforce to explore the issues can only be described as disappointing.
We suggest now that an inclusive coalition of fast mover countries should support the calls for a financial intermediary fund – or ‘FIF’ – and make financial commitments to reach the projected goal of $10B per annum. The World Bank should immediately signal their willingness to host the FIF.
Over time though, we believe that the facility should become one based on ability to pay rather than on a charity model. We also want to see significant provision for responding to pandemic threats – to the tune of $100 billion that can be disbursed rapidly and predictably when a threat arises. Pandemic preparedness and response is a global public good. The donor model hasn’t worked for this pandemic, and it will not work in future. A sustainable approach to global public investment in this area is essential. The Global Health Threats Council should play a role in directing allocations from the facility through existing institutions.
There hasn’t been an equitable supply of tools to fight the pandemic, despite the sincere efforts of many people. We’ve talked a lot about vaccines, but many countries have lacked adequate access to other basics such as diagnostics, therapeutics, personal protective equipment, and even oxygen.
There has been some movement on broadening the base of vaccine manufacturing – with plans for mRNA manufacturing in African and Latin American countries. The voluntary licence agreements to deliver the newest oral antivirals to selected countries are also a step in the right direction. It’s a beginning.
But most countries would like to see a TRIPS waiver during the pandemic for vaccines, diagnostics and other technologies for the duration of the pandemic. We support that.
Put bluntly – global public health should not be held hostage to manufacturers who purchase patents – many developed with public monies – to spin into profit, with wealthy countries willing and able to pay top dollar for the products and buy more than they need, thereby excluding others from getting the access they need.
Ultimately the world needs an ACT-A-type platform which is truly end to end – with agreements and modalities to deliver pandemic tools as global public goods.
That is a brief summary of where the world has come on pandemic preparedness and response in the 6 months since our May report. There is more detail in the report, including a dashboard of progress and necessary next steps. .
Where will we be in another 6 months? To summarise – if the world is to end the current pandemic and prevent the next, we need:
While there are some reasons for optimism, time – and lives – continue to be lost for lack of the urgent, cohesive global leadership this pandemic demands.
- a Heads of State and Government summit to agree to a political declaration providing a clear roadmap for ending this pandemic and making the reforms needed to the global architecture. This includes its centrepiece – a Global Health Threats Council led by Heads of State and Government.
- Substantive progress towards a framework convention or treaty that plugs the gaps in the current legal framework – addressing roles and responsibilities for countries and international actors before and during an outbreak threat. It must also address equitable provision of pandemic tools as global public goods. We hope Member States will have focussed and fruitful discussions next week, and in the months to come. There is a lot of work to do to get fit for purpose legal instruments and a strengthened WHO.
- We need a more authoritative and financially secure World Health Organization – with clear powers to investigate outbreaks, declare alerts, and set plans for the response tailored to every region and country.
- Announcement of a new financial mechanism with at least $10 billion per year available for preparedness and the capacity to leverage up to $100 billion to fight future pandemic threats.
- We need to close the vaccine equity gap, full stop. But country leaders also need to be cognisant of the fact that the world can’t vaccinate its way out of this pandemic. A ‘vaccines-plus strategy’ including masks, physical distancing, contact tracing, testing and quarantine, and improved ventilation, diagnostics, and treatments is the only way we’ll get there. This virus slips through every crack it can find.
- And let’s get to work to create an end-to-end platform that will not leave anyone wondering when their turn in the queue will come for a mask, or oxygen, or a vaccine, or treatment.
Thank you once again to our panellists who made this work possible, and to the Panel’s Secretariat staff who continued to support us over the past few months. Thanks to Chatham House for hosting today’s discussion and to my co-discussants, including David Miliband and Zane Dangor of South Africa.
I look forward to hearing from you, and from those around the world taking part today.