On 12 May 2021, the Co-Chairs of the Independent Panel, Her Excellency Ellen Johnson Sirleaf and the Right Honourable Helen Clark, made the following oral presentation of the main report, entitled “COVID-19: Make it the Last Pandemic.” Read the main report, including a summary, the companion evidence-based narrative and a series of background documents here on the Panel’s website.
Remarks of The Right Honourable Helen Clark
The report we present today is the culmination of many months of hard work by the Independent Panel and its dedicated secretariat.
Our task was to understand how COVID-19 could have moved from being a localised outbreak to a global pandemic, and to recommend changes which could avert such a catastrophe happening again.
Remarks of Her Excellency Ellen Johnson Sirleaf
A tremendous amount of work has been done that has resulted in the findings and recommendations we present today. We as a Panel are immensely grateful to all who have taken the time to contribute to our work. Thank you.
As Co-Chairs we thank all our Panel members. They brought deep knowledge, experience, and expertise to our work. Our time together has been intense and focused, and a shared view developed of what needs to be done.
I join you today to present our report from New Zealand, a country with zero tolerance for COVID-19 transmission and with extremely careful monitoring for any sign of the disease.
In our audience today, some may be fortunate to be in countries with decreasing rates of COVID-19 transmission and increasing vaccine coverage.
Yet, elsewhere, cases, illness, and deaths have been on the rise. There has been some welcome news of late – for example, it is understood that the G20 is considering fully funding ACT-A, the Access to COVID-19 Tools Accelerator, and the recent announcement of US support for waiving intellectual property rights for COVID-19 vaccines is a gamechanger. But, as of now, the end of the pandemic is not in sight.
Almost 100,000 people died from COVID-19 last week around the world. The daily news brings us scenes of hospitals, health workers, and systems overwhelmed, and reminds us of the continuing socio-economic and human tragedy of this pandemic. This is a disaster that we believe could have been averted.
Ellen Johnson Sirleaf
The evidence the Panel has gathered shows that an outbreak became a pandemic because of a myriad of failures, gaps, and delays in preparedness and response. That was partly due to a failure to learn from the past
There are reviews of previous health disasters that have gathered dust in basements of the UN and governments for years. The world had been frequently warned of the risk of a global pandemic. Now we must act. This must be the last pandemic to cause devastation on the scale we are witnessing today.
In December 2019, astute clinicians in Wuhan recognised a cluster of pneumonia cases of unknown origin. They collected samples and had them tested. When the results showed that this was potentially a new virus, a notification was issued within the Wuhan Health System. These in turn were quickly picked up by media, by the ProMED system which conducts global reporting of infectious diseases outbreaks, some countries, and WHO.
But then, the systems designed to validate and respond to such an event were too slow to respond to a fast-moving respiratory pathogen. Whilst the virus was spreading, information was being hoarded and decisions were delayed whilst waiting on responses to laborious exchanges of official emails.
As information began to arrive at WHO, the organisation was clearly not sufficiently empowered to investigate, validate, and then confirm speedily that a dangerous outbreak was occurring.
WHO was hindered, not helped, by the International Health Regulations (IHR). The procedures under which it and the Emergency Committee of the IHR operate are not conducive to taking a precautionary approach. We believe, however, that even with the current systems, a Public Health Emergency of International Concern could have been declared by at least the 22nd of January.
Even so, following the declaration on the 30th of January, February was a wasted month. Despite clear warnings, far too many countries believed it would not affect them and adopted, in effect, a wait-and-see approach.
This wasted month of February meant that health systems became overwhelmed as the disease spread rapidly. Time had run out for many countries to avert COVID-19 having a major impact on them. There was also a global, “winner takes all” scramble to secure PPE, therapeutics, and other supplies
Too many countries, including some of the wealthiest, devalued science, denied the disease’s severity, delayed responding, and sowed distrust amongst their citizen with deadly consequences. This was compounded by a lack of global leadership and co-ordination, with geopolitical tensions and nationalism weakening the multilateral system which was designed to keep the world safe.
Pandemic preparedness has long been underinvested in. That failure to prepare and then respond in a timely manner has now resulted in a runaway pandemic which is forecast to have a $22 trillion impact on the world economy by 2025.
As well as directly killing more than 3.25 million individuals so far, the failure by many to invest in social protection, which is especially needed in times of crisis, has served to widen inequalities. The most vulnerable in our societies are suffering the most from the pandemic. 125 million more people have been pushed into extreme poverty. Those in the informal sector have often had little choice over whether to risk infection – their families must be fed.
Women and girls have suffered a disproportionate impact – the effects of the pandemic have been highly gendered. Sexual and reproductive health services have been disrupted, millions of girls whose education has been terminated were put at risk of early forced marriage, and there have been sharp increases in reported domestic violence around the world.
Despite the bleakness of the world’s current predicament, the Panel has noted some reasons for hope.
Frontline health workers have been magnificent during the pandemic, consistently going above and beyond the call of duty for their communities. We have listened to doctors, nurses, midwives, and community health workers who have taken on extra risk to try to save lives. At least 17,000 health workers are known to have died by March this year. All governments have a moral duty to keep the health workforce safe – now and in the future.
Then, the speed at which the virus genome was sequenced and vaccines were developed was unprecedented in human history. Science delivered when the world needed it most, but that science depended on the open sharing of data and knowledge. The benefits must also be shared freely and openly.
We have found example of countries that responded well in the first 90 days of the pandemic across income levels and political systems. The defining factor was competence, and not wealth. Those that heeded the lessons of the past, prepared well, were guided by evidence, and engaged communities in the response through transparent communication tended to be more successful.
Ellen Johnson Sirleaf
Now, on to our recommendations.
These come as a direct result of the findings from our review. They should be implemented as a complete package. If fully implemented, the package can accelerate the end of the current pandemic and put the world on course to ensure that this will be the last pandemic to cause devastation on the scale we are experiencing now.
Although most of our recommendations are focused on preventing the next pandemic, it is clear that there is an urgent need to take action to end the suffering from the current one. COVID-19 must not evolve into a neglected pandemic, controlled in wealthy countries while those with lesser means face border closures and years of waiting to access vaccines.
Clearly manufacturing of vaccines needs to be scaled up rapidly. But we also need those high-income countries with a vaccine pipeline for adequate coverage of their populations to commit to provide the 92 low- and middle-income countries covered by the COVAX Advanced Market Commitments with at least one billion doses no later than 1 September, and more than two billion doses by mid next year.
Right now, vaccine demand outstrips supply. If all the existing vaccines were redistributed, the total amount available would be grossly insufficient. The US announcement of support for a TRIPS waiver is a vital step in the right direction. But we need voluntary licensing and knowledge and technology transfer agreements now. We call on WHO and WTO jointly to convene the major vaccine-producing countries and manufacturers to get agreement on that. If there is no action within three months, a TRIPS waiver should come into force immediately.
We are calling for ACT-A to be fully funded, and for its $19 billion funding gap to be closed. We understand that the G20 is considering providing the full amount, which would be most welcome. Meanwhile, and on an ongoing basis, countries must utilise all the public health tools available to them to curb transmission – masking, social distancing, testing and contact tracing, to name but a few.
Another dangerous pathogen could emerge tomorrow. The world was not prepared for this one. It must be ready for the next.
Pandemics are an existential threat to humanity and highly destructive of societies and economies. Yet outside of a crisis, preparedness for them has not been a high priority for many. This pandemic has shown the importance of multilateralism, global leadership, and whole-of-society and whole-of-government approaches.
Our Panel recommends the creation of a Global Health Threats Council at the level of Heads of State and Government. Pandemic preparedness must be led from the top, and it must be multisectoral.
WHO staff have worked hard to issue relevant technical guidance and support to countries as the pandemic has raged. But the Panel believes it needs more powers and funding to do the job expected of it. We make recommendations to increase its authority and independence, including by securing an appropriate level of funding, and having its Director General and Regional Directors in future each serving a single term of seven years.
We are calling on WHO to set benchmarks for country preparedness and response capacities, and for countries to invest accordingly. WHO should formalise universal periodic peer reviews against the benchmarks it sets. We also bring the IMF into the picture – proposing that it incorporates assessments of preparedness as part of its Article Four consultations.
Ultimately, preparedness rests on national governments setting up the right structures, developing the needed capacities, and investing in vital assets such as health and other system resilience and social protection. Governments can listen and learn from the best practices we illustrate in our report.
A greatly improved system for disease surveillance and alert is needed – the current one is an analogue system operating in a digital age. WHO must have the authority to investigate outbreaks of concern rapidly, including being able to publish information and deploy investigatory missions without waiting for Member State approval.
The Panel considers that the current model of development and delivery of vaccines, diagnostics and therapeutics for pandemics is not fit for purpose. We believe there is a need to shift away from a market-based model to one based on global public goods. This can be achieved through a radical transformation of ACT-A.
Funding for pandemic preparedness and response is in general too little too late. These are global public goods.
We propose a new modality – the creation of an international pandemic financing facility. It must be able distribute up to ten billion dollars a year for preparedness and disburse up to one hundred billion in the event of a crisis. Ultimately investing billions in preparedness now will save trillions in the future, as the current pandemic has so clearly illustrated.
Ellen Johnson Sirleaf
We said earlier that our recommendations are a package. We propose that support for the package be formalised in a negotiated political declaration to be adopted by a High-Level Special Session of the UN General Assembly later this year. We also back the calls for a pandemic framework convention. It should fill gaps in the current legal system and clarify the responsibilities between States and international organisations.
Thank you once again for joining us today.
We believe our report is clear on both its diagnosis of how an outbreak became a pandemic, and its prescription of how to curb the current pandemic and prevent a future one. We invite all present to take part in driving this reform agenda. This must be the last pandemic to cause such devastation to human life, societies, and economies.
Ellen Johnson Sirleaf
Thank you. As we said at the beginning this report and the associated background papers are the culminations of months of work by both Panel members and the secretariat. We hope that this is the last report of its kind sounding the alarm on how underprepared the world is for the next pandemic and that it will be acted on.
Thank you. Our report sets out a clear timetable for action, and assigns responsibilities for that to the relevant actors across nation states, WHO and the World Health Assembly, and the UN General Assembly. We hope that the reforms will be implemented as a package in an effort to ensure that this can be the last pandemic.