‘COVID-19 is a powerful demonstration that a pandemic is so much more than a health crisis’

By Tedros Ghebreyesus

 

Dean Williams,
Dean Elmendorf,
To the McNamara family,
Students of the Harvard Kennedy School,
Dear colleagues and friends,

Good afternoon, and thank you so much for the privilege of delivering this year’s Robert McNamara Lecture.

This is indeed a great honor, and such a great pleasure.

But I must admit that the task of delivering a lecture with war and peace in its title weighs heavily on me, at a time when we are now seeing conflict in Europe of a kind we all hoped had been consigned to history.

Like you, we are watching events unfold in Ukraine with deep concern for what this will mean for the region, the world, and especially for the health of the affected populations.

And sadly, Ukraine is not the only conflict in our world. From Afghanistan to Myanmar, Yemen, and my own country of Ethiopia, it’s an unfortunate reality that all too often, conflict and disease go together.

The authors of WHO’s Constitution were well aware of the link between health and peace, which is why they wrote in the preamble that the health of all peoples is fundamental to the attainment of peace and security, and is dependent upon the fullest co-operation of individuals and States.

Since those words were written, the world has faced many outbreaks and epidemics. Just this century, we have seen H5N1 influenza, SARS, MERS, the H1N1 pandemic, multiple Ebola outbreaks, Zika and more.

But of course, nothing matches the scale of the COVID-19 pandemic, which has thrown the world into turmoil for more than two years.

COVID-19 is a powerful demonstration that a pandemic is so much more than a health crisis.

It illustrates the interconnectedness between health and the economy, security, education, and the intimate links between the health of humans, animals and our planet.

There are many lessons to learn about what has worked and what has not.

Let me suggest five:

The first is that science must guide policy, not the other way round.

Throughout the pandemic, WHO has convened thousands of scientists from around the world to examine the rapidly emerging evidence and distil it into the guidance we give the world.

Just this week, we have convened a research and innovation forum to identify the most pressing research priorities and chart the way forward.
Science has given us valuable insights into how this virus spreads, how it causes disease, and how to stop it.

But in some countries and communities, and on social media, the marginalization and politicization of science has impeded the response to the pandemic and cost lives. Politics undermining science.

My point is not that science should be the only consideration in decision-making about public health. My point is that science should be the central and guiding consideration.

The second lesson is that science can in fact widen inequalities, unless it is paired with a commitment to equity.

I’m sure that most or all of you are vaccinated.

And yet as we speak, 83% of the population of Africa is yet to receive a single dose of vaccine.

Vaccine nationalism, export bans and bilateral deals between manufacturers and high-income nations severely restricted the number of doses COVAX was able to ship in the first half of last year.

The supply situation has now improved, and COVAX has been able to ship more than 1.2 billion doses of vaccine to 144 countries and territories.

WHO and our partners are working night and day to support countries to turn vaccines into vaccinations, to reach our target of vaccinating 70% of the population of every country by the middle of this year.

To reach that target, we are calling on all countries to urgently fill the ACT Accelerator’s financing gap of US$16 billion, to ensure equitable access to vaccines, tests and treatments and PPE everywhere.

The third lesson is that a resilient health system is not the same thing as an advanced medical care system.
Even some countries with the most sophisticated medical care were overwhelmed by COVID-19.

By contrast, some middle-income countries with fewer resources fared much better, thanks to investments in public health after outbreaks of SARS, MERS, H1N1 and others, especially in the Mekong region.

For instance, the simple art of contact tracing is one that many high-income countries have struggled with, but it’s one that many low- and middle-income countries have done well, because of their experience with infectious disease outbreaks, and their investments in public health.

The backbone of public health is robust primary health care, for detecting outbreaks at the earliest possible stage, as well as for preventing disease and promoting health at the community level.

The fourth lesson is that the world needs a new agreement that sets the rules of the game for responding to epidemics and pandemics.

Instead of a coherent and cohesive global response, the pandemic has been marked by a chaotic patchwork of responses, which in some cases have punished countries for doing the right thing, as in the case of the travel bans imposed on South Africa and Botswana when they first reported the emergence of the Omicron variant.

And the fifth lesson is that trust is everything.

A study published in The Lancet earlier this month examined the reasons why some countries have had higher rates of infection and death than others from COVID-19.

The age profile of the country, GDP per capita, and mean body mass index were all found to play a part.

But the researchers found that perhaps the single most important factor in countries’ preparedness and ability to respond effectively is trust.

The study concluded that stronger risk communication and community engagement are essential for making the world safer against future epidemics and pandemics.

Vaccines, diagnostics, therapeutics and other tools are essential, but the most effective tool is engaged and empowered communities.

Science; equity; public health; cooperation; and trust.

So what is being done to apply these lessons?

In fact, quite a lot.

There is a strong consensus that the world needs an enhanced global architecture for pandemic prevention, preparedness and response.

The recommendations of the various panels fall into four areas, or pillars:

First, we need stronger governance.
Instead of the confusion and incoherence that has fueled this pandemic, we need cooperation and collaboration in the face of common threats.

At a Special Session of the World Health Assembly last year, WHO’s 194 Member States decided to negotiate a new international instrument, to provide the rules of the game for pandemic prevention, preparedness and response.

Just as countries have united in the past to adopt treaties against tobacco, nuclear, chemical and biological weapons, climate change and more;

So now, the nations of the world have made a strong statement that health security is too important to be left to chance, or goodwill, or shifting geopolitical currents, or vested interests.

Over the past two days, the Intergovernmental Negotiating Body for this new instrument, or treaty, held its first meeting, here at WHO headquarters in Geneva.

A new international accord will not solve every problem on its own, but it will provide an essential overarching framework – the rules of the game – for a more coordinated and harmonized response to future epidemics and pandemics. Above all, obligations from countries.

Second, we need stronger financing.

It’s obvious that nationally and globally, we need substantial resources for strengthening global health security. Our analysis estimates the needs at US$31 billion per year.

To close the gap for the most essential functions – such as surveillance, research and market-shaping for countermeasures – we support the idea of a new dedicated financing facility, anchored in, and directed by, WHO’s constitutional mandate, inclusive governance and technical expertise.

Third, we need stronger systems and tools to prevent, detect, and respond rapidly to epidemics and pandemics.

Already, WHO has taken steps to build some of these systems and tools.

To strengthen surveillance, we have established the WHO Hub for Pandemic and Epidemic Intelligence in Berlin, to harness the power of collaborative and artificial intelligence and other cutting-edge technologies;

To facilitate greater sharing of pathogens and clinical samples, we’re piloting the WHO BioHub System, based at a secure facility in Switzerland;

To improve mutual accountability, solidarity and cooperation between countries, we’re piloting the Universal Health and Preparedness Review, a new peer-review mechanism for enhancing national preparedness, based on gaps identified to improve and strengthen national capacity;

And to strengthen capacities for local production of vaccines and other health products in low- and middle-income countries, we have established the WHO Technology Transfer Hub in South Africa, which has already developed its own mRNA COVID-19 vaccine candidate.

The choice of South Africa is because the greatest gap is in Africa. Of course, the hub will serve Africa and the rest of the world.

And fourth, we need to understand how this pandemic started.

We owe it to those who have died and their families to do our best to identify where this coronavirus came from.

It’s important to understand that WHO does not have a mandate to investigate outbreaks on its own. Our role is to conduct joint studies with affected countries, at their invitation. Especially with the negotiations of the Member States, I hope this will improve and we will have a mandate to investigate.
That is what we did in China last year – joint studies.

Every hypothesis remains on the table, and we are continuing to make progress, but we have also experienced setbacks in sharing of data – especially lab records.
Just last month I met with Premier Li in Beijing during my visit to China for the opening of the Winter Olympic Games.

We discussed the need to advance studies into the origins of the virus, including those relating to a potential lab accident.

To establish a more systematic way of identifying the origins of future outbreaks, we have established the Scientific Advisory Group for the Origins of Novel Pathogens, or SAGO.

There is much more that could be said about each of these areas, and I look forward to our discussion over the next 45 minutes.

Above all, the COVID-19 pandemic reminds us that health is not simply a luxury for the rich, it’s a fundamental human right. But it’s also a right that not everyone enjoys equally.

Last week, the world lost one of its foremost public health professionals, my good friend Paul Farmer.

Paul was one of Harvard’s most distinguished alumni, holding an MD and a PhD, and was the Kolokotrones University Professor and Chair of the Department of Global Health and Social Medicine at Harvard Medical School.

Paul passed in his sleep in Rwanda, where he was doing what he loved to do, supporting medical education at a district hospital.

He was a great humanitarian, and a tireless champion of equity and health as a human right.

Paul once asked, “If access to health care is considered a human right, who is considered human enough to have that right?”

It’s that right that I and the thousands of people I am honored to call my colleagues work for, every day.
Not health for some; not health for most; health for all.

Michelle, thank you and back to you.

Text of the lecture delivered by WHO Director-General, Tedros Ghebreyesus at the Robert S. McNamara Lecture on War and Peace, Harvard Kennedy School – 25 February, 2022