Advice to the Independent Panel on Pandemic Preparedness and Response
The planet is only nine months into the Covid-19 pandemic, yet the scramble has begun to digest the lessons learned and prescribe corrective actions. Earlier this week, the Global Preparedness Monitoring Board and the Lancet COVID-19 Commission each weighed in with recommendations. Eyes are now on the Independent Panel for Pandemic Preparedness and Response (IPPPR), announced by the director-general of the World Health Organization (WHO) in response to the Covid-19 resolution approved by WHO member states in May. This week, the Panel initiates its work with an ambitious timeline to submit interim findings to the next meeting of the World Health Assembly (WHA) in November and a final report next May.
The Panel benefits from two strong co-chairs, former New Zealand prime minister Helen Clark and former Liberian president Ellen Johnson Sirleaf. Both are very familiar with health crises, the geopolitical forces that drive crisis response, the exasperating weaknesses and gaps these crises expose, and the urgency to act. Another seasoned personality, former acting WHO director-general Anders Nordstrom, heads up the Panel secretariat. Twelve experienced and diverse members have just been appointed.
As the CSIS Commission on Strengthening America’s Health Security stated in its November 2019 report, the world has been mired in a cycle of crisis and complacency toward infectious disease outbreaks. The IPPPR is the latest in a long line of international panels that examined health crises from SARS in 2003 to H1N1 in 2009 to the West Africa Ebola outbreak in 2014 to 2016.
Predictably, many post-crisis studies gather dust on shelves, as political will, public attention, and resources shift elsewhere. However, there have been notable instances where these exercises have contributed to significant gains. The Ebola crisis and studies that followed led to the strengthening of the WHO Global Health Emergencies Program and widespread adoption of the Joint External Evaluations (JEEs). The post-Ebola reviews also triggered greater cooperation across industry, governments, foundations, regulatory bodies, international organizations, and research institutes on development of medical countermeasures for epidemic-risk diseases, including creation of the Coalition for Epidemic Preparedness Initiatives (CEPI), which is now a partner with the WHO and Gavi, the Vaccine Alliance, in the new COVAX facility to ensure low- and middle-income countries can access a Covid-19 vaccine.
Our Advice to the Panel
Pick Your Spots
The Panel needs to approach its job with eyes wide-open. The Covid-19 pandemic differs from any other health security crisis the planet has faced since 1918: it is planetary in scope, it is driven by an exceedingly pernicious virus, and it threatens the lives and livelihoods of huge swaths of society, particularly the most vulnerable. Many more months, possibly years, lie ahead amid high uncertainty and the swirl of “mutually exacerbating crises” that threaten to worsen food insecurity and poverty and erode health, human rights, and developmental gains.
Carefully and quickly, the Panel should select what really matters—where it can have significant impact. There is little time to consult and contemplate, and the Panel has a single shot to deliver its findings. Its brief mission is to offer a select set of smart, timely, bold yet actionable recommendations and then leverage every ally and platform at its disposal to ensure they are taken up by those with the power to effect meaningful change.
Confront the Diplomatic Void and Stark Country Disparities
Humankind is living through a fraught, fragmented, and dangerous moment in world history. 2020 has been marked by a startling absence of global leadership and high-level diplomacy amid hyper-nationalism. The toxic, escalating U.S.-China confrontation has politicized the response to Covid-19 and vaccine preparations, generated conspiracies, and paralyzed the UN Security Council. Since the outset of the pandemic, the already fragile WHO has been overwhelmed and boxed in, as it came under grueling pressures from a China determined to delay, deny, and intimidate. Thereafter, the Trump administration battered the WHO, alleging it had become an accomplice of China, and initiated the process of terminating U.S. funding and membership.
Many countries, mostly in Asia and Europe, have shown success in controlling the spread but still struggle with rebound outbreaks. But the larger story—which the Panel cannot shy away from—has been China’s failures at the outset of the pandemic and the subsequent catastrophic failures of governments to take the virus seriously and mount robust responses, most egregiously in the United States but also in Brazil, India, Russia, South Africa, and the United Kingdom.
Gross inequities and bitter divisions between the wealthy and the non-wealthy powers remain stark, whether this involves hoarding the pre-purchase of vaccines or dominating the marketplace for tests, reagents, personal protective equipment, and oxygen. The ACT Accelerator, with its focus on equitable access for lower-income countries to vaccines, therapies, and diagnostics, is one fragile bright spot of international collaboration, but it is far from assured of success. The United States has declined to support the ACT Accelerator on the grounds that the WHO is a partner of this initiative.
Kickstart High-Level Political Leadership
The Panel should bluntly spell out the failures and the successes of state leadership to ensure their own health security capacities. The United States had among the highest country ratings on health security but has far outpaced other countries in Covid-19 cases and deaths. Leadership has been its greatest shortcoming, compounded by a deeply divided political culture and chronically weak local public health system. While no country has been spared Covid-19, those that have best succeeded in containing the pandemic—Germany, New Zealand, South Korea, Taiwan, Thailand, and Vietnam, among others—have exhibited decisive, consistent, and coordinated national leadership, guided by public health experts and the best available science, engendering the public trust.
The Panel should spotlight this diplomatic void. It should exhort world leaders to lift themselves above their narrow, nationalist preoccupations and behave as global statesmen and stateswomen in pursuit of shared common interests. This message should be especially directed at the United States, Russia, China, and the United Kingdom.
Ending this pandemic and stopping future ones requires a new degree of high-level political will and diplomatic action, with a shared commitment to stabilize the least wealthy and most vulnerable countries in the face of a cascade of economic, social, and humanitarian crises and bring about a rapid and equitable deployment of vaccines, therapies, and diagnostics.
Go Back to the Basics—Invest in Preparedness
The Panel should call for a significant increase in investments in the essential core capacities to detect, prevent, and respond to outbreaks at their source. While Covid-19 has laid bare some additional fault lines and gaps in the international system, many, if not most, of the areas for action are well known and have been highlighted by previous expert panels (including the CSIS Commission). Among other things, these include: developing and implementing whole-of-government national health security action plans; establishing rapid and resilient systems for early outbreak warning and detection, including data collection and sample sharing; building a robust frontline health workforce that is well equipped to identify, treat, and contain infectious diseases; and maintaining global, regional, and national supply chains and stockpiles to deliver personal protective equipment, testing, and other lifesaving supplies to the front lines faster.
Most of these needs are already reflected in the International Health Regulations (IHRs), which every country is bound to under international law, and in the JEEs, which more than 100 countries had completed at the end of 2019. They are also reflected in the Global Health Security Agenda 2024 Framework, which more than 70 countries have committed to implement. The Global Health Security Index makes clear that no country in the world is sufficiently prepared, but the problem is especially acute in low- and lower-middle-income countries with the weakest health systems, limited fiscal space, and other pressing development needs—constraints that will only multiply in the wake of the worst global economic recession since World War II.
Closing these capacity gaps will improve pandemic preparedness and create stronger health systems to help governments deliver better health services to their citizens and accelerate the path to universal health coverage—political win-wins. And at an average of $5 per capita, the estimated costs of preparedness are but a tiny fraction of the trillions of dollars and counting in economic losses from Covid-19. Yet despite this compelling case, time and again governments and international donors fail to invest. That is why the Commission has called for the creation of a Global Health Security Challenge Fund that can marshal resources from both public and private sectors commensurate to this challenge and incentivize governments to prioritize preparedness in their national budgets.
Advocate for WHO Inspection Power and Enhanced Global Surveillance
To avoid another grave crisis in which a dangerous pathogen appears on the soil of a powerful country that then chooses to delay, deny, and obfuscate during the critical early days, WHO member states need to be persuaded to yield some measure of sovereignty to a newly established WHO inspection power and enhanced surveillance capacity. This will be no small feat given sovereign sensitivities, hyper-nationalism, and the massive pain and economic dislocation powerful member states are experiencing today. But it is elemental to preventing another Wuhan-style coverup.
Countries have granted authority of this kind to the International Atomic Energy Agency for nuclear weapons inspections to verify compliance with the Nuclear Nonproliferation Treaty, recognizing this as a global security issue. Pandemic threats should be treated in the same way.
The IHRs will need to be reformed to establish such an inspection power. Any movement in this direction will immediately stir resistance from the most powerful and the less powerful who fear interference in their internal affairs. But there has never been a more promising moment for a debate over this issue. Success is imaginable if a determined nucleus of states moves rapidly to capitalize on this moment of global crisis to reopen the IHR treaty and push to win agreement on the creation of new capacities to ensure accountability. That is the boldness that this historic moment demands.
Consolidate R&D Gains and Tackle the Dangerous Reality of the “Infodemic”
The Panel should seek to consolidate and advance the early progress of the ACT Accelerator, including its COVAX vaccine facility, secure the future of CEPI as a global research and development coordination hub for epidemic risk diseases, and ensure that Gavi, the Vaccine Alliance, has the means to expand its role in the procurement and delivery of vaccines to low- and lower-middle-income countries.
No less important, the Panel cannot ignore the growing internet sewer that is rife with falsehoods, paranoid conspiracies, weaponized social media, and suspected espionage. As public trust in government, media, and institutions has declined, anti-science forces have ascended. The Panel will need to say something concrete about what governments and international organizations should do differently to address this dangerous reality and to ensure that a critical mass of humanity will accept vaccines and other countermeasures to stop deadly outbreaks. This effort will need to spotlight the many instances during this pandemic in which public health and biomedical institutions (and their leaders) have come under sustained assault, and what concrete measures are needed to protect and restore their integrity and functionality.
Lay Out a Concrete, Time-Bound Roadmap for International Action
How might this be done? There are ready-made venues for high-level summitry, including the UN General Assembly, UN Security Council, the G7, and G20. The Panel should also engage in systematic outreach to bring in the perspectives of local health providers and communities that have borne a disproportionate burden of Covid-19, owing to poverty, bias, and discrimination.
The Panel should also press the UN secretary general to convene a summit before the end of 2021 at which heads of state commit to the actions their governments will take in response to the Panel’s recommendations. This could also launch an ongoing high-level diplomatic process, akin to the Conference of Parties for climate change, where world leaders come together on a regular basis to review progress and drive coordinated, sustained action on Covid-19 and pandemic preparedness. That process could yield easily accessible and comparable cross-country data so that the media, parliaments, and civil society can shine a spotlight on performance and hold governments to account.
The Covid-19 pandemic has destabilized every corner of the globe. The Panel has a fleeting opportunity to focus the attention of world leaders—and the publics who suffer under the pandemic—on the priority actions needed to compel high-level statesmanship, equip the WHO with the inspection and enhanced surveillance power it sorely needs, convince nations and donors to invest in long-term capacity to protect against pandemics, and push back effectively against anti-science forces. These are the steps that can break the cycle of crisis and complacency.
Stephen Morrison is senior vice president and director of the Global Health Policy Center at the Center for Strategic and International Studies (CSIS) in Washington, D.C. Carolyn Reynolds is a senior associate (non-resident) with the CSIS Global Health Policy Center.
This commentary is a product of the CSIS Commission on Strengthening America’s Health Security, generously supported by the Bill & Melinda Gates Foundation.
Commentary is produced by the Center for Strategic and International Studies (CSIS), a private, tax-exempt institution focusing on international public policy issues. Its research is nonpartisan and nonproprietary. CSIS does not take specific policy positions. Accordingly, all views, positions, and conclusions expressed in this publication should be understood to be solely those of the author(s).
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