The Covid-19 crisis should serve as a “Chernobyl moment” for global pandemic preparedness, triggering a series of actions to speed the end of this pandemic and to ensure it’s the last of its kind the world ever faces, according to a report from an international panel of experts.
The report by the panel, which was established at the behest of member states of the World Health Organization, calls on wealthy countries with Covid vaccine to share their supplies in large volumes and quickly, with 1 billion doses donated by September and another 1 billion by the end of the year. The report calls for swift negotiations to lift intellectual property protections for Covid vaccines — and an automatic waiver if the negotiations fail to deliver within three months.
It also recommends reform of the global architecture for pandemic preparedness and for significant changes to the way the WHO — which has led the global Covid response — is funded and functions, including limiting WHO directors-general to a single seven-year term to ensure their independence. Directors-general can currently serve two five-year terms, but must be reelected to secure the second term.
One of the report’s boldest recommendations is that the WHO should be given the authority to send teams to investigate outbreaks that appear to pose a pandemic threat without having to wait for approval from the country where the disease is spreading. The WHO does not currently have that power and it is not at all clear countries would be willing to give it to the agency. In fact, under the International Health Regulations, a binding treaty designed to protect the world against the spread of infectious diseases, the WHO cannot publish information about disease events in a country without the approval of that country.
“Sensitivities about sovereignty should surely not delay alerting the world to the threat of a new pathogen of pandemic potential,” panel co-chair Helen Clark, a former prime minister of New Zealand, said during a press conference about the report.
The document stems from a decision last May from the World Health Assembly — the annual meeting of the 194 countries that are WHO member states — to order an “independent, impartial, and comprehensive” review of the pandemic and the lessons that can be learned from it to prevent future such outbreaks. The resulting group is called the Independent Panel for Pandemic Preparedness and Response.
WHO Director-General Tedros Adhanom Ghebreyesus named Clark and Ellen Johnson Sirleaf, former president of Liberia and a Nobel Peace Prize laureate, co-chairs of the panel. Sirleaf and Clark then selected 13 additional members, including: Ernesto Zedillo, former president of Mexico; Joanne Liu, former international president of Doctors Without Borders; and Precious Matsoso, former director general of South Africa’s national department of health.
The group concluded that the pandemic could have been averted, had countries been better prepared, if the world had acted quicker, and if the international law governing responses to diseases outbreaks, the International Health Regulations, spurred action rather than hindered it.
“An outbreak of a new pathogen, SARS-CoV-2, became a catastrophic pandemic that has now killed more than 3.25 million people and continues to threaten lives and livelihoods all over the world. It is due to a myriad of failures, gaps, and delays in preparedness and response,” Sirleaf said.
She noted, though, that reports only effect change if they are acted upon.
“The shelves of storage rooms in the U.N. 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 today. This time must be different,” she said.
The report largely focused on changes needed going forward rather than a forensic recounting of the various missteps from early 2020, which drew criticism from Lawrence Gostin, faculty director of the O’Neill Institute for National and Global Health Law and Georgetown University Law Center. “The Panel fails to call out bad actors like China, perpetuating the dysfunctional WHO tradition of diplomacy over frankness, transparency and accountability,” he said in a statement.
Gostin also criticized the report’s recommendations on sharing of Covid-19 vaccine as weak, arguing they fall “woefully short” of what is needed. He said the report should have asked countries with vaccine to donate enough to vaccinate health workers around the world within 60 days.
The report did, however, note that the WHO could have declared the coronavirus outbreak a public health emergency of international concern — a PHEIC, in global health parlance — eight days earlier than it eventually did. (The PHEIC was declared on Jan. 30, 2020.) The panel acknowledged, though, that doing so did not appear to trigger any significant preparatory action, describing February as “a lost month” when many countries seemed to be hoping that what was unfolding would not hit them.
Amanda Glassman, executive vice president of the Center for Global Development, said she largely agreed with the report’s diagnosis of what went wrong in the early days of the pandemic, but wondered about the real-world applicability of some of the recommendations, such as giving the WHO the right to investigate potential outbreaks without seeking the involved country’s approval.
“It’s logical what is proposed, but I think we have to look really at the realpolitik and the incentives that have been operating in the space over the past period,” she said. “I don’t think inspection without some ability to sanction in some way or to have other countries react in way that would sanction — I think it would have less than the desired impact.”
Gostin agreed, saying the report “ultimately gives WHO no real power to enforce state compliance to prevent the next pandemic.”
The panel suggested PHEICs need to be reconfigured, making them “a clarion call for emergency pandemic response” with immediate guidance from the WHO on steps countries should take to prepare to face and mitigate the potential threat. As currently envisaged under the International Health Regulations, PHEICs focus on what countries should not do — instructing them not to put in place trade or travel restrictions.
Many countries have closed their borders during the pandemic, some like New Zealand to dramatic success. This aspect of international law and pandemic response will need to be reviewed, Clark acknowledged.
“I think we have to realize that we’re living in the 21st century, not in medieval times,” she said. “In medieval times, a disease traveled on foot and by donkey. These days, it’s on the next plane. And that, in our view, does require a rethink about the way in which the International Health Regulations deal with the travel issue.”
The report said the International Health Regulations actually hinder steps that could prevent a disease outbreak from spinning out of control. “The bias of the current system of pandemic alert is towards inaction,” it said, allowing control measures to be taken only if the weight of evidence supports them. The paradigm should be flipped, it said, with control measures implemented unless evidence shows they are not needed.
Liu, a pediatric emergency medicine specialist, likened it to treating a child in an emergency room who has symptoms compatible with meningitis. You treat as if it is meningitis until tests prove otherwise, she said, because failing to do so could be catastrophic, resulting in a loss of a limb or even death.
“This is the kind of mechanical mindset that we have to create. … If you kill the egg in its shell,” she said, quoting a French expression that means stopping something in its earliest stages, “that’s going to be it.”
On the issue of ending the current pandemic, the report recommended a number of measures aimed at addressing the imbalance between wealthy countries that have procured vaccines and the many that have had little access to this essential tool. It called on the G7 countries to immediately provide 60% of the $19 billion budget shortfall for the Access to COVID-19 Tools, or ACT Accelerator, an international partnership with a mission to spur development, production, and equitable access to Covid control tools like vaccines, drugs, and tests. The report also recommends that the ACT Accelerator become a permanent structure for developing and delivering global health goods.
As a means of improving global pandemic preparedness, it called for the creation of a Global Health Threats Council, to be headed by someone at the level of a head of state. High-level involvement is needed to keep pandemic preparedness work an all-of-government activity, rather than something left solely to health ministries, it argued. It also called for the creation of an international pandemic financing facility that could help low-income countries fund pandemic preparedness work, and could quickly disburse $50 billion to $100 billion, at short notice, in the event of a pandemic.
The panel also called for significant overhaul in the way the WHO is funded, describing the current system as “a major risk to the integrity and independence of its work.” The WHO’s budget for 2020-2021 is $5.8 billion — less than half of the annual budget of the city of Chicago (currently $12.8 billion).
Countries are assessed what are effectively dues, but those have rarely risen in recent decades and now make up just under 17% of the health agency’s funding. The remainder comes from voluntary contributions from big governments like the United States or the United Kingdom, or big philanthropies like the Bill and Melinda Gates Foundation. But much of the money that comes in through voluntary contributions is “earmarked” and can only be used for a purpose designated by the donor. The result is that big funders have an enormous role in setting WHO’s priorities.
The report called for member dues to be raised so that they make up two-thirds of the WHO’s budget, with the remaining third raised through a pledging process like that used by a number of other global health actors like Gavi, the Vaccine Alliance, or the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
“While countries thus far have not been open to this kind of change, with the present global crisis and the critical role of WHO, the time is right for a necessary shift in financing,” the report said.