Renata Dwan
Good evening, everybody. Welcome to Chatham House, welcome to what has been a busy week, and great to have another in-person event, we’re really delighted to see you all. We have a super panel discussion today. We are also joined by many colleagues online, so, we’ll be taking questions and engaging with you both in the audience and in – online.
My name is Renata Dwan. I’m Deputy Director here at Chatham House, and I’m delighted to welcome two great speakers, one a former colleague, former classmate for – far too long ago, Mark, we won’t talk about that, but, Dr Mark Suzman, who is CEO of the Bill and Melinda Gates Foundation, travelling over from Seattle. And it’s a sign that we’re in some – emerging from some post-pandemic environment when we see people travelling all the way from Seattle, so, great to have you here, Mark.
And we’re also joined by another friend from further down the road of our house, which is the – Sara. Sara is joining us – Pantuliano, CEO of the Overseas Development Institute here in London, and one of the premier development think tanks in the UK. We’re here today to discuss the question of how we resume, how we rethink progress in development in the wake of the pandemic, and in – it’s called, Progress Post-Pandemic.
But really a question that we might ask ourselves is, “Are we really in a post-pandemic moment?” If you think about the statistics on COVID vaccines, we have 60% of middle and high-income countries in the world vaccinated, we have 3% of people from lower-income countries vaccinated. If we think about the global impact on the economy, we see high and middle-income countries growing, 6% growth last year, and we have in lower-income countries losses and decrease and return to poverty. We have an estimated increase of over two point – percent, 2.75, I think, percent in lower-income countries in the year ahead.
So, the pandemic is not over in many, many parts of the world, and I think that should be an important framing for our discussion today. We’re also seeing challenges of development in the context of the green transition, the promise, whether a post-pandemic recovery can lead to growth and movement away from fossil fuel dependency towards energy transition. Big question, whether the promise of $100 billion per year from developed countries to poorer countries to support their climate finance transitions; can that be met in a post-Ukraine world, in a COVID recovery world?
And then of course the backdrop, and I’ve managed to speak for five minutes without mentioning Ukraine, the war in Ukraine and the impact of that, not just on commodity prices worldwide, not just on energy supplies, but on the relationships, the fundamental fabric of our international community, and the relations between states and among states. So, a challenging agenda in which to discuss development. I’m delighted that we have two such eminent speakers with us to discuss that. This event is on the record. If you’d like to take some – your questions, make a comment, just raise your hand and the people will come round with your speakers. Feel free to take off your mask, then, when you do.
For those of you joining us online, please just put in your questions in the Q&A, and I’ll do my best to draw you in, in the discussion. So without further ado, Mark, most welcome to Chatham House, most welcome back to the UK, and we look forward to hearing you.
Dr Mark Suzman
Great, well, look, thank you, Renata, and thank you, everyone, and it is very nice to be at a meeting that is both in-person and online, in our new hybrid universe. This is actually my first international work trip in over two years, where I was in Qatar at the Doha Forum over the weekend, and then here in the UK, before heading back to Seattle tomorrow, and that itself is a sign of the times both pre and post-pandemic, if you like. And so, maybe a couple of opening observations. First, you talked about progress and, you know what is progress? And for basically the lifetime of the Bill and Melinda Gates Foundation, and we were set up in 2000, which was the same year that the Millennium Development Goals were launched at the United Nations, which had a target then of 2015, with ambitious goals of halving global poverty, you know, cutting child mortality by two-thirds, a number of goals and ambitions, which at the time, and I was at the UN at the time, helping launch those goals, were seen as impossible pipe dreams, conversations.
You know, at the time it was widely dismissed at the launch, that this was just another example of the UN having high, lofty aspirations that couldn’t possibly be met by reality, and the Gates Foundation was born into that moment, with a vision that, “Every person deserves the chance to a healthy and productive life,” which is our core mission and vision, and our work in global health and development.
Flash forwards: it is fair to say on most dimensions, certainly, you know, health, education, income, poverty eradication, reductions in child maternal mortality, HI– reductions in HIV, TB, malaria, areas we work on, the first two decades of the 21st Century were arguably the greatest advancement for the greatest number of people across a greater range of geographies all over the world than there has ever been in human history.
That was not widely understood at the time. It’s uneven, you know, I’m not claiming that every country in every part of the world did that, but there are – you know, countries from all over the world did have that kind of progress, and one of our challenges as the Gates Foundation, we find – they’ve – was few people, especially in the Global North, believed that progress had happened. We actually set up a report and a set of events we do at the UN General Assembly called Goalkeepers, to try and highlight on a fact basis, “Here’s how that does happen, why it’s happened, here are the solutions, here are the interventions.” And we still remain, as a foundation, you know, deeply optimistic about the potential for continued long-term development progress now, through the trajectory of the Sustainable Development Goals, which became the successors to the MDGs.
That said, COVID clearly is a moment that is – there is a before and an after. We are in a fundamentally different context geopolitically, economically and certainly in terms of health and development trajectories. First just the blunt fact that COVID itself stalled – you know, as Renata already said, we’ve seen the first increases in extreme poverty globally that there’ve been in aggregate since the late 1990s. We’ve seen a flattening of first reductions in childhood vaccination rates, those vaccination rates, the first increases in malaria after two decades of decline, all of that, and I’ll get – in fact, while having to deal with the COVID crisis itself, was also was a huge amount
Then you layer onto that the economic challenges of declines and, you know, cuts in global aid, the UK being, you know, one example, but not alone, on doing that. That the limited fiscal resources that most developing countries have had available to do, which have already now been largely exhausted, in response to the COVID pandemic, and now some external shocks coming in, like the Ukraine crisis, when it has a knock-on effect on global food security in particular, prices of fertiliser and wheat. And I would argue that, you know, this is a very fragile moment for the world and for the development trajectory more broadly. And I don’t think it’s fully understood and internalised, in a global discussion, because people are still in that vertical of the COVID response, the immediate – you know, the Ukraine war on your television screens, whatever it might be. And I think this is a critical moment where, over the next 12 to 18 months, whether the world, including, you know, some of the groupings from the G7 to the G20, to the, you know, the wider UN family, actually start grappling with this and provide the resources and tools to many of the key multilateral partners, from the World Bank to the regional development banks, to the UN agencies.
You know, there is a real risk that the next few years see continued setbacks rather than progress. I will come back in the discussions to where I do think there are some reasons for optimism, but I do want to be realistic about, that this is a moment that, certainly over the last 25 years, close to, is probably the most risky, in terms of the potential longer-term trajectory for development progress in – of the kind we’ve seen.
Renata Dwan
I am going to get you to come back on some of the good news, because that is a stark message, and one of the things that I think draws out some com – discussions around cohesion, solidarity, under threat; it’s not just a need, but the extent to which there’s cohesion and solidarity. And then something you didn’t touch on, but I think we’ll come back to in the questions, Mark, the discussions around, this isn’t a one-off, COVID-19. If there’s one thing that we’re learning, it’s, how do we prepare for the next pandemic, and if on the lessons of today, so I think there’s three questions that I’ll leave with you, that we’ll come back to in a moment.
But, Sara, how do we recover from where we are, and what is the future of the development agenda?
Dr Sara Pantuliano
Good question, so, let’s start from, you know, what Mark said. I mean, I think there is a pre and post, you know, pandemic, there is a big divider. I think, you know, what we experienced two years ago was probably the most monumental shock to our lives and, you know, our economies that most of us will ever recall. And I think it’s important to reflect on the fact that COVID brought out the best of humanity and the worst of humanity. I think the fact that we were able to produce and rollout 12 billion, you know, vaccines is, you know – and, you know, to have skilling up of social security systems at the time where our economies were ground to a halt, I think that’s a feat of human ingenuity that we should actually celebrate. But at the same time we saw, you know, $17 trillion going into national, you know, stimuli, when overall, overseas development assistance grew by a mere $5 billion overall, and in some countries, like in the UK, it actually fell. So we saw, you know, an incredible response at the national level. There was not much, that response at the international level.
And I think that was, you know, quite, sort of, shaming, shameful to witness, particularly because at the beginning of the pandemic I thought there was a moment where a lot of us felt that we were all together fighting against this common enemy, you know, where they could almost simulate a new international social contract. I mean, I wrote a blog at the beginning of the pandemic that had, you know, huge uptake and the title was, you know, We can’t go back to normal, because normal was the problem, which was really encouraging us to rethink, you know, how we could build better, or more resilient the system, you know, post-pandemic.
And I think that was the hope, you know, for many of us, but clearly it was – from the first signs, the first few months after the pandemic, the difference between the national response and international responses became very clear, and now we are dealing with, you know, a compounded, sort of, effect of COVID, climate and conflict, which is having highly uneven impacts on, you know, different countries, and I would say, even within countries, you know, a very different impact along gender lines, which is something I hope we come back to later on, because that has been, particularly COVID, a very stark, you know, example of these inequalities that we watch. And to me this is a real, you know, symptom of failure of multilateral governance, you know, to protect against shocks and stimulate recovery. So, you asked about making progress. So, for me, if we want to make progress and we want to put progress back on track, we need to put multilateral co-operation back on track, and I think that’s where I’m a little bit pessimistic, I’m afraid, ‘cause I think we’re seeing the opposite.
You know, we’re seeing an international social contract that is really being eroded by richer countries, really responding in a way that is characterised by protectionism and short-sightedness, quite frankly, and I think is leading many countries around the world to wonder whether the West, so-called, is actually a reliable and an honest partner for development by now, and there are many examples of that.
I mean, take the reluctance by the US around the issuance of the SDR, you know, the Special Drawing Rights, because it could benefit China or Iran or Venezuela, and so, you know, it’s a clear sign of the vulnerability of the multilateral system to be weaponised. And also, if you compare, you know, the flexibility of the delivery systems at the national level, you know, how we’ve seen during the pandemic, with the inability of the multilateral development banks to adapt their lending models, you know, so much so that a lot of the funding that was put out there for the procurement of vaccines has actually been in use.
And instead at the national levels – the national level we’ve seen in furlough schemes, we’ve seen unemployment insurance to protect citizens. Instead in the international level we’ve seen lines of credit, which means that, you know, this money will have to be paid back. That inevitably means cutting back on, you know, the, sort of, the expenditure ambitions further down the line, you know, that countries may have differently. And I think even the concern – there’s a concern that the challenges in – of tackling climate change are creating new barriers, you know, we’re seeing that in Europe through the Carbon Border Adjustments, so, even there we’re, sort of, not really creating a system that is equal enough. You talk about Ukraine. I think the freezing of Russian-held US assets is also raising questions around, you know, where next the US may actually use the dominance of the dollar, you know, to hit other countries. And that’s a general discourse I hope we’ll come back to in response to the crisis in Ukraine, right now, ‘cause there is are deal danger, in my view, that it will lead to a further – you know, to a bifurcation of the international system that could be very, you know, detrimental to what we want to achieve on the development side.
But, you know, you asked, “What can we do, what is the optimism?” I think there are things that we can do, and I think for us, you know, as development players, I think it’s – the moment has come to reframe development, because a lot of us talk of development as aid, and I think it’s not about aid. You know, you talk about solidarity; that’s exactly how I see it. We need to reframe development in terms of solidarity. It’s really about, you know, tackling, you know, the core injustice that most of our life chances are really set by where you are – have the fortune of being born.
But to tackle the injustice, I think, you know, the unavoidable reality is that the richer countries, you know, the citizens, the taxpayers in the richer countries will have to be open to, you know, mobilise more resources, because you can only tackle the injustice through greater international public finance. You know, that is what is needed, but, you know, we need to spend it in the best way possible to address these collective global challenges. And to me, it also means, you know, rethinking the multilateral development banks because I don’t think – you know, you talk about them, sort of, investing or putting money back in the MTBs or in the UN systems. I see that slightly different. I think the time has come to think how we put the money much more in the hands of those who are closer, you know, to delivering more directly, be that government, civil society or local businesses, ceding power to those who can decide, you know, better how this money is spent, and actually transcending, you know, the development conversations and going beyond the traditional, you know, development factors, if you want, you know transcending the current development structures, and engaging with, you know, labour associations, trade unions, human rights organisations, grassroots feminist movements, you know, local civil society and local businesses, both in rich and in poor countries, to really, you know, think differently about how we tackle this inequality and injustice in a way that can really, you know, enable, sort of, a transformative response to global challenges.
Renata Dwan
Fascinating to start from where you brought us, Mark, to the optimism of a mere two decades ago, and where you’re bringing us, Sara, to the need for a rethink of the architecture of multilateral assistance, aid, you say, “Solidarity,” that we think anew and in different ways about the development institutions.
Maybe I’ll start by asking both of you, where do you see the institutions that can drive responses right now to scaling up development assistance, to support COVID recovery, to tackle the food insecurity crisis that we’re seeing? G7, is it G20? You talked about multilateral development banks. You also hinted at going beyond state institutions. Mark, where are you trying to, as a foundation with over 53/$54 billion provided since 2000, where are you putting your energies and your channels for delivering aid?
Dr Mark Suzman
Well, do it at multiple levels, but to one degree on the multilateral things, I would say that we at the Gates Foundation are an interesting natural experiment over the past two decades of – Bill and Melinda would say – be among the first to say, when they first set up the foundation, as many people do who come and have generated large amounts of wealth from the private sector, that they don’t see relationships and partnerships with government or multilaterals as a central – is the stereotype, and, you know, we’ve both worked at the UN of these big, amorphous bureaucracies, and there’s, like, with all stereotypes, there’s a lot of truth to it.
But fundamentally what we found as the foundation is, if you want to actually generate results at scale, and outcomes, you need to work with and through these institutions. So, as a result, you know, we often get criticised for the fact we’re the second-largest funder of the World Health Organization after the United States, and does that mean we have disproportionate influence? And my counterpoint all the time is saying, “No, it’s a stunning indictment of how underfunded the World Health Organization is by all the governments and countries of the world.” There’s no way a philanthropy should be the second-largest funder of the World Health Organization, especially now we’ve all seen that in the wake of the global pandemic crisis.
And if you take the health thing again, we did have, while some great successes, in terms of the overall scientific successes, and that’s where a lot of our – some of the optimism I’ll come back to comes from, because we’ve invested and, you know, we were early investors in MRNA vaccines, at a time nobody thought they had a possibility of working, and we now know they do work for COVID, and they have amazing potential now for some of the diseases like TB, malaria, HIV, that have – that there are things that can be done. But what we didn’t have was a world approaching what Sara was talking about, a first truly global challenge, you know, with a global response. We tried. We did some tiptoe steps, the original articulation of what became COVAX was intended to be an instrument of global solidarity across North and South, but it quickly devolved into, you know, high-income countries essentially cornering the market on vaccine availability, leading to some of those disproportionate outcomes you talked about, around the vaccination in developing countries.
And so when you put it back to the institutions, this is where I do think the multilateral institutions have a critical and important role, but you want to do it in a more joined-up architecture. So, sticking with health, but we can come back to, you know, the climate area or others, that we know we need the ecosystem. It’s not just a stronger World Health Organization, it’s, you know, we need – this is a year for the Global Fund to fight HIV, TB and malaria, arguably the most successful single multilateral instrument over the past, you know, 20 or 30 years, in terms of number of lives saved and, you know, true accountability for dollars and pounds that have been put in, in terms of its true impact.
We have a replenishment that’s coming up that the United States is hosting, which – it’s unclear if the world’s going to be able to rise to meet that replenishment. We have the Gavi Vaccine Alliance, which has been the host of COVAX, struggling ‘cause it has to do its basic, core job of routine immunisation across developed countries, where we’ve seen huge success, we’ve got routine vaccination up to 80%, but now, you know, facing some of these challenges of how you follow-up and address this.
And then the point around the traditional world – say, the World Bank or the S – the IMF SDRs, which I completely agree with you, that’s the biggest pool of potentially available capital right now that could and should be being reallocated from the Global North to the Global South, that’s been caught up in geopolitics and, you know, Congress did not approve its initial allocation. There’s still things that the Europeans and others can do on their own, but I think there are those kind of – that’s a lot of – the tools and the architecture is still there. What’s missing is a, sort of, political vision and willingness to try and, you know, take and address those and think about not just the current crisis, but the future crisis. And the – you mentioned the pandemic, the – and I’ll close by saying, I didn’t talk about the future of global health security in my initial remarks, partly because one of my two bosses, Bill Gates, is coming out with a book in early May, and he will be in London at some point, about how to avoid the next pandemic, which I will happily give some previews to. But the short version is, “You should be making a lot of investments right now that the world is not currently making.”
Renata Dwan
And I think that he’s going to have a lot of echoes as we see this in the next few weeks. I think it’s great, this reference you use to the ecosystem, where we need governments to scale up, we need multilateral institutions to also invest in some of the preparation and the paving a way, the reference to vaccine technology, but also we need those alliances with non-state actors, civil society, community.
You flagged the emphasis on leadership and, Sara, I’m going to come to you. The UK has traditionally been a global development leader. It has been a global development leader more broadly, and then particularly in the health space, although not limited to that. This government has now, last year, announced a cut in its development budget, its overseas budget, from its 0.7 commitment of its gross national income to 0.5. At the same time it is – has underscored its desire to continue to play that global leadership role. You’re based in London. How are you tracking that, and what are the choices for the UK, as to where it’s going to seek to make that leadership investment, and how?
Dr Sara Pantuliano
Let me come to that in a second. I first wanted to just pick up something on the multilateral system, which I think is also important. Mark and I are both former, you know, UN officials. I strongly believe in the power and importance of the UN. I do also think that what we need for the multilateral system is really the – you know, particularly for the UN, is their normative standard-setting, standard-monitoring power, less the delivery, that they don’t actually do as efficiently or as effectively as they should do. And so, I think it will be important for us to continue to think of, you know, coalitions of the best-suited partners that can work towards, you know, shared goals, like you’ve done with Gavi, which is, you know, a fantastic example of what you can achieve and get the best of, you know, different players together.
But the tendency from many, you know, bilaterals and large foundations to channel a lot of money through, you know, UN agency, I think it’s not bold, in terms of the best, sort of, results on the ground, and I think we need to evolve these models and really think about, you know, coalitions of actors more and more who share a certain goal and can really make progress towards a certain goal, and strengthen the, you know, the normative evidence, sort of, I mean, gathering and, sort of, standard-setting and monitoring function of the multilateral institutions.
To the UK, so, this is an ongoing conversation at ODI, because we were a bit of a divided house on the 0.7%. Personally, I feel that too much attention and too much energy has been spent by the development community in the UK on advocating for the 0.7, “Let’s focus our attention onto quantum of aid rather than the quality of what we do.” And right now I’m a lot more worried about the quality of what we have, in terms of UK development assistance than the quantum. Of course, we would all like to have more and I would like, you know, to see more solidarity, as I said in my opening remarks. So, obviously, I would prefer, you know, if there was more, you know, overseas development assistance rather than less, but I would also like to see what we have allocated a lot more in line with what, you know, the needs really are, a lot, you know, less politicised and a lot less, if you want, vulnerable to the winds of the moment, which at the moment unfortunately we’re seeing changing, you know, direction, changing focus, changing priorities in a way that is not very well evidence-based or, you know, supported by – yeah, and what we know are the real needs on the ground.
To me that is a much more critical, you know, conversations that we need to have right now. Yes, of course, more would be better, but if the UK wants to be a global leader, it needs to go back to what it once had, which was real expertise at the heart of government, that was nurtured, supported and championed.
I was personally not necessarily against the merger, the merger could have been, you know, improved thing if it was done…
Renata Dwan
Not just for…
Dr Sara Pantuliano
The merger for the…
Renata Dwan
…for our foreign guests.
Dr Sara Pantuliano
…Foreign Office and…
Renata Dwan
The merger of the Foreign Office and the Development Department.
Dr Sara Pantuliano
But again, it was done at the time we were in the middle of the pandemic, so, not particularly opportune, without a clear strategy or set of objectives, because, you know, the two departments were merged, but not – it wasn’t – there wasn’t a vision, you know, around the merger. And so, I’m afraid the merger has been a failure, in terms of, you know, bringing the best ability of Diplomats, the UK Diplomats and the UK development expert, and it’s really, you know, sort of, undermined development expertise in a way that, you know, we see in – reflected in the type of choices of, you know, support.
When the cuts last year were made, they were not led where the UK had contributed to the best achievements, to really, you know, support the best outcomes on the ground, but, you know, they were slightly spurious, you know, in terms of deciding where the money should be allocated or redirected.
Renata Dwan
I’m sure we’ll have some questions on that, so, I’ll pause you here, but maybe to ask you both maybe to turn slightly to the question of climate now and climate financing, because that was and still is a priority of the UK Government. The UK’s still President of the COP until the COP27 in Egypt later this year. We’ve seen an enormous commitment at the vocal level, but also in terms of policy engagement at the G7 last year to – at the COP26 in Glasgow, a commitment to $100 billion per year in financing from developed countries to support developing countries in their energy transitions.
Now we have the COVID challenges, some of which you’ve outlined. Now we have the geopolitical divisions, some of which you’ve outlined, and the implications on energy prices for lower-income countries for the entire world, but felt most acutely in countries with less capacities and income. So, how is that going to shape the energy transition? Are we going to have a green recovery? Is the green recovery in peril and how can development actors think about navigating and channelling that continued commitment to climate transition, climate support in this moment? Mark, I’ll start with you, and then I’ll come to Sara.
Dr Mark Suzman
So, there’s a lot to unpack just in that set of questions. I mean, on the broader energy transition, there are many people with me in this room who have more expertise than I do, in terms of thinking through the implications, but clearly some of the short-term impacts on the current crisis, particularly the Ukraine crisis, have, you know, very short-term negative effects and – you know, but potentially some positive silver linings, in terms of the incentive structures and others for, you know, accelerating some forms of energy transition.
That said, as the Gates Foundation, while, you know, again Bill Gates has on a personal level a number of big projects around energy specifically, particularly an initiative called the Breakthrough Energy Benches, which is a coalition of high-net-wealth individuals making investments in long-term alternatives to fossil fuels. He deliberately uses private capital for that because this is a market-based – though you need incentive for the public sector, but the point is, in energy this should be self-sustaining. And one of our goals and roles as the foundation is always to think, how can we use our philanthropic capital to fill gaps that otherwise would not be being done by either the public or the private sector? And so on the climate stuff, even when you talk about the energy transition, I always take the opportunity to talk about the somewhat forgotten and marginalised bit of climate adaptation, which is quite apart from the transition – and, you know, Africa has taken – you know, has been responsible for less than 5% of greenhouse gas emissions, there are real problems happening right now, on the ground, with huge fluctuations in weather, many more frequent droughts and floods, huge consequences for smallholder farmers.
65% of the population of the poorest are still rural poor who depend on food and agriculture for livelihoods for both nutrition and income, and that knock-on effect which we – currently happening in the Horn of Africa again, or in Afghanistan, or other areas, is truly challenging. And so, there are steps that need to be taken right now, and one of the things I was in Qatar to do, interestingly enough, was to announce a joint partnership with Qatar for an initial, in this case, a $200 million fund looking for investments in climate adaptation of the kind – you know, our initial project just to – I doubt many people talk about chickens in Chatham House that often, but, you know, was what we launched – what we call ‘dual-use poultry’, which is chickens that are bred to actually survive better in the more arid and drought-prone conditions in Africa, where we’ve tested out and pioneered projects in Ethiopia and Nigeria initially, to show what those do. Dual-use means they can be used for both eggs and meat, they can be used by households both for their own nutrition, and they can be income generation.
And you mentioned gender early. They’re – overwhelmingly poultry is done by women farmers, and so, it generates income for those farmers and it allows them to, you know, invest in their own children. But that’s a climate investment, those set of investments into drought. I spent this morning, you know, up in Cambridge, looking at some of our partnerships and one big project partner where there is a new Crop Science Centre, which we’ve been helping launch and set out, that’s supported by the UK Government, which is looking at ambitious ways to transform nitrogen fixation and improve photosynthesis for crops, that will allow them to grow in more drought and flood-resistant areas.
So, it’s not a full answer to your question, I’ll let Sara talk a little bit moment, but I do want to make sure that whenever we talk about climate, you think about the consequences in real time, because no matter what happens, in terms of mitigation, the energy transition, for the next two decades the world is going to get warmer, and exactly those climate shocks that I’m talking about, that are already disproportionately affecting the very poorest, largely in South Asia and Sub-Saharan Africa, are going to be with us and need to be addressed as well.
Renata Dwan
And the empowering of those communities to adapt and respond…
Dr Mark Suzman
Absolutely.
Renata Dwan
…to that. Sara, your views on the…
Dr Sara Pantuliano
So, we are trying to monitor a little bit what the impact of, you know, the war in Ukraine can have on energy transition, and I think we’re – in the short-term it’s really difficult to determine, because there is a real danger that, you know, countries will go back to coal, countries will try and produce, you know, energy if they can, especially in Europe, if they can’t get, you know, sort of, supply from Russia. If they decide, you know, to stop the supply from Russia, they will, you know, sort of, increase their own production.
At the same time, is also true that, you know, energy’s becoming quite unaffordable for many in Europe and, you know, we could see a reduction, simply because it’s going to be an issue of affordability for many families. In the medium to long-term, I think the – our sense is that in Europe we will – this will be used as an opportunity to really, you know, step up the transition. So, there could be, you know, a positive benefit, you know, from the crisis, that this transformation actually will be accelerated.
But we’re not sure that that will be the case for the US, quite frankly, where the sense is that, you know, the crisis may end up, sort of, making, produce – you know, sort of, drilling the wells, so, sort of, extracting, sort of, more from the wells actually cheaper than it is now, and so, sort of, push, you know, the US, especially because, of course, some of Biden’s, sort of attempts, you know, to get the Bill to Congress didn’t go through, then actually this transition will be stalled, and will not progress as fast as, you know, we were hoping.
But there is an opportunity to actually use, you know, what’s happening, you know, geopolitically with Russia to underscore the importance of, you know, the green transition. The problem is how to make this transition just, how to make that equitable, a bit, you know, to Mark’s point, because of course we’ll be seeing, particularly with some of the, you know, the carbon adjustments here in Europe, actually it ends having an impact on, you know, producers in Africa that are actually very sustainable, and, you know, really, sort of, trying to be as energy-efficient as possible, you’re trying to be as, you know, sort of green as possible, blocked from accessing our markets, you know, blocked, you know, in terms of trade by, you know, sort of, impositions that limit, you know, their ability to make the most of very green, very sustainable production models.
Renata Dwan
Which links us up also, interestingly, to the question of sanctions as well, and how they’re managed in the regime. I’m going to turn now to the floor, to questions and answers. I’m aware that we have got a gender question that I want to come back, ‘cause I know it’s an area of passion that interest you both, but I’m going to start with a few questions, and we have this gentleman over here. If you’d like just to introduce yourself as you take the floor, that would be great. Thank you.
Sam Geall
Hi, I’m Sam Geall from China Dialogue, which is an independent publication headquartered in London. I agree with Dr Pantuliano’s initial, sort of, remarks about the failure of the West to demonstrate solidarity, you know, and to focus on this moment when the creation of new SDRs was blocked out of a fear for increasing, sort of, Chinese power. But I’d like to hear your reflection on where the scorecard sits, in terms of China as a rising donor, you know, that this year has had more of an opportunity to be involved in conversations around debt suspension, climate finance, a number of other areas, and Mark Suzman as well, just to – yeah, just to see how that stacks up. Thanks.
Renata Dwan
Sara, do you want to take that first?
Dr Sara Pantuliano
Sure. Now, I’ve been monitoring China really, really closely actually for a number of years, both on humanitarian, the development side, so, it’s that – it’s probably – we still call, sort of, China ‘a rising dollar’. I think it’s risen, it’s risen some time ago, it’s just that it’s less under the radar for some of the Western countries, because of the way they do it, which is a lot more direct, it’s a lot more bilateral, it’s a lot more in kind. And I think, you know, China, sort of, seize an opportunity during, you know, the pandemic to be seen as the most ready in solidarity, a lot more directly, you know, by providing vaccine to a number of African countries in particular. That was, you know, welcomed by African countries. It is at the moment also seizing the, you know, the opportunity to show solidarity with countries that are seeing the fallout of the Russian crisis, in terms of, you know, crisis of commodities going up and, you know, food insecurity growing, because they’ve been very fast at offering, you know, solidarity.
And there is, you know, an element of, if you want, rhetoric there as well, there is an element of, sort of, opportunists, but they’re seen as – by a number of, you know, African countries in particular, as actually being more forthcoming in, you know, their offer of support than the West has been for the past two years. So, geopolitically there is a serious consideration for, you know, Western countries that, particularly in the UK, makes a, sort of, a lot of importance of counter – you know, containing the rise of China, but actually, in terms of, you know, the overall shifts in the geopolitics, we’re seeing China rising quite prominently, in terms of being seen as reliable partner. And also, partner that dictates less what, sort of, lower-income countries, lower-middle-income countries would like to see. So, it’s seen as a country where the overseas development assistance is offered in the spirit of, you know, sort of, South-South co-operation, there is less conditionalities, if you want.
It’s not always true, but the perceptions are strong, and the perceptions ultimately determine, you know, the way partnerships are growing for many Sub-Saharan African countries, and some in the Middle East as well.
Renata Dwan
Yes.
Dr Mark Suzman
Yeah, we have an office in China, and we’ve worked in China for 15 years or so, and we started off initially working on domestic issues in China, particularly around HIV and tuberculosis, and we still do some work particularly around tuberculosis there. But over time our partnership evolved into ways in which we might look to work together on some global issues.
Some of it is research and development around, you know, health and drug discovery and the role of Chinese companies in entering global vaccine in other markets, ahead of COVID. Some of it is around areas like agriculture where, you know, China, for example, has some of the world’s best expertise in rice research, and we have partnerships with the Chinese Academy of Agricultural Sciences because, you know, the world’s largest rice importing region is West Africa, and working with them to try and see, are there ways you can breed more efficient, kind of, crops? So, I think there are areas of collaboration and co-operation, which are important.
Clearly the geopolitical context between the US and China rivalry has made that more challenging, to find areas together, but, you know, I’ve had discussions, even in the last year, with both US and Chinese Government officials about areas of still – can you have it, even if there is a greater power rivalry including on your – some of the developed work.
Coming back to the global health area, you know, a historical footnote: after the Ebola crisis one of the institutions that was set up, that has since played a pivotal role in helping address COVID, was the Africa Centers for Disease Control and Prevention. And the three initial funders and supporters that helped stand up for that now has a range of other supporters, and it’s a strong institution with strong leadership, were the Chinese Centers for Disease Control and Prevention and the US Centers for Disease Control, Prevention, and the Bill and Melinda Gates Foundation. Because this is a common public good, not just for Africa, but for the world, because it helps through testing, disease surveillance, it will help the next pandemic. It provides broader resilience, so, I think there are important and interesting areas of collaboration and co-operation in which, you know, China can be and is a very constructive partner, but, you know, alongside the US and the UK and others.
Renata Dwan
You talked about the three Cs, you talked about COVID, climate, conflict, and then when we talk about China, it’s often co-operation, competition, contestation, and whether global health is one of those areas of possible co-operation. We have another question here, my colleague.
Robert Yates
Thank you very much. Yes, I’m Robert Yates, so, I’m Director of the Health Programme here at Chatham House. I mean, clearly underinvested in health big-time, as has been shown through the pandemic, but just wondering what your views are about the relative balance between us concentrating on multilateral financing, as opposed to increasing domestic financing for health right across the world. And perhaps just give you a, sort of, an example of a very successful project that was after the SARS epidemic in China, where a very small project, actually funded by the WHO and DFID, helped the Chinese Government really understand that they were, in effect, sleepwalking into a US-style health financing system. And the Chinese Government then, in effect, renationalised its health financing system, and put $400 billion of tax financing into their health system since.
Now, you can see that in this pandemic the initial response in Wuhan was inadequate, but the subsequent public health response has been quite astonishing in China and, you know, that it’s been very successful in dealing with it there.
Looking forward though, do you think that we should be trying to help more countries do that type of approach, thinking that India, Bangladesh, Pakistan, so many countries have just been flat-lining at 1% GDP public health spend, and if we could concentrate more of our efforts on helping those countries make big step changes in public financing, that would dwarf the money in the Global Fund and Gavi and on these other multilateral approaches. And you know, perhaps we’re not getting the balance quite right, in thinking that we should be supporting domestic financing as much as multilateral stuff.
Renata Dwan
Gets us back to our first question, and where we need to go in the future. Do you want to take a go at that question, Mark?
Dr Mark Suzman
Yes, well, the first – the short answer is, yes, and yes. Clearly, we spend a great deal of time advocating across pretty well all government, saying why investing in health and human capital is actually one of the highest dividend-paying, long-term impact economically, socially, for society as a whole. I think it’s a no-brainer set of investments, but it’s done – you see the return over decades, and unfortunately, finance ministries and governments and others tend to think in terms of two, three, four-year periods, and health often gets short-changed. It doesn’t rise to the top level in many of these countries. But absolutely, the domestic financing is key and, you know, we work extensively in India and Bangladesh, Pakistan, Nigeria, Ethiopia, a wide range of these countries, and working both on how you raise those resources, how you spend them more effectively, ‘cause there’s also – you’ve talked about the quality of aid, but the quality of domestic expenditure in health is just as important.
And I want to be clear, when I talk about the multilateral financing, including the MDBs, I’m not talking about, sort of, top-down ecosystems. I’m talking about making sure they are providing and investing in the national infrastructures of those countries, and ideally led and guided by health plans that are developed by the countries themselves. I think, for all the successes of Gavi and the Global Fund, which we’ve been very proud to be partners of, and I think they’re real, I do think one of the misses has been really thinking across about how you are responding and helping these countries build stronger health systems, which become platforms for the full range of health delivery. We’re seeing that right now in the COVID responses, you’re trying to get that last-mile COVID delivery and realising that the health systems aren’t structured sufficiently to deliver that.
Clearly, the world would have been better off if we’d built some of those broader, sort of, supply chain systems, infrastructure beforehand, and that is – again trying to go back to some of the optimism, I think there is a real opportunity now, both for greater alignment and collaboration across the global entities, whether it’s the World Health Organization, UNICEF, how countries leverage World Bank or African Development Bank or other regional development bank resources, and match those with a much greater, more sustained investment – domestic set of investments in health.
Dr Sara Pantuliano
Yeah, just on the score, what Mark is saying, I completely agree and in fact, I mean, one of the things ODI is best known for around the world is our fellowship scheme. We have Economists seconded to 40 low- and middle-income countries around the world and the latest strand of the fellowship scheme is actually Health Economists do to precisely that, to help, you know, Ministries of Health as well as, you know, Treasury Departments and Ministry of Finance to, you know, enhance the health spend, the domestic health spend, to improve, you know, the way in which resources are used. And it’s worked really well, both in the response to the Ebola, you know, pandemic, particularly in Sierra Leone and Liberia, where our Health Economists really worked at the heart of government, but also, you know, in response to COVID in a number of countries, where they stayed in post and really helped, you know, try to get a number of the data that could improve, you know, how to respond domestically, but competitive, and that is the key.
Renata Dwan
I think it’s interesting, and it’s a good reminder of some of the points that you’re raising in the conversation: the SARS epidemic, the Ebola, the COVID. It’s a good reminder for us that it – that COVID isn’t a one-off, one-time pandemic, that the spread of infectious disease is the reflection of our globalised world, is something that – without wanting to terrify us, needs to be part of our lived existence and our planning and or thinking and our preparing. So, that really reinforces your message about domestic resilience.
We have two final questions here and then I’m going to go to our online if I may? Thank you. This gentleman here, and then our Director, Robin Niblett.
Michael Pugh
My name’s Michael Pugh. I’m a Lawyer and Academic. To what extent do you believe that in recalibrating our priorities, development priorities post COVID, there is a chance to create a world – help to create a world that is better than the world that we live in, which, some people might comment, is part of what has got us into this mess in the first place? And I’ve got a number of particular points to look at, like health. For example, Mark, you mentioned chicken and, you know, that’s really important, but the overabundance, if you like, of chicken and meat and food in general in the West has helped to create an obesity crisis and an explosion of cancer and lots of other health problems, and there are lots of other issues related to that as well.
You know, there’s a mental health crisis, which seems to be off the scale. The buildings and the cities that we live in are made of concrete, which is extremely carbon-intensive, condemned in COP26. We should be, according to the policies of COP26, looking for different materials. And then we’ve got our manufacturing model that is the basis of how many people make money, that the laptop that Renata is using, how long will that live and how long is that destined to last for? Because our model, it seems to me, is based, that that – you know, if you’re lucky, looks like a good one, it may last for six years or seven years, and then you’ll buy another one and, you know, part of that whole model is seen by some people as the cause of some of the problems that we’re in at the moment.
Renata Dwan
Thank you for that. That’s a very big question that is echoed by someone, Barry Murphy online, asking, “Well, was the model good before we went into COVID, and should we think about that?” Because we have quite a few questions, I’m going to let you digest that thought, and bring in Robin, our Director.
Robin Niblett
Yeah, thanks very much. I was trying to be – looking on the optimistic side, and I was harking back to something Mark said at the beginning. To what extent do you think, post-COVID, some of the technical breakthroughs that have taken place, for example, in MRNA, development of vaccines, could then be spread over to other areas, the digital provision of healthcare, which has exploded obviously in the last year or two?
Are there some areas where actually we could come out of this better, cheaper provision of healthcare, better solutions that are better suited to be delivered in more unequal societies? So, is there some hope out there on the technology side? I think, asking, well, both of you, but obviously from the Gates side.
Renata Dwan
Do you want to look for the hope?
Dr Mark Suzman
Yeah, so, let me try and tackle both. First, you know, is the question you raised and online and, you know, that’s a much bigger and more fundamental question about, you know, the world we live in, sustainable living patterns, what we have to do. It’s a very important set of questions, and I don’t want to underplay them, but I do want to emphasise, what I’m talking about, and which, you know, people often misunderstand, the visceral nature of extreme poverty that still exists for hundreds of millions of people around the world, and increased.
These are people living on $1.90 a day or less, they don’t have enough to eat, they – the chicken – it’s not a problem of sustainable chicken production. These are populations where 30 to 40% of the population grow up stunted and malnourished because they don’t have enough protein or access to protein, very basic there. The mothers are undernourished during pregnancy. These are – having the interventions to provide the income and tools and products for that proportion of the population, the least fortunate is not going to have a big disproportionate impact on the overall sustainability of the planet. You know, one week’s stop of emissions of, you know, people in a large or mid-size American city would probably have the same impact. And so, I don’t want to underplay it, but I do think that focus on the needs of the very poorest, which is where we come from, you know, is something, and with the climate adaptation, is something that, you know, we almost need to keep it separate. It’s not – that’s almost a – well, for my purpose, it’s both a moral and practical set of things that it just shouldn’t – we shouldn’t allow a world that has that, kind of, avoidable extreme poverty and, yes, we should be tackling these much wider set of issues. And that’s why I was a little gloomy in my opening bit about saying, “Actually, we had been making a lot of progress on a number of these areas for decades, at least two decades, that is now at risk.” That said, and coming back to Robin’s thing, yes, I think those are the reasons for it, but I still think the immediate, you know, here and now is going to be very tough, for all the reasons we’ve discussed today.
But some of the civil lines that have come out, there are new technologies, and I mentioned the MRNA technologies are a thing which could, and I think have a very high chance, of being transformative in terms of the way in which we tackle some of the diseases like HIV, TB and malaria, that have plagued humanity for a lot longer than COVID.
The digital tools that you’re talking about, not just in digital health, but actually, again the short-term damage of the loss of education by school closings and other things globally, including in high-income countries, has been devastating, as I said. That said, there have been some real innovations around digital tools of curriculum and teaching that can work even in very low-resource settings, that I think have potential to have much higher quality of education, which has long been a challenge in the primary and secondary education, I think, over the next five to ten years.
So, yes, in those types – those are the ones that we need those resources to both identify, properly fund and then, you know, help, and this is the role, I think, of foundations like mine and other partners of, do some of the high-risk testing to prove the scalability or proposition of the model that then allows governments, with international and domestic resources, to take and scale up. But – so, in the medium-term, yes, I do remain and think there is some real cause for optimism.
Renata Dwan
And I would just add two other points that I think are worth thinking about, Mark. Doctors and Nurses and medical workers became the heroes, and in many cases, the heroes of our society, and I think that support, that engagement, that understanding of the scale of the crisis and how people and communities and systems responded is something we need to sustain.
The other aspect that I think was very interesting was some of the new public/private partnerships that we saw. Health came on the agenda for many private-sector actors, that perhaps it hadn’t been before and – or to the extent before, you – quite apart from the Gates Foundation. So, is that something that we can think of, going forward?
I’m going to pose the last question to you, Sara, if I can. It comes from – we didn’t have too many – much of a gender diversity in the room in our questions, but we do have a gender diversity in our questions from Helga Flores Trejo from the – our online audience, and she asks about the food security crisis that is impending, which was there and threatening already. We had lots of warnings from WFP, but clearly the events in Ukraine are impounding that. How can we advance multilateral action? What steps could we take now, in the next few months that maybe are akin to the steps that we saw at the beginning of COVID to respond and to move and to pre – seem to pre-empt some of the worst potential fallouts of the food security crisis, at a time where it’s spring in the Global North? How – what actions could be taken in the short to medium-term?
Dr Sara Pantuliano
So, to be honest, there is a lot of awareness of, you know, how significant the food insecurity crisis really is, and how much worse it could become. We have some very strong data, there are very reliable tools have been created by the multilateral system over the years, you know, like the integrated phase classification, so, we know that what is happening, particularly in East Africa, and should worry all of us and keep us awake at night. And, you know, for all the ills of the multilateral system, my colleagues that work on humanitarian side of the UN have been, you know, raising the alarm and have been, you know, documenting the challenge that exists.
The problem is the willingness to act, and that is always the problem and the gap between the early warning that is very often raised quite timely in many, you know, food security crisis, and the action is always delayed, always almost to pre-famine conditions, which is unfortunately where we may end up this time too. You know, my husband is a Senior Executive at Oxfam, he’s about to go to Kenya, Ethiopia and Somalia just this weekend, because they’re trying to make a point that, “We cannot forget about this crisis because we’re distracted by Ukraine.”
But this is the problem, is, you know, the – our attention is distracted by the crisis in Ukraine. Well, we had some really significant crisis that actually made worse by what is happening in Ukraine, because we see the impact in the rise of, you know, the prices of wheat, of the prices of, you know, sort of, all kind of food commodities, which are actually creating, in addition to, you know, the – some real level of vulnerability in rural areas, also urban food security crisis, because we’re seeing riots in Cairo, as in Khartoum, as in other places, you know, in North Africa, in the – and in the Horn, because the prices are going, you know, through the roof. So, they could also create further instability and further crisis further down the line, because it will destabilise countries.
But, Renata, before we close, one thing we said we would touch on and we haven’t is really the gender dimension of the, you know, pandemic, as well as many other crisis, because I think the regression that we have seen during the pandemic should make us all pause, and I think, I just wanted to make sure we don’t forget that, ‘cause it’s really important. We’ve seen once again, you know, women bearing the brunt of the impact of the crisis, you know, the – all the unpaid care work fell on women. You know, we’ve seen so much – so many women, sort of, decrease the amount of paid work because they were taking care of the kids and they were doing the, you know, the schooling at home, all sorts of dimension.
I, you know, often quote the fact that – I’m the Editor-in-Chief of a journal. We saw, as many other journals, the number of submissions by men go through the roof, and the number of submissions by female academics plummet. All of this is in addition to what we have seen over the years, being a growing backlash against women’s rights that should really worry us, because I think for a while we’ve taken the progress that women had made for granted, and I actually think that the progress we’ve made, you know, in terms of gender advancement is, you know, neither is reversible nor, sort of, unchallenged. And right now we see a very concerted and actually well-resourced effort to push regressive, you know, sort of, policies against women, they’re amplified online, and we’ve actually also documented the number of, you know, sort of, resources that are put, you know, to this end, which should also call on all of us to be more vigilant and be, sort of, more consistently with, you know, sort of, grassroots feminist movements, both, you know, North and South, to make sure that the gains that we have made over the years are not lost.
Renata Dwan
It’s a sign of a good conversation when you end up with the most – some of the most critical questions right at the end. We are going to have to draw this to a close, but I really do want to underscore the importance of Sara’s points, and bring it to the discussions that we began with, which is, development is fragile if it’s not sustained. Progress can go backwards and we need concerted efforts to continue addressing poor issues.
We need to frame it as a solidarity issue and not a them-and-us issue, and we need to think creatively about new pathways for progressing development, and gender is not just a progression, as we were talking in the room before we came in, to support over 50% of the world’s population. It’s a vehicle to achieve development for 100% of the world’s population, because it is the entry vehicle for thinking about resilience, for thinking about delivery, for thinking about our next generations and for moving forward in new ways. So, I think that’s part of the – we began to think, “Does development need a rethink?” And I think it really is helpful to put gender back in that place, that when we rethink and we think of new pathways, or reinforcing pathways, that can be one of them.
I’m sorry that we have to bring this to a close, I know there’s many other questions. You will have an opportunity, for those of you who are live, to continue the conversation. Please join us upstairs in the Neill Malcolm room, where we have a reception, and where I hope we can tempt Sara and Mark to stay with us for a little bit and continue the conversation.
For those that aren’t lucky enough to be with us online today, or who joining us online, thank you for your attendance, thank you for joining us, and thank you for your interest in looking at new ways of thinking about old debates and how we go forward on that. I’d like to thank our speakers very much and look forward to the discussions [applause].
