Emma Ross
Okay, so welcome, everyone, to members and friends of – to Chatham House, where we’ve been convening on the big issues in international affairs for over 100 years. Thanks for joining us this evening and to help us continue this tradition. This discussion is on the record – bit of housekeeping first – and is being recorded and livestreamed. So, please do tweet if you’d like to, using the #CHEvents and @ChathamHouse to flag Chatham House.
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Okay, so let’s get started. With the fifth anniversary of the onset of the COVID pandemic upon us and the negotiations on the pandemic treaty in overtime and still struggling, we’re now battling to contain the mpox outbreak that began more than two years ago in Africa and is spawning new strains that are spreading to countries that never before have seen the disease. Calls for those sitting on stockpiled mpox vaccines to share them to help the outbreaks on the continent are going largely unheeded. Report after report is saying that the threat of pandemics is growing and that we are just not ready for it.
There’ll be many examinations of our state of readiness to face the next pandemic more successfully as we get closer to this five-year milestone, but for this discussion, I want to zero in on the critical aspects of political will and global equity. With me to discuss this today are three distinguished panellists, Former UN Secretary-General, Ban Ki-moon, Former New Zealand Prime Minister, The Rt Hon Helen Clark, the Veteran Champion of International Co-operation for Pandemic Prevention, Preparedness and Response, who is also one of our Presidents at Chatham House. And the Global Health Programme’s very own Osman Dar, an Associate Fellow, who is a leader in international co-operation on outbreak control and the One Health approach to tackling this issue, where efforts to protect us from emerging infectious disease threats are co-ordinated between animal, human and ecosystem health sectors, for a more effective prevention response.
We’ll first hear, though, some scene setting from Denis Mukwege, who is one of The Elders, who is going to set the scene for us before our discussion. Denis, if you’d like to come up [pause].
Dr Denis Mukwege
Distinguished members of Chatham House, ladies and gentlemen, dear friends, it’s an honour to have come here tonight to this important discussion. To speak bluntly and without wanting to pre-empt my fellow Elders on the panel, the question of whether the world is ready for the next pandemic can be answered easily. No. So, one word describes a litany of political and public health failure over the past five years and begs many more questions about the type of leadership needed to ensure that the lessons of COVID-19 are eventually learn and future catastrophes averted. This is why we are here tonight.
Speaking as a member of The Elders, but also, as a Physician, whose hospital in the Democratic Republic of Congo experienced first-hand the inequity in global health systems during the last pandemic, my conclusion is that we are confronted with a failure of leadership, precisely when it is most need. In 2020, when governments worldwide were scrambling to protect their populations and prevent an economic meltdown, my hospital struggled to gather the appropriate personal protection equipment and the medicines to adequately protect our staff and treat our patients. Large inequities within, and between countries, resulted in society’s most vulnerable paying too high a price, especially when it come to test drug and vaccine access.
As a former member of the World Health Organization scientific community, I saw reason to hope that the pandemic will prompt a political sea change, one towards a greater commitment to future preparedness, prevention and response. We saw some excellent scientifical backed reports and recommendations come out of organisations like the Independent Panel for Pandemic Prevention, Preparedness and Response, of which Helen Clark was a Co-Chair, and the Global Preparedness Monitoring Board, of which Dr Gro Harlem was a Founding Co-Chair. Combined with the lessons from previous disease outbreaks, global leaders need – knew what they had to do to make sure the world was better prepared for the next pandemic.
From the vantage point of 2024, I have to admit that I was wrong to hope. It is obvious that the lessons of COVID-19 are being forgotten. The world remains stuck in the familiar circle of panic and neglect that has characterised the past approach to pandemics. We need only look at the response, or lack of it. The current mpox epidemic hitting my country, and other African nations, wealthy countries in the developed world are largely stockpiling vaccine, while poor states actually confronted with the epidemic are going without. And as conflict intensify across the continent, the associated public health risks multiply. Ignoring these issues not only threatens lives but undermines any genuine preparedness for future pandemics and the health crisis which have no borders. More broadly, we are paying the price for so-called ‘pandemic fatigue’ among government and citizen alike.
While it is understandable that the public wants to move on from the trauma experienced during the COVID-19 pandemic, governments don’t have that luxury. Indeed, they have a responsibility to analyse the past, to hold accountable those whose decisions, or failure to make decisions, worsen the health, economic and social impacts, and to ensure that the future policies are sufficiently robust and comprehensive to protect the citizen in the face of future pandemics. We are not operating in a vacuum here. We have the know-how, the research and the data.
But at a national and international level, I have to say that this responsibility is being invaded and the political will is absent. Consider the attempts to negotiate a new pandemic accord that have been taking place at the World Health Organization in Geneva over the past year. In May, the World Health Assembly failed to finalise a new accord, even though the intergovernmental negotiating body have been working on the global pact for two years. Member states have extended talks for up to 12 month, but their governments still seem unwilling to provide a Negotiator with the political support needed to step up and agree on measures that can move the dial on equity in pandemic readiness, response and recovery. The negotiation is simply not being prioritised by global leaders. The failure to find consensus on substantive matters is symptomatic of growing trust deficit between advance and emerging economies, and of the ineffectiveness of the multilateral system in an era of deepening geopolitical tensions.
This is also apparent in the failure of the recent UN Summit of the Future to agree on emergency platforms that could better co-ordinate an international response to future global shocks, such as pandemics. Misplaced or distorted concerns about national sovereignty are hampering vital progress, as is the growing threat posed by misinformation in our digitally networked world. But this cannot be an excuse to delay action on one of the biggest threats of our time. I reminded of – I’m reminded of the word of The Elders previous Chair, Kofi Annan. He said, “Where the leaders fail to lead, the people will take the lead and make the leader follow.” This is our responsibility today, and I hope it will inform our decisions here tonight. Thank you.
Emma Ross
[Pause] Well, thank you, Denis. That’s quite a tour de force of where we are with this issue at the moment. So, I’d like to start with you, Mr Ban and ask you – it’s clear that five years on from the onset of COVID-19, world leaders are failing to take seriously enough the threat of pandemics. Be grateful for your reflections as – on your time as Secretary-General, on where you think we are with political will to face this challenge and what global leaders could be doing differently.
Ban Ki-moon
Well, indeed, the whole world’s people have gone through nightmarish days and years. Looking back, what had happened – I’m sorry – how international community, particularly political leaders, they had addressed this issue, I think there seems to be many, many issues which we have – we should not repeat. First of all, when coronavirus happened, was known that it was a coronavirus 19 – COVID-19, then, I think then President of the United State, Trump, just shouted that, “It is Wuhan virus, Wuhan virus.” That was terrible. I think virus can take place anytime, anywhere. Had international community and United State and developed countries used the WHO and their political power to address this issue, without complaining to a particular country, then I think that was the beginning of the bad things continuing – spreading all throughout the world.
Chinese Government was very unhappy, very angry, and they did not allow even the WHO inspection teams. That really made situation worse and worse. Therefore, looking back, we should repeat. Whenever such kind of things happen, that we should really leave it to Head of State. It’s alarming now to see that all these issues were given to WHO and also, some not responsible persons. Had this issue been taken care of, from the beginning, by the Head of State or Prime Minister, Head of the Government, then it might have much better. This is what we are now thinking.
Looking back, what had happened five years before COVID-19, when Ebola crisis happened in Western Africa. It took just one day, for me as the Secretary-General, to report to the Security Council that this is a serious threat to international peace and security. The Security Council was united at the time, and just took one day, declared, by adapting the resolution that this is serious threat to international peace and security, and it was brought to the attention of the General Assembly. General Assembly took just one day, one day, repeating the same things, and authorised my proposal to establish UNMEER, United Nations Mission for Ebola virus Response.
What happened to COVID-19? It took 49 days for the Security Council to take same action. Only after many people are dying, they realise that this is no longer political issue. This is a virus issue, therefore we should – only the time was too late. Whole viruses have been spreading all throughout the world. It is, basically, poor people, poor countries, they all were die. Even in South Korea, my country, one of the OECD members, one of the richest countries in the world, we had to wait long to buy mask, just one-piece mask. This was terrible even for me. Therefore, I hope that we should never repeat these kind of things.
Now, looking back to Ebola case, Ebola was also caused by viruses, but when it happened in Liberia, Guinea, Sierra Leone, we realised that there was no control at all among these three countries. Then we decided to block these frontiers so that people could not go and visit each other. And African people, they have some special tradition, like the Koreans or Asians. When their beloved people died, they would just embrace dead body. By doing that, I think all these viruses were spreading to family members and therefore, we deployed the Soldiers, military Soldiers, just to block people from coming and going.
United State deployed 3,000 Soldiers in Liberia, and United Kingdom and French Government, they took each countries, Sierra Leone by United Kingdom, Liberia by United State and Guinea by French people. By doing that we were able to contain this one. Then we established the headquarter in Ghana. I think that it is the first time in the history of the United Nations that to prevent virus, the United Nations and international military armies, military were deployed. That really helped a lot. Then I travelled myself to all these three countries, including Mali, which was almost sure that there would be – I really took myself and visited four countries. After returning home, of course, all our staff and myself were checked, thoroughly checked, by the CDC people at the JFK. Then we were under strict control by CDC. Because I was the Secretary-General, I was given some – a little bit special treatment, but all our staff had been quarantined 18 days. I was given one big telephone by CDC, I was told that, “You must not move around radius 25 miles. Just move around within Manhattan.” But ten days later, I was a little loosed – loose, then I was going out to New Jersey to play golf. And then suddenly, this telephone rang. There’s a recorded message…
Emma Ross
Okay, well, let me ask you…
Ban Ki-moon
…“Please return, please return to your home.” So, I had to cancel my golf.
Emma Ross
You violator of the rules.
Ban Ki-moon
This is something which had – must have been applied to the case of COVID-19. This is my – just reflection, you know.
Emma Ross
Yeah, sure. Well, that, kind of, brings me onto – I mean, we could discuss why is it that after that experience with Ebola being centrally addressed by the UN in New York, how did it end up at WHO this time round? We could debate that, how that happened, but – that would be interesting. But, also, looking forward, with the pandemic treaty, I remember at the time, there was quite a bit of discussion, should it be negotiated at the UN, or should it be negotiated under WHO? The decision was made, put it under WHO. Are you saying – do you think that was the right decision? Here we are with no agreement, it’s a bit of a shambles. Not sure, there are some people in the audience that are closer to the negotiations that might be able to update us on whether we’ll ever get one. But in hindsight, and moving forward, do you think this is one of the lessons that these things need to be handled, you know, maybe at the UN central? Why did it happen that way? What about the pandemic treaty, and will we learn from that – prospects for that happening?
Ban Ki-moon
Well, in hindsight, if and when this kind of crisis happens, I think there should be a strictly co-ordinated measures, and this kind of crisis should be taken at the level of the President and Prime Minister, who has direct authority, who can give command. Otherwise, you know, we may have to repeat. It will be very silly, if our human being – humanity, repeat the same things twice, having gone through all this hard work for five years now.
Emma Ross
Yeah, Helen, you’re nodding a lot.
The Rt Hon Helen Clark
Oh, I…
Emma Ross
What’s up with you?
The Rt Hon Helen Clark
…completely agree with Former Secretary-General Ban Ki-moon’s recollection of events, because I was there. The WHO manifestly failed with Ebola, and Secretary-General Ban stepped in, picked it up, went to the Security Council, with a lot of support from the members, got the mission established, and also appointed a high level panel, headed by Former President Jakaya Kikwete of Tanzania, which brought down a report. And the report recommended setting up a global health security council comprised of leaders, and then the institutions fought it to the ground, and that opportunity was missed.
But Ban Ki-moon is absolutely right to say, this needs the attention of leaders, which is why the independent panel that I Co-Chaired with another Elder, Ellen Johnson Sirleaf and President Ernesto Zedillo from Mexico, was on it, also with us tonight, we recommended a global health threats council, a standing council, comprised of leaders, which would keep an overview of the state of readiness for pandemics, and be ready to advocate for mobilisation of resources and response when required, but that, too, has been fought by institutions. Now, we made a recommendation from that panel that there be a pandemic agreement negotiated under Article 19 of the WHO Constitution, and Zeid Al Hussein said to me the other day, “Why didn’t you recommend it be done in New York?” Truth was, we never thought of it, but it should have been done in New York, which is better at negotiating treaties, and you bring more seasoned, I think, Negotiators into that forum.
So, the INB has struggled, the Intergovernmental Negotiating Body, in Geneva, and if, you know, you look at our title of your session tonight, “Is the World Ready for the Next Pandemic?” No, because the big reforms haven’t been made. Some reforms to the international health regulations, which are useful, but the accord stutters. The Pandemic Fund has only ever got a fraction of what’s required to support low-income countries for preparedness. There is, as yet, not concerted attention on the surge mechanism for when the worst happens and you need to scale up a response very quickly, although I see a G7-led group is beginning to talk about it. We’ve made no progress, really, on the issue of the TRIPS waivers. I mean, on the independent panel, and I think among The Elders, there’s a strong view that when you have a pandemic, all bets should be off. People must have access to the knowledge and technology to create the vaccines and the treatments, to stop things in their tracks.
That actually did not happen through a TRIPS waiver with HIV and it ended up being a negotiation, and it certainly didn’t happen with COVID. So, then you come to all the inequity issues where in the high income countries, you know, people were getting the first vaccines in the United Kingdom in December 2020. You could probably fast forward two years and health workers in Denis Mukwege’s country still haven’t had their vaccines, at all. You know, we’d probably had two or three boosters by the time the first ones got to frontline health workers in some of the low income countries.
All of this has left an incredibly sour taste, between North and South, between Africa and the North, and it’s not surprising the negotiations for the accord have run into a lot of trouble, because the South sees the North as protecting its pharmaceutical industries. In fact, I heard a surprising admission in a Chatham House Rules discussion, so I won’t say who said it, but a key Negotiator for a high-income country said that often their instructions – to the effect, often their instructions seem to be more like industry protection than global health protection.
Emma Ross
Hmmm, yeah, not surprising. Osman, I wanted to ask you your perspective on what you think is going on with the dynamics with the pandemic accord, or why – what’s going on with political will?
Dr Osman Dar
So, I think it really does fundamentally come down to this issue around inequalities and inequity. There’s a, almost a clear divide between the Global North, OECD countries, and the Global South, within the pandemic accord negotiations. And a lot of it is around pathogen access and benefit sharing, this technology transfer issue, the IP issues. In many ways, the divide between the old colonial powers and what are now supposedly independent countries, in that there’s almost this view that they – we need to keep this dependency going. We don’t want them to become self-sufficient. We want them to stay dependent on us, need us, you know, vaccines and therapeutics, diagnostics, need to be, sort of, donated. They shouldn’t have their own independent manufacturing capability or capacity, not be so self-sufficient in those terms and in that respect, and that’s an enduring feature.
And I think, you know, it’s bleeding – the whole issues around inequalities is bleeding across all areas of global public policy, really. It’s the fundamental fracture line across a whole set of issues, and it’s – when you talk about equity, it’s across the whole spectrum of PPR. So, it’s not just around response. It’s around the prevention side of it, the preparedness side of it, the response side of it, and between the sectors that are involved, as well. So, we know with emerging infections or diseases of pandemic potential, most of them arise in wildlife or in ecosystems, and then they spill over into livestock, they spill over, then, into humans. And there’s inequalities between those three sectors, as well, the environmental sector, the animal sector and the human health sector, and it’s good to just, perhaps, illustrate the size of the inequality.
So, just on response. OECD countries, in the first year of their – of the COVID-19 pandemic response, how much money had they spent on their own countries? Anybody guess? Something close to $11.7 trillion, in the first year, and that includes, you know, things like furlough, social security protections, all that. So, the response in OECD countries, the richest 4o countries, was around $11.7 trillion. By December 2021, so almost the end of the second year of the pandemic, WHO still hadn’t gotten all the money for the $1.5 billion they had asked for. There was still half a billion dollar funding gap. And they had already spent 11.7 – nobody had thought, okay, you know, we can borrow at 0% interest rates and fund – you know, issue all kinds of bonds and everything to fund our own responses. Let’s just give WHO a few tuppence to fund a global response. So, that’s the level of the inequality just on the response side.
On the animal health side, I mean, take a country like Sierra Leone, for example. Sierra Leone has five Public Health Vets, in the whole country. That’s the size of the animal health sector. How is it reasonable to ask somebody in the animal health sector, a Public Health Vet, in the animal sector, to also focus on anthrax or some disease that’s relevant to humans around surveillance, and just ignore, you know, whether fund – what is – what the person’s fundamental role is, which is control of animal diseases. The level of inequality is so huge that, you know, we sometimes don’t appreciate just how limiting a factor it then becomes in dealing with these kinds of – you know, in improving the control of pandemics and emerging infections.
And then, finally, on the political side, there’s the inequities within the multilateral system itself. And we’ve seen that – and, you know, it’s very difficult to sanitise or separate global public policy issues, and wherever you go with the pandemic accord negotiations, you know, I spent time with policymakers across Africa, across Asia, one of the conversations they’re always having – and I know this is coming in, sort of, sideways, is the war in Israel-Palestine. They say that the whole fund – the whole multilateral system is so unfair and so unbalanced, there’s no accountability, you know. If you’re powerful and wealthy and a military power, you can do whatever you want, you can ride roughshod over all kinds of international agreements. What is the point of even having a pandemic accord, if wealthy countries don’t abide by it?
So, I think these are the kinds of conversations that people are starting to have, and the dividing line between rich and poor is becoming wider, between what was colonised and what was – the colonizer is becoming wider and more open.
Emma Ross
That sounds quite depressing, a mountain to climb. Mr Ban and Helen, I wanted to ask a, kind of, reality check. We’ve, kind of, established that maybe it would have been better if this was handled at – in New York, rather than through WHO, but can we just get a bit of a reality check. Would it really have been credible for COVID to have gone that way, or even now for it to go that way, given the geopolitical climate? I mean, is the geopolitical climate today pretty much the same as it was during Ebola, so it could be possible to turn it, or are we in a different situation now that makes it more difficult to get a grip on this? Because what we’re doing now seems to be really, really difficult.
Ban Ki-moon
I sincerely wish to God that nothing will happen on the current political situation. Now, there is a very serious relationship between United State and China. then Russia, one of the three largest military power and the biggest – one of the biggest power, Security Council member, is now fighting, and President Putin has been indicted by ICC, International Criminal Court, then what can we expect among our leaders? That’s – therefore, we must do all, first of all, to solve these kind of political and security problems.
Now, Middle East issues, under these circumstances, had any virus happen, I think it will be a terrible situations. Now, United State is also very much divided because of the presidential election, as you might have been very closely following up. Therefore, I would really urge the leadership, particularly G20 leaders, including G7, they are the most powerful and they meet regularly, they can mobilise all this communication around themselves. Of course, it will difficult to talk to President Putin at this time, a member of G20, therefore, we hope that – just not leave it to WHO.
As the Secretary-General, I had worked very closely with WHO, and many other organisations, like Gavi, Unite – UNICEF and UNESCO, and all – UN Aid, etc., etc. Then even, I worked very closely with Bill Gates and – Bill and Melinda Gates, to get some support from all these foundations. Therefore, we need to really be prepared, prepared, had something happen then we should mobilise this one. I sincerely hope that the G20 and G7 pay more attention in the regard to next year, next year G20 Summit will be held in Brazil, and South Africa is going to hold the G20 Summit. Therefore, I hope that the leaders, when they gather together, while they may talk more – talk about political issues, they should talk much more how they can do better for our humanity and planet Earth.
Of course, climate change issue has become the number one top priority, but I know that when climate change is not addressed, virus will again happen, because of the situations. Therefore, there must be a comprehensive review and address all these issue, global issues, comprehensive way. The United Nations should play much, much stronger and co-ordinate way. When I was working, I working very closely with all these so-called H8, which I mentioned, health agency eight, and even I worked very closely with World Bank and IMF and other regional banks, so that we can really make sure that money and funds will be flowing. I believe that the political leadership with the very sound judgment, I think that will be the key for us to prevent any further viruses happening now.
Emma Ross
So, I’m sure The Elders is working with the G20 presidencies to craft their agenda. What’s the ask? I mean, where is the leadership going to come from, and what would you like to see them do? All three of you, if we’re talking about Brazil, South Africa, what’s the ask? What should they be doing, and how it is going? Is there any engagement at the moment to plan for that?
The Rt Hon Helen Clark
There is some, although this hasn’t been the key focus of Brazil’s G20 Finance Minister’s track, really. But I think when it goes to South Africa, President Ramaphosa really did show regionwide leadership on the African continent with COVID. And I think there remains an interest in South Africa in trying to crack some of these, you know, big countermeasures issues. You know, there are the negotiations around the pathogen access and benefit sharing, and so on, which at some point, you know, may be resolved through negotiation. But, in a sense, that is a charitable model, where developing countries are guaranteed a certain percentage of X.
What we advocated from the Independent Panel, and which The Elders has also been advocating for, is really a different ecosystem, where there is support for R&D in the Global South. Building on the mRNA hub and spoke arrangement that the WHO backed with the hub – South Africa and elsewhere, with the capacity for R&D in the South to quickly pivot to whatever the disease arising was, to get the vaccines, the treatment, and then for that to be linked to manufacturing capacity. Now, Africa, for example, has a continent-wide pharmaceutical manufacturing strategy, it needs investment. I know the Pasteur Institute in Senegal, which has research capacity, obviously, has also approached the International Finance Co-operation, the private sector arm of the World Bank, for lending, to get manufacturing going, in – you know, in the event that they need to scale up.
So, we really need that different ecosystem. It should be supported by the readiness window of the Pandemic Fund at the R&D level. It should be supported by the bank’s private sector lending arm, at the manufacturing company level. And then it needs the surge mechanism, which the G7’s starting to talk about, for when the worst happens and you need to scale up manufacturing and get allocation out to low and middle income countries quickly. I mean, none of this needs to wait for a treaty. There’s some practical things that could be done here, and that’s really what the G20 agenda could drive, how you fund each steps of this process.
Emma Ross
Okay, Osman?
Dr Osman Dar
I just wanted to comment on a point related to that with another illustrative example, and this is from national legislation in the US. Now, most people, me included, don’t often have anything nice to say about Donald J Trump, but one thing he did do, in March of 2020, was in the US and in – across a lot of the high-income – a lot of high-income countries, there was a shortage of ventilators if you remember. ICUs were, you know – ICUs were getting overwhelmed in high-income settings and nobody had enough ventilators. And he used a piece of legislation that was developed just before the Korean War in the US, called the Defence Production Act, a very powerful tool. And he ordered General Motors, which makes cars, to produce ventilators, because the President of the United States has the authority to take over manufacturing cape – capacity and capabilities of the entire industrial base, in order to deal with a emergency.
And that’s the kind of thing, you have to have that kind of – a sledgehammer in your back pocket, to be able to use when, you know, everything goes…
The Rt Hon Helen Clark
Hmmm, haywire.
Dr Osman Dar
…haywire, globally. and so, you need something like that, to be able to hold over the pharmaceutical industry that, you know, push comes to shove, if this happens, we get a pandemic where, you know, the mortality rate isn’t point whatever percent, but 10% and it’s not affecting, I don’t know, people in their 80s and 90s, but mothers and children or whatever, that you have that in your back pocket to be able to use globally.
Emma Ross
So, that – before I go to audience question, I’m going to go to audience questions soon, but I want to ask Helen, you talked about the IP system…
The Rt Hon Helen Clark
Hmmm.
Emma Ross
…and how that hasn’t really served. TRIPS flexibilities not working. These equity struggles on intellectual properties have been going on for decades, and as we know, yes, there are the TRIPS flexibilities, but in reality, they’re not delivering equity. And it – I mean, it seems that something is obviously not working here. Why haven’t we been able to fix this, and how can the global IP system be reformed to be more appropriate in times of global emergency? Are there pro – will that ever happen? Are there prospects for it, or do we have to live with the fact that, you know, pharmaceutical company protection is just too strong in geopolitics, we’re not going to get that, and if we don’t, where does that leave us?
The Rt Hon Helen Clark
Well, the reality is you have high-income countries which are very protective of the interests of Western pharmaceutical companies. The WTO did have a go at negotiating with South Africa and India, putting the issues squarely on their agenda, and eventually, some decisions were made, which did not admit – did not amount to a TRIPS waiver. They purported to simplify the compulsory licensing of, you know, different – of patented stuff, but it didn’t really lead to anything much. Now, Colombia has been successful in getting a decision from WTO to have a review of the TRIPS system, and undoubtedly, the review will show that there aren’t flexibilities really, at all, in practice. And it was also noted in discussions we had earlier today that we’re – countries have tried to use some of these flexibilities or use the compulsory licensing provisions, that they actually get stood over and threatened by other countries.
Emma Ross
Or punished.
The Rt Hon Helen Clark
Yeah, punished. So, this is not satisfactory, at all, and it should be a major issue on the WTO agenda.
Emma Ross
Okay. I’ll start with some interv – some audience questions. There’s first hand up there.
Ian Sheridan
Great. Can you hear me okay?
Emma Ross
Yes, if you could just…
Ian Sheridan
Good evening.
Emma Ross
…identify yourself, and…
Ian Sheridan
Yes, Ian Sheridan, Barrister. My question concerns The Elders and their publishing intentions on this very topic. I mean, briefly, John Kerry was here in the last two years in Chatham House, and it was very telling and memorable. He said, “Well, in the context of climate change, it’s borderless, and therefore, of all the issues, this is one that you can get quite a broad, powerful coalition together.” So, my question is simply, what are The Elders going to do next beyond this in terms of publishing and influencing?
The Rt Hon Helen Clark
So, we do have a formal and quite comprehensive position paper coming, June next year. There’s been a lot of advocacy from The Elders, and some of us are double or triple hatted with other initiatives and commissions, as well. Zeid Al Hussein, who’s with us in the front row, has played a, you know, a very important role in trying to bring Negotiators together around Geneva circles. We need to stay, you know, seized of the issue as long as these negotiations take, to try to get something over the line. There’ll also be another high-level meeting in New York in 2026, on PPPR, so that also needs to be focused on. The last one was a bit of a washout, so can that be any better done next time? But this remains firmly on The Elders’ agenda, hmmm.
Emma Ross
Thank you. Any other questions? Yes, okay, there, and then here in the front. Thank you.
Saad
Hi, my name is Saad, and I’m a Resident Doctor based in London at the moment. I actually worked during the pandemic in one of the largest Trusts in London, for about – first wave and second wave. One thing that I noticed was the policymakers in our hospital, as well, had, you know, dismissed it, COVID, when it came as, oh, this is – the reason why there’s a high mortality is because it’s China. How can we combat this distrust of other countries and WHO when it comes to – and, you know, irrespective of political differences, when it comes to health?
Emma Ross
Thank you, and then the question here in the front. Distrust of countries and WHO.
Dr Ishaka Shitu
Thank you so much, all the panellists, thank you so much. My question – I’m Dr Ishaka Shitu, I’m a Lecturer, International Shipping, Supply Chain, and also a Consultant, member of Chatham House. My question is very simple, you all said COVID-19 pandemic preparedness has failed. Lesson learnt is not much. If you look at Africa and developing world, the allocations of vaccine was very, very slow, extremely slow, and Her Excellency also mentioned that, Helen Clark. And if you see all these pharmaceutical companies are all in the Western world. Is there any way out of a strategic plan for manufacturing base for vaccines in Africa at the moment? I know there are some improvement in some African countries, I cannot remember some of the names, and, also, there’s lack of information sharing among international confederations of pharmaceutical manufacturers’ associations. And that’s causing headache to make sure all these medications or vaccines are given to people that need it in Africa. And, you know, Africa governance is a issue, as well, so that’s a double headache. Thank you so much.
Emma Ross
Thank you, Helen, do you want to take that and then…?
The Rt Hon Helen Clark
Sure. I think – I understand the Africa CDC has set a goal to develop, manufacture and supply 60% of the continent’s vaccines on the continent by 2040. As I said, the African Union has a pharmaceutical manufacturing strategy. There’s also work being done on a common medicines regulator, which you need, right, because otherwise. you make something in one country and it may not be recognised in another. So, that – but that tidying up, you know, these issues. What’s needed is some real investment in the R&D and that should come through, you know, global solidarity funding, like a readiness window of the Pandemic Fund, then they need the support for investment in their own manufacturing. And there is a difference between that and the factory in a box approach of Moderna saying, “Well, you know, we’ll do something in Rwanda,” which Rwanda won’t control and be very subject of the vagaries of, you know, where Moderna wants to invest.
So, I think if any region is onto it, it’s Africa, because it was the most penalised by what happened last time, and they really are on the move to find solutions on the continent.
Ban Ki-moon
Now, let me just add one thing. While working at the United Nations, I had been repeatedly saying that without addressing African challenges, we will never be able to declare that we are living in a sustainable world. Likewise, while virus will not, you know, what – care whoever people or wherever one may be, it is after all, the people living in developing world, particularly Africa, who will be hit most seriously, that’s a fact of our life. And that’s why the priority, I’ve been always saying that “We must do much more for Africa.” Look at this COVID-19 or Ebola crisis. The Ebola crisis happened in Africa, then when you really want to solve this problem, there must be whole support, whole support, concentrating on Africa issues.
That’s why COVID-19 – I mean, Ebola crisis was able to be eradicated at a very relatively quick time. But when it comes to COVID-19, I think that every country, everybody went on their own, because of the political situations between certain countries were not at all good. Therefore, it – I’m, again, emphasising that we must do much more for African people so that we will – all the people in this planet will be able to live harmoniously. Then, before that, we must make sure that these climate change issues must be given top priority, without making our planet Earth liveable. Then there will be more and more viruses happening, particularly in the developing world. That’s what I am arguing even now, after my retirement, to the United Nations, that they should do more, and G7 and G20, rich countries, they should do much, much more. That’s their moral and political responsibility, yeah.
Emma Ross
Thank you. Osman, do you want to take on the trust thing, or…
Dr Osman Dar
Okay…
Emma Ross
…add to this question?
Dr Osman Dar
…I’ll say maybe a couple of things on both points. On the trust thing, yes, I mean, one of the big issues has been a cultural difference across, you know, different parts of the world. Here, in Northern Europe, perhaps in North America, I think it’d be fair to say that they didn’t want to learn lessons from the South Korean response or the Japanese response or the Chinese response. Their view in the early days was – of the COVID-19 pandemic was, “Oh no, our people are different,” or, you know, “We’ll never accept a lockdown. You know, we’ve simulated this with flu pandemic exercises and our people would just never accept a lockdown, or never accept quarantine measures or movement restrictions.”
And they didn’t want to learn the lesson. They didn’t want to have teleconferences with their colleagues in the Far East, and that’s something that needs to change. There’s a thing – you know, a trend in public health, or global health, called reverse innovation, where you can learn from low-income settings on how they use efficiencies, ‘cause they have less resources. There are certain things that they manage and handle and control better than we would here in a high-income setting. And I think we did miss a trick with that in the COVID-19 pandemic, so there is this deficit of trust between different parts of the world, and we need to find ways to overcome that, and be more open to the idea that we can learn from people from a different culture or a different tradition. That’s – I suppose goes without saying.
On the issue of Afric – on Africa. Governance has been fundamental to the whole relationship between Africa and the Global North, or the global system, right? It’s a joke even now at the Af – you know, I go to meetings at the Africa CDC or the African Union, and they’ll say, quite candidly, you know, that “As soon as we have a upstanding independent leader within Africa, they either end up dead or assassinated or, you know, there’s a coup in the country.” And, you know, DRC’s the best example, why do you we have so many repeated outbreaks in DRC? Ebola, mpox, repeated Ebola outbreaks, repeated epidemics. Because since it’s independent, it’s had this fractured governance across the country, right? The first Prime Minister, one of the best leaders Africa has produced, Patrice Lumumba…
The Rt Hon Helen Clark
Hmmm.
Dr Osman Dar
…there were three different intelligence agencies trying to assassinate him at the same time, from high-income settings, at the same time, and DRC has been unstable ever since. Though the one province that remained stable was the province that – where all the extractives come out of, Katanga province. So, all your lithium, your – everything around your mobile phones and your fancy electric cars comes from there. So, you know, there’s an interest in keeping these places unstable and easier to extract resources from. So, there’s that enduring tension between keeping the place unstable so we can extract resources, but also keeping it stable enough so we can control a pandemic or control whatever health issue we want to…
Emma Ross
Well, that…
Dr Osman Dar
…control.
Emma Ross
…actually brings me onto asking you about the global equity thing, is – and why that’s not – that’s such a struggle for pandemic preparedness. a) is it that the international community doesn’t understand the centrality, the fundamental role that global equity will play in actually preventing pandemics and more effective response, or do they get it perfectly well, but it’s not in their interest to go there? What actually do you think, Osman, is going on here? Do they get it, or they…
Dr Osman Dar
I…
Emma Ross
…do get it but they don’t care?
Dr Osman Dar
…I think the system is working as it’s intended.
Emma Ross
What does that mean?
Dr Osman Dar
That means that the UN system is set up in a way – the multilateral system is set up in a way to advantage certain countries, certain groupings of countries, and every country, or – countries make – they look at it like an equation, right? What is more important to us at this particular time? What is our self-interest? We want to protect that industry, we want to – we’ve got a certain advantage in a sector or a space, and we want to maintain that advantage in that sector, in that space. And, okay, so there’s a risk around global pandemics, but it’s a, you know, low probability, high impact event. So, I can deal with that when it happens.
But right now, over the short to medium term, I’ve got this amazing pharmaceutical industry, I’m not going to let it go, and even if it means, you know, a few dead older people in my own country, that’s a gamble I’m willing to take, and we saw that play out, didn’t we? People in care homes were – okay, they’re in their 70s and 80s, they’re not viewed in the same way by governments as other parts of the electorate, or the public, right? So, we saw that play out in our own high-income country, so how do you think that plays out on the international stage between a group of high income states and a group of low income states?
Emma Ross
Helen, do you agree?
The Rt Hon Helen Clark
Well, I think…
Emma Ross
That’s pretty harsh.
The Rt Hon Helen Clark
It is harsh, but I think there is a certain cynicism about it when you see the extent to which the Western pharmaceutical industry’s interests are being protected by high-income countries. I think, you know, there was also another dynamic at play eventually, which was, you know, every dog for himself, and those – the high-income countries had the means to get the orders in for the vaccines early and pay the price that was required. And any leader of a high-income country’s going to be under a lot of pressure from electors to deliver that. So, they weren’t thinking solidarity. They were thinking, how do we protect ourselves?
But as we know with viruses, they don’t care, the viruses don’t care. They go over any border that we can put between, you know, countries, those transient continents. We’re all in it together, but we have no rational global mechanism for allocation according to the greatest need. In a perfect world, you would have, you know, looked a COVID and said it’s going to be most deadly to the old and the health vulnerable across all countries. Therefore, if you had a global allocation mechanism, you would have allocated on that basis. Instead, as I said, you know, all of us, irrespective of health status in high-income countries, were getting our second, third, fourth boosters before many people in low-income countries ever saw a sign of a vaccine. None of this is rational if you’re trying to control the spread of a pandemic disease.
Dr Osman Dar
And not to be too, sort of, negative, there are solutions around some of this, and there – and you can take lessons from other sectors. So, you know, when – in this country, for instance, it’s perfectly acceptable that you have price caps on energy. People need to be able to heat their homes in the winter, and so, there’s an understanding, okay, you can make a profit on oil and gas and energy and whatever, but there’s a price cap, because we’re in a situation right now where we have to heat everyone’s home in the winter.
There’s no reason why you can’t, in theory, have that with the pharmaceutical industry. I mean, how many tens of millions of dollars is enough as a profit? You look at HIV medicines, or – when HIV was under IP protection, HIV meds, it was $1,000 a month per patient. This – as soon as Indian generic manufacturers started producing – Cipla started producing HIV meds, it dropped from $1,000 a month to $300 a year. It made tens of millions of people who had a death sentence suddenly be able to access treatment and get care and survive. The same things happened with hepatitis C, the drug of choice, when it came out, was $70,000 per patient for treatment, and it’s a curative treatment. Now Malaysia produce it for $200 per dose. And the company that made it, you know, they must have made $60/$70 billion on one drug.
Emma Ross
Okay, we’ve gone over. I’m going to take one question from online, and then I’m going to ask you all a final question, but the question from online is from Christoph Hamelmann, and I think Mr Ban, this is for you. “If the INB is not making progress, can the UN Secretary-General intervene, and when would be the appropriate time for him to do that?”
Ban Ki-moon
Wha…
Emma Ross
Can the UN Secretary-General take over the pandemic accord? Can he intervene, or does he not have the authority? And if he does have the authority…?
Ban Ki-moon
I think Secretary-General can take all responsibility and good ideas. We have many pandemic or disease-related agencies, as I’ve said, H8. If he mobilises all, then in that regard I would propose that the Secretary-General has some – needs to have some special – a special person as Advisor, Special Advisor to address this kind of iss – during my time, I have brought David Nabarro, Dr David Nabarro. He belongs – he belonged to WHO, but I brought him to my office and during my time, he’s been always near me. So, he will – I was very much, you know, supported by his special and professional knowledge and experience. Therefore, I hope that Secretary-General of the United Nation can think about how he can strengthen his ability, his leadership, with the help of those, you know, expert level people, yeah.
Emma Ross
Okay, that’s Mike Ryan’s next job, maybe. So, final question for you all before we close, and that is going back to talking about fostering political will to get the job done. A lot of us in this room already care, otherwise we wouldn’t be here talking about it, or listening to you all talk about it, but why is there not a grassroots civil society movement for this issue, akin to what we saw with HIV in the early days, or even what we see with the climate warriors? I mean, how important do you think that would be for stimulating global political will, and what are the prospects of that happening? So, one last word from each of you. Helen, I’ll start with you.
The Rt Hon Helen Clark
I don’t think the prospects are great. I think, you know, just as a lot of political leaders are over COVID and have been over it for a couple of years and moved onto other issues, the public also tired of lockdowns and measures and want to put it behind them. The reality is that COVID-19 is still a, you know, a dangerous disease. It kills, you know, many people every year, but people have almost factored it into their lives, as they factor in that flu will kill a certain number of people a year, which is all a bit tragic, really. So, we’re not seeing governments do what they need to do for winter surges to try and, you know, protect people. And civil society, you know, apart from the sterling efforts of those who affiliate into the Pandemic Action Network, which has been…
Emma Ross
Sure.
The Rt Hon Helen Clark
…it’s been terrific, it – civil society at the street level really isn’t mobilised, hmmm.
Emma Ross
Any thoughts?
Dr Osman Dar
I mean, I’ll just say that the way to control pandemics, which are, you know, low probability – relatively low probability, high impact events, is to have good health systems dealing with routine things, and that’s what people care about. So, at the grassroots level, there are cholera outbreaks, anthrax outbreaks, water and sanitation issues, food security issues. You know, we’re doing that simulation exercises through Chatham House across Zambia, Zimbabwe, Botswana, Namibia, very shortly, cross-border simulation exercise. They’ve got drought issues there. they’ve got foot and mouth disease killing their animals and their cattle. They’re not – if you go to them and say, you know, “What about a pandemic that might come along in the next five years?” They’re like, “We’re hungry now, we’ve got this infection now. My kids are, you know – don’t have water, clean water, to drink now. We’d like you to deal with these issues.”
If you’re dealing with these issues well, the risk of the pan – of a pandemic or an epidemic with pandemic potential arising in the first place becomes drastically or exponentially less. But the issue that we’re faced with this prevention paradox, right? If we – if you prevent something, nobody gets any political mileage out of it, and that’s fundamentally, one of the main issues.
Emma Ross
Mr Ban, final word.
Ban Ki-moon
Now, I would just emphasise the importance of partnership. There are many global issues are taking place, but every country goes on their own way, then it will never be possible. Therefore, I sincerely hope that, including Secretary-General of the United Nations, so that he can be empowered by G20 and G7 and other countries, too. If Secretary-General representing whole member state is not empowered, then he or she cannot do anything. Therefore, I’d like to emphasise the partnership among countries and organisations, etc. I think without partnership, however powerful or resourceful one country may be, this cannot be addressed by one or two big countries, there should be partnership among government, business community and civil society. When this trilateral partnership becomes stronger, then there is nothing which we cannot address.
That’s what I have been always emphasising. You see, suppose United State and United Kingdom they are quite the strong and resourceful country, but however resourceful one may be, one cannot do it alone, including climate change, pandemic issues, education. All these are requiring some co-ordinated partnership. That’s what I’d like to emphasise.
Emma Ross
Thank you, a call for international co-operation, multisectoral co-operation, and support for the multilateral approach. That’s all we have time for, and I’ve stolen a bit more time, actually, only two minutes from when we started, but I know we started late, so apologies that we didn’t get to all the questions. But thank you all for joining, and please join me in thanking our panellists.
