WHO Director-Common’s visitor lecture at Vice-Chancellor Lectures on Globalization, Sustainability, and the Energy of Concepts, College of Cambridge – 1 March 2022
Thank you so much, Professor Cordonier Segger for that very kind introduction,
And thank you, Professor Toope, for your welcome, and to all students and faculty who have joined us today,
It’s an honor for me to be with you, albeit virtually.
Let me begin by talking about a pandemic – but not COVID-19.
It’s the deadliest pandemic in recorded history – the Black Death, which killed an estimated one third of the population of Europe, including up to 60% of the population of Cambridge.
The terrible toll of the Black Death was in part because no one knew exactly what caused it, how it spread, how to prevent it or how to treat it.
It wasn’t until hundreds of years later, in 1894, that Alexandre Yersin identified the bacterium that causes bubonic plague.
By contrast, the novel coronavirus that causes COVID-19 was identified and sequenced within just two weeks of the first reported cases.
Science has given us tools to fight this virus our ancestors could not even have dreamed of – the ability to track its evolution almost in real time, to test for it rapidly, to treat it, and of course, to prevent it with safe and effective vaccines.
But the global failure to distribute those tools equitably has prolonged the pandemic.
And so, here we are, more than two years into the pandemic, and the world remains in its grip.
It may not feel like that in Cambridge, and it’s certainly pleasing to see that reported cases and deaths are declining in the UK, and life is returning to some semblance of normality.
But the global reality is that this pandemic is far from over.
Since the beginning of this year, more than 60 thousand people have died a week, on average.
That’s about the population of Cambridge, every two weeks. ;
And of course, the threat remains of a new emerging variant that is more transmissible, more virulent, and less susceptible to vaccines.
We might be done with COVID-19, but it is not done with us.
The effects of the pandemic go far beyond the death and disease caused by the virus itself.
Health systems have been severely disrupted, with millions of people missing out on essential services.
As you know only too well, education has been disrupted for millions of students – especially those for whom online learning is not an option;
Millions of people have lost their jobs, or been plunged into poverty.
The global economy is still clawing its way out of recession.
Political divisions have deepened, nationally and globally.
Science has been undermined. And inequalities have widened.
COVID-19 is a brutal demonstration that a pandemic is so much more than a health crisis.
It touches every area of life: economics, education, families, employment, business, technology, trade, travel, tourism, politics, security – and so much more.
When health is at risk everything is at risk.
As we look to the future, I’d like to suggest five areas in which I believe we need substantial change to make the world if not pandemic-proof, at least more pandemic-resilient.
First, we need a realization, globally, nationally and locally, that health is central to sustainable development.
For far too long, health has been compartmentalized and deprioritized, nationally and internationally.
In too many countries, health has been seen as a cost to be contained, rather than an investment to be nurtured – an investment in social and economic development and sustainability.
History teaches us that health is not an outcome of development; it is the means.
Both the UK and Japan, for example, began their journeys towards universal health coverage in the aftermath of the Second World War, not when they were economically strong, but when both countries had been impoverished by war.
And in both cases, universal health coverage has been one of the foundations for the decades of stability and prosperity that have followed.
Importantly, it’s not just the size of the investment that matters. It’s where the investment is made.
Which leads me to my second shift: a greater emphasis on public health.
In recent years, many high-income countries have invested heavily in advanced medical care, but many have neglected investments in public health.
As a result, they were overwhelmed when the pandemic struck.
For example, contact tracing is one of the most simple but effective public health tools for responding to outbreaks.
Through their experience with previous outbreaks of infectious diseases, many lower-income countries have developed strong infrastructure and “muscle memory” for contact tracing, which has helped them respond well in this pandemic.
The bedrock of public health is strong primary health care, which is the eyes and ears of every health system, helping to detect and respond to outbreaks at their earliest stages, at the community level.
Primary health care is also essential for promoting health and preventing disease.
I do not mean to downplay the importance of secondary and tertiary care, which are vital too.
But a strong primary health care system can help to prevent or delay the need for secondary or tertiary care, leading to better health outcomes for people and lower costs for health systems.
Essential to this effort is a well-paid, well-supplied, and well-trained health workforce.
Another vital element in a strong health system is access to safe, effective, quality and affordable essential medicines and vaccines.
Which brings me to the third shift: local production.
While the pandemic has posed a global threat, the manufacturing capacity for the tools to stop it have been concentrated in the hands of a few mostly high-income countries.
This was the case with personal protective equipment in the early days of the pandemic, and is also the case with vaccines.
Vaccine nationalism, export bans and bilateral deals between manufacturers and high-income nations effectively excluded COVAX, and the countries that were relying on it, from the global vaccine marketplace.
Even before the pandemic, expanding local production of medicines and vaccines was a priority for WHO. The pandemic has made that need even more acute.
That’s why WHO has established a technology transfer hub for mRNA vaccines in South Africa, as a public-private partnership.
The hub has already developed its own vaccine candidate, and 13 countries have been approved to receive technology from the hub.
Increasing local production is essential not only for strengthening health security, but also offers huge economic benefits.
This lack of global solidarity in sharing vaccines and other tools has been symptomatic of a broader deficiency in the global response, which leads me to the fourth shift: the need for significant changes in the global health architecture for pandemic prevention, preparedness and response.
Briefly, WHO believes change is needed in three areas:
First, we need stronger governance.
In the face of a common threat, the world needs a common approach, with common rules of the game that govern the global response.
Instead, this pandemic has been marked by a patchwork of different and sometimes contradictory responses, which have led to confusion, division, inequity and stigmatization.
However, there is encouraging progress in this area. At a Special Session of the World Health Assembly last year, WHO’s 194 Member States decided to negotiate a new international instrument to provide an overarching framework for pandemic prevention, preparedness and response.
An Intergovernmental Negotiating Body for this new instrument, or treaty, held its first meeting here at WHO headquarters in Geneva last week.
Second, we need stronger financing.
It’s obvious that nationally and globally, we need substantial resources for strengthening global health security. Our analysis estimates the needs at 31 billion US dollars per year.
To close the gap for the most essential functions – such as surveillance, research and market-shaping for countermeasures – we support the idea of a new dedicated financing facility, anchored in, and directed by, WHO’s constitutional mandate, inclusive governance and technical expertise.
And third, we need stronger systems and tools.
Already, WHO has taken steps to build some of these new tools.
To strengthen surveillance, we have established the WHO Hub for Pandemic and Epidemic Intelligence in Berlin;
To facilitate greater sharing of pathogens and clinical samples, we’re piloting the WHO BioHub System, based at a secure facility in Switzerland;
And to improve mutual accountability, solidarity and cooperation between countries, we’re piloting the Universal Health and Preparedness Review.
And finally, the fifth shift is the need to move from a siled view of human health to a “One Health” approach that acknowledges and addresses the intimate links between the health of humans, animals and the planet that sustains all life.
About 75 percent of emerging infectious diseases enter human populations from animal populations.
At the same time, human activities including deforestation and intensive agriculture that encroach on wildlife habitats can create opportunities for contact with previously unknown pathogens.
Unplanned and rapid urbanization can also exacerbate social disparities and inequities in accessing health services, and expose people to environmental risks.
And of course, many of these same activities also contribute to climate change. In other words, the same unsustainable choices that are killing our planet are killing people.;
We can only safeguard human health if we also safeguard the health of the planet on which we depend.
So to summarize, these are the five shifts I believe the world must make:
From seeing health as a cost to health as an investment;
From health systems focused purely on treating diseases to systems focused on preventing diseases and promoting health;
From concentrated production to local production;
From a fragmented global architecture to a cohesive architecture, with stronger governance, financing and tools;
And from a siled approach to human health to a “One Health” approach.
Let me finish with the words of Dr Sze Szeming (pron. sher sir-ming). His name may be unfamiliar to you, but Dr Sze was a Cambridge alumnus, a Chinese diplomat, and one of the founders of the World Health Organization.
Dr Sze is reported to have said, “Of course we can learn from history. We learn from the mistakes made, if not from the successes. Learning the reasons why certain things happened often saves us from making the same mistakes again”.
It seems so simple and obvious. But unfortunately, the history of epidemics and pandemics is one of panic and neglect: as a global community, we rush to respond to a crisis, and when it is over, we forget its lessons, and do nothing to prevent history repeating.
The COVID-19 pandemic is teaching us all many painful lessons.
My hope is that together, we will learn them, that we will make the changes that must be made for a healthier, safer, fairer and more sustainable future.