Africa: The Co-Chairs' Presentation of the Second Report on Progress to the WHO Executive Board, 19 January 2021.

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The Co-Chairs of the Independent Panel, Her Excellency Ellen Johnson Sirleaf and the Right Honourable Helen Clark, made the following oral presentation of the Independent Panel's Second Report on Progress to the WHO 148th Executive Board on 19 January 2021. Read the Panel's Second Report on Progress, available in six languages, in the Core Documents section: www.TheIndependentPanel.org/documents.

The Right Honourable Helen Clark

Minister Vardhan and honourable members and guests of the Executive Board.

Good morning, good afternoon and good evening from Auckland, New Zealand.

On behalf of President Sirleaf and me, thank you for enabling us to present you with key findings and messages from the Independent Panel's Second Progress Report.

We are all acutely aware that the pandemic we are experiencing is unprecedented in our lifetimes. It continues to rage and to evolve.  Two million people have died. There have been over 95 million recorded infections.

The impact on human lives, the great strain placed on health systems, and the scale of social and economic devastation brought about by the pandemic make it clear that the world must do two things: act more decisively now to stem the pandemic, and fundamentally reset its preparedness and response systems to help ensure that this doesn't happen again. These points are at the core of the Panel's Progress Report which we are pleased to present to you today.

These are not abstract policy issues. In a recent meeting hosted by the Panel with the global nursing community, we heard directly from nurses about the crisis in healthcare facilities.  Many nurses reported being burnt out. They report that many colleagues want to leave the profession when the main impact of the pandemic is over.  Already the world is estimated to require the creation of six million more nursing jobs by 2030. An exodus now exacerbates these pressures.

Since our appointment as Co-Chairs of the Independent Panel in July 2020, we have heard from many stakeholders. The feedback we have received has included helpful and forward-looking contributions made directly by Member States.

The Panel has made considerable progress on synthesising all such contributions and is beginning to build the necessary evidence base required for the comprehensive, impartial, and independent review of the international health response to COVID-19 with which we have been tasked.

While our evidence gathering continues, our progress report now has an unequivocal message: course correction in handling the pandemic is needed now.

The Independent Panel strongly recommends that all  countries immediately and consistently adopt the public health measures  which will reduce the spread and the impact of COVID-19. Simply put, we must do all we can to stop the pandemic now, and there are the means available to do so. The tools which  reduce the numbers of cases and deaths must be used.

Detecting cases as early as possible, contact tracing and isolation, and reducing spread through physical distancing and mask wearing are measures which are just as relevant now as they were at the outset. The countries which make consistent and sustained  efforts to implement such measures will benefit from reduced transmission, illness, and deaths.

The Panel's report identifies a series of  critical early failings in the global and national responses to COVID-19 . There had been a failure to prepare adequately for a pandemic threat, despite years of warnings that better preparation was necessary.

Taken as a whole, preparedness metrics both from WHO and academic institutions did not predict how well countries would control COVID-19. They were unable to capture what seems to be a critical dimension in pandemic control:  the mix of government effectiveness, concerted leadership, working with communities, and being guided by science.

The Report considers whether the international system acted fast enough to detect and alert the world to this novel infectious pathogen with pandemic potential, and, once the alert was issued, whether countries were fast enough in their responses.

Let us also be clear that there is no doubt many people were working very hard at the time the new virus was emerging, to understand what was happening, and to mitigate the threat. What we say here today, and in our report, is in no way meant to undermine the work of committed professionals. It is about learning for the future.

With the benefit of hindsight, detection and alert may have been speedy by the standards of earlier novel pathogens, but viruses move in minutes and hours, rather than in days and weeks. When, almost four weeks after a new virus was identified, the WHO declared the highest possible alert agreed in the international system – a Public Health Emergency of International Concern, too many countries failed to act quickly and decisively enough to apply necessary and recommended public health measures.

The Panel believes that the  international system for alert and response has the trappings of an analog system in a digital age.  Modern information systems pick up signals of potential disease by sifting through hundreds of thousands of data points daily, outpacing country reporting and the procedures and protocols of the International Health Regulations, including the declaration of a Public Health Emergency of International Concern.

The Panel is looking at what would be needed for mechanisms to work at the speed necessary, and to be able integrate signals from local clinics and laboratories into real-time, globally available data gathering and decision-making tools.

I will now hand over to President Sirleaf to share some more of the messages and findings from our report.

Her Excellent Ellen Johnson Sirleaf

Thank you, Prime Minister Clark. Greetings to all of you.  I want to underline two key additional concerns from the Panel's report.

First, the pandemic has laid bare inequalities  both within and between nations, and the response has deepened these inequalities.

As with so many pandemics in history – poorer nations have missed out when it comes to the means to fight the pandemic, and in wealthier countries, it has been the least well off who have suffered most.

(Slide 6: Everyone must have access: Peruvians queuing for oxygen from report)   

The Panel believes that the systemic and structural inequalities which have been made worse by the pandemic, must be the lens through which we view all of our work. This is true whether we look at the unequal impact of the virus on marginalized communities – such as migrant workers, and indigenous communities – or at the unequal access to testing, supplies, medicines, and vaccines.

  (Slide 7: Economist Vaccine Map)

We are grateful to scientists for developing vaccines in record time. As 2020 ended, we felt hope. But the Panel is discouraged and, frankly, disappointed by the unequal plans for vaccine rollout. Tens of millions of doses of vaccine are already available in some of the wealthiest countries. But, based on current plans, vaccines will not be widely available across the African continent, for example, until 2022 or even 2023. As our report says, where you are born should not be the factor that determines your place in the vaccine queue.

As former leaders of our countries, Prime Minister Clark and I understand the massive political pressure every leader is facing to vaccinate all their own people first.  But it is unacceptable for wealthy countries to be able to vaccinate 100% of their populations while poorer countries make do with only 20%.

It is no exaggeration to say that we are at risk of creating a vaccine distribution system grounded in inequity. We cannot let this happen.  The Panel believes that fairness based on public health needs – not narrow national interests – should determine who gets access to the vaccine and when.

Speeding up vaccination for all – and investing in the frontline health workers and primary healthcare systems that deliver them – isn't just the right thing to do. It is the smart thing to do. No one is safe until everyone is safe.

Second, let me now underscore another key finding in the Panel's report.

The Panel believes, like many of you, that major changes in the systems which should protect global health are needed.

After every new pandemic or other major health threat, there are many evaluations which come up with dozens of recommendations. They are nearly too numerous to count, and too few of them have been acted on.  The Panel expresses deep concern at the level of action which has followed earlier reports, and we hope Member States  share that concern.

This mistake cannot be made again. In November, Member States challenged us to make recommendations which were implementable, costed, and had clear timelines. We were challenged to be unafraid to speak uncomfortable truths. From our interviews and meetings with Member States, we know there is recognition of the need for action:  this is a unique opportunity born out of the gravity of this crisis, to reset the system.

Real change in global and national health systems that will benefit every country and every citizen must challenge the status quo. That means we need to listen more to health care workers and heed their advice.  It means drawing on the knowledge of those who manage local responses, such as mayors. And it means not only hearing, but also acting on what people on the margins of society are telling us – their experience of what goes wrong will show us what we must do to make it right.

Our report makes it clear that the world is more reliant on an effective WHO than ever before. But while  Member States turn to the WHO for leadership, they have kept it under-powered and under-resourced to do the job expected of it.   For example, many of you have pointed out that if WHO is expected to fundraise perpetually because assessed contributions to it remain low, then this will come at the expense of its ability to focus on pandemic preparedness and response – amongst other core priorities.

Pandemic preparedness financing has been treated as a cost to come out of a limited official development assistance bucket, rather than what it truly is – a global public good – an investment in our collective future.  This unprecedented pandemic has led to unprecedented challenges for our world. If we do not act not now, then when? If not us, then who?

I will now hand back to my co-chair, Prime Minister Clark.

Prime Minister Clark

Thank you, President Sirleaf.

To conclude, the Panel is making progress, and has already collated a series of observations and potential areas for recommendations. We still have a good deal of work to do before reporting to the World Health Assembly in May. That report will go into more detail and make a series of concrete and evidence-based recommendations on creating a fit for purpose pandemic preparedness and response system.

The Panel is grateful to the many stakeholders who are continuing to provide us with information and ideas,  including through the Panel's website, and including Member States. In the interests of transparency, we will continue to post our meeting reports and key materials we are considering on our website, including written contributions which have been made to the Panel.

We will also continue to host public exchanges like the one with global nursing community to which I referred earlier.

There is still much to learn and analyse. We look forward to the ongoing feedback, comments, and suggestions of Member States. What we have presented to you is an interim report on progress not our main report.

The international community is at a crossroads with respect to pandemic threats and responses:   the choices which are made in the coming months will show whether the world is determined to be more prepared, more health secure, more equitable, and more resilient.

I will now hand back to you, Minister Vardhan. We look forward to hearing from the Chairs of the IHR Review Committee, the IOAC, and the GPMB; and then to hearing the Executive Board's feedback. Thank you.

 

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