There are many lessons from the Covid-19 pandemic. One of the most important is that when warnings and proposals about reforms on big global issues are not heeded, the world is asking for trouble.
In the case of pandemic preparedness and response, 11 different panels in the last 20 years have made such proposals. Most recommendations have been ignored. And the world has now paid the price, with the biggest burden borne by the poorest. For many there is no end in sight.
One of us (Rajiv Shah) served on the 2016 Kikwete panel (it was chaired by the former president of Tanzania, Jakaya Kikwete) following the Ebola outbreak. It recommended, among other things, the creation of a high-level council to “monitor political and non-health issues related to prevention and preparedness imperatives for a potential epidemic of global proportions. It will reaffirm guidance during times of health crises and will intervene in affected fields outside the health field”. It would have been convened at head of government level.
However, the proposal was quietly buried. A global preparedness monitoring board was set up instead. It has done important work. In 2019, its annual report entitled A World at Risk warned that “the world is not prepared for a fast-moving, virulent respiratory pathogen pandemic”. The board’s research and analysis were as rigorous as their findings were prescient. But without political leverage and resources, its recommendations went unheeded.
Time and again the Covid-19 crisis has shown what happens when global political leadership is not available to back up global scientific and health leadership. The World Health Organisation (WHO) machinery for declaring a public health emergency worked slowly in January 2020. The emergency committee did not meet until 22 January. But even when a “public health emergency of international concern” was finally declared on 31 January, there was not the reaction needed. Conferences continued. Travel continued. Mask mandates were a rarity.
The reason is simple. Pandemic prevention and response is treated as a health issue. The WHO and its accountable body, the World Health Assembly, is made up of health experts. Health ministers lead the work. But pandemics are different than other health issues. Pandemics belong on the desks of presidents, prime ministers and finance ministers. Not just after the pandemic strikes, but before, because pandemics have consequences way beyond health, as we have learnt to our cost.
This is the context for the proposal from the independent panel on pandemic preparedness and response (on which David Miliband sits) for the creation of a Global Health Threats Council. The panel recommend clear functions for the council: to sustain political commitment to pandemic preparedness and response, to ensure maximum international coordination, to monitor progress towards clear goals for pandemic preparedness and response, to guide allocation of extra resources for securing effective preparedness and response, and to hold countries and international bodies accountable for progress. The council would provide high-level political backing to a stronger, more independent and better-funded WHO.
The panel recommend that in order to achieve inclusiveness and effectiveness, the Global Health Threats Council be co-chaired by two representatives, at head of government level, chosen by the UN General Assembly, and one representative, also at head of government level, of the G20 countries, which represent over 80 per cent of global GDP.
The co-chairs would serve for three-year terms. The panel propose that there be no more than 20 members of the council, to enable agile decision making, and that representatives of the global private sector and civil society be invited to join. The panel also proposes that the council oversee the allocation of significant financial resources through a new facility that links long-term, reliable support for preparedness with rapid surge financing for early response. Oversight of this facility gives the council leverage and resources to ensure gaps in the system are addressed. This structure centres on the role of member states, recognising the importance of national leadership in managing health threats within borders as well as the need for coordination across borders.
Imagine if this council had been in existence since the Kikwete Commission proposed a similar body in 2016. When countries were under-investing in pandemic preparedness before the pandemic, they would have faced political pressure. When pandemic response plans were torn up, as the Trump administration did on coming to office, they would have faced rebuke.
Most important, when the director-general of the WHO declared a public health emergency on 31 January 2020, there would have been a ready audience of political leaders primed to take the message internationally that business-as-usual needed to stop, that surge funding for PPE and diagnostics was needed, and that Covid-19 was not a “health issue” but a global emergency.
We cannot bring back the lives lost to Covid-19 or recover the trillions of dollars in economic losses. The crisis is far from over. Many parts of the world are suffering more than ever and the virus may be here to stay, a pandemic that becomes endemic as inequity, with distrust hampering the vaccine rollout. But we can learn the right lessons.
The Covid-19 nightmare is all the worse for having been predicted. With the World Health Assembly underway, the call for a high-level council is all the more urgent for having been made five years ago. There will always be outbreaks. But an international system must ensure that they are contained, if not nationally then regionally. That is possible, but only if we change our ways.
David Miliband is president and CEO of the International Rescue Committee . From 2007 to 2010, he served as UK foreign secretary
Dr Rajiv J Shah is president of the Rockefeller Foundation, a global institution with a mission to promote the wellbeing of humanity around the world. From 2010 to 2015, he served as USAID administrator, leading the US response to the Haiti earthquake and the west African Ebola pandemic