Meeting

COVID-19 Update: A Conversation With David Nabarro

Wednesday, May 27, 2020
Brendan McDermid/REUTERS
Speaker

Special Envoy on COVID-19, World Health Organization

Presider

Cofounder and Chief Executive Officer, Seed Global Health; Associate Professor of Medicine, Harvard Medical School

Dr. David Nabarro discusses the current state of the COVID-19 pandemic around the globe, the role of the World Health Organization (WHO) in responding to the pandemic, and how the WHO advises member states to inform policymaking.

KERRY: Thank you very much. So I am Vanessa Kerry. I’m the CEO of Seed Global Health, an organization that partners with governments in sub-Saharan Africa to invest in strong health-care systems, which are essential for a functioning government, for economic development, for populations to be able to ultimately thrive. I also am a critical care physician at Mass General Hospital in Boston, which has been very hard hit, as you know, from COVID. And I sit at Harvard Medical School, where I run a program in global public policy and social change looking at the intersections of health, diplomacy, politics, economics, national security, and all the pieces that we know health is fundamental to.

It’s a big part of what our conversation is going to be about today. We have the extraordinary honor of being joined by Dr. David Nabarro, who brings—and you’ve all seen his bio, so I’m not going to belabor the details there, but will just highlight that he truly brings a depth of experience, perspective, understanding of the complexity and the critical moment that we are in. I think it’s going to be an extraordinary discussion today over the next hour.

We will spend about the first half-an-hour engaging in a Zoom fireside chat, an opportunity to ask a few questions, to start to elucidate some of his thinking and perspectives on what is happening in this moment. And then we’ll move into a question and answer session for the second half of the hour. I want to highlight, not surprisingly, that we have a large number of participants on today’s call, probably over five hundred at this point. So we will do our best to be in touch or to answer as many questions as possible when we get to that, but please be patient if we don’t seem to get to your question or don’t have an opportunity to get to all of them. Just as a reminder, this will be on the record. So please keep that in mind. But we still look forward to a very candid conversation exploring some of these difficult issues. So thank you, Dr. Nabarro, David, for joining today.

I want to open—you know, we had a little bit of a chance to discuss before we went live on the broadcast. And I—you know, one of the questions I did really want to ask you, sort of two parts. One is, what is the biggest challenge? We’ve obviously had a series of challenges through the last sort of six months—five, six months of what we’ve experienced with COVID. But I’m curious what you see as the biggest challenges, you know, in this moment now as we go forward into kind of a new reality of this really being endemic to kind of what’s happening in our world at this point, and to sort of get a vision from you about what you see over the next six months, and where you see us in six months’ time.

NABARRO: Vanessa, thank you. And I’m really pleased to be here today interacting with the Council on Foreign Relations. Such an important group, not just for the United States but for the whole world.

So in a way, the framing of that question gives me the lead for what I really want to communicate today, and that is that the virus that’s causing COVID is really dangerous. And it’s also here to stay. It’s not going to go away anytime soon. So the big challenge right now is to enable everybody everywhere in our world to recognize that it’s a dangerous virus, to recognize that it’s not going away anytime soon, and to recognize that we can actually get ahead of this virus as humanity and we can live with it, but there are pretty important things that we’ve got to do to get it right.

And that’s the most important point that I keep trying to communicate to business leaders, to government leaders, at the local level, at the national level, and to heads of community organizations, is that it’s not a choice between public health or the economy. It’s you’ve got to get the public health part right, and then the economy can flourish again. If you don’t get the public health part right then the economy will be under threat on a pretty constant basis, not just in the United States but all over the world.

And I really want to just dig into that a tiny bit.

KERRY: Please do. No, this is exactly what we want to hear.

NABARRO: Well, the public health part is not complicated. This is a virus that’s primarily transmitted through small droplets when we cough, as you know. And you’re seeing it in your hospital all the time, that there are people with COVID who are coughing. And they are projecting in their cough certainly over three feet and perhaps as much as six feet—but usually, fortunately, not so much—they’re projecting little droplets that contain the virus. And then the other person just breathes it in, and they are at risk of getting COVID themselves. It’s so basic, the mode of transmission.

And so avoiding transmission is about keeping a physical distance. It may be about protecting your face if you can’t keep a physical distance. It’s about shielding people who are at risk. And it’s about protecting those who in the course of their work get exposed all the time. And it’s about remembering that even if you don’t die of your COVID, it can be a really horrible infection—especially for people who are fit want to get back to exercising again. They suddenly find they’re short of breath at the beginning of their run. Or people who occasionally feel that they’re not as strong in their heads as they want to be, and after their COVID they feel so tired, and so depressed, and it’s an awful lot—awfully difficult to get back again.

So this is not a nice disease. And so we do need to respect it by maintaining the physical distances, by protecting our faces, and by shielding those who are vulnerable. And then if transmission does start, we must stop it straightaway. We must stop it as soon as we see any people who we think have got the disease, isolate, and make sure they isolate, keep them isolated, find those with whom they’ve been in contact, isolate them, test if at all possible because it’s good to know where the virus is, but really make certain that we interrupt transmission quickly through isolation.

And we have to keep that practice up again, and again, and again, and again, because this is not like flu. You don’t shift from isolating to contain the disease right over to saying, oh well, too bad, it’s going to affect everybody. We will just try to reduce the worst consequences. No. With this COVID you have to keep preventing transmission all the time. And you have to keep it up so that it becomes something that we build into our society. So that’s the East Asian experience. That’s the German experience. And that’s what we all have to do. And—

KERRY: Could you expand on that a little bit? Because I think it’s helpful to understand the details of what it means to isolate. When we think of isolating people think, OK, I just stay in my home. But what are the responsibilities of business owners and employers to help support that kind of isolation? What is the responsibility of government? How do we support those communities where social distancing is difficult? I think some of that practicality or detail would be terrific.

NABARRO: Well, the first thing is isolation means isolation. But I want to stress, it’s physical isolation. It doesn’t mean you can’t have contact. And in fact, some sort of connection during isolation is absolutely key. But actually being away from other people when you’ve got this disease is so important because that’s how you break the transmission. In East Asian countries actually they don’t rely just on self-isolating at home. They think that creates too many risks of inside a household transmission, and also people don’t always respect the rules. So actually there’s quite a custom now of moving people into places where they can be isolated—a hotel where you’re going really out of your hotel room at all.

I doubt very much that that kind of isolation by the state will be practiced in the more—in the countries of Western Europe and the U.S. So what we require is people to actually be rigorous and diligent about isolating from the moment that they think that they might have the COVID. And so that means employers have to really be tolerant when staff ring up to say: I’m not feeling well, I think I might have the COVID. And instead of assuming that that’s just somebody who perhaps wants an extra day off, they’re going to have to build into their employee relations an agreement that they can take time off.

I’ve heard that some of the workers in the meat processing plants which have had big outbreaks, some of the workers there were actually quite nervous about saying that they were unwell and wanting to take time off. They thought they might lose their jobs. Now, that kind of incentive for people to keep working even when they have symptoms of COVID is not a good idea. So part of good employment practice is going to have to include enabling employees to take time off and to isolate if they think they might have the symptoms. Almost certainly employers will say: Well, could you please get a test? But I want to say, it’s good for an employee to take time off even if she or he is suspecting they might have COVID because the most infectious time, as you would know, Vanessa, is right at the beginning, often before the cough starts, often before the fever starts. You need to get out the way.

You’ve just lost your sense of smell, uh-uh, you’ve not lost your sense of smell ever before, that’s pretty much a sign that you are getting the COVID. So you’ve got to isolate right at the beginning. That’s the time when you’re most infectious. And so there are going to be implications for employers practices. And I quite appreciate it’s going to be tough. But so too for people who are poor, and who need to work, and who absolutely have to get the cash, but then there are also big problems because there will be a massive economic cost to not turning up to work or to not doing the tasks they did in order to try to get cash. So altogether we have to really look again at employee relations, at working conditions, can people actually maintain physical distance, and the agreement as to whether or not people are allowed to self-isolate the moment they have symptoms.

KERRY: So, you know, the situation we’ve just been discussing obviously sounds incredibly dire. We’ve described COVID as being a part of our life for months. It’s here to stay. It’s not like the flu; it doesn’t come in waves. You know, you’ll have spot outbreaks, but it’s because it’s consistently out there, and then somebody picks it up, and ends up spreading it around others. And so talking about the economy being deeply in trouble and, you know, the massive implications of that, the economic hit of workers being out of work, employers having to adjust work policies. But do you see opportunities where maybe we emerge better, stronger, you know? Is there an upside or silver lining to what we’re going through that we could help structure or work towards also?

NABARRO: Well, Vanessa, for me, there is definitely an upside because we’re learning that there are certain employment conditions that make it more likely that people will be exposed to COVID. There are certain kinds of living conditions that make it more likely that people will be exposed to COVID. There are certain kinds of health care situations or even social care situations that increase the risk of COVID. And actually, the changes that could be made to reduce the risk of COVID are also changes that would be very good for working conditions, very good for living conditions, very good for social care.

Just some examples. I mean, I appreciate that what I’m about to say may appear a little bit utopian, but why don’t I try? In Singapore after extraordinary success at getting on top of their early COVID, the country’s now having to deal with some new outbreaks. Where are these outbreaks occurring? In the dormitories that are set up for the foreign workers who come into the country to help with construction and so on. There are somewhere in the region of nine hundred thousand foreign workers, I think, in about twenty-four dormitory blocks. And they are very tightly packed inside multiple-bed dormitory rooms. And COVID has got into at least one of these dormitories. And it’s in the public domain so I think I’m not saying anything wrong by talking about this.

But it may well lead to some reconsideration of the accommodation for foreign workers who come and operate in their construction sites. But it’s not just in that one country. COVID is in foreign worker dormitories in a number of Middle Eastern countries, people who are working on giant construction projects. COVID is in migrant worker dormitories for migrant workers who are coming from Eastern Europe to Western Europe to help with harvesting food in fields. And I’ve already said that COVID is in meat processing plants, not just in the U.S., but in Canada, in Ireland, in Australia, in Poland, in France, and more. So this gives us a chance, if we want to, to work with the employers to improve the working conditions and to create much better working environments where people are not so crammed together, they’re not having to work so hard that they’re finding it really difficult to practice the necessary protection.

And then where is the COVID in India at the moment? Well, it’s in some of the densely populated cities of Mumbai, Aminabad, New Delhi, Chennai, and more. And so perhaps it’s a chance to rethink the basic living standards that people should be encouraged to live under, not in a way that penalizes the poor but empowers the poor to have access to water so that they can practice hand hygiene, to have slightly larger accommodation so that they can live without having to be so close together. And perhaps it will lead to new standards for urban housing.

And thirdly, we’ve seen that in residential care for old people, once COVID gets in it has a terrible impact on the residents and also on the staff. So perhaps this will lead to better standards for residential care for old people. And perhaps—and this is a dream of mine—better pay for the people who work in these settings because quite often the conditions under which they work are really difficult, both in terms of renumeration and conditions. And so, yes, there will be some pressure for things to be improved. I appreciate that this implies extra work for businesses who are particularly involved in these sectors, and extra work for the state if the state is responsible for the conditions. But it will, I think, set new standards—or, at least, encourage us to set new standards—which will be good for health and good for wellbeing.

KERRY: But let me ask about that because there’s no way, at least from my perspective, that you can separate politics from our pandemic right now, and the public health response, and the political willingness to engage or invest in certain aspects of the public health response. So I’m curious, from your perspective, how do we get some of the leaders, and you don’t have to name names, but to—unless you want to—but how do we start to get health to be valued in way that we’re willing to make and invest in those changes? Because for a long time we’ve always been pushing an economic bottom line, not sort of looking at an overall wellbeing and the benefits that can come from making these investments in health, or investments in better housing situations, or better home care, and kind of what the cascade of good that is that can come from that isn’t always economic, and so we haven’t always made those in-depth investments.

And so now we’re at a moment where we’re going to potentially have to ask people to really rethink how we—where we invest, how much we invest, in what we invest, and how to weigh different outcomes than maybe we have before to achieve those exact results you’ve talked about. So I’m curious, how do we help shift a movement in that direction and galvanize some of the political leadership that’s going to be needed to do that?

NABARRO: Thanks very much indeed. I’ve always thought that those of us who work in public health are also inevitably fighting for justice because so often we see that people who are particularly poor also suffer much greater consequences in terms of sickness and death. And we see it throughout the world, really, that people in poorer countries have lower life expectancies and have much worse outcomes when they get common illnesses. And so we see it with COVID. It’s revealing injustice everywhere.

You just have to look at the people who are dying in the United States with their COVID. They’re mostly poorer people. They’re mostly people from ethnic minorities. They’re mostly people who can’t afford some of the elements of health care that are so important for staying healthy. And it’s not just in the United States. It’s in the United Kingdom as well. Bus drivers, security guards, people who work in residential care for older people, people working in prisons. They are very much at risk. They are also people who have much less flexibility when it comes to not going to work or working from home. And so, yeah, there is an underlying injustice to the way in which COVID is affecting humanity right now.

KERRY: But how do you mobilize politics to be willing to break that injustice?

NABARRO: Well politics, of course, is about the exercise of power. And as somebody who works in public health, I’ve always believed that the reason to exercise power is to bring benefits to people who otherwise don’t have them. Otherwise, what’s the point of politics? You might just as well say we’ll just let things go on as they normally do. And obviously that under the normal circumstances those with wealth are better able to look after themselves and to exercise whatever authority they want to, and there’s nothing to restrict that or restrain that.

But, you know, the reality is that we live in a world where we depend an enormous amount on people with low pay. And therefore it’s really important that those with power do whatever they can with that power to enable those who are low paid to have better lives, to have better opportunities. And perhaps most importantly, we want to make sure that those who are low paid are not put in positions where they’re more likely to get ill. Otherwise, as I say, what on Earth is the point of having power?

So I would have thought that we have to make this point through moral arguments, which of course I do. I think that’s just about all a person who’s a public health professional can do, is to keep emphasizing that poverty is associated with much greater risk of illness and death. But then I think there are others who perhaps are in different professions or different occupations who can make the point from arguments based on what’s good for the wellbeing of their society, what’s good for the security of the society, what’s good for the opportunities in society. But whatever it is, I would hope that everybody who’s dealing with COVID is also saying: If you have power, use that power to reduce the inequities and the injustices that are revealed through this disease in all nations.

KERRY: Which actually raises another question I think is very important to address, especially considering you, you know, work for the WHO. You know, the WHO, since the Bretton Woods, has been our international health agency to provide guidance and in many ways often be our moral compass about the injustices around health, and our need to try to correct those, and to build sort of a common market or conversation around that, providing critical guidelines and kind of filling in the market failures that happen across countries. There’s obviously been a lot of attention on the WHO with recent epidemics—both with Ebola back in 2014 and obviously now with COVID as well. And the value of the WHO, to me, is deadly clear. I teach about it when I teach my class at Yale on politics and health about the power of the WHO, the example’s it’s done in terms of helping us to mount global responses to epidemics that don’t respect borders, as we’re seeing now.

You know, this has not necessarily been valued by the current administration in the United States, for example, who has threatened to cut off the WHO funding—I believe it’s something like 20 percent of the WHO’s total funding—and is saying that’ll go away. You know, if you could just—and I don’t mean to be simplistic about it, but if you could just please share with this wide audience why the WHO is so important and what is really at risk with the threat of withdrawal of that funding, I think it would be really powerful to hear from you.

NABARRO: Thanks very much indeed, Vanessa.

The World Health Organization has a staff of around seven thousand people in more than a hundred countries, six regional offices, and the headquarters in Geneva. Its budget is—its annual budget is about one-third of the United States Centers for Disease Control and Prevention. One-third. Its owned, the WHO, by 194 countries. They’re called member states. Each year they meet together, and they set the rules under which the secretariat of seven thousand people works. And they’re very tough when they set the rules. They negotiate them. They reach very precise agreements. Then they allocate the budget, which has not changed very much in the last few years, and then they ask WHO to do everything they can possible on a whole variety of areas with this budget.

It’s an organization that is really quite tightly governed. And within that governance, there’s a thing called the International Health Regulations. You might know about it, Vanessa. It was negotiated in 2005 after the SARS outbreaks in eastern Asia. And that sets out very clearly what the WHO secretariat may do and what it may not do. And it also sets out very clearly the obligations of different governments within an infectious disease threat. So for example, WHO cannot report the existence of an infectious disease unless it is told about the infectious disease by a member state. Even if there’s a rumor, WHO has to go to the member state and say: Is it true that such-and-such a thing is happening? Otherwise, it is forbidden from reporting it. It’s a very clear rule.

Secondly, WHO is not allowed to unilaterally suggest travel restrictions unless, again, it has a very clear case for doing so. And if any country unilaterally imposes travel restrictions, the WHO is required under the International Health Regulations to ask what is going on. That’s simply the rules. And the secretariat, which is made up of people like me, I used to work there for quite a long time, we operate within those rules. We do the best we can. And so when we hear rumors we have dialogue with countries. We ask them to tell us more. It’s very much done on the basis of respect and inviting them to share.

But the organization is not a global health inspectorate. It’s not going around the place demanding to enter into countries and then making a great big fuss if it can’t. Otherwise, we’d never have any cooperation with any country. And that’s the basis under which this system works. It was set up like that by the member states, all of them. And it has to operate like that. There’s just no other capacity. So of course, countries get really upset when an outbreak starts. And they’re always going to say: Couldn’t action have been taken earlier? Couldn’t it have been stopped at the source?

I remember this during the Ebola outbreak when I was involved in 2014 and 2015. We had the same issues with avian influenza in 2005. And always afterwards you say: If only we could have acted earlier. If only we could have contained it quicker. And that’s really a very good thing to do. And these kind of deep evaluation afterwards is how you find out what’s going on and you make things better. But the kind of weird thing that’s happened recently, three weeks ago—actually, I’ve lost track of time; two weeks ago—is WHO suddenly told in the middle of doing everything it can to bring everybody together to deal with this totally new situation that’s really damaging the whole world at great speed, suddenly we’re told: Sorry, you’re just about to have a 20 percent cash cut. You’re really messing up. And we don’t think you’re any good.

So the country on which globally we’ve most depended for leadership on global health, what’s called global health security, suddenly says: We’re pulling out. It’s really odd. You wonder what could possibly lead a country which has been such an important leader in global health on so many issues to just say: We’re out. Of course, we almost certainly made loads of mistakes. I mean, you do in dealing with these kind of things. You can find things out that are wrong, and you’re always ready to be accountable for it. And I’m the person—I want to be called to account. I want to be told what I could have done better. But not right in the middle of this extraordinary, dangerous, damaging crisis, when the country on which we most depend says, bye.

KERRY: No, it’s very interesting. And I think a lot of it—you know, the WHO, a one of the advantages, obviously, of being an international organization is you can transcend diplomatic breaks, right? So if Iran is having a huge outbreak that still threatens the world, because people travel in and out of Iran, and the U.S. doesn’t speak to it. There’s still the capability at the WHO to be able to get information. You know, obviously as you know well, with the SARS epidemic the WHO was able to get access to the genetic sequence of the virus in a way that becomes available to the global community to develop vaccines. And so I think that extraordinary power to kind of transcend what is bilateral politics is incredibly powerful, and certainly needed in this particular moment. So I share that sentiment with you, certainly.

If it’s all right, what I’d like to do now actually is to ask our—Laura, our operator colleague—to join us now and to begin to take some questions from participants on the call, because I’m sure there are going to be many. And I want to thank you just for sharing your initial thoughts in the beginning. And it means a great deal to me, just as a public health practitioner and somebody who’s thinking constantly about how do we elevate health and investments in health systems, to learn from you a little bit.

But, Laura, let me ask for your help how to field some phone calls.

STAFF: (Gives queuing instructions.)

We’ll take the first question from Dan Sharp.

Q: Hi, David.

I want to ask you a question about vaccines. Can you hear me OK?

NABARRO: Yeah.

Q: It’s good to see you. I remember during the H5N1 period when I was with the Royal Institution World Science Assembly we worked together. And I remember at that time being very concerned about the capacity of the world to produce vaccine. At that time, it was somewhere we thought around three hundred million doses per year, which was grossly inadequate not only for the U.S., but for the world. Could you kind of talk us through how the capacity to produce vaccines has changed, and what the—what the timeline might be? There’s been so much fantasy discussion about having a vaccine that people could use this year that we really need you to give us some sense of reality about the timeframe, about the capacity, about the challenges of the supply chain, of products, and getting it manufactured and distributed. Can you bring us up to date on that, please?

NABARRO: Thanks, Dan.

Vanessa, is it OK to go straight to the question or would you like me to defer—it’s OK? Cool.

KERRY: Please go ahead.

NABARRO: Thank you. Well, of course Dan was talking about the H5N1 avian influenza situation, which was a disease that affected birds, particularly poultry, in very large number. And we were really concerned that it was starting to jump into humans and would cause a human pandemic. And in fact, there were sporadic cases of the virus moving into the human population, and we were extremely concerned. So we were checking out what’s the capacity of manufacturing rapidly a new influenza vaccine. And, yes, there are limitations because at that time the process of manufacturing influenza vaccines was based on a technology which was very hard to scale up.

But, Dan, I’m told—and I’m not an expert on this—but I’m told there are a lot of really interesting new technologies that are being used to develop antigens that can then become a new vaccine. And there’s one quite well-known group in the U.S. that I believe is using a particular new technology, it’s not an easy technology, but they believe they have capacity to scale up to several hundred million doses, or perhaps even a billion, if they can get the right level of investment.

And this is great. But a billion isn’t enough. And I think that my concern, and it’s not—I’m not the only one—is that if there is going to be an effective vaccine against this new virus, what’s important is to have enough vaccine to immunize everybody—and I mean everybody. You see, it’s no good having a vaccine that just protects the people from rich countries who can afford to get a down payment to buy it. It’s just no good, because the rest of the world is still going to have the disease. And will the rich countries just want to close their borders, and say: We don’t want to communicate with the rest of the world? And we’ll all just be immunized, but everyone else will be without vaccine? I don’t think so.

And I don’t think some of the governments that have contributed nearly $8 billion towards the cost of vaccine development want that either. And I certainly don’t think that health workers in poor countries who are currently unable to get hold of protective equipment because of market failures—I don’t think they’re going to want that either. And really I think that the only way to move ahead on a COVID vaccine is for every single country to agree that this will be distributed to those who need it the most first, as soon as we’ve been able to be convinced that the vaccine is safe, as well as effective.

Otherwise, if it just goes to the few that can afford, what does it say about us as human beings? What does it say about our priorities? And what does it say about our view of what is right and wrong? And perhaps one of the biggest tests of humanity in the coming weeks and months, as the vaccines do come on stream, is going to be the extent to which we will be able to say: Our first task, having tested the vaccine, is to make sure there’s at least eight billion, and ideally a lot more, doses available so that people in poorer countries who’ve been very seriously endangered by this virus can be at the front of it too.

And so, Dan, that’s up to us as global citizens to call for. And it’s up to world leaders to act for. But I think it will be a pretty terrible stain on the conscience of humanity if there’s not a totally equitable approach to the distribution of COVID vaccines once they actually appear and are shown to work. That’s my view.

KERRY: And I think it speaks to the fact that we’re going to need multiple vaccines produced to be available at that kind of volume. And I think that’s why we should be rooting for every vaccine company that’s coming forth.

NABARRO: And, please, don’t cut any corners on the testing.

KERRY: No. (Laughs.)

NABARRO: Really strong community of people who are very worried about vaccines at the moment, otherwise we wouldn’t be having big measles outbreaks in our countries. So let’s just be respectful of them as well. No corners cut. No short circuits. Really we must show that whatever vaccine comes along is safe. And if it’s got any side effects, we need to be utterly transparent about that.

KERRY: Great. Take another question, please.

STAFF: We’ll take the next question from Katherine Hagen.

Q: Hello. This is Katherine Hagen.

Looking forward to your response, David, to the remarkable work that you have been doing in this particular initiative, but also many others. And I would hope that we could look at the ACT Accelerator, and in particular the crucial aspects of it with regard to multi-stakeholder engagement, and the presence of very substantial American business and philanthropy involved in it as well, and the G-20 connection as well. If you would comment on those two aspects of what’s going on with regard to trying to mobilize a global response to this issue, I would appreciate it. Thanks.

NABARRO: OK. Katherine, my greetings to you, and joyful to hear your voice.

Well, I want to stress, Katherine, that the countries that are suffering the most as a result of this disease are poor nations, particularly poor nations that moved really fast to do everything they could to limit its spread. They didn’t wait, but as soon as they had their early cases they did what they could to strengthen their public health services within the limitations they had. They did what they could to repurpose their hospitals, within the limitations they had. And they restricted movement to try to stop any spread. And they had to cope with enormous unemployment and deepening poverty. And I think all of us know that poor countries have been hurting really, really badly in the last eight weeks, and that the level of poverty in the world has dramatically increased during the first half of 2020.

Who’s going to come to the help of these poor countries? We’ve got really serious balance of payment shortages and whose businesses, particularly as small or medium enterprises, are going bankrupt at an incredible rate? Well, I would hope it’ll be the International Monetary Fund, because that’s what’s happened before. But I’m told that the amount of cash available to the International Monetary Fund to help poor countries is really limited. Some have said that multiple trillions of dollars are needed to enable poor countries to survive this without great increases in poverty, associated risks of hunger and malnutrition, and then other serious and difficult challenges further downstream.

If the International Monetary Fund had even a proportion of the resources that wealthy nations have used to keep large businesses afloat, to keep small and medium enterprises afloat, that would go a long way to helping the poor world weather this terrible storm. So who does one turn to, to try to get that kind of global solidarity put in place? Well, it’s the G-20, because they are representing the world’s most powerful economies . I’ve not yet seen any signs that the G-20 is taking on the major challenge of enabling poor countries not only to cope with the economic challenges associated with trying to deal with COVID, which has arrived in their borders unexpected and, of course, unwanted. But I don’t see signs of the G-20 actually saying: We’re really going to support the poorer nations of this world even with a tiny proportions of what we spent on keeping our own businesses afloat.

But that solidarity is not there. And it’s absolutely, seriously needed because also poor nations are going to need help to build up their public health services. And they’re going to need big money, otherwise it’s going to be very hard for their people once air travel resumes to be able to be welcome in the developed world, even though the developed world has actually had much bigger COVID problems and much more difficulty getting on top of its COVID. So there’s a very tricky situation in the world today.

And I suppose if I had a magic wand, it would be to say to the G-20 leaders: Please recognize that this is a massive global challenge and that poor nations and the poor people in poor nations are hurting desperately. And even if you can’t feel it, I can tell you they are hurting. And please make certain that in coming weeks and months that there is enough cash available to enable poor nations to keep afloat and not to go bankrupt, because the consequences of poor nations going bankrupt as a result of COVID will be extremely serious for our world. And I don’t need to say what they are, Katherine.

So, yes, the ACT Accelerator is a great thing because it has led to real solidarity among some nations on diagnostics, on therapeutics, and on vaccines. But I’m saying we need solidarity in one more area, which is to support the poor nations of our world as they cope with the economic devastation to public finances, as well as to the incredible level of defaulting on private debt that is occurring as a result of COVID. That is also an emergency that needs very strong global leadership right now.

KERRY: Thank you. I really appreciate that strong message. I think that there is an underestimation of what it means to leave these countries continually behind, which we’ve been doing for a long time, but in this moment as well. So thank you.

Why don’t we move to the next question, please?

STAFF: We’ll take the next question from Kilaparti Ramakrishna.

Q: Great to see you, David. Thank you for your comments.

I’m trying to follow up on what the minister said about separating the politics from the pandemic. And one of the positive things said about COVID-19 is the phenomenal collaboration amongst doctors and epidemiologists around the world in finding solutions, will they be about the virus and so on. But given the restrictions place in China about preapprovals by the government before that information is shared, what do you see as the impact of that in moving us forward with solutions? And what role do you see WHO play, particularly in light of the funding issues that the United States has raised? Thank you.

NABARRO: Thanks very much indeed. Kilaparti, it’s nice to see you.

And I must say, your question is, in a way, challenging on one hand, but also not at all challenging on another. So let me start with the easier part, which is that I have never felt such a willingness on the part of scientists of all kinds, from all nations, to collaborate in an open and uncompetitive way—whether it’s epidemiologists and behavioral scientists, or virologists and immunologists, or public health experts of all kinds. There is a real wish of every person that I have come across to work together as openly and as strongly as possible, for the sake of humanity. But then, as I’ve explained before, the whole World Health Organization, the community of world health actors, that were united in a common values system of wanting to work for the public good, has to function within the constraints of national politics.

And because national politics is now dominated by suspicion and name-calling, particularly between big powers, it actually creates an impediment to scientific collaboration, because scientists suddenly find that they’re not allowed to share, that they’re not encouraged to be open, that they are even subject to disciplinary threats if they explain what they’re seeing. And again, I’d just like to say to all political leaders that the way humanity will come through this is through trust, respect, and openness. And humanity will be defeated by this if we are secretive, mistrustful, and if we are disrespectful.

It’s quite simple. If you start telling somebody that you don’t like them, that you mistrust them, that you don’t value them, they’re not going to cooperate. It’s so obvious. And so you are so right that what we need right now more than ever is the political environment that encourages trust. Now, I know that me simply saying it will cut no ice with those who basically just don’t get it. And I have to learn to respect that and I have to learn to try to understand it. What is leading those in power deciding that it matters more to find reasons why they should not cooperate rather than to find reasons to cooperate when we’re dealing with such an enormous, massive, total economic and political crisis that the only way to resolve it is by using the best characteristics of humanity, which is to work on problems together.

And so if anybody has got the answer to what it will take to help those in power to decide that they’re going to prioritize, respect, and trust, and encourage cooperation between scientists, please let people like me know because we are desperately searching for the answer to that. We are searching for it so intensely because we are seeing the extraordinary results of lack of cooperation impeding scientists from being able to share, impeding public health experts from being able to work together. And I feel that’s really sad. So I’m sorry I don’t have an answer, but I think your point is very well made.

KERRY: Thank you. Really a lot to think about. Incredibly powerful. Though, with that I am going to ask us to move to the next question, though it’s hard to transition from that.

STAFF: We’ll take the next question from Eric Polovsky (sp).

Q: Thank you very much, David, for doing this.

I wondered if you might comment on what you think the current analysis of whether the infection followed by recovery affords medium term, short term immunity to the disease. And if we don’t know, which I’ve talked to a number of experts and I think the answer to the first question is we don’t really know yet, when will we know? And sort of what timeline are efforts to establish the duration of that immunity are they on? Thank you.

NABARRO: Thank you, Eric.

Everybody, this is probably the most important question of all when it comes to trying to understand about this virus and what it does. And the reason why it’s an important question is that there is a concern that after you’ve had the COVID that although you develop antibodies to the COVID, the virus, those antibodies may not last long enough to protect you against another infection after six months or one year. Or if they do protect you, they might just protect you a bit, and if you get a heavy infection you still might get it. And that’s because actually immunity after coronavirus infections is not something that we can assume happens. There are all sorts of questions about the duration and nature of that immunity. So I’m actually going to have to say to Eric, I’m so sorry. I don’t know the answer. And secondly, I don’t know how long it’s going to take for us to get the answer.

A lot of the data that we have about COVID, particularly about how it behaves, comes from studies that have been done and shared by Chinese colleagues, particularly during a very detailed investigation that was done by a joint group of WHO and China in the middle of February this year. And I believe that we will get more information from our Chinese colleagues as and when they’re ready to share it with us, because they really have done a lot. And I think also colleagues in the U.S. are doing a huge amount as well. So I’m anticipating we will know some of the answers to these questions, it’ll be murky and it won’t be very precise, in the next two months or so. And it’s extremely important that we have a better understanding of that because that will also have an influence on our approach to developing a vaccine.

So thank you for making the point, and I’m sorry I can’t be more precise.

KERRY: Why don’t we take the next question, please?

STAFF: We’ll take the next question from Jeffrey Sturchio.

Q: Thank you. David, this has really been a fascinating conversation. And I want to thank you for the clarity of your insights on this very complex question.

I wanted to just go back to the comments you made about the need for trust, and respect, and openness in bringing countries and stakeholders together to address the coronavirus pandemic. And I wanted to just ask you to go back twenty years to when you and I played a small role in helping the WHO, and UNAIDS, and other multilateral agencies work with a group of countries to bring antiretroviral treatments to Africa, and begin to enable those countries to get more equitable access to those—to those drugs.

You know, what was different then than now is that it seemed to me that WHO had a much more flexible approach to working with the private sector on a key issue like that. And what’s intervened in the last twenty years is the framework for engagement with nonstate actors, which often makes it challenging for WHO to have the kind of dialogue and to build the sort of trust that we did twenty years ago around HIV. I just wanted to you reflect on, do you see that WHO and the others who you’ve been talking about are able to engage with the private sector in a way that will lead to important developments, that will lead to us having eight billion doses of a vaccine, if one comes along, rather than it not being that broadly available.

I think everybody understands we need to have that kind of cooperation, but are the—is the framework in place to make sure that happens?

NABARRO: Well, of course, Jeffrey—and, first of all, I have to say how wonderful it is to know that you’re here, and to remember all that time when people were saying HIV/AIDS treatment in Africa is just too expensive, can’t be done. And I remember how you brought the CEOs together, with Pete Piot and Gro Harlem Brundtland. And then I remember the meeting with Kofi Annan, where he just said: Can’t we just do it? And the drug company leaders said, yeah, OK. We’ll do it. And suddenly it was possible for HIV/AIDS treatment to be about 100 times less expensive for people in Africa. And the rest is history. It’s become a treatable disease. So thank you for your leadership.

I mean, I agree that rules have changed, and that there is this thing that was agreed by the member states—it wasn’t done by the WHO secretariat. The member states agreed a new framework. But I just wanted to say, Jeff, that over the last few weeks I’ve felt a bit like I felt twenty years ago when that miracle happened and the prices suddenly came down, that actually the cooperation between companies and between companies and the World Health Organization team, led by Dr. Tedros—who’s not at all scared of engaging in dialogue with anybody who can help—I think it’s happening. But I think that it’s time to go on as we move through this and look to the future of thinking of how the cooperation between all the different actors can be improved.

The one thing that I keep reminding myself as I get up each morning now and scan the news, and look at the situation reports and feel more and more totally anxious about what’s going on, is that all the different stakeholders are coming together now like never before to find new therapies, to look for vaccines, to develop better diagnostics, to deal with the market failures, whether it’s through the World Business Council for Sustainable Development, World Economic Forum, the Consumer Goods Council, or others. It’s happening.

But, yeah, Jeffrey, you’re right to point out to us that sometimes we make life a bit difficult for ourselves. And so I keep thinking back to that time, as you say twenty years ago. And we just got to remember that capacity of people to work together is still there and we must take advantage of it. Thank you for your leadership, Jeff.

KERRY: Thank you for, I think, reminding us of the power of what is possible, because I think there are many barriers. We can certainly look to those, or we can look to the opportunity and the fact that—you know, and you touched on this on one question before, that we’re in a very profoundly existential moment. And what our future is, and how good it’s going to look, and how much better we can emerge is totally going to be determined on our decisions, our actions, and our cooperation in this moment.

And so I want to echo Jeff’s, you know, words in saying that this has been a really extraordinary conversation and opportunity to draw upon your experience and your insights, your unique perspective, your wisdom, and your candor for where we don’t have answers, because candor is also deeply appreciated right now, and identifying that. And I just am deeply honored to have the time to help lead this conversation with you and to have you share your thoughts with this audience.

We have come to the close of the hour. For those that we did not get to your questions, I apologize. We have many participants and it was unlikely, unfortunately, with our time, that we were going to be able to get to all of them. But I think the biggest thing is—for all of us to remember is that we all play a part in determining this next step and this future. And I want to thank you in advance for thinking about how you can help contribute to the global social contract in which we live as a member of this world in this moment. So thank you for your time.

NABARRO: Thank you. Bye-bye, all. Thanks very much for the chance to be with you. Thanks, again, Vanessa, and all the team who supported us.

KERRY: Yeah. And thank you very much to CFR.

NABARRO: Hurrahs, as they say.

(END)

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