Global Health Governance: Perspectives From Abroad

Ahead of the 2022 convenings of the Group of Seven (G7) and Group of Twenty (G20), our panelists discuss policy and governance challenges arising from the COVID-19 pandemic that pose problems for pandemic prevention, preparedness, and response in the future.

This meeting is made possible thanks to the generous support of the Bill and Melinda Gates Foundation.

FINK: Thank you very much, and I would like to welcome everybody to today’s Council on Foreign Relations meeting on “Global Health Governance: Perspectives From Abroad.” And I’m told by CFR that this meeting is made possible with the generous support of the Bill and Melinda Gates Foundation.

I’m Sheri Fink. I’m author of a forthcoming book on the global pandemic called Surge, and I’ll be presiding over today’s discussion.

The minister of health from Indonesia had to go to a meeting, apparently, with the president. So we are very fortunate today to have a full hour with our guest, Dr. Jörg Kukies, who is the state secretary for economic finance and European affairs, and the G-7/G-20 sherpa at the Federal Chancellery in Germany. So, very big welcome to you, Dr. Kukies. And thank you so much for joining us today.

I want to start—we have a very sophisticated audience, people who may know quite a lot about these institutions and about global health. But just to get everybody on the same page, just tell us a little bit about the role of these institutions, the G-7 and the G-20, and in global health governance, how you see it—how Germany, which is leading the G-7, the rotating head of the G-7 this year. How do you see these institutions and their role in global health?

KUKIES: Yes, thank you. Thank you very much for inviting me.

And of course, it’s a pleasure to be here, and I think of course, our G-7 presidency has been changed quite substantially, where, as we wanted to focus on the issues of climate, of health, of infrastructure, of course, the Russian war of choice against Ukraine has changed priorities quite fundamentally.

And rightly so, because of course, the G-7 is not only an important alliance of large and economically strong nations, but also an alliance based on values, and therefore, it’s very obvious. And the leader statement that we released today to condemn the atrocities committed by the Russian army in Bucha, of course, shows that the leader statements, of course, have focused very strongly on the—on the events that are unfolding, unfortunately, in the Ukraine.

So in that sense, of course, the agenda setting, which we expected to be quite strongly dominated by the fight against COVID-19 has, of course, been supplemented, I would say, with this hugely relevant topic that, of course, has so much human tragedy and so much—in its ruthlessness, also so many attacks on the health infrastructure, and all of the civilian infrastructure that causes so much damage, that it’s very obvious that this has been pushed to the forefront of the discussion. So in that sense, I think it’s important that we focus on this.

But at the same time, of course, we have to maintain the focus on the pandemic and making sure that the focus on COVID-19 and fighting its consequences stays present, because of course, the combination of, on the one side, the war in Ukraine, but on the other side, of course, the fact that the COVID pandemic has been followed—or at the moment, been dominated by a version that is less severe in its—in its effect—also of course, helped a lot by the success of vaccination campaigns in some countries—has also led to less public attention.

But all of our experts tell us that that is a very dangerous sense of calm that some in the public sphere have on this topic. Because of course, as my friend and colleague, Health Minister Lauterbach always tells me, the risk of the next variant being much more severe and much more dangerous is very, very relevant, and actually requires our full attention. So in that sense, I think we still are going to maintain our focus on this topic in the G-7 presidency.

Of course, we will discuss a lot about infrastructure. In our analysis of the situation, the ACT Accelerator has done an enormously good job, and has led to the fact that the global community has been able to find an organizational framework. The funding of ACT-A, of course, is still an open issue, and that’s one of the big priorities that we have in ’22, because of its importance to fight the pandemic.

Germany—as G-7 president, we thought we need to lead by example as president and donated 1.5 billion U.S. dollars for ACT-A and supporting measures. So in that sense, we think it’s extremely important. And the upcoming large events—the COVAX AMC Summit, which is taking place tomorrow, the COVID-19 summit hosted by President Biden, the World Health Assembly at the end of May—are all important venues to show leadership in global health. And going into the G-7 Summit, which will take place at the end of June, all of these events will, of course, crystallize focus on the health topics affecting us in general, and the COVID situation in particular.

We will, of course, follow up on the one side on vaccine donation, but of course, the focus has shifted. It will be very interesting, what the experts on this call say, but on many other conversations that we are having—and I have to admit, decidedly, I’m not a health expert by training or experience, so I listen a lot—and a lot of experts who we talk to tell us that the situation on COVID-19 has changed very fundamentally, because we no longer have, as the key constraint to higher vaccination rates, the availability of the vaccines themselves.

Both industry and health experts tell us that the world can produce sufficient vaccines, as we stand, to vaccinate the world multiple times over. The big question is cooling-chains infrastructure, overcoming misinformation, overcoming qualification issues, overcoming simple things like availability of clean syringes in some parts of the world. So, the whole chain from delivering the vaccine to actually—delivering the vaccines to the airport, to actually getting the shots in the arms seems to be the binding constraint at the moment. But it’ll be interesting to hear from you what the—what the discussion brings.

That doesn’t mean, by the way, that we think the production as it stands is optimally organized. We announced a few weeks ago a cooperation with several African countries to localize production. So we’ve partnered with the industry and with several African states to deliver mobile production facilities to those countries, so that local production gains a foothold. So that’s also very important.

The G-7 presidency has also done quite a lot of work on long-term actions for pandemic preparedness. On the one side, we did the G-7 tabletop exercise, that led us to practical experiences and discussion on how to accelerate the speed of vaccine development, and better reaction to future pandemics. We are still working on quite a lot of activities on health system strengthening, primary healthcare, expanding production capacities—I gave you one example there.

On technology transfer, of course, we’re all aware of the very political discussion on TRIPS waivers. So if there’s views on that, I’d also, of course, be interested in hearing them. We’re hopefully heading for a compromise on all of that. And of course, there’s a big divergence of views, where some tell me the debate around TRIPS waivers is completely misplaced; it’s not the real issue hindering vaccinations. Others, especially from countries of the Global South, tend to disagree with that view, and say it’s actually a very relevant question. So, we’re hearing different opinions on that, and I’m keen to hear what the thinking is here.

But as long as the debate is ongoing, we are working on a lot of instruments and elements of voluntary technology transfer. And we actually find the—those—the patent holders to be very cooperative in that process, and actually delivering some of their IP in part for free, or posting it online, or making it available. So in that sense, I think those are important elements.

Of course, strengthening the World Health Organization is a topic that is still very much relevant for us. We do see a consensus emerging that the capacities of the World Health Organization currently are not sufficient, and that we need a strengthening to meet the World Health Organization’s requirements. It’s, therefore, very important in the context of the upcoming World Health Assembly in May to get involved in that dialogue. And that’s also very important for us.

In terms of the global health governance, we are looking to strengthen the global surveillance capacities, making progress towards a better integrated system that considers the One Health principles. Therefore, we’re also building on existing initiatives—the WHO Hub for Pandemic and Endemic Intelligence, the International Pandemic Surveillance Network, the One Health High-Level Expert Panel—and other activities.

Then just quickly, as a—as a—as the last points of my initial comments, there’s two big projects on our G-7 agenda. On the one side, antimicrobial resistance—that’s a topic that I also discussed yesterday with the Science 7, who are integrated in the G-7 process. We’ll focus on this area, especially on surveillance and research.

And the second area being all of the interrelation between climate change and health, on the one side, contributing to sustainable and climate-neutral health systems per se, but of course, also address all of the impacts that climate change has on occupational health and safety.

So with that, many thanks. That’s sort of the whirlwind tour of our G-7 presidency priorities, but happy to go into any of those elements as desired by the audience.

Thank you.

FINK: Wonderful, thank you.

You’ve touched on many, many important aspects. And I think both your introductory comment, as well as the breadth of what you just listed as priorities, really drives home an important point that maybe we should go a little deeper on, which is that there are so many priorities. And there is a sense that—and you mentioned that there's a sense that this is a milder variant, and people aren’t as concerned. But in fact, deaths in places like the U.S. are much higher with this variant, and we’re still seeing, you know, a lot of deaths in—now in the Pacific. And so, it may have been a misperception by a large part of the world that this didn’t need to be taken seriously, as I’m sure you would agree.

So—but you highlighted the fact that there are all of these now, you know, competing priorities. And so, you know, I guess that—let’s go a little bit deeper on the subject of your expertise, which is how things are all paid for. So, in terms of the global recognition that pandemic preparedness and response is an incredible—incredibly important priority, there are so many challenges of financing it with all of these other priorities and immediate crises. And you’ve talked about the involvement of Germany and other countries in these replenishments—CEPI replenishments has been announced, and Germany has contributed, and the Gavi COVAX AMC tomorrow.

But there’s still a long way to go, for—in terms of the asks versus the commitments. And you know, how do the leading economies address all of these different demands? And you know, is a global fair share perhaps the correct way, tapping security resources, since you could argue this is a, you know, a security issue, something else? You know, how do you look at the paying for it part? Or are we just going to take our eyes off the ball, and end up, you know, not taking the lessons of this crisis into the future?

KUKIES: I mean, my impression is that the world needs to agree on a governance, because one of the reasons that my—in my perception, just from the first few months of G-7 discussions that we’ve had since we took over the presidency in early January—is part of the reluctance to contribute more, of course, has to do with the fact that we haven’t agreed yet on the appropriate structure.

What I said on the WHO, I think, is somewhat emblematic that there is so much—there has been so much distrust of global cooperation and global institutions. Multilateralism has become somewhat of a—of a—of a—of a negative term. Although everyone on the one side says we can only solve these problems at the global level together, but still, we still aren’t seeing enough willingness to support, for example, the financial and resource needs of the WHO. And that’s why we are putting these discussions about what is the appropriate institutional framework at the forefront, because, certainly, the G-7 isn’t lacking a general willingness to cooperate at the global level. That’s definitely been a big positive change, I would say, to the G-7 work in some of the previous years. But we also, on the other side, haven’t yet reached the level of agreement that we need on institutional frameworks.

And by the way, this is not only a health issue; this also relates, for example, to the structure of the World Trade Organization, which—of course, the lack of agreement on an appropriate framework for the World Trade Organization, of course, also has adverse repercussions into health, because, of course, the global trade in pharmaceuticals is, of course, also affected by the lack of agreement on the way we govern and organize global trade.

FINK: And is there anything more that you want to say about how you envision, you know, the G-7 and the G-20 supporting a type of improved pandemic preparedness, in response funding, financing mechanisms, so that, you know, we’re not scrambling in the future, so that in the interepidemic periods, there can be rapid release of funds when there are threats that need to be responded to? And there’s—you mentioned the FIF. If you want to discuss that more, you know, if that’s— what functions do you envision that covering?

KUKIES: Yeah. Yeah.

Yeah, so, of course, the debate around FIF is a lively one, and we’re not—we definitely engage very actively in the discussions around FIF. We support the Indonesian presidency because, of course, we’ll have to have a debate on this at the G-20. We haven’t made a decision yet to join FIF as a donor; there are still quite a few open questions on scope, on governance, on how occasions, on links in particular to the WHO, how do we avoid duplication too. So all of these issues still need to be—need to be specified.

I think one of the issues that I named is the clarification of the scope of FIF. So, I think the issue of core capacity implementation, of course, is a key question there, ensuring that the FIF is truly inclusive, has buy-in of as many of the G-20 nations that we can. Buy-in of the WHO member-states, I think, is an important issue. So, all of these things are key to the success of FIF.

Of course, all of this is not disconnected from a fundamental problem that we will have in the G-20 this year. I don’t think we can evade that problem. The fact that Russia is present in the group will make it very, very hard to engage in the G-20 in the cooperative framework. So in that sense, I don’t think we can be sort of negligent of that shadow hanging over the G-20 in this year, and we need to find a balance on how to deal with this thing.

But at least for our government, that I know, and many of the other governments who have condemned the Russian invasion, it’s completely unclear if the G-20, which was intended to be one of the fora to discuss this, is an appropriate forum anymore to debate this topic.

FINK: And I think, just for people who aren’t experts, do you want to describe what a Financial Intermediary Fund is—what the proposal is, and then maybe segue from that, to going a little deeper on something you just brought up, which is really important, which is, you know, the role of WHO, the fact that WHO is a member-state organization of all countries, whereas something like the G-7, is, seven.

And you know, just the—I think it’s interesting that we’re having this discussion, and that if we step back and think about the members, and how they’ve done with the pandemic, and yet, are taking, or perhaps having such a powerful role in the future shape of global health governance, or the financing. And maybe you could just talk about those aspects.

KUKIES: Well, it’s a little bit tricky, right? Because there’s so much—as I said, there’s still so many decisions to be made on the exact structure. You know, like the exact role of the World Bank, that needs to be defined and scoped out. That, I think, is an important one. Then, as I said, the exact formulation within the G-20, I think, is a—is a big question that has only increased.

Of course, we can—we can see if there is an agreement on how to proceed with the G-20 governance in general, but I think it’s hard to really spec out the details of how the FIF institutional setup—the scope, the governance, and all of that—can be, as long as, you know, that there is this big question of, does the G-20—how does the fact that Russia, which is being condemned all over the place, in the United Nations, is part of the debate, how does that affect this—all of these questions?

I think that’s the overriding question, before we get into all of the details. And of course, it hinders the finalization of all of these details that we need to finalize.

FINK: Yes, that’s a good point. I guess, going a little deeper in something else that you touched on earlier, which is that the aspirations of countries in the Global South are, perhaps, at odds in some cases, with how things are seen in the Global North, or in the—within the countries that are in these powerful institutions. And one example has to do with manufacturing capacity, for example.

So, I’m curious, what role do you see the G-7 and G-20 in supporting these aspirations of countries in the Global South, coordinating health security efforts with organizations, regional organizations like ASEAN and African Union?

KUKIES: Yes, I mean, I think one of the big projects that we have is the support of all of the WHO hubs. That, I think, is a big opportunity for us to provide funding infrastructure and support. Also, of course, as the example of the BioNTech project with Rwanda, Senegal, South Africa shows, we are willing to work with the owners of patents, and technology, and IP, to broaden and expand the know-how, and the knowledge, and the research into the Global South. So, I think those are—those are all important steps that we—that we want to be helpful with.

And you know, we try to provide as much funding as we can to those initiatives, as I showed you with our—with our commitment that we have. But that’s, of course, only a fraction of the—of the development aid that we do in this sector.

FINK: Mmm hmm.

You’re painting a very depressing picture. (Laughs.) So maybe just before we go into—I mean, hopeful, in terms of many, many—many things to work on, many priorities, a lot of work going on, and of people who are passionate and committed in—to making progress, but then, of course, the reality check of what may or may not get accomplished.

So I’m going to—we’re going to be going in a moment to questions from all of the attendees, who have a wonderful range of expertise in these issues. But I would just ask you, you know, what would be the greatest achievement or deliverable for global health this year, from, let’s say, the G-7, which is the process you—you know, Germany has the presidency for?

KUKIES: I think ACT-A is, of course, that’s—I mean, that is, for me, the big—the big hope. And we’re having a lot of discussions, that we deliver on ACT-A, and proper financing of this instrument, because it is the, for me, most efficient vehicle and instrument that we have at the moment. So that’s why we consciously decided to move ahead, and despite all of the additional financing requirements that energy prices and all of the sort of fallout of the Russian aggression has on our citizens, to move ahead with ACT-A and to commit the resources.

So if we proportionately think about the one-and-a-half billion that we gave as a—as an initial commitment, you know, that—I would say, in contrast to the necessarily depressing element of the war in the Ukraine, you know, that does show that other priorities are also taken into account.

FINK: Great, and that—I’m sure our audience know the ACT Accelerator, this body that was created on the spot after this pandemic started, to try to promote global equity in vaccines and other countermeasures, access to diagnostics and treatments, and health systems strengthening.

OK. So I would like to open the question and answer. At this time, I’d like to invite members to join the conversation with your questions. And a reminder to everybody that this meeting is on the record. The operator will remind you how to join the discussion now.

OPERATOR: Thank you.

(Gives queuing instructions.)

We’ll take the first question from Jay Markowitz.

Q: Good morning. Thank you both for doing this important and timely call, and for CFR for hosting it.

I know that COVID, for all the right reasons, is front of mind for everyone. But your—you’ve talked about—you mentioned antimicrobial resistance, which is also known as, you know, the hidden pandemic that, you know, kills an estimated 1.3 million people a year, and is slowly spreading throughout the world.

I work at ARCH Venture Partners, a venture capital firm. And one of the challenges that we have is that the model for antimicrobial therapy disincentivizes companies from making an investment in the drugs that we need to treat these resistant organisms, and even develop vaccines that would prevent them from occurring in the first place.

So, I’m curious what you and the G-7 are doing to address this silent pandemic that will only get worse. Thank you.

KUKIES: So of course, I mean, the first—the first answer I would say, is of course, technology and research. So of course, we continue to believe in the power of research and technology, and to developing new antibiotics that overcome this problem of AMR. But of course, we know that it’s a little bit of a constant evolution of new antibiotics and resistance against them. So, we also think that the element of surveillance is an important component of the—of the—of the—of the solution to the problem, whether it’s on animals, humans, the environment, that will play a role as well. And we need to get more sophisticated on that topic.

The health ministers, by the way, the G-7 health ministers’ strand are very, very focused on this topic. And it is one where they are deploying all of their expertise, and we will get quite a lot of input from them going into the G-7 Summit. So watch this space, and we’ll—the health ministers have just started work on this, but they are evolving in their thinking, and we’re going to be making a lot of progress on this topic.

Q: Well, thank you. If I could just clarify, perhaps, because it’s not so much that people aren’t, you know, interested in—it’s the economic model that’s broken.

KUKIES: Mmm.

Q: So that companies cannot get a return on the massive investments necessary to create these drugs, because their use is so restricted, and the pricing is viewed as impossible or unsustainable, in terms of charging what would be necessary to get the return on investment. So to the extent that the research could be subsidized, or that the use can somehow be liberalized, such that the prices can be reasonable, would be necessary to get the private sector to make the necessary investments. So, that was really what I was trying to get at, is what—

FING: Could we—I’m sorry. (Laughs.) I think our—

Q: Can we change the economic model? Sorry.

FING: —our tradition here is to ask questions. Thank you for the good points, and I’m sure Dr. Kukies appreciates it.

But would you like to respond to that before we move on?

KUKIES: I mean, I think this is—I mean, that goes to the heart of the question of the economic incentives. And you know, that’s—I mean, on a related topic, in a way, that’s somewhat related to all of the questions about TRIPS waivers, and patent protection, and pricing, where, of course, I completely understand your views. And as you know, the German government on TRIPS waivers is very much in the area of understanding that if we want to incentivize research, the economic reward from the very few medications that end up being the product of commercially viable—end up being commercially viable, needs to be there. And you know, with BioNTech, we have one company that has shown that it is possible, and that you cannot have the ex-post consideration, and only say, oh, BioNTech is making so much money, and it’s unfair. And therefore, we have to—we have to get rid of patent protection.

So, I completely understand the tradeoff there. And it is something that I’m happy to look at in more detail also on AMR, because of course, the discussion on waivers and pricing and all of these questions has focused a lot on the COVID-19 phenomenon, but it’s equally relevant for AMR, I think.

FINK: Thank you.

Kayla, would you like to go to the next question, please?

OPERATOR: Sure.

We’ll take our next question from Jove Oliver.

Q: Thank you both for a great discussion today. Really appreciate it.

Dr. Kukies, so I want—I was really pleased you mentioned One Health in your introductory remarks. I used to work on zoonotic tuberculosis. I used to work with the World Health Organization. I now do some consulting in global health.

Even before the pandemic, I was sort of surprised at how, you know, the global health and the environmental communities are pretty separate, in the NGO level and the research level. You have different ministries responsible for them in government, different U.N. agencies that look after them globally.

And so when the pandemic hit, I was just struck—and, you know, especially with climate change and sort of the need for more connective tissue between these two communities, I’m just wondering what you could do at the G-7, at the G-20, you know, to sort of help, you know, bring these two communities—whether it’s from the research end, right through to the on the ground, and the advocacy—you know, how can we bring them together?

And you’re on mute there, sir. But thank you for the—thank you for the—your response.

KUKIES: Yes, I mean, we are—I mean, that’s exactly what we are trying to do in the—in the presidency, of getting UNEP, WHO, FAO, and all of the communities to hold joint meetings. Of course, we are going to look very carefully at the recommendations of the One Health Expert Panel that I think is going to, in its new structure, provide a lot of this interconnected work between the various—the various areas.

Our health minister is working extremely closely with our minister for economic cooperation and development in the G-7 work, and is trying to integrate those elements. I mean, we—in a way, the reaction to the pandemic was an exercise in all of this, because when we organized our response, all of a sudden, you know, the health minister, of course, was always in the lead, but we needed assistance for—from all of the economics sides on how to retool production, supply chains. We had, of course, the financing of it being a key element. So we will involve all of those strands in the debate here, as well, on One Health.

And I’m really hopeful—and you know, if you disagree, please let me know, if our trust and faith in the One Health Expert Panel is—needs adjustment, or if there’s things we can do better there. If you have input on that, that would be highly welcome.

FINK: I’m not sure if the—if the person is still on there—(laughs)—to answer your question.

Q: Oh, no, just—thank you. I thank you for the effort you’re putting on that, and certainly eagerly await the recommendations of the expert panel, and hope that during the presidency, you all can continue—as you are doing—to shine a light on a pretty critical topic, not just in terms of COVID, but I think in terms of climate and environmental resiliency moving forward. So, thank you for the discussion and the points.

FINK: Great.

Kayla, we can go to the next question, please.

OPERATOR: We’ll take the next question from Emmanuel d’Harcourt.

Q: Thank you very much for this, and for the really interesting talk and questions.

So, my question for—is for Herr Kukies, is regarding the—exactly what Sheri alluded to, in terms of the very different perceptions we're hearing from African countries and Asian countries. Because as Sheri said, we’re hearing, for example, people saying, how is this different from Iraq, for example, talking about the Russian invasion. The, you know, tangible action on COVID vaccine came late in the game, on the kind of “you’ll eat after we’ve had our full meal” model. Russia did all this in Syria; there was very different reactions. And then, you know, things like health system strengthening, which you mentioned, has been led by a coterie of health system experts primarily from rich countries, who really have very little to show for it.

So, the combination of these kind of hollow promises, double standard, gets in the way when a pandemic hits, when it’s time to cut off Russia, or to asking, you know, poorer countries to cut off Russia. So—I know that’s a lot to kind of handle, but what can G-7 and the German government do to rebuild this trust? Thank you.

KUKIES: Well, I think it’s a—it’s going to be a balanced reaction of, on the one side, direct financial support. So, I think what I said about the ACT Accelerator is important there. And of course, that goes directly—of course, we are also, in terms of setting up of our budgets—and I know my colleagues in the other G-7 are thinking the same way—of course, shifting quite substantial resources in their development cooperation, into the question of health in general, but also directly into COVID-19 response.

But in addition, also, as One Health experts once told me, COVID-19 is only one of around twenty-five potential sources of pandemic, and there is many more out there. So, working together on exploring those, and researching those, and finding vaccines and potential cures for those, is, of course, also extremely important.

The next topic, I think—which I think we didn’t get right at all—is the question of immediate response to South Africa’s detection of Omicron. While the world should have praised the work done in South Africa and looked immediately at how to help, travel bans were imposed and restrictive measures were imposed that, at the end, didn’t prove useful or efficient. So that, I think, lessons learned from the reaction to the Omicron, I think, is also something that the G-7 has to look at, and is looking at very carefully.

FINK: Thanks.

Just to go a little more into this—well, two aspects—let’s just start, you know, there—you’re speaking to an American audience. There are some big issues right now, with having a sense of whether there will be funding, both for domestic COVID priorities, as well as the global COVID response. And so, you know, what does the rest of that response look like, if there really is, you know, no more USG money? And can you—you know, what are your thoughts on that?

KUKIES: Well, of course, I won’t comment on U.S. domestic policy choices. So, obviously, the question of USG money is not something I can address. I can only say—I mean, the response in my country is, I would say, is still to take the threat from further permutations enormously seriously. And that’s why we are still deploying a very, very substantial amount of financing and funding to all of the things that we talked about.

Of course, in Germany, the question of still insufficient vaccination is a core topic. We’re still sort of now stuck in the low- to mid-70s (percent), depending on the exact way that the numbers are counted. And we’re still seeing—and in fact, German parliament is debating this as we speak—about an obligatory vaccination scheme. It looks like in the first round, the parliament actually rejected this today—i.e., the imposition of mandatory vaccination may not happen.

But that certainly will still continue to be an element of the debate, how we get from low 70s closer to 100 (percent), especially in the vulnerable groups, because we are seeing that despite the fact that vaccinations and boosters don’t prevent infections from accruing, they do dampen the severity of infections quite massively. And that’s what we’re seeing.

Our health minister told a cabinet just yesterday about the studies in Israel that show that, actually, a fourth vaccination, especially in the age groups above sixty, is being shown in some clinical trials and tests and empirical studies as being highly relevant and effective.

So in that sense, that’s also something that we’re keeping our eye on very carefully.

FINK: Yes, so clearly, not over. Clearly, still threats, and especially in vulnerable populations.

But I want to—I just want to clarify a little bit what I was trying to get at with that question, which is—and I guess it’s kind of the bottom line of a lot of the themes that we’ve been talking about, which is, you know, we have this pandemic. There was massive inequities in terms of the tools, the countermeasures, the things that countries and populations needed to have access to, to protect themselves. It was, you know, early on especially, just such a lag with, you know, access to those tools, and really, you know, the financing, the ability to ensure that there is money to, you know, quickly ensure that both the science—which is a good news story here—gets done, but also that these tools and access to them are, you know, more equitably accessed.

So, you know, if—this—the U.S. example that I gave, not asking you to weigh in our domestic policy, but more just the idea that a country may be all in at one point, and then priorities may shift. And it may not be all in.

So, what are the types of institutions that—or, you know, the financing mechanisms, you know, what structures can be strengthened? What worked? What can be, you know, improved upon? What can we learn and put in place so that it won’t be so dependent on this?

And you talked about the importance of strengthening existing institutions. I think there’s a lot of fear that there will be lots of new institutions, or fragmentation. And so, you know, maybe just address that. That seems such the core issue going forward, from this horrific, horrific, you know—the just catastrophic loss of life, and—you know, that we’ve seen. So, how do we do better? How do we ensure—how does the G-7, you know, which is your focus—

KUKIES: Yeah.

FINK: —contribute to that?

KUKIES: Yeah.

So first of all, I think the—I wouldn’t have as negative an interpretation as you just outlined, because you know, the fact that the world was able to develop vaccines in a very short time span, the fact that our two countries—Germany with BioNTech, and Pfizer in the U.S.—cooperated enormously closely, the fact that, of course, after a first impulse to the contrary, the European Union converged and set up a massive funding program—that of course, as the previous speaker said, was initially for the own population. But as the pandemic evolved, of course, the fact that the funding from the European Union for the BioNTech-Pfizer, Moderna, and the other products was rolled out so quickly, after a first impulse to sort of idiosyncratic, isolated solutions the European Union got together, the U.S. provided funding.

So there was a very, very large amount of billions and billions of euros and dollars that went to those who scaled up the production very quickly, who established the supply chains, who built up the infrastructure for vaccinations. I don’t know how many examples in the past decades there are of such a massive rollout of millions and millions of vaccines taking place in such a time frame. That now leads us to the position where the efficiency of our production facilities are such that vaccine construction isn’t the binding constraint on actual vaccination success.

Probably, if history is written about this tragedy, we will rightly be criticized for focusing too much on sheer output and sheer numbers of—vaccine numbers, and too little on the infrastructure behind it, cooling chains, localizing production, and figuring out how to provide the amount of sterile syringes in all corners of the world, and sheer volume of dollars. Probably that wouldn’t—probably the allocation was too much on production and too little on distribution, I would say, ex post. So that certainly will—should guide our thoughts on what we can improve.

But the fact that, you know, we have enough vaccines—as one expert told me recently, we have enough vaccines to double vaccinate and booster the planet—is an achievement, right? The big problem is weren’t getting there yet.

FINK: No, absolutely it’s true. And it is much faster than ever in history that, you know, some of that inequity has been addressed. And certainly this time there was an effort, and you mentioned ACT-A and, you know, COVAX, and a recognition early on that this was a goal that was important to get behind. Not taking away anything from that. But I mean, I’ve been going around the world. We’re in April of 2022 where we have this situation of enough production. But I watched people die, you know, along the way. So every lag, every, you know, gap in the time was people’s lives.

So isn’t there a goal of having some mechanisms in place for the future where it will just be a lot more, you know, equal from the beginning? Or is that not what the world is going to get behind? Developing countries, the countries that have the resources, you know, to promote some structures that could address it sooner, and to be able to have those institutions have the funds to, you know, play in the marketplace early on when those products are being, you know, bought and reserved for when they’re available. Not to mention all of what you just said, which is tremendously important, which is that it’s not just the product.

KUKIES: No, but please don’t get me wrong. I mean, if you look at the global map I recently saw—I’m not exactly sure from whom it came—vaccination rates in a world map. And of course, there’s a massive, massive, massive north-south gap on that map. And certainly that’s, as I said, the point that we will be criticized for. I mean, please don’t forget, one of my biggest concerns that we still have, and the most obvious deliverable that we will not be able to meet, is the goal of the WHO, endorsed by G-20 last year, that we will achieve a 70 percent vaccination rate in each country by mid-’22s, right?

And if you look at some countries, especially in the global south, we just had the EU-African Union summit in Brussels in February. You know, the numbers very clearly indicate, and we have not made that much progress since mid-February, that we will be remotely far away from achieving the 70 percent in each country goal. We may as an average get somewhere near the 70 percent globally, but, you know, in terms of the inequity of the distribution between rich countries and poor countries, and within the rich countries between the well-off and less well-off population, I mean, the inequity is still very, very strong.

The key question is, again, is that because we don’t have enough product? Is it because we don’t have enough distribution? Or is it because we don’t have enough education? And I’m getting enormously divergent views from experts on those questions, although I would say the expert community is converging now on the fact that we have enough product. The question that people are asking, is the product the right product, right? Because of course, the product has been—has been developed for the needs of populations and the ability of countries who are able to cool vaccines to minus 70 degrees Celsius. But of course, for African, where that cooling chain is not available, maybe the product has to be altered.

So I think that’s a lot of the things that the WHO is working on, and we’re trying to support that. But of course, the WHO I think needs to be strengthened. And that, to me, is a key, key question where we—where we still have institutional—an institution that still needs very substantial strengthening that would be ideally placed, as a 194 member-state organization, to coordinate and organize this. And of course, in the—in the G-7 there’s the question of financing the World Health Assembly is a key question because that, I think, is the lever to get the WHO institutional reform and strengthening going.

FINK: OK. Let’s go to another question from our members.

OPERATOR: We’ll take the next question from David Fidler.

Q: Hi. I’m David Fidler. I’m a senior fellow for global health and cybersecurity at Council on Foreign Relations.

I wanted to ask a question about China’s role in the global responses to the pandemic. You mentioned that in the G-20 Russia’s going to be—the issue of Russia is going to be a problem. It’s not as if the United States and other members of the G-7 have good relations with China either. I think this also spills over into, you know, proposals to strengthen the WHO. So I was wondering if you could comment on your perspective, or the G-7 perspective, on what China’s role in this sort of epidemic of proposals that we have to fix global health governance. Because if we’re—we can’t trust Russia, and we don’t have good relations with China, are responses for these institutional fixes really going to be global in nature? Or is this something that’s just going to be on the G-7 agenda?

KUKIES: I mean, I think it’s not—on China, it’s certainly not for lack of trying. So we’ve—as the German government, I know for my colleagues in the U.S.—have offered cooperation with the Chinese government several times. And in a lot of cases, it has worked, right? I mean, if we remember the early phases of the pandemic, Chinese masks were enormously helpful during the time where all of a sudden, I know that for my country, the German government asked potential providers of medically sophisticated masks how quickly they could scale up production. And the answer was three months, six months, nine months, we don’t know. And of course, the fact that China had all the production facilities and was able to scale those up very, very quickly helped us tremendously in the early stages. And I don’t think that should be forgotten.

Of course, on the question of cooperation on efficiency of vaccines, those used in China, we could, of course, see a much, much closer cooperation. And we always encourage more cooperation. That, of course, is not at the ideal level yet. And of course, again going back to the elephant in the room, so to speak, of course the reaction by the Chinese government to the Russian invasion of Ukraine makes this dialogue more tricky. That’s pretty obvious. Of course, this difference in view on the assessment of the Russian invasion of Ukraine can’t be decoupled for all of the other questions of cooperation. And so in that sense I think we will continue to engage. But at a moment, that is a very challenging project.

FINK: Well, Dr. Kukies, you have managed to keep our interest and give us a lot to think about all on your own for this hour. I would just give you the chance, we have about one minute left, to make any concluding remarks, anything that you really want to get across that we didn’t get to, with regard to our topic today.

KUKIES: No, many thanks. I think it was very useful to have this discussion. And I’m taking with me quite a few points and questions that my colleague who was also on the call is—has all noted and put into the follow-up items of our discussion, especially the questions on incentives and the right mechanics or the right institutional framework and setup I think is extremely important. We still have a loss of life in Germany of between 250 and 300 individuals every single day. I mean, and the public isn’t taking note of it anymore. And so I think the—exactly what you said at the—in your statement, making sure that the world is aware that this crisis is in no way, shape, or form losing any kind of its threat, or that those who are still warning about potential future even more harmful permutations—those voices have to be heard. And we want to give platform to those voices.

FINK: Well, thank you. Thank you to our members too for joining today’s virtual meeting. And thank you so much to our speaker this evening. And please note that the video and the transcript of today’s meeting will be posted on the CFR website. Thank you very much, everyone.

KUKIES: Thank you.

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