The Global Health Security and Diplomacy in the Twenty-First Century symposium is cohosted by the Council on Foreign Relations and the recently launched Bureau of Global Health Security and Diplomacy at the U.S. Department of State.
This event convenes a globally representative set of influential policymakers, practitioners, and thought leaders to discuss the global need for better cooperation, coordination, and communication in tackling health security threats, which also threaten national security.
Speakers include U.S. Global AIDS Coordinator and Senior Bureau Official for Global Health Security and Diplomacy John Nkengasong, former Chief Medical Advisor to the President Anthony Fauci, Director of U.S. Centers for Disease Control and Prevention Mandy K. Cohen, and UNAIDS Executive Director Winnie Byanyima.
Speakers making welcoming remarks include U.S. Secretary of State Antony Blinken (pre-recorded video message to participants), U.S. Ambassador to the United Nations Linda Thomas-Greenfield, and Director-General of the World Health Organization Tedros Adhanom Ghebreyesus.
BOLLYKY: Good morning. Well, welcome to today’s symposium on Global Health Security and Diplomacy in the Twenty-First Century. We’re so pleased to have you. This symposium is co-hosted with the Council on Foreign Relations and the Global Health Security and Diplomacy Bureau at the U.S. Department of State.
I’m Tom Bollyky. I direct the Global Health Program here at the Council on Foreign Relations.
I think there are three takeaways you should take from today’s packed and totally amazing agenda. The first is that the effort to ensure global health security remains a focus of our regular diplomatic discourse, remains a high priority even as COVID-19—the crisis wanes.
You can see that from the terrific speakers we have today—multiple U.S. Cabinet officials, leaders of intergovernmental institutions and regional alliances, high-level representatives of foreign governments, CEOs, leading practitioners, civil society luminaries.
The second takeaway I would draw from today’s agenda is that global health security is very much a wide-ranging affair, drawing the engagement of many governments, institutions, companies, alliances, and NGOs, as it should. Pandemic proofing the future is a team sport and today you’ll have the opportunity to hear from some of the leading players.
The third takeaway from today’s agenda is that an agenda like this takes planning and I want to thank my CFR colleagues, especially Stacey LaFollette and Carrie Bueche as well as our State Department friends Josh Glasser, Nora Towey (ph), and Hillary Carter.
And with that said, I will disrupt the delicate planning of today’s agenda no more. And it is my great pleasure to introduce the first speaker, U.S. Secretary of State Antony Blinken, who sent welcoming remarks via video.
(Video presentation begins.)
BLINKEN: Hello, everybody, and welcome to the Global Health Security and Diplomacy Symposium. A special thanks to the Council on Foreign Relations and my longtime colleague and good friend Michael Froman for co-hosting today’s event, and to our partners from across other governments, civil society, and the private sector thanks for joining us today.
All of us now know the profound risks of a global pandemic. COVID-19 took the lives of millions of people. It upended those of hundreds of millions more. It devastated economies, and all of us now know that there is only one way to enhance global health security, together.
Indeed, because we worked together through a coalition of thirty-two countries, the African Union, the European Union, the World Health Organization, alongside civil society and private-sector partners from around the world we were able to lead a global response that helped the world emerge from the acute phase of the COVID-19 pandemic.
The United States has long been committed to using the power of our diplomacy to strengthen global health security to work to eradicate diseases like malaria, tuberculosis, and cholera; to contain outbreaks like the swine flu, Ebola, and Zika, and we’ve directed one of the United States’ most transformational foreign assistance initiatives, the President’s Emergency Plan for AIDS Relief, created by President Bush, sustained through four administrations with bipartisan support.
PEPFAR has helped save more than 25 million lives and created much of the health infrastructure used to combat other outbreaks ever since including COVID-19. Today the State Department is focused on leading the charge to ensure the international community is ready for the next health threat when it comes.
That’s why we worked with Congress to create the State Department’s Bureau of Global Health Security and Diplomacy. Over the past several months, under the leadership of Ambassador John Nkengasong, our new bureau has been hard at work bringing the power and purpose of American diplomacy to that urgent mission.
Let me tell you about just a few of the things we’ve been up to. First, we’re applying PEPFAR’s many lessons, for instance, on how to effectively track outbreaks and deliver medicines to hard to reach populations across our broader health security efforts even as we continue to prioritize its life-saving work on HIV/AIDS.
We’re also expanding PEPFAR’s reach to more effectively prevent the disease and serve those living with it. One of the ways we’re doing this is by increasing our collaboration with regional bodies like the Africa Centers for Disease Control and Prevention, the Pan-American Health Organization, and helping build up regional manufacturing capabilities in countries including Senegal and South Africa.
We’re doing this so that countries can more quickly produce and distribute treatments, tests, protective equipment, and become less reliant on and vulnerable to foreign supply. It’s vital that PEPFAR’s work continue and I look forward to working with our colleagues in Congress to secure a clean five-year reauthorization.
Second, we’re rallying international support for the World Bank’s Pandemic Fund, which will help us respond to future health threats. Already the Fund is undertaking vital work to build up regional disease surveillance networks, create early warning systems, and expand public health workforces around the world.
Since the Fund’s launch a year ago the United States has contributed $450 million, about a quarter of its total contributions to date and will continue to work with partners to mobilize additional support.
Third, we’re strengthening our global health security infrastructure for the long haul by helping modernize existing institutions like the World Health Organization. We’re working alongside other WHO members to amend the international health regulations, to negotiate a pandemic accord, and to take other steps to ensure that we can address future health threats with speed, coordination, transparency, and equity.
And there’s more that we’re doing: creating regular opportunities for foreign ministers to meet and coordinate efforts, building greater health expertise throughout our own diplomatic corps here in Washington and in posts around the world, weaving together and updating partnerships to tackle emerging health threats as we’ll do next month in Dubai where ministers will meet to discuss issues at the intersection of health and climate at COP-28, for example, the rising risks posed by more frequent extreme weather events.
Today and in the days, weeks, and months ahead we will look to all of you for your ideas, perspectives, and partnerships because only if we work together can we build a more healthy, safe, and secure world for all.
Thanks, everybody. (Applause.)
(Video presentation ends.)
BOLLYKY: Great. Well, that’s a wonderful opportunity to hear from Secretary Blinken multiple times about the breadth of activities that are going on and I am excited—at the State Department I’m excited to welcome U.S. ambassador to the United Nations Linda Thomas-Greenfield to talk about what is going on in New York and her activities.
Thank you so much for coming, Secretary—or Ambassador.
THOMAS-GREENFIELD: Good morning, everyone. Kind of hard to follow the secretary of state, and you won’t get to hear me more than once. (Laughs.)
Let me thank you, Tom, and CFR for bringing us together today, for your leadership, and I particularly want to thank Dr. Nkengasong on for all of his efforts not just here in the State Department but in helping to set up the Africa Center for Disease Control. So it’s really wonderful to be here with you.
Gathered here today we do have the who’s who of public health leaders. People sometimes will ask me when was the moment you knew you’d made it, and while I don’t have a clear answer for myself I do have one of—one for today’s panelist, Dr. Fauci.
Dr. Fauci, you made it. You made it when we could suddenly go into New York into a gift shop and buy a bobble head doll. So something I’m hoping that I get to achieve one day.
But in all seriousness, it really is an honor to help kick off today’s symposium and to share a few words about the United States’ commitment to global health, a commitment that is at the center of our foreign policy, and it has to be because as the past few years have shown us public health emergencies pose a direct threat to every aspect of our lives and to international peace and security.
COVID-19 was a wakeup call. It was a wakeup call for all of us, for the entire international community, and it was a deeply painful one. So many of us lost loved ones and the aftershocks of COVID including economic dislocations, a spike in global food insecurity, and supply chain disruptions have been profoundly disruptive.
We cannot repeat the cycle of neglect and panic that has historically characterized our pandemic response. We must roll up our sleeves and get to work so we are better able to root out today’s public health challenges and better prepared to prevent future ones.
As Secretary Blinken just spoke to, these goals are at the heart of the State Department’s new Bureau of Global Health Security and Diplomacy, which is designed to strengthen the global health security architecture and effectively prevent, detect, control, and respond to infectious diseases.
This is not new to us. The United States has long been the leading donor to global health initiatives, and over the course of my four decades in government I’ve seen how our leadership has helped eradicate diseases and saved millions of lives.
But let’s be clear, global public health threats require a global response and international institutions play a key role in galvanizing collective action. I see that every day at the United Nations and in my engagements with stakeholders across the multilateral system including through the One Health Quadripartite, which brings together the WHO, the U.N. environmental program, the World Organization for Animal Health, and the Food and Agricultural Organization, and it’s great to have so many leaders from across our multilateral system participating in this program today including Dr. Tedros.
As we discuss the importance of partnerships and health equity, the effects of climate change on public health, and other critical topics my hope is that we use today as a jumping off point, that we turn these conversations into concrete actions because, unfortunately, it’s not a matter of if. It’s not a matter of if we face another public health crisis. It’s a matter of when.
I’ll leave you with one final thought and something I always try to remind myself when I’m frustrated with minor inconveniences or small personal setbacks or even difficult things like what we’re dealing with in New York today.
I have my health and my family has their health. Because if you and your loved ones don’t have that you have nothing and you can’t tackle these really difficult problems that we’re all facing today.
All of us who have had medical scares or cared for someone in their time of need we all understand that. So when we talk about global public health let’s remember that it’s not some abstract policy debate.
The decisions we make have real impacts on people around the world and especially the most vulnerable among us, and it is within our power to stamp out deadly diseases, to prevent and prepare for future pandemics, to strengthen our global health infrastructure, and to advance Sustainable Development Goal Three.
So let us all work together. Let us act with urgency and let us ensure that no one is left behind. Thank you very much. (Applause.)
BOLLYKY: Thank you, Ambassador, for those remarks. Health is foundational.
And we are next going to hear from an institution that has that ethos or message at its core, and I will now like to introduce WHO Director-General Tedros Ghebreyesus, who will be connecting with us via—or live via Zoom. Please.
GHEBREYESUS: Thank you. Thank you, moderator, Ambassador Thomas-Greenfield, Ambassador John Nkengasong, honorable ministers, dear colleagues, and friends.
I thank Secretary Blinken and the United States for hosting this important and timely discussion. When I was first elected director-general people would ask me what kept me awake at night. I answered, without thinking, a pandemic of a respiratory pathogen.
COVID-19 was the realization of my greatest fear but it was so much more than a health crisis. It demonstrated that when health is at risk everything is at risk. The pandemic had profound effects on societies, economies, businesses, schools, trade, tourism, even geopolitics. No sphere of life was untouched.
The world was unprepared for this pandemic and it remains unprepared. Meanwhile, threats to health are proliferating. Urbanization, deforestation, and intensified land use provide ideal conditions for zoonotic spillovers.
Climate change is fueling the spread of infectious diseases. Complex and prolonged conflicts pose a critical risk to global security and health, and while scientific advancements carry great potential for humanity they also pose a threat. Advances in biology, genomics, and gain of function research have made it possible to manipulate pathogens to increase their virulence, transmission, and resistance.
Adding to these challenges is increasing public skepticism about institutions and science. No country or institution can address those challenges alone. We need collective and coordinated action. When the next pandemic strikes we need to be able to spread rapidly—to respond rapidly and decisively to protect communities, build trust, and rapidly scale health services to save lives.
For the past three years WHO has been working with our member states on several initiatives to strengthen the world’s defenses against epidemics and pandemics. As you know, member states are now in the process of negotiating a new legally binding agreement on pandemic preparedness and response and amendments to the international health regulations. That too will form the vital legal framework for a safer world.
In addition WHO is working with member states and partners to strengthen the governance, financing, and systems for a more equitable, inclusive, and coherent global health architecture. Together with the World Bank we have established the Pandemic Fund for enhanced accountability, the Universal Health & Preparedness Review for enhanced surveillance the WHO have for pandemic and epidemic intelligence, and the International Pathogen Surveillance Network for an enhanced emergency response workforce, the Global health emergency corps for enhanced sharing of biological samples, the WHO bio hub system for enhanced monitoring, the Global Preparedness Monitoring Board, and more.
None of these initiatives alone is enough to keep the world safe. It’s only their combined strengths and the combined strengths of countries working together. In our divided world health is one of the few areas in which nations can work together across the ideological divide, and in that sense health can be a bridge to peace.
This is what WHO’s founders meant when they wrote in our constitution that health is not only a fundamental human right but also fundamental to peace and security and, yet, too often health is politicized or even attacked, as we have seen in Gaza, Israel, Sudan, Ukraine, and elsewhere.
Excellencies, let me leave you with three priorities for action.
First, we must close the governments’ gap. I urge member states to deliver the pandemic agreement and the package of IHR amendments to the World Health Assembly in May next year. This is a generational opportunity that we must not miss.
Second, we must close the financing gap. I urge all countries and partners to fully capitalize the Pandemic Fund in line with the investment needs identified by countries.
And, third, as we work to strengthen global health security we must protect health care from politicization and attack. We appreciate U.S. leadership on the Pandemic Fund and global health security but this commitment is not new.
When I began as minister of health in Ethiopia in 2005 HIV/AIDS was practically a death sentence. Powerful new antiviral retrovirals were out of reach for lower income countries like mine. That changed with the advent of PEPFAR.
Globally PEPFAR has saved 25 million lives and prevented 5.5 million babies from being born with HIV. When President Bush started PEPFAR the goal of an AIDS-free generation seemed implausible. Now it’s real, with sixteen countries validated for the elimination of mother-to-child transmission of HIV.
However, we are now at a critical juncture as funding for PEPFAR and other life-saving programs are under pressure. Leadership—continued leadership from the U.S. is more important than ever. By reauthorizing PEPFAR, lawmakers will send a clear signal to the world that the United States remains committed to ending AIDS and to securing a healthy and safe world for all.
Ambassador Greenfield, thank you so much for inviting me and Ambassador Nkengasong, and I wish us a successful meeting. And, moderator, back to you. I thank you. (Applause.)
BOLLYKY: Great. Thank you, Dr. Tedros, for those thoughtful remarks.
Continuing on the theme of collective coordinated action our next set of remarks will come from World Trade Organization Director-General Ngozi Okonjo-Iweala, who is also appearing live via Zoom.
OKONJO-IWEALA: Thank you very much.
Secretary Blinken, Ambassador Thomas-Greenfield, Secretary-General Kao, my brothers, Ambassador Nkengasong and Dr. Tedros, excellencies, ladies and gentlemen, greetings from Geneva and thank you for inviting me to join the lineup for this event.
This is the right time to update on how we think about foreign policy, diplomacy, and the pursuit of global health security. The COVID-19 pandemic response demonstrated that international cooperation, coordination, and communication are essential for governments to protect the health of their populations.
It also underscored that open global trade is indispensable for global health security. Trade was a mechanism for scaling up the production and deployment of everything from PPs and pulse oximeters to vaccines.
At the WTO we helped keep supply chains open and functioning, working with vaccine company CEOs to address problems with the cross-border flow of inputs and manufactured doses.
On the negative side of the ledger we saw the vulnerabilities created by excessive geographic concentration in the production of a handful of critical goods. Some governments restricted vital exports and in the scramble for vaccines poor countries were relegated to the back of the queue.
We must face up to these failings and prevent a reoccurrence in future crises. But let me be blunt. Our actions since suggest we have not learned the lessons from the COVID-19 experience. Governments collectively spent $14 trillion on fiscal support to prop up economies and shore up households during the first year of the pandemic.
How can it be that today they seem incapable of pulling together $10 billion in annual support for the World Bank Pandemic Fund? The multilateral system of institutions was built over the past seventy-five years. To facilitate the collaboration we need to address cross-border crisis. Why are we not investing more in supporting and strengthening these multilaterals to deliver more for the world?
I know there’s a lot going on in the world today but we cannot afford to let pandemic risk fall off the radar screen. We need a stronger political push in the WHO pandemic treaty process, as my brother just highlighted.
We must also move ahead with diversification initiatives like the WHO World Local Production Forum to reduce the heavy geographical concentration of production capacity for medical products and better prepare for future crises.
Prior to the pandemic, 80 percent of traded vaccines came from the top ten exporters. This concentration meant that a crisis in one major exporter was enough to disrupt global supplies.
The vulnerabilities of global supply chains led people to think of reshoring, and while some reshoring may be inevitable let me emphasize that making everything at home does not necessarily equal resilience as demonstrated by last year’s baby formula crisis in the U.S.
That is why we support the World Local Production Initiative, because at the WTO we believe that a more effective path to resilience is a deeper and more diversified global production base that can count on open and predictable trade in inputs on finished products.
We call this reglobalization, a reimagining of global production networks that makes them more resilient and more inclusive. At the WTO we have been working to do our part for the international framework supporting global health security.
At our twelfth ministerial conference last year our 164 members laid out a blueprint for pandemic preparedness in which they pledged to keep trade flowing in medical goods and services.
They also reached a hard-fought consensus compromise on the proposal to provide more flexibility within the TRIPS agreement by waiving intellectual property protections on COVID-19 vaccines for a limited number of years.
But our members are still to deliver on the request by a majority of developing country members to allow the same flexibility for therapeutics and diagnostics. We continue to push for a solution in these negotiations hopefully by our thirteenth ministerial conference in Abu Dhabi at the end of February next year.
Intellectual property has become a hot-button issue. A well-functioning IP system is a critical part of an effective innovation ecosystem. The rapid development of COVID-19 vaccines during the pandemic deserves celebration, and innovation and research must be supported and rewarded.
At the same time, however, we cannot repeat the gross inequities in access. Global health security would be best served by pragmatic evidence-based approach to intellectual property issues. The IP system is a public policy tool designed to be flexible and adaptable in the service of delivering social and economic benefits including public health.
Public policy safeguards like compulsory licenses and government use provisions are embedded legitimately in the IP system. It is appropriate for developing countries to use these safeguards just as developed countries themselves did not hesitate to use them during the pandemic.
The private sector can and should be proactive in pursuing voluntary licensing and production partnerships in developing countries. Doing so would contribute to reglobalization and resilience and could unlock unexpected revenue streams in the process.
But developing countries must also put in place the appropriate legal and regulatory frameworks to implement existing and new flexibilities that might imagine IP and voluntary licensing regimes.
It’s important to emphasize here that many developing countries do not have these legal frameworks in place. Fighting for rights and flexibilities in the absence of their ability to use them undermine the credibility of requests for inclusion.
Through our trilateral partnership the WTO, WIPO, and WHO stand ready to help countries build the legal and regulatory capacities they need to take advantage of IP and other flexibilities and, hence, support global health security.
Let me conclude here. This dialogue rightly places health security challenges at the center of twenty-first-century foreign policy. Trade and the WTO are working to be a full part of the holistic responses we need. We look forward to partnering with all of you and wish you the best of luck in this dialogue.
Thank you. (Applause.)
BOLLYKY: Thank you so much, Director-General.
Security cannot be achieved at home alone and with that theme in mind our last set of opening remarks come from ASEAN Secretary-General Kao Kim Hourn, who will also be participating live via Zoom.
HOURN: Thank you very much, Mr. Moderator.
Excellency Antony Blinken, U.S. secretary of state; Excellency Linda Thomas-Greenfield, U.S. ambassador to United Nations; Excellency Dr. Tedros Adhanom Ghebreyesus, director-general World Health Organization; Excellency Ngozi Okonjo-Iweala, director-general of the World Trade Organization; excellencies; ladies and gentlemen: Greetings from Jakarta, Indonesia.
It is my honor to join you albeit virtually in this inaugural global symposium on global health security and diplomacy in the twentieth century. This is a good opportunity for ASEAN to share how related cooperation and developments in the region have a critical role in maintaining peace, security, stability, and prosperity in our region and beyond.
We place the well-being of our people at the center of the ASEAN community building. At its core is to ensure a healthy, caring, and sustainable ASEAN community by promoting healthy lifestyle, responding to all hazards and emerging threats, strengthening health systems, and access to care and ensuring food safety.
Together with our partners here in the region and from around the world we collectively work to achieve the full health potential of the ASEAN peoples through resilient health systems that protect our peoples from public health threats under the form—and other forms of threats.
I’m pleased to share that both ASEAN and the United States are working together on health-related initiatives that support the achievements of the 2030 agenda for Sustainable Development Goals and advancing global health security agenda including peace and security by fast tracking capacity-building cooperation to prevent, detect, and rapidly respond to infectious disease threats, particularly diseases with pandemic potential.
Amidst ASEAN’s socioeconomic recovery from the impacts of the COVID-19 pandemic and based on recent health developments in the region, the ASEAN-U.S. health sector engagement has been deepened with the adoption of the terms of reference of our health cooperation.
We have established platforms at ministerial, senior official, and technical levels with the exchange of information, best practices, and global health goals and priorities through the implementation of the ASEAN-U.S. health sector work plan.
At the ASEAN-U.S. special session health ministerial meeting in May 2022 our health minister agreed to focus our cooperation on health system, strengthening for public health emergencies, health workforce development and capacity building, and information and data system strengthening.
Joint initiatives have been carried out to support regional mechanisms to address infectious diseases such as through setting up the ASEAN Center for Public Health Emergencies and Emerging Diseases and implementation of scope of work on prevention, preparedness, detections, and response.
We also support a robust coordination structure and increasing regional capacity to respond effectively and efficiently against these threats to the ASEAN public health emergency coordination system framework and technical system on disease, civilians, laboratory capacity building, and infection prevention and control.
Excellencies, ladies and gentlemen, the engagement of ASEAN with the United States on health security through the U.S. Department of Health and Human Services and other relevant ministries and partners have operationalized our shared commitments in fostering regional and global public health cooperation as one of the building blocks of stability and prosperity in the region and beyond.
On this matter we look forward to the successful outcome of our three-year joint (health?) plan. In short, I believe that it’s important for us to continue to focus on the three Ps: the people—the well-being of the people—the pandemic, particularly lesson learned and the fact that we need to work together to prevent future pandemic, and, of course, partnership that we need to continue to build effective and efficient partnership particularly with the United States, providing important leadership role.
Let me close by congratulating the United States—the U.S. Department of State Bureau for Global Health Security and Diplomacy for convening this global symposium in partnership with the Council on Foreign Relations.
I thank you. (Applause.)
BOLLYKY: Great. Thank you so much, Secretary-General.
Our—the morning’s riches continue and I’m very pleased to invite Dr. Anthony Fauci and Ambassador John Nkengasong to the stage for a fireside chat. Thank you so much. (Applause.)
NKENGASONG: Thank you. Wonderful. Good morning, everyone. What an opening, yes.
Colleagues, let’s—let me start with a promise. Two things—that this is going to be a very rich conversation and I would like to ensure that we save time for a one-on-one but also get into reactions from the floor because it’s not every day that you get to get Tony to spend the morning with all of us. Second, it’s going to be valuable. So it’s not just an academic exercise but it’s going to add value.
Tony, thank you being here this morning.
FAUCI: Thank you. Good to be with you, John.
NKENGASONG: In the green room we were chatting a little bit about your forty-two years’ experience in HIV, and then I turned to Linda—she just stepped out and I said when I was planning this and saw what she was doing on the floor of the Security Council I said to myself, goodness me, why am I pulling her out from the U.N. Security Council to do this, and she said diplomacy is difficult.
But then it occurred to me that what you did in setting up PEPFAR twenty years ago, what you all did in setting up the Global Fund could never have been possible without diplomacy. So the two came together and the two were in that room, in the green room this morning.
So let me just remind all of us what the bureau—why the bureau was created.
Three things. We said the secretary thought the bureau should advance—lead with a diplomacy to coordinate our efforts in global health security; secondly, to elevate global security as part of foreign policy; and, thirdly, to leverage the assets that we have across the board to advance global health security.
You’ve been in HIV/AIDS for about forty years. You led the pandemic response. Help us think through where do we go from here. How do we prepare for the next pandemic, given your experience, and how—what do you—what did we learn from HIV that has helped us respond to pandemic—to COVID and what lessons did we learn from COVID-19 that should help us prepare for the next pandemic?
FAUCI: Well, those are the questions. Thank you, John, for those extremely relevant and important questions.
So there were always lessons learned when you have completed the ordeal of a particular pandemic to look back on what you did right and what you maybe could have done better, and certainly with HIV the lessons of COVID from HIV, for example, that was very profound and important lessons for me was the engagement of the community when you’re trying to deal with a public health crisis instead of a top-down to actually get a community input and that was very, very important with HIV because we learned so much interacting with the community.
When you look at the scientific back and forth between COVID and HIV, I tend to look at public health crises, particularly pandemics, which is the manifestation of the ultimate public health crisis. You think about it in two separate buckets, in the scientific bucket and in the public health bucket, and the lessons that are learned in one can actually inform the other.
When I look back at what we’ve experienced through COVID there are so many lessons that absolutely have to be drilled into our corporate memory and not forgotten, which we tend to do when we have a pandemic in the rearview mirror.
The first thing among—these are very fresh in my mind. I just thought about the maybe twenty-five lessons that we learned from COVID and I focused it down to ten. I want to mention just two or three of them this morning.
The first is, really, when you’re dealing with pandemics to expect the unexpected because if you look at how we looked at COVID in the beginning we put—we as a global health community put it in the framework of our prior experiences. The one that was most important was influenza.
So influenza comes in a big blast in a season and then it just goes away. It’s spread mostly by people who are symptomatic, not asymptomatic. It rarely spreads by aerosol, mostly by droplet, and then all of a sudden we had an outbreak that was evolving right before us. So that we know that the science and the knowledge that we were getting was a moving target.
So when you’re dealing with a pandemic that’s a brand new outbreak it may not be like every other outbreak that you experienced and we really painfully learned that. Whenever in the history of outbreaks did we ever have an outbreak in which in the same outbreak we had multiple—up to six or more variants?
It was always 1918 pandemic flu, it goes up, comes back, goes away, and that’s it. You know, one virus may be changed a little not going from the original ancestral strain to now the tenth variant out of Omicron, which is from the lineage of Omicron, not to mention Alpha, Beta, Gamma, and then Delta, which fooled us all.
Those are the things that we’ve really got to learn. We’ve got to be flexible and we’ve got to be humble. I don’t want to take too much time but I want to mention just a couple of others and I think we’re going to get into this in a bit, that when you talk about the global network that we’re all hoping form that every one of the speakers spoke about, John, that you’ve been very much involved in, it’s absolutely critical and important because transparency and immediate sharing of information is absolutely critical.
If you look at the uncertainty of what was going on in the first weeks of the outbreak it was just an evolving moving target. The virus is not spread very effectively from human to human. Oh, yes, it is spread effectively. Well, it spread really effectively and maybe the most spreading virus that we’ve known since measles.
So it went from an inefficient spreader to a measles like spread. That’s the first thing. The thing that in my mind was one of the showstoppers was how long it took us to realize that we were dealing with a virus so unprecedented that 50 (percent) to 60 percent of the transmissibilities were from someone who had no symptoms, either will never get symptoms or is in the presymptomatic stage.
When you put the syndromic model of influenza into that category you are in a completely different ballgame and all types of different recommendations are depending on the kind of virus you’re dealing with.
So we could go on and on but I’ll stop there. There are many lessons that you can learn from one outbreak to the other and we’ve just got to not forget them.
NKENGASONG: No, thank you. I mean, I would like to just lead from there. You ended up with the kind of virus we’re dealing with. There are about twenty families of viruses out there that can potentially infect humans and that suggests to all of us that it’s a question of when, not if—
NKENGASONG: —that we may have a next pandemic.
Let me paint a picture. And the picture that I’m going to paint is not meant to scare anyone, but it’s just to bring to reality some of the things that are very possible and that we leave with in your experience as the head of NIAID.
In 2002, we witnessed the SARS as COVID-1. It had a fatality rate of about 15 percent?
NKENGASONG: It spread less than SARS COVID-2. Twenty years later, we have SARS COVID-2. Has a case fatality rate of about 3 percent or less, but spreads like smoke—spreads during asymptomatic phases, which is not what we saw in SARS COVID-1.
So let’s imagine hypothetically SARS COVID-X that combines the two properties. How do we prepare from the lens of cooperation, coordination, and collaboration, as you just said, transparently to address it because we will not have the luxury of being sequential in our efforts in dealing with such a fast-moving respiratory infection?
FAUCI: Yeah. Well, yes, that’s a possibility that you would combine the transmissibility of one with the pathogenesis of another, which would be the absolute worst case scenario, the things that keep us all up at night.
But you mentioned there are about twenty families of viruses and we can’t make an absolute countermeasure for each of those. But one of the approaches that we were and still are—I mean, I stepped down from the NIAID but what I put in place for at least a year or more before we left what is called the prototype pathogen approach.
If you take those twenty families of virus there are about seven or eight families that are much more likely at risk of evolving into a pandemic. You know, the alphas, the bunyas, the filos, all of the—and the coronavirus have crossed. The coronavirus is telling us something, John, that we better listen to, and I hope we don’t forget about that.
What one can do is take what we call the prototype pathogen approach is to intensively study a prototype within a particular family of virus and develop everything from correlates of immunity to understanding the right animal model to understanding what the best vector or platform of a vaccine would be and to prepare not all the way through to a phase three trial, which you’ll never do because you can’t do a phase three trial if you don’t have an outbreak, but to at least get a head start on those high-risk families.
That’s going to cost a lot of money. It’s going to cost, at least from a scientific standpoint at the NIH, hundreds and hundreds of millions of dollars to do it. When you look at the trillions of dollars that was spent in health care throughout the world, it’s like pencil dust compared to what we’ve had to deal with.
So that’s the thing that I keep encouraging and that gets into the concept of corporate memory. If you do that right now that you will be much better prepared because it might not be a coronavirus. It might be a variety of a Nipah virus or it might be one of the other viruses that we’re concerned about it.
We can’t just drop back and say we’ve gotten this behind us, now let’s move on to the next problem of the day, because the next problem of the day may not happen tomorrow or the next day but it’s going to happen because history has told us that.
I mean, we are living in an arena of emerging infections. Historically, before recorded history—I always tell the story, you know, before recorded history we had pandemics and we didn’t know what the pathogen is.
We didn’t know what the pathogen was with the 1918 pandemic. Everybody thinks we did. Influenza was not discovered then, and then in our own lifetime we’ve had 1957, 1968, 2009, and now COVID, and I think the shot across the bow in 2002, John, was the first COVID to say that a coronavirus can actually evolve into a deadly virus, not a common cold. So we better not forget that.
NKENGASONG: Thank you. I would ask one more question. Then we’ll turn to the audience. I just want to prime the audience that should get ready with their questions for Tony.
But before I do that, Tony, let me pick on what you just said, problem of the day.
I’ve always thought, and I might be wrong, that the best way to prepare for the unknowns is to invest more in the knowns—
NKENGASONG: —and the knowns we are dealing with today is HIV, still a pandemic. UNAIDS CCA and Winnie, welcome. According to data from UNAIDS, last year alone there were about—or this year, 1.3 million new infections of HIV—new infections. It’s a field that you’ve worked in for so many years, helped to create PEPFAR. Are we seeing fatigue in the response to HIV/AIDS? What should we do to maintain that visibility in HIV/AIDS as a platform to continue to fight and leverage on to fight other pandemics?
FAUCI: Well, I’m just thinking—(inaudible). Don’t get me started. (Laughter.)
Well, if you look at HIV, as we know, apart from the unfinished business of a cure and a vaccine the scientific advances that have been made because of the investments in science have been nothing short of breathtaking.
I don’t think we’ve ever seen anything in which you went from—and I know because I had the painful dark years’ experience of taking care of hundreds and hundreds and hundreds of persons with HIV in the early to mid-1980s into the ’90s when you had essentially everybody dying.
Then along come the scientific development of the types of therapies we have and we now have completely transformed the lives of persons—the audience knows this—I’m telling you things you already know—who have access to the drugs that are available, both the treatments to prevent transmission—U=U treatment as prevention as well as the preexposure prophylaxis, which has gone now, as you know, from one pill a day to an injection that we might be giving every six months.
The critical issue is the implementation and that to me is why it is so, so important to continue the support both in authorization and appropriations for PEPFAR because we have the tools. We just need to implement them, and if you talk about—and, again, getting back to your remarks and the remarks before by the secretary about PEPFAR, that has already saved 25 million lives.
So we know we can save 25 million lives and the idea of even considering not having the optimal support for the implementation of the scientific advances that have evolved over decades from the very beginning, and for those of us who didn’t have any tools back in 1981, ’82, ’83, ’84, ’85, ’86, to now when you have the capability of giving somebody a single pill either as a treatment or as a prevention to me it’s completely unconscionable that we don’t implement that because we have the tools and we need to implement them.
NKENGASONG: Isn’t that amazing where we came from with a cocktail of drugs to one pill and with the prospects of getting to 2013—
NKENGASONG: —bringing HIV/AIDS to an end as a public health threat?
Thank you, Tony.
So let’s turn this to the floor and, yes, please, bring the microphone. Bring it up closer. Just state who you are and then ask your question directly to Tony.
Q: Hi. Thank you both and everyone here so much for being here. My name is Daniel Marshall (ph) and I’m actually a member in the Young Professionals Group of the CFR.
My question for you, Dr. Fauci, is—especially pressing for someone in my circumstance—what do you say to, you know, a young professional, someone who’s eager to make change but, as you said, you know, we have the tools but we need to work on this implementation? So what is the—what is the optimal way to learn to be able to implement as you feel, you know, the world needs?
FAUCI: Well, the optimal way to implement is to do what—you know, what John and everybody else is talking about is to get—I mean, we’ve got to be very, very aggressive in pushing this agenda.
We can’t expect people to intuitively understand these things and that’s the reason why when you’re dealing with something that requires it you have to, you know, put a full court press on everything.
To me it’s so obvious, you know, that I feel like I want to get on the top of a building and shout it. Are you kidding me? You know, you have a drug that is life saving and you’ve already proven that you can save 25 million lives and we’re playing around with considering that maybe you’re not going to reauthorize something or maybe you’re not going to give it its full appreciation.
We should be shaming people into that. I mean, that’s how I feel about it, to just be really aggressive about that. Sorry, but I—(laughter.) (Applause.)
NKENGASONG: At the front here, please.
Q: Good morning, Dr. Fauci, Ambassador Nkengasong.
Gratitude not only for being here but your years and decades of service and leadership. I’m Monique Mansoura at the MITRE Corporation. Formerly served a decade at BARDA after 9/11.
Admiral Bernard has written passionately and powerfully about the barriers between the worlds of health and the worlds of security. We’ve seen even this morning in the remarks is this a security mission? Is this public health? Global health? And right behind you, again, the bringing together of health insecurity and the new bureau at the State Department.
Can you speak a little bit to the cultures in the world of health and the world of security, and where they can really reinforce and strengthen each other and where they have been challenged over the last couple of decades?
As the ambassador said, when health is affected, everything is affected—our financial health, our mental health, security risks, economic progress.
So how do we bring these worlds of health and security together in a truly meaningful way where we’re looking, of course, with health but all of those sectors that are so involved in a security way?
FAUCI: Yeah. Well, you know, from my standpoint the reason why I support John so much for the Bureau of Global Health Security is I remember years ago before when I was involved in the White House putting the PEPFAR program together Secretary of State Colin Powell sat down with me and I should have known this before but he said, you know, Tony, global health is global security because if you don’t have health then everything else can fall apart.
And Ambassador Greenfield just mentioned that the—like, she was giving you the metaphor, I have my health and health is everything. And I just think that we just need to be more explicit and verbal and writing about the fact that if you have health disparities and health deficiencies you’re going to have an insecure world, you know, and it was back then—as secretary of state when Colin Powell told me he was concerned that with HIV back then where 30 (percent) to 40 percent of some of the military in the developing world countries were actually living with HIV with no therapy, that he was concerned that we were going to have in certain countries the breakdown of the system of government in a country because of health.
Now, that was the rather dramatic and draconian example but he was absolutely correct. So I think what you’re asking now is that they have to be inseparable. You can’t have health care security there and say they’re different and maybe occasionally they’ll meet. They are integral parts of it.
So every time we talk about security we’ve got to talk about health and every time we talk about health we’ve got to talk about security.
NKENGASONG: Maybe just to supplement that, Tony is absolutely right. HIV/AIDS is perhaps the only disease that the U.N. Security Council has issued a resolution as a security threat, Resolution 1308. So I think, yes, in 2000 so that was foundational in changing the way we saw HIV/AIDS.
So let’s—I see a couple of hands there. Please just let’s take two questions so that—yes, please, the middle and go right back. Take those two questions and then Tony will respond to this.
Q: Leaders, it’s a pleasure. Captain Grant Hall (sp).
We’ve identified that community-driven health solutions often are the best way to actually drive change. But there’s a desperate need for regional and global uniformity in action.
How do we pair this? Find solutions in this dichotomy? Where do we find that middle ground where we strike the community’s needs and willingness to work together towards a solution with a uniform approach from a top down?
NKENGASONG: OK. Yes, in the back, please. Just move your microphone behind. Yes.
Q: Hi. Alex Dehgan. I was former chief scientist at USAID.
You know, there was a study that came out from the Cary Institute of Ecosystem Services that looked at five thousand mammals and showed 2,500 of them were effective carriers of COVID, five hundred of them extremely effective, right. We know 17 percent of the rats in the New York City subways carry COVID, 40 percent of the deer in the Midwest.
When we are thinking about how to prevent the next pandemic how do we think upstream to go beyond just responding to a pandemic but thinking about wildlife spillover and having effective biosurveillance systems?
FAUCI: OK. Great question.
So the first with regard—the way I look at it everything—and this gets back to one of the—one of the comments I made to John just a few minutes ago that, you know, everything starts and has to fit and be right at the local level.
So when you say the community up to the regional I think it has to be from the grassroots ground up to the regional. I mean, they obviously have to be joined, ultimately, together and if you don’t have that we’re going to get, I think, a disheveled response.
One of the real problems in its ultimate that has bothered me for COVID where you had strategies that were based on good public health principles that came from the top and that there was a disparity of the responses at the local level, I think if we had had—you know, we are living in a diverse country and we have diverse communities. You know, mountain states are different from prairie, are different from cities, are different from coastal.
But the fact is they were so, so different that we had, I think, a kind of discombobulated response to COVID that wasn’t—in my mind, not so strictly unified that it doesn’t account for the differences throughout the country.
But it was so different that there were things that were done in some regions that just were not good public health practices. So I think everything has to be unified but it has to come from the bottom up. That’s the first thing.
The wildlife issue that was one of the lessons learned that I didn’t mention in response to John’s question is we have to pay attention to the animal-human interface. History has told us that 75 (percent) to 80 percent of all of the new emerging infections of zoonotic have jumped species—75 (percent) to 80 percent.
HIV/AIDS, chimp, human, flu, bird, pig, human, Ebola—you know, somewhere in the jungle primate from a bat to whomever, and on and on and on. And to me it just doesn’t make any sense to not pay very, very strict attention.
You know, the One Health issue, all the things we do, there are two ways of getting into trouble with zoonotic infections. Either you encroach on the environment where animals essentially are not in close contact with humans or you bring the animals into the human population which exactly what happens in the wet markets, which was one of—the reason—proven reason in 2002 when it went from a bat to a civet cat to a human and very likely the situation that occurred in Wuhan.
So history is trying to tell us something about that and, again, that’s one of the maybe top ten lessons that we need to learn when you’re dealing with outbreaks.
NKENGASONG: And, unfortunately, time—we’ll signal that time is not working for us. So thank you, Tony, for that—
NKENGASONG: —very rich conversation, I think, highlighting the importance of collaboration, transparency in sharing information, coordinating our efforts to addressing this potential trust that we see, and highlighting the importance of HIV/AIDS as an unfinished fight but a fight that is possible if we continue to apply ourselves appropriately. Thank you so much, and I look forward to the rest of the conversation. (Applause.)
CARTER: Well, good morning, everyone. It’s really a pleasure to be here with you. Welcome to Session Two for the Symposium on Global Health Security and Diplomacy in the Twenty-First Century. My name is Hillary Carter, and I will serve as the moderate for this session, which is focused on “The Power of Partnerships in Collaboration to Advance Global Health Security.”
I’m joined by an incredible group of panelists who represent diverse organizations that are critical to advancing global health security. And it’s my pleasure to briefly introduce our panelists. First, on the screen, we have Dr. Jarbas Barbosa, who is the director of the Pan American Health Organization. Welcome. We have Dr. Joy St. John, who is the executive director of the Caribbean Public Health Agency. We have Dr. Ayoade Alakija, who is the World Health Organization’s special envoy for Access to COVID-19 Tools Accelerator. Welcome. And then joining us here in the room we have Ms. Rachel King, who is the president of the Biotechnology Innovation Organization. And we have Dr. Jean Kaseya, who is the director-general of the African Centers for Disease Control and Prevention.
So I’ll start with a little bit of framing, but want to reserve the bulk of our time for hearing from our excellent panelists. We know that partnerships are powerful. When we come together, we can achieve things we can’t do alone. The COVID-19 pandemic taught us that partnerships are essential to saving lives and restoring livelihoods. Sometimes these partnerships are predictable and other times these partnerships are more unconventional, but equally as important. We heard this morning from Secretary Blinken that the only way to advance global health security is together. We heard from DG Tedros about coordinated and collective action.
And I wanted to kick off the panel with a few questions, and then let’s get started. So, first, how do you harness the power of partnerships from your unique vantage point? Where do you see opportunities for furthering partnerships of all kinds? And, generally, what impacts have partnerships had on your organizations? And we are going to turn first to Dr. Barbosa to get us started, on the screen. Dr. Barbosa, over to you.
BARBOSA: Thank you. Thank you. Good afternoon, or good morning for you. First of all, I want to thank the Global Health Security office for inviting me to participate. You know, the Pan American Health Organization is, I think, a concrete example of collaboration and partnership. Our organization was created more than 120 years ago when the countries in the region came together to the be able to build the Panama Canal. That was a very important enterprise at that moment. Since then, the Pan American Health Organization has built many partnerships and collaborations with different entities, organizations, foundations, public and private, the companies, they have worked together.
And this partnership and collaborations were crucial to provide the main achievement for the region of the American. We were the fifth region of the world to eliminate the polio, to eliminate the measles. So I think that these are very concrete examples that together, and working not only with our member states, all the countries and territories in the Americas, but also with different organizations and foundations, we have delivered many important advances in the health of the region. The Americas, you see, are a very variable region, with many challenges ahead. But, for sure, that the—with these partnerships and collaborations, we were able—we were able to achieve many, many advances in the region. And we were also able to respond better to the COVID-19 pandemic. Thank you.
CARTER: Thank you very much, Dr. Barbosa, for sharing that perspective. Let’s now come in the room here. DG Kaseya.
KASEYA: Thank you. Thank you, the Office of Global Health Security, for inviting me. We bring the voice of Africa, because we value partnership. Our head of state, they have to learn from COVID. And they decided to put in place what we call the new public health order. And one of the pillars of the new public order is the
respectful partnership, because we believe that if we have a respect that will help us to advance this agenda of health security. And saying that, they decided to support this respectful partnership. They wanted to have a strong Africa CDC, at the highest political level. And they decided to have a director-general politically appointed by head of state, who can talk to them directly, who can push the agenda, who can convene them, we can put all countries together.
Let me inform you, colleagues, thanks to that now I’m leading an agenda, how Africa can come strongly to advocate for the reauthorization of PEPFAR. I’m meeting a number of head of state. You will see what we’ll do in the coming days to show that Africa is pushing this agenda under the leadership of Africa CDC. This respectful partnership is also to help us to build a strong PPPR agenda because, as Tedros said, the question is not if, the question is when. And for us to win, we need to accelerate. And we need this partnership to come to support, like, the local manufacturing.
Africa CDC is leading this agenda. I’m so happy to see my brother Amadou here. We are leading this agenda, not only for vaccines but also for diagnostics and for therapeutics. And this local manufacturing is what I called, as I was discussing with president—one of our head of state. I said, this is the second independence of Africa, having Africa manufacturing their own product. It’s not just for health security. It’s building our economies. It’s creating jobs. And, you know, we have many angles to take this strategic partnership and respectful partnership.
CARTER: Great. Thank you so much, DG Kaseya.
Let’s go back to the screen and Dr. St. John. Can we hear from you, please, on the power of partnerships?
ST. JOHN: So CARPHA is a close partner of the member states in the regional—sub-regional CARICOM space for all things public health. We know their needs, and we know how they function best to achieve these needs. And because our strategic planning process is informed by the CARICOM strategic plan, the Caribbean Cooperation in Health, in its fourth iteration, the PAHO plan, and the SDGs, we ensure through our annual process that our member states say clearly what their priorities are. So CARPHA has both the thirty-foot regional perspective, as well as understanding of the national needs which are best suited to partner interventions. We also understand partner perspectives, because we’ve been trained and facilitated training for our member states.
So CARPHA hosts many networks for the chief medical officers, in laboratories, vector control, communications, medicines regulation, research ethics, noncommunicable diseases, nutrition, and mental health focal points, which allow CARPHA to get granular with subject matter focal points. The networks further enhance the interface between a subject intervention and a partner. So for future partnerships, I see climate change, environmental sustainability, and environmental health, noncommunicable diseases, mental health, violence and injuries prevention as my top picks for the topics for further partnerships.
And our partners have been good to CARPHA and the region and have so far stayed with us, because we deliver. So, the partners have allowed us a process of modernizing our corporate processes. So we’re results based, about to run through ERP, and after a risk management exercise CARPHA won the risk management company of the year. The pandemic period also allowed us to support health security, strengthening of our member states through an explosion of partners from the usual to the new. and allowed us some unusual achievements through unusual collaborations.
CARTER: Fantastic. Thank you, Dr. St. John.
Let’s come back into the room here. Rachel, I wonder if you can tell us about partnerships from the private sector perspective.
KING: Yeah, thank you. Thank you. And as Hilary indicated, I’m the CEO of the Biotechnology Innovation Organization, which is the industry organization that has about 1,000 members, primarily small and mid-sized biotechnology companies. So these are the innovators developing new drugs, new therapies, vaccines. And as much as the COVID experience was a tragedy around the world, and terrible—you know, a huge challenge for humanity, one of the reflections that I think we would share as we look back on it was the amazing accomplishments that we were able to achieve together, because of partnerships.
Really the unprecedented speed with which the vaccines were developed and the way that the pandemic was cut short, as much as, again, there was a lot of suffering in the world during the pandemic. But the fact that that the world was able to come together as we did to address it is really remarkable. It’s a success that I think we all share, as a result of partnerships. Looking at research, manufacturing, clinical development, supply chain, all across the whole spectrum of development the reason we were able to succeed was because of the partnerships. So as we look ahead to some of the learnings from that, and we think about kind of an inter-pandemic period and potentially a pandemic period, there are a number of areas where I think we would look to continued partnerships.
One is enhancing investment in these platform technologies, both from governments and the private sector. And we don’t know where the solutions are going to come from. I think that’s an important—an important thing to emphasize. So we need to invest broadly in platform technologies in order to ensure that we have a robust capacity in the event that another pandemic occurs. So that’s one area. Another is strengthening regulatory regimes and ensuring harmonization. Again, another area where we’ll require intense partnership and collaboration. Strengthening supply chains. And, as you’ve indicated also, expanding the diverse manufacturing—diverse regional manufacturing capabilities, I would say, is another important aspect of preparation.
During a pandemic itself, we want to ensure that there’s unfettered access to pathogens, so that we can partner together with academic, regional, and industry collaborators, all to ensure that we get as quickly as possible to the vaccines and therapeutics that we need. We want to ensure good background of surveillance and good health systems are in place so that we can effectively distribute the vaccines and therapies that are developed. And that we fully fund procurement mechanisms. All of this, in our view, also requires a strong IP regime, so that we can ensure that the intellectual property is present in order to incentivize the investment that’s going to be required.
So across all of these different aspects of the development and the implementation of the vaccines and therapeutics, we need, critically, to partner. We learned that in COVID. We’ve learned that through the normal development process that we go through as industry. And so we very much look forward to working together through conversations like this going forward, as well as ongoing collaborations, to ensure that, together, we participate in a way that prepares us as well as possible for whatever next pandemic may come.
CARTER: Fantastic. Thank you, Rachel.
And then let’s go, last but not least, to Dr. Alakija, to share how partnerships have shaped your work.
ALAKIJA: Thank you so much. It’s a real pleasure to be with you today. I’m speaking to you from Indonesia, where I’ve just literally come in from what is a physical manifestation of partnerships. I’ve just been in the remote islands of the—of Indonesia, all over the place, looking at people working at the very lowest levels of community—community health workers, health workers. Incredible women, mostly. You know, so as we talk of partnerships here today, I want to also raise partnerships and women leading partnerships. And looking at what they can do, because health security—which is our topic today—cannot be health security unless you have local security, unless we have country, community-level security. Unless my home is secure, my country, my community, cannot be secure.
But we saw traditional partnerships falter in the past few years during the pandemic. We’ve seen traditional partnerships falter even recently, in more recent months. And yet our collective health security has never been more urgent. In my work, and you sort of say in my work and that’s sort of a difficult question to answer. And as Rachel spoke just now, she talked about, you know, vaccines, and therapeutics, and partnerships. But I also chair FIND, which is the foundation for diagnostics and sort of the diagnostics alliance of the world. And just in the last few days, I’ve had incredible meetings speaking to what dear Jean Kaseya just said about local production, meeting with incredible people here in Indonesia who are producing diagnostics, who are working in local production. It was in labs. It was in in local perkesamas (ph) and buskesamas (ph) and little community clinics, where we were able to see rapid tests for HIV, for syphilis, for TB that would be produced by people in this country. That is the core of partnerships.
And we have come here—so I represent partnerships not just on a multilateral level—which I’ve been introduced as a special envoy to my dear brother Dr. Tedros—for the Access to COVID Tools Accelerator, but my proudest partnership is with the Africa Vaccine Delivery Alliance, which was started under the leadership of dear John, Dr. John—Ambassador, sorry—His Excellency Ambassador John Nkengasong in his previous iteration as the head of Africa CDC under the incredible work that he did there. And we saw regional partnerships. So I can speak to so many partnerships—regional partnerships with investment institutions, with the Afreximbank, for instance, who started Africa’s procurement mechanism for COVID vaccines and for—not just vaccine, but for diagnostics, for PPE, for therapeutics. Partnerships are critical.
And my sister Anyaga (ph), my namesake, Joy just referred to the SDGs. Partnerships are core to SDG 17. And yet, in my work I’m seeing a world where—you spoke earlier, Hillary, about the need, potentially—one of the speakers spoke about the need for unconventional partnerships. And I think as this world is faltering more and more, we need to start looking at unconventional partnerships. We need to start looking at that work together. I heard Rachel just stay together. My brother Tedros earlier said together. The world needs to come together in such a way that it is respectful, just like Jean Kaseya just said. But respect is not just between continents; respect is also within continents. We have to show respect to one another before we expect the world to show respect to us.
Partnerships is about respect. It is about—it is about understanding that you are not OK—I am not OK if you are not OK. It’s about working together as a global community to ensure that the health of this world—not just our health security, but the health total of this world—is together in one place.
So for me, partnerships have been incredible in the last few years. I have seen them—I have seen the power of partnerships, and I have also seen how partnerships can dissolve when we try to restrain them too strongly within traditional limits or when we don’t have the right leadership for certain partnerships and we try to force those partnerships into place that they don’t fit.
I’ll leave it there for now. But for those who are in the room, I know that Ambassador Nkengasong, I hope, is there, but my message is for Dr. Fauci. I hope he’s still around. And somebody put it on record if he’s there that his incredible work during COVID-19 led so many partnerships in this world, and we want—I really want to thank and salute him for his service. And if I were there today, I would want to give him the biggest hug ever. (Laughter.)
CARTER: Well, thank you so much. I think there’s many of us who would want to replicate that hug for the work that he did.
Let’s—what we’re hearing is a lot of support for partnerships and how they’re critical for the work that each of you do day in and day out. I’m wondering if we can get more specific, and if you can share with us a specific partnership and the impact that it has had on the work that you do, and maybe one of the most impactful partnerships, if you could share with us. So let’s go back to Dr. Barbosa. If you could share the experience from PAHO.
BARBOSA: Thank you. I will have not to tell you what’s the most impactful, because maybe I will not be fair with many hundreds of good partnership, but to give two examples, very concrete.
One was the, in March 2022, we—working with many partners including U.S. government, we establish our COVID-19 Genomic Surveillance Regional Network, COVIGEN. Now we have thirty-three laboratories from thirty countries and territories that are participating in this network, and over six hundred thousand— (inaudible)—specimens from Latin America and the Caribbean have been shared through this—through the global database. So I think that this is a very concrete example that, working together, we can, in only three years, change the way that we are performing genomic surveillance in the region.
And the second is that the—a partnership trying to reduce the vulnerability of Latin America and the Caribbean. Following the recommendations from our member states, we established a regional platform that is bringing together public and private companies to strengthen their capacity in Latin America and the Caribbean to produce vaccines, medicines, laboratory (kits, and others ?). That is one outcome important of this process. Now we have two projects—one in Argentina, one in Brazil—to develop the mRNA vaccines that will benefit not only Brazil and Argentina, but the whole region through PAHO’s Revolving Fund.
So these are two very concrete examples that I have, probably the most recent ones. Thank you. CARTER: Thank you, Dr. Barbosa.
Rachel, can we come to you? We heard Dr. Barbosa talk about public-private partnerships and would love to hear your perspective.
KING: Sure. I would say—I would name three types of partnerships. There are many that the industry benefited from that I could name, but I’ll name three as such that were—that were particularly important.
One is a background of both public and private investment. And I want to name that first because that is the foundation, from a—from a basic technology perspective, that we need to have in place in order to ensure that when the pandemic hits we have technologies available. So that was both government investment and venture capital investment as a partnership with industry that forms a basis of innovation.
Another I would name is the advance purchase agreements, which were a public-private partnership, again, that made it possible for industry to invest in manufacturing, which was the third thing that I would mention as a critical partnership. Scaling up the manufacturing of the vaccines—in particular of the vaccines—was an incredible challenge in terms of the supply chains, in terms of the capacity. And it could not have been accomplished without a tremendous amount of partnerships.
So I would highlight those three among many. One is the background of investment, second is the advance purchase agreements, and the third is the incredible collaborations that took place around manufacturing and supply chain.
Joy, can we come to you to share your most impactful or one of your most impactful partnerships?
ST. JOHN: So, for me the most impactful partnership I have experienced is the partnership with the members of the CARICOM Security Cluster—CARICOM-MPACS; CDEMA; RSS; and my own organization, CARPHA. We are responsible for maintaining and enhancing regional security from many perspectives—traditional security with armed forces, health security, disaster preparedness and response, and security surveillance.
So, among ourselves with the support of a wide range of sectoral partners, we have—including PAHO and WHO—we have also tried to ring-fence the CARICOM region. So this partnership was a literal lifesaver during the pandemic. And right now, we are working together to build a secure foundation of extreme solidity with pillars of capacity building, surveillance, border security, and response to support the staging of the Men’s T20 Cricket World Cup in the region and the U.S. in the midst of warmup matches in May and June, the actual matches next year. We are marshaling out national focal points, much as we did during the pandemic, to ensure that they fully understand their critical roles to protect national security while making this event a true pleasure for the players, officials, spectators, and visitors. We are also sensitizing our sectoral partners about the key areas of need which their unique contributions can fulfill capacity building, of course providing linkages to other regions which have staged mass-gathering events for guidance and avoidance of pitfalls, and resource mobilization.
So these—this describes my most impactful partnership. CARTER: Wonderful.
DG Kaseya, can we hear from you?
KASEYA: (Laughs.) As my friend Jarbas said, when you are leading a continental organization and we have to talk about one partnership specifically, you know, it’s like you are forgetting others and you are creating a number of issues. But I will just talk about one regarding the PPP—public-private partnership—as Rachel said.
Why I’m talking about it? Because when I was special advisor and minister in my country, at that moment talking about PPP was like a scene. But today it becomes that we are really doing, what we are pushing.
Africa CDC, we have a partnership with Mastercard Foundation. And that one is the gamechanger in Africa, not only for Africa CDC but I’ll say in Africa, because this funding that we got from Mastercard Foundation, it was for COVID. Now I think a number of you will CPHIA. This is the second-biggest public-health event in the world. That will take place in Zambia. We are expecting twenty thousand people. During this CPHIA, we launched the second phase of our partnership with Mastercard Foundation. What this partnership is doing? We are changing the face of Africa.
First, we are targeting all flagships that are important—local manufacturing, and workforce, and lab, everything. But more important, we are using that to leverage more domestic resources because we are giving an example. I have to say to my head of state: We cannot rely on external resources. Even if we wanted, let me tell you, my budget for next year is around $1 billion. I’m still expecting that Office of Global Health Security, they will help me to move from 1 million from the U.S. to maybe a hundred million. (Laughter.) And what is important is to see how African countries can start now to invest in their health system, and what we are sharing with them is the model from Mastercard Foundation.
Now this model is transforming the way we are perceiving health in Africa, and we are using that also to advocate. As you know, Africa CDC appointed President Ramaphosa as the champion for PPP. Reeta, I will talk with you. Now you would see President Ramaphosa and myself coming strongly to support how we can advocate for more funding for Pandemic Fund. And as you know, Africa CDC is—plan to become an implementing entity because we want to leverage resources from Africa to support also Pandemic Fund by being implementing entity.
I think there are a number of lessons we are learning from this partnership with Mastercard Foundation. CARTER: Great. And it’s an example of a catalytic partnership—
CARTER: —a partnership that leads to additional partnerships. Fantastic. So let’s go back to our screen. Ayoade, please go ahead.
ALAKIJA: Thank you. Well, you talked about catalytic partnerships, so let me talk about a partnership that I have been involved in that really has sparked off much of what we’re talking today.
In the middle of COVID or at the very beginning of COVID, the Bureau of the Heads of State—African Bureau of Heads of State established a three-pronged pillar of the continental response. One was the CONCVACT, which was looking after tests and trials. One was the AVAT, which was supporting procurement mechanisms for Africa, which was led by Strive Masiyiwa and John Nkengasong in his then-iteration and many others, and Afreximbank very importantly. And the third was the Africa Vaccine Delivery Alliance, which has now become the Africa Countermeasures and Readiness Alliance, that I co-chaired with then-Dr. John Nkengasong, now Ambassador Nkengasong. It is that partnership that was catalytic in really—you know, you have Amadou, my brother, there in the room today—in starting local production in Africa, in starting local production not just in Senegal but in Rwanda, but in South Africa with people like Afrigen, with whom I was—I was together in Berlin or wherever that was last week. It wasn’t Berlin. Where was last week? Last week was the Netherlands. (Laughter.) Last week was the Netherlands. Go figure. You know?
And so I love the fact that you’re talking about catalytic partnerships because partnerships, you know, they’re— it’s not a—it’s not a static construct; it’s a dynamic construct. You know, partnerships evolve and they change over time. That particular partnership led with what—was at the front—very forefront. And it was not just, you know, African governments; it was private sector, it was CSOs, it was logistics companies. It was actually the way the world should be, is, you know, when I talk to my brothers now within ACT-A—which is another partnership that I lead at the moment and co-lead together with the former prime minister of Sweden, Carl Bildt—you know, when I talk to them, when I say, what does the future of PPPR look like—which, you know, Jean Kaseya just mentioned—that looks like that partnership. It looks like what AFTA (ph) did. It looks like what ACARA (ph) is now—is now turning into, which is a sort of—not just multilateral, but it includes, you know, people from communities who understand. I say all the time, and I speak in my language a lot which is Yoruba, that (speaks Yoruba.) It is a person who wears the shoe who understands where it is hurting. So we need people at that level to be able to be within our partnerships so that they can help us.
You know, like Rachel was saying earlier, how do we deliver to the last mile? The people that I met with today, I went to some of the clinics and literally seven hours, eight hours away from Jakarta, by some very bumpy boat rides, I might add. You know, so I’ve sort of, you know, been taking a little bit of my motion sickness pills and got back here just in time. You know, but they will tell you that the big freezer that they have, which has been supplied by GAVI or by whoever, it doesn’t work. The electricity in their community doesn’t work. So they still rely on the cold chain. Some of the diagnostic tools that we looked at—oh, my goodness, does any one of you girls remember those colposcopy tables where you have to sit on it and, like, splay your legs and have a, you know, visual, and instead of the proper—I mean, OMG. That’s what we were dealing with today.
And we have to have people like this at the table. That is what partnerships are about. So partnerships also have to be about investment. And that’s my third point. The first was the Africa Vaccine Delivery Alliance, started under the leadership of Dr. Nkengasong and also President Ramaphosa, in his then lead as chair of the African Union. But the third one is investment partnerships, which we saw within Africa with the Afreximbank. You know, Professor Benedict Oramah and Afreximbank came to the table. I have recently been appointed co-chair of the G-7—thank you, USA, because you were all there as well—of the G-7 Impact Investment Initiative for Global Health. That is another partnership, looking at the fact that the world needs more money in this space, but we need to get creative. And let me go back to your—almost your first words, Hillary. We need unconventional partnerships. And we need, as Dr. Tedros said, to do them together. Over.
CARTER: Thank you. Really great. Thank you for helping us understand the dynamic partnerships and the types of investments that we need for those partnerships.
So we are right on time to open it up to the audience. At this time, I would like to invite members and guests in Washington and on Zoom to join our conversations with their questions. A reminder that this meeting is on the record. And we will take our first question here in Washington in the room. Don’t be shy. Yes.
Q: Thank you, again, so much for your time. Captain Grant Hall (sp).
I’m very curious to hear what your opinions on what the biggest barriers are to these new partnerships. And, particularly, the unconventional partnerships that you talked about, if we’re going to start building them.
CARTER: Thank you. I think all of our panelists could respond to this question. So maybe let’s do a lightning round. And we’ll start first maybe with Rachel.
KING: So that’s a good—that’s a good question. And I think, to some degree, the barrier depends on the partnership that we’re talking about. I mean, one of the concerns that—what I think from the industry perspective, from the perspective of the small-to-medium sized companies that are driving a lot of innovation in the biotechnology industry, one of the critical barriers to being able to partner is being able to finance and being able to have investable assets to partner. And that really requires a strong ecosystem for investment, part of which is intellectual property. And I know that may be a controversial topic within this—within this group, but I think to enable the small-and-middle sized companies to be able to really raise the financing and to partner, we need to have—we need to ensure that we have strong intellectual property regimes around the world that enable them to incentivize investments. So I think that’s a critical potential barrier to investment for small and medium companies.
CARTER: Great. DG Kaseya.
KASEYA: I will answer this question by quoting President Ruto when he attended the meeting in Paris. He said—(inaudible)—with President Macron. And he said, one of the key barriers is lack of respect. Sometimes I’m talking like—I’m talking health leader, African leader. Sometimes people, they can think that they know what they can do for us. They can come to Africa to impose even the model to implement the program. We don’t want it anymore. And this is what my head of state they are saying. This is what I’m seeing as DG Africa CDC. In health sector, I’m leading the agenda of health.
You think that you can invest in health sector in Africa, please come in. We can talk with you. We are open. We know our needs and priorities. We know where we need to invest, what we need to do. You think that you can support the local manufacturing, come to Africa CDC. We’ll talk and we’ll guide you, and we’ll convene. In September we had a meeting with ten ministers, regulatory authorities, GAVI. And let me say I respect Gavi, because Gavi, they know how to respect partnership. We managed to talk with Gavi. We secured one billion for African manufacturers. I think Amadou attended this meeting. This is what we are doing. And we will do that for diagnostics, for therapeutics. I think, for us in Africa, as my head of state are saying, it’s mostly lack of respect. And thinking that others, they know more than ourselves we know for our health system.
CARTER: Thank you.
Would the virtual panelists like to respond? Joy, would you like to respond?
ST. JOHN: I think the biggest barrier is not understanding the rules of engagement. And if you don’t make it clear what the boundaries are, and where the unusual collaborations can be, you’re either hampering or giving too much license to a partner. And so it’s very important to understand the issues of partnering, and the conflicts of interest, and so on. The next biggest barrier, from my experience, is understanding precisely what the
recipients of the partnering process will gain. And I’m here thinking of, for example, my member states. And they, therefore, have to put some skin in the game and say what their needs are, so it’s easier for partners to really come in and support rather than to come in and dictate.
CARTER: Great. Ayoade, can we turn to you?
ALAKIJA: Thank you. I would agree with what Joy just said—lack of understanding rules of engagement. And I would add to that also the lack of understanding of the political economy in which one operates. I think too often, there is a helicoptering into various sort of situations. I mean, only speak from the sort of, you know, the Global South perspective. As I said, I’m in Indonesia today, so I’m sort of not wearing just an Africa hat but I’m wearing sort of a wider Global South hat. And I’ve done a lot of work in India this year working with the Indian government and through that whole G-20 process.
And, you know, what is clear to those of us who work in these settings is that people do not fully understand the political economy of the environments in which they work. Recently, last week, I was at the local—I just remembered where I was now—it was at the Local Production Summit, World Local Production Summit in the Netherlands. And, you know, a lot of conversations around local production. And I sort of chaired the leaders panel at that meeting, where I challenged them to say that everybody’s talking about local production but, you know, if every single country in every region of the world started producing vaccines, who’s going to—who’s going to buy them? If we don’t understand the local—you know, these are the elephants in the room. I also brought up my country.
Of course, you know, working very closely with my own minister of health at the moment, and my dear brother, Professor Muhammad Pate. You know, if Nigeria wakes up—the sleeping giant finally wakes up one day and starts producing vaccines, therapeutics, diagnostics, it’s over for everybody else because that is the biggest market in Africa. So if you don’t engage with Nigeria, you can’t engage with Africa. If you don’t engage with—you know, you have to understand. I don’t say that just as—you don’t engage with Ethiopia, you don’t engage with South Africa. You know, so it’s a lack of understanding.
And then I think the third thing I would say is the lack of—there is no—there’s very limited risk appetite at the moment in the world. You know, everybody is very happy within their little sort of boxes and their little—their little sort of, you know, global health fraternities, as I call them, because that’s—let’s face it, that’s what they are. They’re little fraternities. Girls, we need to form a sorority. (Laughs.) You know? But they’re really happy with that. So there’s not—that there is very limited risk to go out.
And the question specifically said, how do we get into these unconventional partnerships? That was what the gentleman said. And to get into unconventional partnerships, you have to take risks. You have to take risks. And those risks must then be de-risked, if you like, you know, because the risks are largely financial. You know, you could invite me to a meeting. That’s a risk. You know, if Ambassador Nkengasong invites Ayoade to a meeting, oh, my God, what is she going to say? You know, BBC invites Ayoade to an interview, oh, my God, what is she going to say? That’s not a risk. But the risk is where you put your money where your mouth is. And so we need financial institutions—so Priya’s there today in the World Bank, and others to—you know, IFC and many others, to help de-risk the environments that we live in. That is where we can get into unconventional partnerships.
Let me end with AVDA. I mean, I led—I’m continuing to lead AVDA now as a sort of independent thing, you know, once we—once the previous director left. And we’re all volunteers. Were unpaid. We started the very first delivery partnership for vaccines, therapeutics, and diagnostics in the world. CoVDP, the one that came out of ACT-A, which I also co-chair, copied our model. Yet the world was comfortable with funding CoVDP, because it was—it was not an unconventional partnership. But they would not fund through Africa the work that we did, which was the model for that. That is—those are the key barriers. Over. Thank you.
CARTER: Thank you.
And let’s go last to Dr. Barbosa on the challenges to partnerships.
BARBOSA: Thank you. Owe you all for commenting on this topic, my dear friend Ayoade and also Jean. Of course, that we have—one important barrier is when you have some conflict of interest, you don’t have a really a common objective is to deal with. But I think that the main talk in our days is how we can translate some complex issues into partnership that can work. And I will comment on this topic of the local regional production.
In Latin America and the Caribbean, I think that the experience that the countries had, the lack of access for PPE, for medicine, for ventilators, and for vaccines was so traumatic that everybody would like to produce everything. And we know this is not feasible. So this is, I think, a very concrete example of a complex issue. That is, how we can translate this legitimate political will to reduce the vulnerability into partnerships, bringing together public and private sector, working together to establish a reasonable production that can reduce the vulnerability, that it can leverage the current capacity that we already have in Latin America and the Caribbean, and can let us be better—much better prepare in a new pandemic. So I think that this is the kind of problem is that is complex, that with different—many different interests. But that that we can convene them together to work in a collaborative way.
CARTER: Thank you. We have to set the table for partnerships to overcome those complexities and to take risk. You have to know the rules of engagement. I think we have—OK, I’m getting the signal that it is time to conclude our session. Thank you all so much. This was a really rich and diverse conversation, thank you. (Applause.)
BOLLYKY: Great. Well, welcome to panel three. We will be talking about “Future Priorities for Global Health Coordination.”
Frankly, the need for coordination on global health is intuitive. We're talking about threats that do not know national boundaries. But the reality is, is that coordination has not always been evident. That was especially true in the early days of the pandemic, and also especially true on the distribution and production of countermeasures against COVID-19. And the anger and the legacy of that lack of coordination still reverberate, really, through global health, and are a topic that we deal with in thinking about the future priorities for coordination.
We are blessed to have a(n) all-star panel today to discuss these issues, including many friends and all people I admire. In the interest of time, I am going to introduce them only by their current titles. I hope they and you will forgive me for not delving into their very impressive backgrounds. I'm going to start with the people in the room and then move on online.
To my immediate left is Peter Hotez. He is the dean of the National School of Tropical Medicine at Baylor College of Medicine, and also the co-director of Texas Children's Center for vaccine development.
Next to him is Amadou Sall, who is the director of the Institut Pasteur de Dakar.
And next to him is Winnie Byanyima, who is the executive director of UNAIDS.
On our screen coming in remotely, we have my good friend and CFR colleague Tom Frieden, who is also the CEO of Resolve to Save Lives.
Next, we have Peter Piot, a special adviser to President von der Leyen on European and global health security for the European Commission.
And next we have Chikwe Ihekweazu, who is the assistant director-general for the Hub of Pandemic and Epidemic Intelligence at the World Health Organization.
Thank you all so much for joining us today.
My question to the panel is going to be the same but it is going to be in two parts. The first question I have to ask is how the successes and failures of the COVID-19 crisis have changed you or your organization's priorities for global health coordination. And what is one opportunity you are taking to try to advance those priorities?
And why don't we start to the far left with the executive director to lead us off, please.
BYANYIMA: Thank you, Tom. I start by congratulating Ambassador Nkengasong and your team for launching the Bureau for Global Health, Security and Diplomacy, and organizing this important meeting.
I lead the United Nations Joint Programme on HIV/AIDS, and we have twenty-seven years of experience fighting HIV/AIDS. It's not over as we just heard. When COVID struck in 2020, we fought hard working with our partners like PEPFAR, Global Fund, supporting governments and communities to keep the HIV response on track and to contribute to fighting COVID.
Four things. Many of the partners we fought with are here, like Africa CDC. We were with them from the very beginning, led by Ambassador Nkengasong fighting for personal protection equipment, fighting for the vaccines. Fighting every step of the way.
Four things we learn from HIV that we were trying to get into the COVID response with some success, but a lot of failure. One, that global health security requires global coordination of a multisectoral, all of government, all of society approach. You try that in some countries, bringing in what HIV had taught us with some success, but we didn't succeed globally.
The world came together to create UNAIDS. We set the global standards. We set a strategic direction and targets. The whole world comes together to raise resources. PEPFAR is the biggest bilateral program to respond to a global pandemic. This Global Fund created twenty years ago that brings together donors to finance a global response, all this didn't happen. There were some targets set for COVID. Secretary-general kept saying by this time, we should have so many people vaccinated, but there was no plan behind that target. There were no resources behind it. So we failed in that respect.
The second is about sharing technology. By 2000, there was ARV treatment available here in the North. But 12 million people died in the South, mostly in Africa, because ARVs went well beyond what they could afford. Through activism and through generic production, now most people, 28 million people are in treatment, 30 million are on treatment today. You may be in Ouagadougou, you may be in London, you can get the same ARV tablet price differently. This was an achievement of the HIV response. Didn't happen this time. You know the story of how vaccines were hoarded by a few companies, out of reach for most countries, and 1.3 million lives could have been saved that were not saved because of that hoarding. We fought for a trips waiver for one year. At the WHO, most countries wanted it. A handful didn't want it. We never got the trips waiver. Sharing technology didn't happen. Millions died. Economies shut down. We could have saved that.
The third is financing. Again, developing countries were already hit by debt. They were paying four times more for debt servicing than they were putting in the health of their people. They said we need some debt relief. All they got was a suspension for two years of the debt service. That meant nothing because they were still paying out more to debt service than to fighting COVID.
Common framework for G-20 didn't yield anything until COVID was over. So financing that came together up today for HIV, we still have a PEPFAR program putting billions into saving lives; 25 million lives saved today by PEPFAR alone, one bilateral program. All this coming together to finance a pandemic didn't happen for COVID.
Lastly, communities. You heard Professor Fauci here say that the most important thing for him as a leading expert here was the empowerment of communities to fight for their lives. This did happen in some countries. South Africa, we saw the news. The same communities they brought together to fight HIV, do the contact tracing, do the work, connect with scientists to fight COVID, and that is why they registered some success. That country with 8 (million), 10 million people living with HIV was also fighting COVID. We need communities to lead for themselves.
So in short, four things: global coordination of a multisectoral approach; all-of-government approach is needed; sharing technology, lifesaving technology, is needed; ensuring that there’s funding for every country to fight; and letting communities lead. Those are the four things that come from HIV that we try to bring it into the COVID response with a little success somewhere, but with failure at the global level, I'm sorry to say. Thank you.
BOLLYKY: Great, thank you so much.
We're going to stick on the multilateral theme, and I'm next going to go to Chikwe Ihekweazu, please.
IHEKWEAZU: Thanks, Tom.
And also, congrats to Ambassador Nkengasong and his team. You know, I'll focus on one bit. There are many areas one could pick on. But let me focus on a shared experience that we all had and I think all lived through from whatever country, wherever we sat, we watched our leaders literally in real time struggle to make decisions. And one of the reasons for that—there were many other reasons—but one of the reasons for that, was that our systems in public health were just not prepared, developed, designed, or implemented in a way with the agility, flexibility to give these leaders the information that they needed to make the decisions with the agility and speed they demanded. So you know, when you think about the evolution of the HIV epidemic—and Winnie alluded to that—we had a slow burn, pandemic evolved, and the data and analytical demands were different. And we had the time to think, to go back to analyze, to derive hypotheses, and come back with possible answers, and design a response.
Unfortunately, with the speed and intensity of this pandemic, we simply did not have that privilege. And in public health, generally, our national public health agencies, our science institutions, just did not have that ability to access not only health data, but all the other related data systems. So on that particular problem—and there were many others—but the emergencies program acted literally within the pandemic. So similar to when the health emergencies program was set up post-Ebola, you know, almost immediately after, this was during the pandemic, we realized, WHO realized that there was a gap, and set up within the emergencies program a new division called Surveillance and Health Emergency Intelligence Systems, which then include the new Pandemic and Epidemic Intelligence Hub in Berlin, to support ourselves, support the organization, and support our member states in getting better at collecting, using ,analyzing information to make more—make important public health decisions with the time, with the precision, agility that was needed to react to pandemics.
So really, one of our key lessons from this is that there's a big gap. And while we've started working on this in Berlin, working on it in Berlin will not be enough to solve the problems around the world. The most critical interface are the countries, to support our leaders in countries, ministers of health, heads of national agencies to do the same. And to do that, we're now starting some exciting work with partners like Resolve to Save Lives—Tom is on the panel—with national public health agencies with more advanced capabilities to integrate all the new opportunities, whether it's genomics, whether it's population data, whether it’s healthcare data—to be better prepared to integrate this rapidly in order to then provide our leaders the opportunity to make the best decisions possible.
Listen, we've watched the pandemic. We know that even with the best data, we still can’t guarantee that our political leaders will make the best decisions. But that's outside of our gifts. They are elected to make decisions. Our responsibility is to give them the best possible opportunity to do so. And I definitely will not want to stand before any political leader in the next pandemic when it comes—I say will—in the same situation I was three years ago, struggling to collate and, you know, provide them with what they needed to make decisions.
So this is an exciting piece of work. It cuts across many aspects—governance, technology, people, resources, intersections, collaboration. But the work has started.
And Tom, that's really one of our big challenges and the one piece I wanted to use this incredible opportunity of the beginning of the new bureau to kind of highlight and share with colleagues.
Back to you.
BOLLYKY: Thank you, Chikwe. That was fantastic.
I want to move from the multilateral to the regional and talk or move next to Amadou Sall, who leads one of I think among the most promising local and regional manufacturing initiatives, and we'd love to hear from you.
SALL: Thank you. Thank you very much, Tom, and also thanking the organizer and Ambassador Nkengasong for inviting us.
Coming to your question, there is really two very important lesson that we've learned from COVID in terms of coordination. When COVID hit, there were two labs in Africa that has the capacity to make the diagnostics. Thanks to coordinations and discussions with Africa CDC, we could train as early as February twenty-five countries in Senegal and, a few months—a few weeks later, more than twenty-two countries from South Africa. What is—that is when you coordinate, you can have a very good access to be able either to detect and respond, because that was one of the key questions at the beginning.
Second example I want to talk about is the one dealing with medical countermeasure, where really one of the issue was really the AAA: access, availability, affordability. Because we end up with Africa CDC as part of this partnership for COVID testing to literally move 3.2 million tests to all these different people from Institut Pasteur in Dakar. In coordination from Germany, have to move it.
So all these two lesson lead us to very important activity that we have to thought very clearly. Number one, when it comes to medical countermeasure, we have to build a very resilient system by design, meaning that you can—we want to make sure that you have extra capacity that we can leverage if needed. We have to build actually possibilities to have some standardized way to make it. And the third thing, we want to make sure that we can do that in coordination with other people so what we deliver is something that makes sense.
And when I talked about that, during the COVID, we did diagnostics for COVID rapid test. We could develop in record time this rapid test that can be channeled to West Africa and with West African health organizations, and we could do the same together with Africa CDC to reach more people.
The other way is the diagnostics—sorry, the vaccine. Why the vaccine? Because we are the only WHO-prequalified vaccine manufacturer in Africa for yellow fever, and we've been this since 1966. We've been making vaccine for more than eighty years. How do we leverage that to deal with security when it comes to vaccines? And that's how, once again, with coordination with Africa, CDC, we came up with this partnership for African vaccine manufacturing, which lead us today to build a platform where we have end-to-end manufacturing, multi-technology, (eggs ?), cell culture, messenger RNA, going together with R&D, meaning that you developing the vaccine that they going to be manufacturing.
We also do that in parallel with workforce development. This is a huge gap we have in Africa when it comes to manufacturing. Workforce is very, very important. Regulatory is very important. But dealing with those in coordination with AMA, with Africa CDC, with WHO is absolutely critical to be able to build those regional hub that can serve the Africa purpose. Today, we are in a position actually to launch very soon this platform that will over the next coming years be able to do 300 million dose of vaccine on pandemic, on routine, and on epidemic vaccine. And this is typically coming out of the COVID.
The second part I want to talk in terms of looking forward is really when it comes to the detection. Very clearly today, it's really important when we talk about surveillance we understand that having surveillance from the very last mile, up to the top central level, is something that we have to do.
In Senegal, what we have done is really have this digitally empowered syndromic surveillance that go from the community up to central level. What this gives us is a platform where through the sentinel sites that we spread out within the countries, we could detect within maximum ten days any epidemics that would happen. Why this is important is when you bring innovation to that, bringing point of care, bringing genomics, you can go down up to one to two days. You can close that. And this is really critical when we talk about health security. It's about containing at the source, at the community level, this threat to detect them and respond—I think really this approach first detector, first responder at the very last mile, because that last mile is your first mile to build global health security.
And that's why on these two sides, the regional manufacturing on the side of the detection and response, we have to make sure through coordination we're bringing that together. And that's where I think technology is critically important. Today being able on each of those sides to find a way to do sequencing within twenty-four hours, share the samples and these information with other people can be extremely useful not only to be able for people to get ready, but also a bridge that is the capacity on which you manufacture. Today, having a sequence can help you to have a very good molecular testing. Having a sequence using messenger RNA technology can help with that thinking designing a vaccine. And making sure you can share that at the global level is really where bridging detection and manufacturing capacity with technology like AI, like messenger RNA, like sequencing, you can build something that is very strong, make sure security at the highest level, from the regional and from the most local part up to the highest level.
The last thing I want to talk about that. which is really, really important, we tend to really sometimes overlook the role that the health system being extremely strong is very, very important. And that's where also coordination is critical. Because let's be clear, you can have a vaccine. Until you have a system that is strong to deliver vaccination, you are really stuck. So it's really, really important that the health system being the channel that would bring that, and that's where really coordination is important.
My last word is we're doing that in Senegal at Pasteur Institut. But it really matters if we do it in coordination, that with other hubs We need to have those different hubs where manufacturing are entwined with detection and response and good end to end with workforce development. If we have that in different areas in a coordinated way, then when we make products, we have a product that is really done, that is really in a context where the market is shaped to be able to absorb that product. That's where the coordination is also critical. We don't all need to do the same sort of vaccine and overwhelm the market with that. But agreeing on the fact that South Africa should focus on some specific vaccine, Senegal, Egypt, Morocco, and other people may help us actually have the right market shaping to be able to make those capacities financially viable and also in the long term being something like a shield that can help not only Africa and the region, but be a very strong foundation for the global health security.
BOLLYKY: Great. Thank you, Amadou. That’s a thoughtful and compelling vision.
Sticking on the regional theme, I'm going to turn next to Peter Piot. Please, Peter.
PIOT: Yeah. Thanks, Tom. And also, again, congratulations to John Nkengasong and his team for organizing this.
I'll bring a European perspective. But before that, let me say we heard a strong rationale starting with Secretary Blinken for including health in foreign policy in general, and certainly, obviously, in time of pandemics. And as John mentioned in the dialogue with Tony Fauci, the UN Security Council discussed AIDS already in 2001 and—in 2000, sorry. And it was the first meeting of the millennium, and there was a session on Ebola. But the fact that the biggest epidemic of the last hundred years did not make it to the Security Council, and there was no special session of the UN General Assembly—I'm not talking about a high-level meeting but special session—for me is a failure also of, you know, international leadership and the fact that we could not really bring everybody together, which may be explained by the far more complicated environment.
But in terms of Europe—and since we are in the in the U.S. here, let me remind that the EU, the European Union, is a union of twenty-seven sovereign states, and that health as such has not been a core legal competency of the union. And because there are competencies that are common to the union, such as foreign trade, environmental regulations, and industrial norms, and so on, but not health.
However, COVID has changed that—and because that was one of your questions. And we COVID put health squarely on the political agenda of the of the union. Also, thanks to the leadership of President Ursula von der Leyen. And this has resulted in some very concrete actions and activities to join procurement of vaccines, uniform vaccine certificate for twenty-seven member states, agreements on continuing free circulation of goods and people and so on.
And now we have what's called a health union, which is one step to ensure health security not only for the European Union, but beyond that. HERA was created. That's the Health Emergency Response and Preparedness Authority. So there is now a body in the European Commission that is the locus for preparing and dealing with pandemics, stronger mandates for the European Medicines Agency, for the European Centre for Disease Control, and also rules for declaring a health emergency within Europe.
And I should, of course, specify that healthcare remains a competency of member states, and rightly so because it's so complex. And we'll hear from the next session from some country representatives, what they're doing. And let's not forget that the EU and the Commission plus member states are really basically the largest to gather the National Development donor, though in the field of global health, the U.S. is still the largest one. But the U.S. and EU really join hands, and that led to the creation of the pandemic fund, and that's something that's another illustration of that this has now gone up to the top agenda.
But also, as a result of COVID, a broader global health strategy for the EU was developed—and not only COVID, but also, you know, developments that are there, the emergence of regional bodies. and I think that the role of the AU and Africa CDC in this pandemic is a turning point in how Africa is no longer waiting for charity from the Global North to deal with its own business and emergencies, and also demographic changes, and so on.
And this strategy was a commission-wide initiative and effort, including for the first time the external service, which is slightly a mini foreign affairs or state department, although with far less, you know, authority, and explicitly positions, you know, global health as an essential pillar of the EU's external policy. And that is really very new.
However, it's not yet approved, because some member states have problems with their reference to gender and sexual and reproductive health. So for our American friends, you're not the only ones.
So what's different in this new strategy? And I mentioned it because, again, it includes, of course, pandemic preparedness in a big way, but it's—one of the first principle is that of partnerships, which is quite a different approach than in the past with our partnerships on equal basis in terms of planning and implementation.
Two, it’s resolutely multisectoral and embraces one health.
Three, it's strengthened—it really emphasizes, you know, system strengthening for primary health care, but also very important when we talk about health security is strengthening national institutes for public health, and in each and every country—something that I—like, Chikwe, you have worked on in a big way, but we still have a long way to go.
Fourth also is that we need to go beyond infectious diseases and the classic public health, something that Tom has been working on, Tom Frieden, in this case, you know, with diabetes, hypertension, and things like that, that that are becoming and are already the main cause of deaths and of ill health in many, many countries, also low and middle-income countries.
And finally, a resolute support for what Amadou do is doing is support for regional and local manufacturing. Actually, the EU has allocated 1.1 billion euro to support local manufacturing, not only vaccines, but also diagnostics and drugs in low and middle—low-income countries basically. And, finally, the strategy also explicitly calls for stronger collaboration with other regional entities. And, you know, the collaboration with AU particularly is really getting stronger and stronger, at least in the field of global health, pandemic preparedness, Africa CDC, but also with other so-called donor countries, and strengthening international organizations. And in other words, it is supporting the global network that was mentioned earlier on.
I must say that the there was a strategy on global health 2010, but it was never really implemented. Partly a lack of leadership, partly a lack of competencies. But having such a strategy now that puts global health security in a broader context, plus the creation of HERA and other things, plus the numerous activities in member states means that we are now in a much better position, and also to support international efforts. Thanks, I stop here.
BOLLYKY: Great. Thank you, Peter. It's great to hear about the commission's strategy.
We've moved from the multilateral to the regional. We're now going to move to civil society and the role of practitioners and enabling and holding us accountable for this global health coordination, and I'm going to turn to Peter Hotez next.
HOTEZ: Thank you so much, Tom, and a shout-out to you, Ambassador Nkengasong, and to you, Tom, as well, because I know how hard it is to get important organizations like the United States State Department and the Council on Foreign Relations to care about global health, and so it's a testament not only to your brilliance, but your force of personality. So thank you for that.
Just a few comments that I want to make. I'm a vaccine scientist. And if I could, I'd like to use my three minutes—and I hear Wolf Blitzer's producer shouting in my ear, wrap up, wrap up—my three minutes to address the two issues that I see around vaccine equity, because I am a vaccine scientist, that are somewhat on nonintuitive.
And first, around promoting vaccine equity, access, and also countering anti-vaccine activism. Regarding the access feature, we developed two recombinant protein COVID vaccines that wound up reaching 100 million people, Corbevax in India, produced by Biological E. and BioPharma in Indonesia produced IndoVac, which became one of the first Halal COVID vaccines. And so we provide a proof of concept that you don't have to be a big pharma company to do big things.
But the back story was, you know, in 2020 and 2021, we were getting frantic phone calls from ministers of health and ministries of science across the African continent, in Asia, in Latin America. The reason why? Because they realized that the mRNA vaccines weren't coming—
right?—weren’t coming any time soon. They realized the particle vaccines weren't coming—or weren't coming anytime soon. Could we help them? We did. We transferred the technology, no patent, no strings attached, and 100 million people got immunized.
The problem was, in my view, it was a science policy failure. We were so focused on speed and so focused on innovation, and what I sometimes say in my moments of frustration the shiny new toys, that nobody had the situational awareness to step back and say, hey, if we only focus on new technologies like mRNA and particle vaccines, there's a learning curve before you go from zero to the 15 billion doses that we needed. And so what happened was, in those early days, enough vaccine got produced to get bought up by North American countries and Europe and Japan, leaving low- and middle-income countries out in the cold. We can't let that happen again. And I think, very much with my colleague here, that means empowering the vaccine producers in the low- and middle-income countries, but really empowering them; not dictating what vaccines that they're going to make, or not relying on the big pharma companies to develop the technology and hope the crumbs filter down to the low- and middle-income countries. We're not there yet.
The second piece of that vaccine access piece is empowering the national regulatory authorities in those countries. The WHO pre-qualification mechanism failed during the pandemic. What happened was, the big companies came in, they put a velvet rope around the big pharma companies, and all—most of the low- and middle-income country vaccine producers couldn't get their vaccines pre-qualified by WHO.
The alternative strategy is to have stringent regulatory authorities. They can do this and have it largely rubber stamped by the WHO pre-qualifying mechanism, but who are the stringent regulatory authorities? USFDA in the U.S.—you know where this is going—Canada, the U.K., the EMA in Europe, Australia, and Japan—all high-income countries. We're not empowering national regulatory authorities in India and in Indonesia and Brazil to take this on, and we have to fix that. That's the second piece.
Regarding the other piece, countering vaccine hesitancy, it's a disaster. My new book, “The Deadly Rise of Anti-Science,” says that two hundred thousand Americans— two hundred thousand—needlessly died because they refused a COVID vaccine. They were not victims of misinformation. They were not victims of infodemic, meaning they were not victims of some random junk appearing on the internet. It was an organized, targeted, predatory, politically motivated anti-vaccine ecosystem that came out of the highest levels of the United States Congress and the House Freedom Caucus, Senators Rand Paul, Senators Ron Johnson amplified every night on Fox News, and it killed two hundred thousand Americans, including forty thousand people in my state of Texas.
And now it's globalizing. And I met with Dr. Tedros last year at this time. It's growing not only into Canada and into Europe, but it's going into low- and middle-income countries, and you're seeing it affect the uptake of the malaria vaccine, for instance. This thing is a monster. And so now everyone's talking about empowering organizations like Institut Pasteur in Dakar to make mRNA vaccines.
Right now, the mRNA technology could be dead in the water. Now why do I say that? Because if you look at what's happened in the U.S. right now with the bivalent vaccines, fewer than 20 percent of Americans took the bivalent vaccines last year. The new XBB booster annual immunization, I took it and about six other Americans took it, and that's going to be our new starting place when the next pandemic hits and mRNA vaccines, because the anti-vaccine lobby has become so powerful.
I got into this because I have four adult kids, including Rachel has autism and intellectual disabilities and wrote a book a few years ago called, “Vaccines Did Not Cause Rachel's Autism,” which made me public enemy number one or two with the anti-vaccine groups. Our good friend Robert F. Kennedy, Jr. has publicly labeled me the OG villain, which I'm so old and square, I had to look up what that means. The original gangster villain. So thank you for having the original gangster villain talk to you.
BOLLYKY: It's a pleasure. Thank you so much for that.
With that, we will turn last but certainly not least to my CFR colleague, Tom Frieden, whose organization is doing a remarkable breadth of activities on this. And I would love to hear from you, Tom.
FRIEDEN: Thank you so much, and really appreciate being on the panel with so many great folks. And I don't want to repeat what's been said. You asked what are the biggest successes and failures, and I think with individuals and organizations, greatest strength and greatest weakness are often two sides of the same coin. And I would say that's the case with our response to COVID. Vaccines, measures to reduce infections and treatments—all of them had huge successes and huge failures. Vaccines, who could have thought that within a year we'd have a remarkably effective vaccine, and yet, the unacceptable failure of solidarity resulting in deaths around the world when there was demand for vaccine, and the partisan infection of vaccines that's potentially undermining not just COVID, but many other public health programs?
Second, measures to reduce infections—closures, masks, ventilation. They worked. They dramatically tamped down the acute phase, and they ignited a partisanship and undermined trust in public health and government. So again, strength and failure.
And treatment. We had good treatments early on, steroids for severely ill people, Paxlovid and others. Excellent new guidelines just released by WHO, very clear. And yet, huge failure to apply what works.
So you've asked what are we doing differently because of this. And I think, to me, we've worked with WHO to promote a target which allows acceleration, accountability, and advocacy: 717—every single outbreak found within seven days of emergence, reported to public health within one day, and all essential control measures in place within seven days. It gives you a way of using every single outbreak—cholera, measles, yellow fever, food poisoning, whatever—as a way of strengthening your system.
But to me, one of the biggest changes is the growing recognition, difficult as it is, that we have to engage with strengthening of primary health care. Primary health care is essential. We've outlined what epidemic-ready primary healthcare would look like, whether its treatment of hypertension. Thank you, Peter, for the shout out on that. It's the world's leading cause of death, accounts for less than 1 percent of global health funding. This is not acceptable, either ethically or epidemiologically. Whether it's vaccination, detection of outbreaks, response to outbreaks, HIV, TB, malaria, the 717 target, all of the public health programs stumble on the weakness of primary healthcare systems, and we have to address this. We have to address the financing, the governance, the linkage with hospitals, the relation with hospitals. We've got fifty years of very little progress strengthening primary healthcare. And if we keep not looking at how to make that happen, we're going to be in a very difficult situation going forward.
We do see programs like PEPFAR substantially strengthening the platform not just of HIV treatment but primary care services. But to me, this is one of the main lessons that we have to do more to make primary healthcare truly, not just in rhetoric, but in reality, the center of our healthcare systems.
BOLLYKY: Great. Well, I have good news and I have bad news. The good news is our six panelists have done the remarkable feat of delivering important and inspiring remarks within forty minutes, and I'm grateful for them for that. The bad news is I'm not sure we have time for questions. We have time for one? We can take one. OK, terrific.
Please, sir, if we could have your question. If you recall, this event is on the record, and if you'd state your name and affiliation, please.
Q: Sure. I'm Daniel Singer. I'm on assignment from the CDC.
I just want to pull on a thread that Dr. Hotez mentioned, which is this morning, Dr. Fauci talked about all of the technological—about the advancements that came through COVID-19. But the implementation of them was impeded by a lack of trust of science and a lack of trust in scientists, and inadequate trust of governments and between governments. So my question for the panel is, how are we going to advance those disciplines of diplomacy and risk communication so that we actually can implement the technologies that we are developing so that for the next event, we're not fighting ourselves at the same time we're fighting a virus?
BOLLYKY: Great. Thank you for that excellent question. Again, we are short on time. So I'm just going to call on two speakers who have not spoken on that particular topic to give them the chance to. And why don't we go to people—let's start with people in the room.
And I'm interested to hear from Amadou, if you could start us off. Particularly when you're thinking about building up regional capacity in Africa, how do you think about this issue of trust and confidence in the products that you're working hard to be able to produce?
SALL: I think one of the most important thing that broke that trust is things happened very late. And for me, the fact that you have regional capacities, something that would help give these people they can—they have some self-reliance, would help a lot.
And the other thing which is important is bringing the right information. We've done very good studies on why people are not getting vaccinated, even healthcare workers. And if they get the right information, this is the best way actually to bring them in. We should not stop informing people with what is the right thing. We know it's tough, but this is the way to go, bringing more and more the right information and getting people being the actors of their own work.
And clearly if you build the capacities, dedicate them to do HIV, to do the thing that are on a regular basis a problem for them, that's also how you make the system more being trust, and help actually build that trust in more general terms.
Winnie, HIV has a history on this. This is not a new problem for HIV in terms of misinformation on effective countermeasures. Would you give us a minute of your thoughts on this topic of building trust?
BYANYIMA: I think the elephant in the room is how science is rewarded and how health technologies are traded. This is a barrier, a huge barrier in the global economy. Long ago, science was not rewarded the way it is today. Science was not traded the way it is today. Health science was not. But today, you can trade a lifesaving technology the way you trade this luxury handbag. It can't be right. A technology that saves lives has to be invested in by public resources, as it was here. Moderna was paid for largely by American taxpayers and must also be traded with regulations by the public. There must be public regulation on lifesaving technologies. We see now that that was over time taken away. So now you can have a company using public resources to produce something that saves lives, and then privatize the benefits of that product, of the profits from it. It's not right.
We need a global system where we protect, yes, innovation, but at the same time save lives as well. That's what we were fighting for with the TRIPS waiver at the WTO; that when there's a pandemic, that something kicks in that says: First of all, save lives. You will get profits, but they will be reasonable profits, not super profits. People will be saved, and then you can continue making even more profits after that. So regulation of how health products, our health technologies are traded is critical. And we still need to do some work through the pandemic treaty. It seems to me that we will not be prepared for the next pandemic, unless we address this issue of access to health technologies head on through that treaty as well.
We have just a couple of minutes before the next session. I do feel badly about shortchanging our other speakers. So I'm going to ask each of you just thirty seconds or a minute at most.
Chikwe, why don't we go to you next on surveillance, WHO, how are you building trust in that information?
IHEKWEAZU: Thanks. So very quickly, I think whatever—we can't build surveillance for the next pandemic, right? We have to build surveillance for the things happening every day in our countries and enable local communities, local public health leaders to respond to that, which is their priority to respond to. And the more we do that, the more we build trust that the health system is able to detect and respond to the priorities of every community. And then on top of that, we can hope that this system will work in a pandemic, or we’ll say it's much more likely to work in a pandemic, if it works for the small outbreaks, small incidents that matter to every community working around the world. And that’s our target in the next few years.
BOLLYKY: Great, thank you, Chikwe.
Peter, thirty seconds or a minute from you.
PIOT: Yeah. First of all, this is not only about lack of trust, or mistrust, or misinformation about vaccines. It's a trust in technology, in governments, in policies, in science. And we, as Peter said, you know, Peter Hotez, we should not be naive. This is not only a spontaneous type of thing. So we need to understand because it's complex. It's not the same reasons that are behind it, because it's often about something else that are the same in every population. So we need actually to develop also a science of it, understanding, and then invest the means in going and reestablishing trust.
You know, in public health, we've just neglected the whole thing of just working with people, with communities, and we need to invest as much, let's say, in marketing, to use that term, in understanding and working with people as we—you know, as the companies are doing. So that requires specific budgets. Otherwise, we will always be faced with the same problem, particularly in polarizing political contexts.
BOLLYKY: Thank you, Peter.
Tom, you have experience with this, TB in New York City, Ebola at the CDC. Any brief thoughts from you?
FRIEDEN: Communication is key, and communication is two-way. It means listening and finding the messages that resonate and the messengers who can be heard. It means being frank about what we know, when we know it. As we learn more, being frank about that, what we don't know, that's essential.
And I also go back to the primary healthcare point. There are many, many people who are not going to get vaccinated for this or the next threat unless their doctor who they trust recommends it, but far too many people don't have a doctor or clinician who they trust. So get the message right, get the messenger, right, strengthen primary healthcare, and hone those communication skills so we're frank with people; we tell people what we know, when we know it. We're forthright and empathetic, credible. It's not going to be easy. It's a much broader trend than public health, but we can be part of the solution.
It's unfair to ask Peter Hotez to sum up a career focus in thirty seconds, but if you'd like to give us your thoughts.
HOTEZ: Yeah, I mean, I'm in agreement with everything that was said. But you know, my big view right now is that the health sector really doesn't know what to do. And so what you see is the health sector kind of skirting around the edges, right? We have to talk to the heads of the social media companies so things don't go viral. Yes, of course. We have to improve our system of health communication. Yes, of course. We have to reach out to trusted community leaders. Yes, of course. You do all those things, you do all those things well, we'll get to about 30 to 40 percent of the problem. But we won't get the big piece. The big piece is that this is an organized movement that is threatening global health, and we have to take it on with the same urgency that we do other global health pandemic threats, and yet we're not prepared to do that. It means reaching across sectors and talking to other UN agencies. It means for the Biden administration, or whoever's in power after 2024, to not only talk to the health and human services agencies, but it means talking to people who know about this kind of stuff in Homeland Security, the State Department because of Putin's involvement in using this as a wedge issue, and other foreign actors; the Commerce Department, the Justice Department. They may have a better understanding of the levers that we have to pull and push. We're not doing that so far.
Well, thank you to the indulgence of my CFR colleagues, letting me get everyone's view on this. It probably has come at the cost of your coffee break, but I hope you feel like it was worth it. Please join me in thanking our speakers. (Applause.)
DENTZER: Welcome back, everyone. I'm Susan Dentzer, president and chief executive officer of America's Physician Groups and a Council member, and I'm delighted to lead our conversation with global health ambassadors.
At this point in the day, it's probably a good idea to try to pull together some of the threads of the conversation this morning so far. Obviously, in the context of speaking about global health, security, and diplomacy, as we heard from Tony Fauci, we need to recognize that health is security and security is health. With that very simple construct, however, we know we plunge immediately into some very multifaceted issues. And we heard about those. In fact, Tony Fauci told us there were twenty-five lessons from the COVID pandemic, and he was able to get through two of them in his conversation with us. Important, too, but obviously we had twenty-three left to go. So that's kind of emblematic of this conversation, for better, for worse.
I took away certainly two key themes from this morning. One is the importance of reauthorizing PEPFAR. As Tony said, we need to go around shaming the world—and including starting here in Washington, D.C.—shaming individuals for not continuing to pursue a program that has saved 25 million lives so far and has 30 million people on treatment.
Second big takeaway is obviously that we need to get ready for the next pandemic, drawing on the lessons from COVID rather than ignoring them, which seems to be the predominant tendency, certainly here in the United States at the moment.
So, what is inherent in all of that, as we've heard today, global coordination, particularly around surveillance, partnerships, ongoing financing, and investment, reglobalization, as we heard, more emphasis on local production and dispersed production, and then certainly the importance of intellectual property and sharing of technology.
We also heard a lot about some more inchoate factors—soft skills, if you will, even emotions, the role of bottom-up versus top-down approaches, risk aversion versus risk-taking. Respect, or lack thereof, has been a theme today, transparency, or lack thereof, anger around the lack of coordination during the pandemic. And now, most recently, we've heard a lot about anti-science. So all of that is in the mix as well.
There is no good way to moderate a panel on a topic as complex with this with five people in forty minutes, but we're going to try. And what I'm going to do instead of introducing everybody at first, I'll introduce them as I ask the first question.
So I’m going to start with you, Ambassador Kolker. Jimmy Kolker is the senior advisor at the Bureau of Global Health Security and Diplomacy at the State Department. He retired in 2017 as the assistant secretary for global affairs at the Department of Health and Human Services. He has a very long and distinguished diplomatic career, plus a lot of expertise in responding to various infectious disease outbreaks, Ebola and Zika, and also was the deputy global AIDS coordinator from 2005 to 2007.
So with that, Jimmy, let me ask you, of all of this that we've been talking about today, from your perspective, we have to prioritize, as we know, what is the most important set of actions to undertake at this point?
KOLKER: Well, I think every government's priority has to be the health of its own people, and global health has to be seen in that context, and one of the many lessons of COVID is how complicated that is. And so institutionally, I’m pleased that the United States government has responded in at least two ways. We've set up the Bureau of Global Health Security and Diplomacy, because we missed so many opportunities by having U.S. government and the State Department not speaking with one voice, not well coordinated internally. And in particular, from the diplomatic side, that we were—the State Department itself, we've now brought together three and a half bureaus that were at times giving different instructions to our posts overseas and we were not seizing partnerships, collaboration, and opportunities that might have helped us along the way in the COVID response, and we hope we'll see this in the future. Also now set up a director for pandemic preparedness in the White House. Again, that did not exist when COVID started, and it gives us an advantage in terms of interagency coordination with very important contributions of Department of Health and Human Services, USAID, and many others to global health.
So we've heard a lot about global health architecture today, and to me, architecture implies that there was a blueprint and that we designed all these institutions according to a plan, and we know that wasn't the case. So we talked about landscapes. And so well, we didn't design it, but we could describe it; we can draw a picture of it. And that's not true either, because iso many parts are moving, and we saw the dynamics of that. And to me, it's more of a traffic jam. So we have that on days when the weather is good and there's not a crash, most people can get to where they need in global health and get some results. But if there's a problem, there's a gridlock. And what I think we need in terms of what are our priorities are both an express lane and a bike lane. And the partners in that are, one, at an institutional level globally, we certainly are talking about improving international health regulations, talking about a pandemic accord that would look at information sharing, would look at equity and access, benefit sharing. We need in public-private partnerships, as we've heard a lot about supply chain, about reliability, talking with industry, and domestically looking at state and local governments data availability. Chikwe phrased it perfectly: How do we get the best information to decision makers and politicians?
And in that context, reinforcing the Centers for Disease Control domestically is essential, and reinforcing their global role is equally important. The Global Fund, the Pandemic Fund are important in this as well. And so there are so many actors and partners in this. And I'm just pleased that at least from the U.S. government side, the new bureau might be able to play a role in kind of galvanizing some of this activity.
DENTZER: So to sum up, the most important thing we need to do is enhance this system of global traffic control, which is not really a system. It's just—it's a kind of a blob that has evolved. But we need to create, as you said, these two lanes, expressly—and I gather you mean one to move very, very quickly in the event of a pandemic. And a bike lane is what?
KOLKER: Bike lane is how do we actually reach the last mile. How do we get services, diagnostics, countermeasures, vaccines to people when there is an emergency and when everyone has a simultaneous need. There's certainly in outbreaks like Ebola and Zika, the need was more isolated and the timing was a little bit different. But COVID certainly reminded us that we don't have the capacity to do everything all at once, and that the people who suffered most were those who were the most marginalized, isolated living in low- and middle-income countries. Equity questions were so apparent in our response.
DENTZER: Great, great, thank you.
I’d like to turn now to Stephanie Williams, who's principal health specialist and former ambassador for regional health security in Australia. And among the many things she does now is to guide the implementation of the partnerships for a Healthy Region Initiative and the Regional Vaccine Access Initiative, which are two major health initiatives in the Indo-Pacific Region. So, Stephanie, from your perspective, most important activity we need to undertake as a globe? WILLIAMS: Thank you for the opportunity to join you today. And congratulations, Mr. Ambassador Nkengasong, for the new bureau.
I think the headline perspective from, you know, what's the most important thing, what you see in Australia's response to the pandemic is renewed and strengthened commitment to global health, both as a priority within the aid program, but also within our foreign policy and diplomatic setting, as well as some domestic institutional responses, which includes the establishment soon to start over new Centers for Disease Control in Australia.
But the way I was thinking about today was really thinking about as a reflection on what our experience in having health ambassadors is in the region and the globe and what value a new bureau, as Jimmy has outlined, in terms of an easier navigation for outsiders into the U.S. system, and what it could offer in growing the strength of networks of health ambassadors and health as a foreign policy priority.
So, in a brief, very brief, potted history of the Australian approach to this issue is that we've had a health ambassador from 2006 to 2016. It was an HIV ambassador. It reflected an MDG era and HIV as the principal investment of our aid program.
Fast forward to 2017, in an institutional response to the Ebola pandemic, the government, the then government implemented the Indo-Pacific Health Security Initiative, retitled the ambassador for regional health security, which is the job I was doing until last week. And I'm thrilled to say that we have a new ambassador for global health, Dr. Lucas de Toca, which has been a name change and also a reflection of a renewed investment in regional initiatives, the partnerships for a healthy region in the Indo-Pacific.
Alongside that institutionally, and I think to find echoes and parallels between the U.S. and the Australian system, in 2013, we combined our State Department and our aid agency in the Department of Foreign Affairs and Trade, which we combined both functions. But it has taken some time. And COVID, for its devastation, which we wish would never have happened, did help us internally in the politics of health in a foreign affairs agency. So we are making slow progress in moving how our diplomatic corps and our broader health network and stakeholders in Canberra and the globe see health not as a nice to have and critical, important for all the right reasons of equity and rights and access to treatment from an equity perspective, being the right thing to do, but also as a strategic and relevant agenda for foreign policy.
So what helps us and what has always helped me in my role, and just to reflect on the theme of today, is being able to look and partner with the United States, which is much more clearly health security, of national security, where the infrastructure and the dialogue is there, and it strengthens—it makes my job easier and has done over the last three years to be able to work within an alliance that that can see the importance of both domestic and international responses to those issues.
So I actually don't have a long list of vaccine or topic-specific relationships. I wanted to just address this question as the what I see is the strength in mutually reinforcing institutional structures between countries in response to health crises that actually make us stronger globally incrementally as we as we go forward.
DENTZER: Well, thank you for that. And just briefly, you mentioned that you are creating now, you've created in Australia a new CDC, correct?
WILLIAMS: It's a commitment of the current government, and it will be stood up in early 2024. And that's actually my next role as a special adviser to our new CDC starting on Monday.
And coming from a country where we continue to examine the role of our own CBC, what's going to be different about the new CDC in Australia?
WILLIAMS: It’s we are learning—we have a federal system, slightly less complicated than fifty states. We have less states to negotiate with. But we are having to really assess what are the key federal powers, responsibilities, and structures that worked and didn't work, as well as learn from how we reach community from a federal agency perspective when our states are the face of health in the delivery.
DENTZER: Sounds like the same issues we face here.
WILLIAMS: With one big difference, is that we are not building a CDC in Australia off of a science-based like the CDC, originated in the U.S., for example. So we have some key differences, but lots to learn from what has worked and hasn't worked here as well.
DENTZER: Good. We will look forward to learning what you learn as you go through this process.
Alright, let's go to our colleagues on Zoom. We're going to start with John-Arne Røttingen, who's the ambassador for global health at the Ministry of Foreign Affairs in Norway. He was the founding CEO of CEPI, the Coalition for Epidemic Preparedness Innovations, and has had a number of other distinguished positions as well.
John, from your perspective, the most important activity from the Norwegian point of view?
RØTTINGEN: Thank you, Susan.
DENTZER: Go ahead, please.
RØTTINGEN: Yeah, no, thank you, Susan, and thanks to State Department and CFR for organizing this.
And congratulations to John. He is now welcome to a small group but actually growing group of global health ambassadors placed in foreign ministries or in heads of state’s offices.
We've just heard a very rich session on priorities for coordination. As a health diplomat, I think what is sort of on our mind is to really try to make sense of those different priorities. And I've sort of categorized them in two different buckets, but they can definitely be aligned with Jimmy's metaphor on two different lanes.
I heard a traffic jam problem, and to me that heard—it sounded like sort of an emergence of a town in the Midwest of the U.S. I guess I have a bit more of a city planner approach, in the sense of being ambitious on what we try to make sense of in the global sphere. But we know it's complicated. And we know there are complex processes now going on both for amending what is an existing framework through the international health regulations, but also adding on the potential pandemic agreement to be agreed in May 2024.
It is about ensuring preparedness and prevention capabilities in countries but also ensuring what we just heard from several panels, the equitable access of medical countermeasures, but not forgetting also the capacity to deliver sound public health and social measures in countries. And it's about financing. I think we really need to just stand up the Pandemic Fund properly, aligned with the ambitions of the G-20 high-level panel, so that it can deliver financing for preparedness and response. And we need to think more thoroughly about surge financing capacities.
But to me, as from a health diplomacy point of view, this is sort of a mosaic of different institutional functions. Some of them can be potentially integrated as the combination of HR and the new pandemic agreement, but others needs to be institutionally aligned on the part of an overall framework that we can at least understand collectively as the same system. So that needs to be a priority for health diplomats.
And I think we need to learn from the pandemic. So this is really the express lane. It's the health security lane. It's about making sure we can handle new emergencies in a much better way. But the other lane, it's maybe a bike line. But to me, that is more on from a sustainability point of view. We also need, as we saw in the pandemic, to really continue building a global health system where global health financing can continue, but continue to support and strengthen country governments so that they can be empowered to deliver both healthcare and health promotion efforts as well as protection efforts to their citizens. As David said, it's the responsibility of governments to protect but also then to help and sustain systems in their own countries. But we need a global health financing system that is better sort of aligned to do that, so aligning with country governments and making sure that we can align around one country plan, one budget, and one way of following that up. And we need to harmonize to a larger extent all our international efforts through both multilateral to dedicated global funds, to bilateral funding, how we can ensure sustainability. So I guess Norway's priority is really to try to make these two different buckets to align better, because we know we have no global health security without actually having solid health system every day. And that is our key priority, and we have worked alongside other health ambassadors. And we’re looking forward to the views from my colleagues here on the screen.
DENTZER: Great, thank you so much.
And again, back to the analogy of traffic, obviously much to do on both lanes.
Let's go now to Olive Shisana, who is special advisor on social policy to the president of South Africa, Cyril Ramaphosa. She is now country-chairing with Norway the Johannesburg Process, which is a multi-stakeholder consultative group with representatives from the AU COVID-19 commission and others, including former ACT-A reference group of countries to discuss medical countermeasures. So, Olive, from your perspective, most important priority at this point?
SHISANA: Well, I would like to emphasize really the critical importance of pandemic preparedness as a global health priority for South Africa. In our country, we recognize that infectious diseases, including COVID-19, HIV, TB, know no borders. They pose a threat not only to our own population but to the entire global community. So for us in South Africa prioritizing pandemic preparedness, we contribute to global health security with a hope that we can reduce the risk of the international disease spread and really focus on collective defense against global health threats.
So having witnessed the profound effect of COVID-19, we feel that it has clearly devastated our own economy. And therefore, it's necessary for us to really address the economic impact insofar as safeguarding the critical economic activities such as tourism and trade in our country, and also employment in our country. We lost a lot of jobs in our country. And we therefore feel that we have to work in an interconnected global economy, meaning that we should be aware of the fact that when there is disruption in one particular region, it will have a ripple effect worldwide.
So our commitment to pandemic preparedness is driven by that understanding that a proactive approach can actually mitigate the economic impact of this crisis. We have been involved, as you said earlier on, with collaborative efforts, which are very crucial in addressing pandemics effectively. As we worked with Norway, we really were able to really focus on the development production and equitable access to COVID-19 tests, treatments, and vaccines.
We initiated the Johannesburg Process really in order to foster deliberations among a coalition of governments and stakeholders so that we can be able to establish a global coordination mechanism for medical countermeasures platform as you indicated earlier on. We also work very closely with the G-7 on the Medical Countermeasures Delivery Platform, the MCDP, so that we can coordinate support aligned with national pandemic response plans.
Now, the participation in my view of the Bureau of Global Health Security and Diplomacy, as part and parcel of this new initiative of bringing everybody together, it’s really welcome. We really would like them to continue to work with us, particularly in the Johannesburg Process. We have now entered as South Africa the G-20 Troika, and we remain committed to the G-20 health priorities so that we can collaborate very closely with the G-20 Joint Health and Finance Task Force through the Johannesburg Process so that we can ensure that the work has adequate warm body and surge financing.
Finally, I just want to say that, you know, with our president, Ramaphosa, being chair of the African Union COVID-19, which is now in the process of transitioning to pandemic prevention, preparedness, and response, implies that we are going to be a big player, obviously, within the African continent to deal with these issues related to pandemic preparedness.
Thank you very much.
DENTZER: Great, thank you very much as well.
And just to drill down a little bit on the Norway-South Africa partnership, say a little bit more about what are the particular features of that that you would hold up for emulation worldwide.
SHISANA: Well, it was very important for us to raise funding to ensure that we can be able to make available the COVID-19 vaccines. We were faced with major challenges where countries from the South were not able to get access to COVID-19 vaccines. So we really advocated very strongly to ensure that the low- and middle-income countries are able to access vaccines, who were not very successful in that particular area until after the North had had its own share of vaccines.
Secondly, we wanted to make sure that there are diagnostic equipment that are available, particularly to those countries that are much more vulnerable and who do not have resources. And in so doing, we were able to encourage production of our diagnostic equipment. Unfortunately, we're not able to really convince people that the Global South should actually be able to produce the diagnostic equipment as well as the question of vaccines.
Furthermore, therapeutics was a big problem, because there were not many treatment options that were available on time. They became available at a later time and still for all are not accessible to many other places. And ACT-A was really a strong advocate for that. But we realized that there were challenges in the way in which we ran ACT-A in the sense that the low- and middle-income countries were not as involved as they should have been. At the later point, we felt that we needed to have the Johannesburg process and start bringing in the low- and middle-income countries. We haven't won it yet. It's still a challenge. But at least now this Global South has got a voice.
DENTZER: Great, thank you very much.
And now we'll go to David Whineray, who's director of Global Health at the Foreign Commonwealth and Development Office in the United Kingdom. Prior to this role, he served as director of the COVID-19 program at the Department of Health and Social Care in the United Kingdom and also has a very long experience in foreign affairs and diplomacy.
So, David, from the perspective of the U.K., top priority in this arena?
WHINERAY: Well, thanks. Yeah. And first of all, just to echo others, thank you very much to John, State, and CFR for arranging this and for the invite, and it's great to see this new bureau up and running. And just to kind of reiterate the U.K.’s commitment to global health in terms of our spend. I think we're one of the highest spends of any country, as well as our kind of broader science and pharmaceutical base.
I mean, I would say, in terms of our priorities, there's kind of five areas where we are kind of focused on. In no particular order, one is very much the global health security space for all the reasons that everyone has given. And I think that's about kind of bilaterally helping lower-income countries so that they are able to strengthen their healthcare system, so they're better able to manage the next disease outbreak or pandemic, everything from sharing expertise to IFI reforms to release finance.
And then I agree with what everyone else has said in terms of multilaterally the IHR negotiations, and in particular, the new pandemic accord. And I think that's important, the pandemic accord in itself, but also for the credibility of the multilateral system more broadly in showing that multilateralism can respond to today's contemporary political challenges.
And the second area I would highlight would be getting back on track, as the U.S. ambassador to the U.N. was highlighting earlier on the SDGs, where some of the statistics post-COVID are not in a good place, so everything from the rolling out of new vaccines, advancing universal healthcare coverage. There's an opportunity to strengthen the multilateral institutions with the upcoming replenishments we have for WHO, for Gavi, for Global Fund, etc.
I'd say third, there's what I would call a kind of a human rights element to global health we are seeing in various countries around the world and Africa, a roll back in SRHRs, an attempt by some countries to use SRHR as a wedge issue across some of those countries. So supporting those rights is important.
The fourth I would highlight would be the climate crisis, which I know we're coming on to later, but very striking that WHO has declared climate change the biggest threat now to human health. We're already seeing malaria rates up 10 percent this year. That's an agenda that the U.K. has led following COP-26 with the ATACH plan and working group. And I think the meeting of climate and health ministers at COP-28 will be particularly important.
And then the final area I would just highlight is kind of the geopolitics around all of this as well, which is I think why the new bureau is so important. As someone else said, everything is geopolitical in the 2020s. Global Health isn't really an exemption from that. It has become more geopolitical. Some countries are using their health assistance for wider political objectives. Some countries in the Global South point to the COVID pandemic as being the thing that changed their relationship with other countries in the West more widely. So I think kind of managing those links between global health and our wider geopolitical objectives and ensuring that those are mutually reinforcing would be my fifth.
DENTZER: Great, thank you very much.
Well, let's take up the question that David just left us with, which is climate, because we've underemphasized climate in the conversation today, because there's been so much else important to talk about. But obviously, these things very much intersect. We can't talk about climate change without talking about spread of zoonotic disease, etc., etc., not to mention all the other ramifications to human health in terms of famine, etc., etc. So, from the standpoint of you as global health ambassadors, let's talk about where you see your role is going in terms of this global conversation about climate.
KOLKER: Sure, the impact of climate change is going to be felt most acutely in people's health. That's going to be the metric by which I think individuals are going to see climate change both in terms of spread of diseases such as malaria reaching parts of the United States, where it hadn't been until this year, the high temperatures in parts of I think the Middle East and Asia which could result because of hypertension and other things we've talked about before in deaths from diseases which up to now haven't had that effect, just because weather is so hot. And but in every society there'll be changes of people where adaptation hasn't caught up to the effects of climate. So in terms of—first, I think we need to be sure we're sharing information, to be sure that we're using the best science to predict what might be the effects of climate change, to merge our humanitarian response to natural disasters and emergencies with our health response, which is actually an emergency, still a work in progress. We are not using necessarily our best institutions and resources in the health emergency response. And USAID is certainly a leader in that, multilateral system leaders in that, but we found that sometimes we're not able to respond as quickly or as efficiently as we could, especially building local capacity, local resources on that.
And then certainly in the sense of how do we talk to each other. These are huge empires, and we do have fraternities, maybe eventually sororities in the areas of health and climate.
DENTZER: Or we could have gender neutral.
KOLKER: We could have gender-neutral groups. And I hope that we'll be able, in Dubai, to use that health day at the Conference of the Parties genuinely to talk about how we're going to make this channel really a rich dialogue and look at the effects, the synergies, or what the negative synergies of health and climate might be.
All right, I’m going to come back to others of you on that question. But I do want to give the audience some time to answer questions. We have about five minutes left. And I'll just remind everybody, we're standing between ourselves and lunch. So we're going to try to end on time. Questions or comments from anybody?
Let's take a question right here, please. And again, identify yourself by name and affiliation, if you would.
Q: Monique Mansoura of the MITRE Corporation.
Jimmy, if I could just follow along with this idea of we have to talk to each other and the challenges. I used to be a leader in the U.S. government, trying to work on medical countermeasure enterprise across multiple departments. How do we hold ourselves accountable? What measures are we using? We saw some of the struggles of measuring preparedness before COVID-19. So how can we get more specific about our state of readiness, roles and responsibilities and accountabilities?
KOLKER: Well, it's a great question. I think we have had both in the climate and the health world that indicators or what we've looked at in terms of—I mean, we had this Global Health Security Index, which turned out not to be predictive at all. And I congratulate Tom and CFR for doing some real research in that and finding that some of the micro indicators—for instance, the U.S. exercise, its pandemic response, we got a zero score. And that turned out to be a problem for us, or the equity of our own response was a weak point. So we identified some of our strengths and weaknesses in that index. But it turned out to be random, that COVID’s response was not predicted by the numeric score there.
And so we do need, I think, to use the pandemic fund, the technical review that's involved in the pandemic fund, some of the strengthening of the IHR’s ability through information sharing, perhaps something that could be in the Pandemic Accord, that would give us a much better baseline and a better measure of progress. It's certainly a work in progress. Because as everyone has said today, no one knows what the next outbreak is going to be. And how we keep outbreaks from becoming epidemics and how we keep epidemics from becoming pandemics, measuring our successes is very difficult. The fact that, no, you did—Disney World was not closed. Mandy Cohen has said, oh, did you hear Disney World was closed this year and we had to cancel cruise lines and that the stadiums were this summer? Well, no, you didn't hear any of that, because we actually succeeded. And so how do we measure those successes of nonevents which because we were vigilant we prevented things from happening? I don't have the answer to your question. But you've identified something that we as a community have to work with, and maybe the climate and health people can inform each other.
DENTZER: All right, let's take another question. I want to prioritize questions for our non-U.S. ambassadors here, please.
So you have one that falls into that category? Okay, please go ahead.
Q: Thank you. My name’s Chris Collins. I’m with Friends of the Global Fight. (Comes on mic.) And now you can hear me. Chris Collins with Friends of the Global Fight. Thank you for this.
I had a comment and a little reaction to it. I'm really hoping that the new bureau in addition to things that Ambassador Nkengasong has outlined, really thinks of itself as a testing ground and a convener and a communicator about how to get this right, about how to have a holistic and integrated approach to pandemic preparedness because there's a few strains here that we need leadership from all countries, but including the bureau in the United States on. HIV, TB, and malaria: There's no health security as long as those epidemics continue to rage. So part of health security is continuing the effort on AIDS, TB, and Malaria.
At the same time, we know we've got to leverage current platforms. It's not just about Pandemic Fund-funded projects. We've also got to leverage the AIDS, TB, and malaria in other platforms. And I think the Bureau for sure can help us do that.
A lot of those platforms come with a value set about including community and about respecting human rights and about addressing the most vulnerable people, people in key populations. We need to bring that value set from PEPFAR and Global Fund into how we think about the future of health security.
On financing, we need to do a lot more to—
DENTZER: Okay, we need to—can you sum up your final statement on what we need? Because I do want to get back to—OK.
Q: —Pandemic Fund, being more integrated with existing institutions. So I think there's a huge role there for the bureau in terms of bringing those together and being a testing ground for a more holistic response.
DENTZER: Great, thank you very much.
KOLKER (?): John-Arne had his hand up. I don't know if he wanted to answer that.
DENTZER: I'm sorry?
KOLKER (?): John-Arne had his hand up. Did he want to answer that?
DENTZER: OK, yes. Well, in fact, I was going to go exactly to him. So advice of back to the U.S. to the new bureau. John?
RØTTINGEN: No, just a follow-up from a comment from Chris Collins, because I think definitely we need to leverage existing platforms, and that's why I wanted to say that the two buckets would need to come together. But my reading of what are the most important existing platforms are the national health systems and actually the capacities in countries. So all other platforms are just vehicle and instruments to capacitate governments and their communities to deliver. So I think my reading is that that is the ambition of the bureau. I'm really looking forward to collaborating the new bureau on making sure that we can deliver health systems strengthening based on primary healthcare capacities and community health care, and then deliver health impacts, ensure that we can deliver on the three big infectious diseases, but also understand that climate change will be a driver and accelerator of new problems. And we need to make sure they’re used as an opportunity and make sure to prepare in advance.
And, David, let me ask you to add to that a final comment for this session, please.
WHINERAY: Thanks. No, I agree with that. And as, you know, we have as I was mentioning kind of earlier—and as well as WHO—I know Peter is coming up later from Global Fund and Gavi we have a number of replenishments kind of coming up and strategies coming up for the big funds, so it's an opportunity to look at what the what the direction should be. And I agree with what John-Arne is saying in terms of this is about helping and assisting and working in partnership with lower-middle-income countries in terms of strengthening their healthcare systems. and work that you do to strengthen those healthcare systems more broadly is also good in terms of pandemic response.
And just on climate, very much agree. I mean, it's very important that we see the climate crisis as a global health crisis. Climate security is global health security. And that's a reality for global health, and it's also the right way to see the climate crisis as well. And I agree with the comments that's been made in terms of that the health is the angle that most concern people in terms of climate change, and we need to work out and we need to use COP as a way of how can we support those countries whose healthcare systems are going to come under more pressure because of the climate change that we're seeing. There are countries already with stretched healthcare systems that are going to have to run just to stand still, and what is the financial support, the financial framework that can be put around to assist them in order in tackling the health impacts of climate change?
DENTZER: I said that was the final comment, but I'm going to borrow Tom's example and steal another minute so that we can get thirty more seconds from you on this, Stephanie, and thirty more seconds also for Olive. So—
WILLIAMS: So in response to a couple of comments that focused on the climate change and health nexus, so domestically, our chief medical officer is just finishing a national climate and health strategy. So it has been elevated domestically, looking for some accountability and action. Internationally, climate change is a pillar of our new international development policy. I think in health and climate, we talk around and we have a great conceptual understanding. And as an example, a very practical example of how the Australian aid program is adjusting to that is that every investment over $3 million is going to have to have a climate change objective to it. So we'll have a health system, a health system strengthening investment in the Solomon Islands, for example. It has to have a climate change and a gender objective as principal objectives. So it’s an example of turning what we understand to be a conceptual link into a practical action. I thought that was quite a useful thing to add to the conversation.
DENTZER: Great, thank you so much.
And then, Olive, you officially get the last word here.
SHISANA: Yeah, thank you very much. I would like to end by saying that we should encourage the U.S. to really reauthorize PEPFAR, because COVID-19 has really set us back. We really are beginning to see many more people becoming infected. We're seeing more people dying now than before COVID. So we'd like to see PEPFAR being reauthorized, being strengthened, so that we can deal with HIV, we can also deal with TB. It’s very important that we do that, especially for us who are in the Southern Africa Region. We really, really are pleading that PEPFAR must be reauthorized.
DENTZER: Great. Thank you very much, Olive, and thank you for that important comment. (Applause.)
And following on what Tony Fauci said, we’ll take care of the shaming here in the United States for the folks we need to shame on that.
Well, I've just learned that the dumbest question to ask in a panel on global health is what is your top priority. But thank you all for delving into that question and giving us your top priorities as global health ambassadors.
And now I think to invoke Jimmy's analogy, we are now on the express lane to lunch. So join me in thanking all of them for a great conversation. (Applause.)
MONAHAN: So we have—to say the least, we have a daunting challenge over the next forty-five minutes that tie together three of the biggest collective action problems in the world: climate change, global health, the future of the disease priorities such as HIV, malaria, other specific disease programs, all through the lens of health equity.
So it’s a small topic but we have a terrific group. (Laughter.) We have some of the best people in the world to help us think this through with a special eye to the role that the U.S. government can play to drive synergy in the—that brings together the health and climate agenda.
So here’s how we’re going to try to do this because we’ve got a lot to cover and we have some spectacular people. Each of our speakers has been asked to take up to two minutes to do a sort of high-level view of their take on this issue.
We’ll then do some specific questions for our speakers and then we’ll reserve time if we can for as many questions from the audience as possible.
So we’re going to go a little out of the sequence on your agenda and I’m going to ask Dr. Victor Dzau, who is the president of the National—I should say one other thing. You all have a really cool little device and a little marker on the back of your agenda which shows you the amazing biographies of the people who are on our panel.
I would—if I read all that we would occupy the entire forty-five minutes. They are exceptional people. I encourage you to read it. So I’m going to be very brief in my introductions.
But we’re going to start a little bit out of sequence. My good friend, Dr. Dzau, has agreed to give us—take part of his two minutes to remind us of why the intersection here of climate and health is so important and talk a little bit about the National Academies. And then we’ll ask each of our speakers to give us, again, two minutes of their high level.
So, Victor, do you want to start us off?
DZAU: Thank you.
First, I want to really congratulate John Nkengasong—Ambassador Nkengasong for really leading this new bureau. It’s so important. I think you’ve already saw this morning the many speeches about why we need, in fact, a bureau that coordinates, strategize, (and of course that’s ?) diplomacy. So I’m very excited.
So in this case why climate is so important and also because HIV, PEPFAR, and equity, all these things come together, in my mind, because you look at the existential threats. No doubt in my mind climate change, infectious outbreaks, and, of course, HIV are the key threats.
So just starting forward about how they are all linked, it is about human equity because, as you know, climate affects particularly those vulnerable communities—sub-Saharan Africa, Southeast Asia, and that’s also where you see a lot of HIV and AIDS cases and hence the importance of looking at the interrelationship between those two. Social, environmental, biologic factors.
So, for example, if you look at climate change—we are talking a little bit more about this—that severe climate extreme events, flooding, you name it, disrupts, in fact, the usual care, and I was just talking to Winnie earlier about how many communities were disrupted, being not able to provide the care of patients with HIV, et cetera, simply because of climate damage, you name it.
But also we also, as I’m sure that they will talk about, the whole infectious outbreak. Vector-borne disease has greatly increased because of climate change, driving vectors further up north—more dengue, malaria, Zika, you name it—but also the fungal infections like histoplasmosis, crypto meningitis are increasing, and these are the ones that really kill patients with HIV—a severe disease and infection. So there’s a lot of interrelationship.
But let me take a step back and say why climate. Well, you know, I’m so glad that we’re having this conversation because, as I said, for the Global Health Committee we have to see climate as one of our major, major commitment initiative. It’s an existential threat.
Seven million people die a year from air pollution, 3-plus million from extreme events such as, you know, heat, flood, hurricane, you name it, and there’s a lot more auto vector-borne disease—drought, famine, poverty—driven into poverty because of climate events.
This is a significant global health crisis. If you think about the magnitude of crisis on an annual basis some numbers come up to, like, 20 million deaths a year globally of climate change.
Of course, in the U.S. we’re not spared from all these numbers either; significant amount of air pollution and many others. So I would say it’s fair to say look at the magnitude. It’s a global health crisis, which is why it’s so important for this bureau and for all of us in global health to take this on as much as pandemic infectious outbreak and others.
And when you look at the—it’s estimated about 130 million people will be driven into poverty by 2030 or so from climate events. So these are significant issues. It’s also equity issue because if you look at those communities which are most affected, low- and middle-income countries, in our country marginalized community, those in fact are communities of color and many which is just because they’re the recipients, not the generators of a lot of carbon emissions but they’re less prepared because of the lack of resources, in our country lack of insurance, in other countries in terms of lack of ability to do adaptation or mitigation. So I think it is real significant event.
So, quickly, my two minutes or less, whatever is left, I will say that there are things you ought to be thinking about. One is that we convert this conversation of climate change from it’s about the environment and future generations to say it is now. Human suffering, human death is a crisis now. This will change the conversation dramatically, I believe, in the overarching public. And, yet, until more recently this has not been a central discussion in work in climate change. So communication, recognizing this is a global health crisis, it’s an equity crisis as well. Key importance.
Second is, of course, being resilient, provide the community, being able to respond to climate changes. All of us seen Katrina and others where you can see destruction of Louisiana and destruction of hospitals and communities. So being able to create a much better health systems resilience and community resilience and to take care of not only of those crisis issues but also long-term issues of climate-related diseases.
Third, I would say, is probably a little known fact to you in U.S. 8.5 percent of carbon emission come from the health sector and globally about 4 (percent) to 5 percent. This is very large. So it means we as a health community have an obligation to say do no harm. What are we doing to do—to reduce our carbon footprint and, importantly, looking at how to actually change the way we do care altogether. Large sources of emission that you can imagine come from facilities, come from high-energy imaging devices, operating room, lots of waste, right, and anesthesia, gas, many others.
So I think a big part of what we’re talking about is what do we need to do to redesign care whereby more care is given maybe more virtually and there can be more prevention and reduce carbon emission. You don’t want to travel to the clinics or whatever, all that stuff, but a big part is supply chain. So we’ll have to work with public-private partnership—the discussion earlier—that supply chain to really work on reducing their emission.
Final point I want to make is looking at the issue of recognizing that the issue of climate and health involves all sectors. It involves transportation. Well, you know that, right? We need to get to the hospital, get to a clinic. Supply chain—it involves agriculture, the food that we eat, and will cause the whole issue of generative agriculture as a possibility and involves energy.
And so to date most of these sectors look at issues very vertically. That is, how much do we consume, how much do we emit, what’s the economic impact, what policy do we need to make. We need climate to be in the middle of all those intersections and have health in all those intersection, have health and all policies of climate so that when you start making decisions about urban planning, about energy, et cetera, you keep health in the midst of that thinking.
So those are my comments.
MONAHAN: Victor, thanks for setting the stage.
I’m thrilled to see a couple of our speakers have joined us now virtually so I’m going to switch to—our first virtual speaker will be Jainey Bavishi, who is the assistant secretary for oceans and atmosphere at the U.S. Department of Commerce, also the deputy administrator of NOAA.
So welcome, Jainey. This is an opportunity, as we discussed, to have—take a couple minutes to give us your sort of high-level perspective on these issues.
BAVISHI: Happy to. Thanks so much for having me.
I apologize for joining the conversation midstream here but really wanted to focus my contributions here on climate-related health impacts and in particular heat.
As we know, extreme heat is one of the deadliest weather-related events we face here in the United States but it also has incredible and serious consequences globally.
Summers have been getting hotter. Increasing summer temperatures put communities at higher risk of heat-related illness or death, and as climate change worsens summers will continue to get hotter and potentially more deadly as a result.
The record-breaking summer we all just experienced just a few months ago will likely be one of the coolest that we have for the foreseeable future, and extreme heat impacts all of us: rural, urban, and tribal communities, the electric and utility sectors, transportation, health care, military and defense operations, agriculture, businesses, and workers.
And heat is fundamentally an equity issue. Many groups are disproportionately impacted by heat such as older adults, children, people experiencing homelessness, people with chronic health conditions, and poor communities.
However, all heat-related illnesses are—and deaths are avoidable. But it does take a multi-sectoral and interdisciplinary approach to really work together to address the challenges of extreme heat and reduce their impact.
But heat is certainly not the only climate-related health impact that we’re seeing. Vector-borne diseases, water-borne diseases, air quality, as we saw in the United States from the wildfires over the summer, food security, and then mental health issues. Prolonged exposure to extreme weather events, displacement, the stress of adapting to changing conditions can all have adverse effects on mental health leading to anxiety, depression, and other psychological disorders.
So here at NOAA, the National Oceanic and Atmospheric Administration, one of our key roles is to provide environmental information and intelligence that often sets precedents for similar agencies in other countries. One example of this is the National Heat Health Information System, or NHHIS.
NOAA, along with our partners at the Centers for Disease Control and Prevention, started and launched NHHIS back in 2015 and it coordinates across the federal government to manage heat risk across multiple time scales.
NHHIS has inspired interest in similar approaches to building a whole of government initiative to address heat risk in countries such as India and Egypt. But we’re also cognizant that providing information is often not enough. We also need to work to build capacity.
As an example, we’ve invested in a workforce development and fellowship opportunity for health experts including practicing doctors to help close the last mile gap and climate service delivery, especially in health-care settings.
I’ll just say one more thing at this point and then look forward to the conversation, which is that, you know, while we’re—while one of our roles is to set precedents we also have a lot to learn from other countries and we’re working with—closely with international organizations such as U.N.-level entities to make sure that we’re participating in the conversation and not wasting any time reinventing the wheel.
One example of this is our work in supporting the launch of the Group on Earth Observations’ Global Heat Resilience Service. So GEO, the Group on Earth Observations, coordinates Earth-observing systems and promotes the use of information to solve societal challenges.
I had the chance to speak at the launch of the Global Heat Resilience Service at the U.N. over the summer and was really pleased to see their focus on partnerships and engagement, and I hope that we can continue the conversation about the need for partnerships and continual engagement to really address these issues head on.
MONAHAN: Jainey, thanks so much. And let’s switch—I think the theme of partnerships and working across sectors is going to be key to this session.
Let me turn now to a different perspective and ask Emi Chutaro, who is the executive director of the Pacific Islands Health Officers Association, and in her work has a very distinct perspective on how we think about this intersection.
So, Emi, can you hear us?
CHUTARO: Yes, thank you. Hopefully you can all hear me.
First, good morning from Hawaii. Good afternoon to those in East Coast and good evening to others who may be joining internationally.
But really want to express my gratitude and my sincere appreciation for being part of this very important convening and inviting me to this panel, and thank you so much, Professor Monahan, for being our moderator.
As mentioned earlier, I’m Emi Chutaro. I’m the executive director for the Pacific Island Health Officers Association, or PIHOA for short, and my background is in health policy and planning with particular focus on health system strengthening in low resource settings.
And just for some context for my statement, PIHOA was established and is governed by the chief health officials of the six U.S. affiliate Pacific Islands that are comprised of three U.S. territories—American Samoa, Guam, and the Commonwealth of the Northern Mariana Islands—as well as three sovereign Pacific Island nations in Compact of Free Association with the United States and that includes the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau, and our mission ultimately is to improve the health and well-being of our Pacific Islander communities through consensus-driven regional collective action advocacy, policymaking, and strategic engagements.
Now, though I reside here in Hawaii I am from the Marshall Islands. I’m a proud Marshallese American. So I come before you today not as a climate and environment subject matter expert but as a health systems development advocate from a country deeply impacted by climate change and environmental injustices.
As many of you know, the Pacific region, also known as Oceania or Blue Continent, are some of the lowest carbon emitters globally and yet we are on the front lines of climate change and environment—of the climate change and environment fight.
With the exception of Papua New Guinea our land masses and populations are very small, very widely dispersed across a very vast ocean, and our islands are comprised primarily of thousands of thousands of low-lying islands and atolls that are barely three meters above sea level.
For us in the Pacific with sea levels undeniably rising due to glacial melts and warming oceans and more frequent and severe meteorological events, particularly typhoons, flooding, and droughts, the Pacific region finds itself in a fight for survival, and as our esteemed colleague mentioned earlier it’s really about human suffering that is happening now.
We are scrambling to find all the new ways to survive, to adapt, to mitigate the impacts of climate change on our very small island environments. There is undeniable evidence that our groundwater sources and atoll water lenses are increasingly becoming and/or at high risk of becoming brackish and salty due to saltwater incursions.
Our coasts are eroding at such a pace that even in my lifetime I have seen whole entire beaches completely disappear, houses slowly tumbling into the reefs and villages retreating back towards the middle of the island. At some point there’s nowhere else to go.
Many islands are facing critical challenges for safe and reliable drinking water, food security, while others face additional challenges with poor water and sanitation standards, compromised health care and education—and compromised health care and education infrastructure.
It is no surprise then that the Pacific has some of the highest per capita rates of a number of noncommunicable and vector-borne diseases. However, I do want to make a point and that is that climate change is not the sole driver of a lot of these challenges. Rather, climate change is a compounding factor building on existing natural and manmade vulnerabilities, legacies of social and environmental injustices, rapid but often unplanned urbanization, misaligned development agendas and vested interests, and sometimes struggling governance mechanisms to enact and sustain transformative action in terms of health and well-being.
In the health-care setting, despite significant investments from the United States government in the Northern Pacific—and I’m speaking specifically about the U.S.-Affiliated Pacific Islands, or USAPIs for short—our health statistics and outcomes show a very different story and ultimately the U.S.-Affiliated Pacific Islands are at the nexus of both U.S. foreign and domestic policies and legislative imperatives which often do not well align for the Pacific.
Nor does this nexus truly get to the heart of the matter with respect to climate change impact on health, well-being, and improving existing health-care infrastructures and services, specifically in our setting where climate change is acute, chronic in small island settings.
The USAPIs have long discussed with the United States government their respective struggles with various systemic and chronic structural inequities in built often very well intended legislative frameworks but not well aligned to the priorities and needs of the Pacific, and though these are not the sole drivers have contributed to some of the health disparities, inequities we see today across the USAPIs.
So, to conclude, the climate change and environment dialogue in the Pacific is ultimately a health systems development debate that must recognize the current and real acuity and chronicity of climate change impacts on our small island environments but underpinned by a legacy of under development and structural inequities and health disparities that climate change has only compounded and exponentially expanded upon.
The two paradigms of dialogue, debate, and response must come together in order to find sound and lasting solutions for our Pacific Islander health and well-being today and in the future, and ultimately ensure a climate resilient Pacific. The two conversations cannot happen in silos. They must happen in tandem and our development partners along with our climate experts we all need to come together to have this conversation.
Thank you so much.
MONAHAN: Terrific, Emi. Thank you, and, again, I think, perfectly reminding us from the perspective of countries that are on the—really on the sharp edge of this nexus of health and climate. That’s where we need to focus.
So let me try—one of our speakers has had some trouble connecting but I’m going to see if Guéladio Cissé, who has been working with the Intergovernmental Panel on Climate Change, is able to join us.
Guéladio, can you hear us?
I think—I think not. So I think we’re—I’m going to ask my colleagues here at CFR to see if we can connect with him.
But let me—let me move on, if I could then, to our next speaker, which is Khuat Thi Hai Oanh, who’s the director of the Support Community Development Initiatives program, SCDI, and ask her to share her two minutes of high-level reflections on our conversation.
OANH: Thank you very much and good morning, everyone. It’s past midnight here so very early morning.
MONAHAN: Then you get a special award. Thank you very much. Everybody here—(laughter).
OANH: I tried to get my—(inaudible). (Laughs.)
Yeah. Yeah, no, thank you. I think we all know about the consequences of climate change and there’s no question that we need to act to address that.
But I think we have a lot of complain, a lot of problem to speak about, but I would like to say some of my observation and experience and thought about what should we do about this, about climate change and health and particularly for key population for the most marginalized population.
I am working for a local NGOs here in Vietnam working with the most marginalized and most vulnerable population and what I have seen is that with the investment in community system we are able to and we will be able to address both the health and climate change.
Just give you an example, community system that the Global Fund have had to invest in Vietnam have helped us to mobilize to engage with the key population even though they are heavily stigmatized and discriminated against. So the community system was able to reach to the sex worker, to people who do drug, to men who have sex with men, to provide services and to mobilize their participation in HIV respond.
So we are—I think we in Vietnam now we can see the end of HIV. The HIV in Vietnam is declining in terms of new infection and we can see the end of it. Similarly, by engaging with the community vulnerable to malaria we are now very, very close to elimination of malaria in the country.
Now, with the same people, with the same community people, we—recently we have a discussion about climate change. So with the people who live in the highland where we have a malaria endemic we discuss climate change. We shared information about which kind of activity emit a lot of greenhouse gas and one of that is—one of their livelihood is to raise cow.
So they have a—they produce beef and cow a lot in the highland. And when they learn that by raising cow they produce a lot of methane, a lot of greenhouse gas, they start to discuss about changing their livelihood. They ask me the question, so can we instead to raise sheep or goat instead of cow so we still have meat, and goat and sheep produce less methane than cow.
So people start to think about that. People start to think about solution. So I think it’d be if we can work more on this to empower the community to bring community together to have this kind of conversation and come up with a solution. If every local—if every community come up with their own solution to reduce emission and to act on the climate issue then I think we will move closer to our climate goal.
I have seen with my own eyes during the pandemic, during the extreme climate event like a flood, like droughts, the community get together and support one another. So, for example, during the pandemic, during the lockdown or flood the people living with HIV, because they are connected to each other, they share their ARV when one person cannot get the supply immediately.
I have my (full ?) box with the same treatment, so I would lend one week of treatment for the other person living with HIV while the supplies on the way to come or when they are cut off for a couple of days.
So I think this kind of community system will be able to contribute a lot on the climate resilient as well, either for adaptation or for mitigation. Also, working on universal health coverage or address the issue like HIV, malaria, dengue fever, and others.
So community system strengthening is one solution that I see with my own eyes is working.
MONAHAN: Thank you so much.
I think, again, just building on where we’ve been the focus on community both as part of—as a place where solutions have to happen but also as the means and the people that need to be engaged in solution on the climate and health side.
So let me switch back to our in-person panel here and ask our colleague, David Walton, who is the head of the President’s Malaria Initiative to share some of his reflections.
WALTON: Thank you very much. It’s wonderful to be here.
The beauty of being the last panelist to speak is I just get to say yes—(laughter)—and really close my remarks to keep us on time.
No, I want to keep my comments brief but I want to give a slightly different perspective around climate change and what I—I mean, I actually really mean yes. You’ve heard so many of the panelists really describe both from a macro standpoint but also in various degrees the degree to which climate change is one of the biggest threats to human health for the foreseeable future.
And I want to echo Victor’s comments by saying this is a problem that we’re facing now, right? I’m going to put my malaria hat on for a bit and talk about malaria very specifically because I think it’s a great way to really understand some of the ramifications at least from a vector-borne disease perspective.
And just for background, the U.S. President’s Malaria Initiative started by President George W. Bush in 2006 it is an interagency collaboration between USAID and CDC. I sit within USAID but I want to make sure that I recognize my CDC colleagues who have been incredibly helpful from the very beginning.
PMI covers thirty countries, and while you’ll hear some folks in academia—and I come from academia so I have great love for them—sort of have an academic debate about, well, in twenty-five years, you know, you’re going to get some areas that are, you know, drier and some are wetter and maybe net even, sure, let’s think about that academic debate.
Let’s do the modeling. Fantastic. The issues we’re facing are today, right? If you just look at some of the challenges we’re facing within these thirty countries, I’ll give you two specific examples because I think it’s always helpful to be concrete.
The first example is we are seeing in areas with seasonal transmission shifting rainy seasons, right, and so it’s important for a couple reasons. Number one, in those seasonal areas one of the things that we do is time the prophylaxis for kids—kids under five—the prophylaxis we give for them to prevent malaria. We time that with the onset of the rainy season, right? It’s called seasonal malaria chemoprevention. It’s a fantastic and very cost effective tool.
If we don’t know when the rainy season has started because there’s been so much variability secondary to climate change we’re not able to mobilize the resources to actually then get our programs in line to distribute that—the prophylaxis. And may seem like a minor thing but in fact when we are misaligned kids are not getting those medications and therefore kids under five are dying because they’re not getting the prophylaxis that cost pennies that we know how to do and we’ve been doing for years.
The second issue is that these rainy seasons in some cases, say, for example, in Senegal are getting longer. It’s always been three months. Starts on this date, ends on this date. Now we’re seeing a fourth month and a fifth month of a rainy season, which then has us add additional cycles to this SMC.
If we’re not prepared, if our supply chains aren’t in line and all these other issues, kids’ lives are at risk.
Example number two, an example we’re all living through, extreme weather events. Incredibly disruptive. But, again, let’s take some examples.
If you just take a look at Madagascar you had—and actually in 2019 Cyclone Idai, the most significant cyclone of that time, two thousand people—two hundred thousand, excuse me, people—internally displaced.
Fast forward to 2023 you have Cyclone Freddy. Hit the country not once but twice. Never seen in history, right? What happens to, say, Madagascar when something like that happens? Excuse me—yeah. Mozambique. Not Madagascar, Mozambique, although both have—yeah, begins with an M, with M—with an M.
What happens to Mozambique? You’re getting, again, huge numbers of internally displaced folks and the tools by which we prevent malaria—the bed nets, the indoor residual spraying, the spraying of insecticide in people’s homes—they are rendered wholly ineffective when you don’t have a home to do the indoor residual spraying that has been washed away. You don’t have a roof or a ceiling to hang that net because you’re internally displaced.
So you see not only do we have internally displaced folks living in communal environments, we also have an inability for us to really effect the change that we know how to do and that we’ve been doing for years.
And the third thing I’ll mention, excuse me, is that the nexus of two different things that are coming at play particularly around climate change where there’s a new vector coming in from Asia into the Horn of Africa called Anopheles stephensi. It’s particularly dangerous. It’s a bit wonky in terms of malaria but it’s a significant global health security threat.
It’s coming in from Asia. It has been found in a variety of countries in Africa, and the issue with this new vector is that it’s a day biter so nets and indoor residual spraying because people are outside are not as effective. It’s sturdy and hearty and so it can live in small little puddles and things of that nature and it likes urban environments. That’s a problem.
And so when you see climate change and the effect of climate change, for example, creating these so-called climate refugees—internally displaced folks—migrating, ruining the farming, you know, in both acute and subacute ways, and having more people move from urban to rural, now you have a vector that likes the urban environment.
Now you have the population at risk that really has been somewhat insulated from malaria because there’s less malaria—not zero but less malaria—in these major cities.
And so when it comes to malaria, which has been—has a variety of different challenges over the years, all of these things, particularly climate change, is one of the biggest threats that we’re facing as we look forward.
The thing I think—one last thing—the thing I think would be—I’ll look at my ambassador here, Ambassador Nkengasong—in terms of the new bureaus sort of one of the many things it can do is I think when I look across the USG, right, let me look inward to the USG. There isn’t an agency in the USG that does not have a climate initiative, a climate person, a climate perspective and, yet coordination, as we all know, is a challenge. And so I think the—what’s that?
MR. : No, I was going to say—
WALTON: Oh, yeah. And so I think one of the opportunities that the new bureau has, that all of us have within the USG, is this need to collaborate across agencies towards this common goal.
MONAHAN: Well, thanks, David.
I think—and I don’t—I believe Guéladio is still unavailable.
So we’ve got less than ten minutes. We’ve heard from five amazing people. A couple of things are clear. Health and climate are real and today, right, and there has to be a way to get communities that work primarily in the climate and primarily in health to collaborate, whether in USG or in the Pacific Islands.
And, three, the other third piece is that community is essential. None of these interventions are going to work without community engagement.
So in the limited time we have I’m going to ask everybody that maybe from where you sit what’s one thing that you could do, and I’d ask particularly the health people to think what do you need from the climate side and maybe ask our folks who are primarily focused on the climate side what do you need from the health community to make a difference, and then we’ll see if we’ve got any time.
I’m going to—I’m going to take the prerogative of starting with Victor because I know he has got to leave at 1:00 sharp. But do you want to help us start? How do we equip ourselves?
DZAU: Yeah, I was going to follow what David said, and I’m so glad that we have this—the agenda today. Thank you, Tom, and thank you, John. Because I think if you look at the issue, for us who work in global health this is a big issue and as you know we’re living in the midst of pandemic, post-pandemic, a lot of discussion on global health security and diplomacy around in fact, you know, pandemics, infectious outbreak.
But this in fact is going to be with us and surely not only can you predict or not it’s going to keep going. So I think putting it top of the agenda for global health is key and I would say that my colleagues in global health are not as focused on this issue as they should be.
So, secondly, with the—and you know the reason for this big existential threat. Second, as been said by David, if I look at the U.S., yes, there’s a lot of climate activities. But when it comes to climate and health actually there’s not as much.
So HHS—the Office of Climate Health and Equity, overseen by John Balbus, report to the secretary, is the major entity mainly focused on U.S. And we work very closely with him, the Academy, in doing this great initiative on looking at Inflation Reduction Act and all the other issues.
But when you look at—NIH is trying to look at different parts of NIH together, but globally—that’s why, John, I think it’s so important that your bureau takes initiative to put this on the agenda globally. When you think about the amount of resources—and we can always argue there’s not enough in Global Fund, in malaria—(inaudible)—right—but actually very little looking at climate change and human health.
So that means that—I said at another meeting—I think it was Josh that day—what about financing. You know, we need a fund for climate change and human health. But, nevertheless, I think the idea that there’s got to be a lot of focus on this. So I just want to amplify this issue.
To your question, obviously, we need to bring people together, right? The policymakers have to understand that in fact climate change is not something just for the environment but they’re hurting their own people. We need to have the right narrative and right data to show what’s happening in different communities just like we’ve seen during COVID.
We need to work together, as I said, in health and all policies. When you begin to think about agriculture, food security, transportation, urban planning, we should, in fact, enter climate into this issue and think of it as related to health.
MONAHAN: Excellent, Victor.
Let me turn to another colleague from the U.S. government and ask Jainey if she might be able to share, as Victor said from—and David from the health side, if you could share from somebody working primarily on climate issues what do you need from the global health community and how can we collaborate better across these domains?
BAVISHI: Thanks for the question.
I really think that what NOAA needs most from the global health community is a persistent invitation to engage and a long-term commitment to collaborate with us. We need a seat at your tables. This includes helping us engage and understand climate and health equity issues at the community scale by connecting us with trusted messengers that have deep relationships and an understanding of these issues.
And in turn, you know, we are committed to pushing more to ensure that health experts have a seat at our tables in places like the World Meteorological Organization, places where we already work and collaborate.
But I think it’s going to take this kind of exchange of expertise and really having seats at each other’s tables to really understand the nexus and find partnerships and collaborations.
MONAHAN: Well stated.
Emi, from where you sit what do you—what’s the one thing you need?
CHUTARO: Yeah. Thank you.
I actually want to say that I absolutely agree with Jainey. I think, you know, the information exchange across sectors is going to be very critical for informed decision making.
But, you know, and a really good example is look at COP-28, you know, one of the premier dialogue—you know, forums for climate change and only at COP-28 just, you know, in a few weeks’ time, you know, will there be an actual dedicated health day within that.
And so I think, you know, it’s taken this long to get to this point where actually health is actually on the agenda of the climate change agenda and I only hope that, you know, USG can continue to support us in the Pacific to continue that advocacy, to continue that cross-sectoral exchange—you know, informatics and information, intelligence, that we all need to make sure that each other’s work is actually complementary and supplementary as opposed to, you know, go diverging into different tangents and really not achieving the same goals.
So I just want to say that I do want to reflect Jainey’s points here. But I think the other one as well is particularly around, you know, atoll environments. With USG, you know, there is a tendency to be very what I call CONUS centric, which is continental United States with respect to the territories and the other.
And so, you know, on behalf of—not on behalf of but speaking for and, hopefully, trying to advocate for is that, you know, with our Puerto Rican, you know, Virgin—U.S. Virgin Islands and the Pacific Islands that, you know, there is the United States out there too and that these are very unique island environments and that, you know, the White House Initiative on Asian Americans, Native Hawaiians, and Pacific Islanders as well as HHS really take that into consideration in terms of, you know, some of the work that it does in terms of what types of technical assistance are going out there, where it’s pulling some of that information from to support initiatives in these island settings.
That’s going to be really critical and we really need that hyper focus, I suppose you can call it, from our HHS USG colleagues to really to consider that and, of course, the Pacific is a broader playground for its defense security as well as health—global health security.
So we want to make sure that that dialogue does not get lost because we are small islands, because we are small populations, you know, and that voice is very critical to help us raise that collective advocacy across the key decision makers on Capitol Hill and the White House.
MONAHAN: Thanks, Emi.
Can I ask Khuat Thi if she might want to add any—a point from her perspective?
Khuat Thi, can you hear me? No? Maybe not.
OANH: Are you—
MONAHAN: I was just wondering if you had any sort of point you’d like to make to—from your perspective what one thing would be really helpful to move forward here?
OANH: Yeah. I think we need to have a climate governance. I think it seems like there’s no governance of climate at the moment and that increase inequality and inequity.
Just a simple example, since the climate become hotter the richer people using more air conditioner so pollute more the air and emit more carbon dioxide, make the climate hotter and the poor people who cannot afford to have air conditioner have to suffer more the climate change.
The richer people will take the plane and fly for vacation to escape the heat, to escape the cold, to escape the pollution, and polluting more the air and the poorer people who have nowhere to go cannot afford to go anywhere, have to breathe the more—the dirty air and suffer the heat and the flood, et cetera.
So I think climate governance is seriously needed. Thank you.
MONAHAN: Thank you, Khuat.
I’m going to see if we can steal maybe five minutes from the break and ask if there are any—a couple questions in the room and I see Howard. So Howard, why don’t—anybody else? Maybe we can take two questions if there—I’m sorry, I can’t see.
So why don’t we start one up here and then the person in the back?
Q: Great. Thank you. Howard Zucker, the deputy director for global health at CDC.
You know, and though I agree that this is a public policy discussion I was curious, based on an earlier panel discussion, are there certain catalysts that we can use in the public-private partnership role to address this to accelerate things separate from just public policy?
MONAHAN: So public-private partnerships. And in the back there a question, and we’ll take two and we’ll see if we can get a couple of comments here before we wrap up.
Q: Hi. I’m Kritika (ph).
I’m doing a Ph.D. at the NIH, but was really curious about the community engagement that you mentioned, especially around the behavior change that comes with when you talk to someone and inform them about that maybe—(inaudible)—cows causes mental—like, how do you encourage that behavior change in people, especially at the grassroots level? As we’ve seen in malaria, it’s a really big deal as well. So thank you.
MONAHAN: Why don’t we take those couple questions? Maybe the second one on community do you want to take that, David?
WALTON: Sure, I’ll do the community piece first. Thank you for your question. And, again, I know we’re short on time. I’ll be brief.
I think what I think a couple of panelists have mentioned but is really critical is, really, as we have said in every single discipline that everyone represents in this room, having a community-centered approach is critical and we have to be able to make sure that we have climate resilient communities.
I think the bigger question is what does that really mean, and it’s a bigger conversation but I think we need to really think about I think as someone else said—I think a friend of Vietnam said, you know, coming to folks with alternatives, making sure that we’re able to not only just sort of say what’s wrong but actually provide alternatives of what is right and provide the ability to create, to sort of facilitate these climate-resilient communities with communities at the center of our response.
DZAU: Can I quickly?
DZAU: Yeah. So on the community side, clearly, having a voice from a community is important. So we’re doing an initiative at the Academy called climate community network that looks at in the United States all the vulnerable community using a heat map approach—which are the ones that’s most affected, which one have the greatest socio economic challenges.
Bring them together along with what we call strategic partners—EPA, HHS, DOE, and others—to look at cause solution, having a co-design solution. So that’s an important area.
On Howard’s question on public-private partnership, no doubt. I mean, clearly, there’s a lot of discussion about alternate energy, et cetera. But in the health sector we are running a big program to decarbonize the health sector in the United States along with the HHS and, of course, what happens is the private sector has to come together.
If not everybody’s on board then you’re just going to tweak around the edges because the private sector, supply chain, manufacturing plays a really important—emit a lot of those carbon. And so we have initiative that bring together everybody including insurance companies.
MONAHAN: Let me ask if anyone on Zoom wants to comment on either of those questions before we wrap.
OANH: Yeah. Maybe I would like to comment on the community engagement.
I think it is—in order to really engage and empower the community we need to invest in the community system. So it needs to be—people need to have a mechanism to work together. They need to—you need to foster the leadership.
It doesn’t come out the thin air. It doesn’t, like, OK, hey community, let’s discuss. They need to have a venue for them to discuss. There’s some institution within the community to make it effective and impactful.
But I am glad that the other panelists also agree in the important and power community, but they need some investment to strengthen the system of community. I think the brilliant example in developing country, (as mine ?), is the investment from the Global Fund. And thanks to the U.S. government and people to be for the biggest donor to the Global Fund.
I see that in front of my eye, that when the community get together, get some investment to organize to build the system it is very powerful. So, yeah, I think we need more than for HIV. We need to—we have the model there. We just need to expand it and mobilize them to work on climate change as well.
MONAHAN: Excellent. Anybody? Either Emi or Jainey?
Otherwise we’ll—further? If not, I guess I would ask—oh, please, Emi?
CHUTARO: Yes. No, just really quickly on the private-public partnerships.
You know, again, I think one of the challenges that we have in the Pacific is that we’re dealing with very small economies and so, you know, economies of scale are really a critical factor in looking at what types of models and modalities of technology actually work in small island settings and which are affordable and are sustainable in these types of very harsh environments.
And so, you know, the conversation around, you know, power and solarization and technologies in health-care settings that can survive high salinity environments, you know, is something that we’re really interested in exploring further and what types of, you know, technologies, for example, in the laboratory—you know, rapid testing technologies—that allow the economies of scale that are affordable in small island economies to be able to support, you know, screening and surveillance efforts so that we can be more effective in supporting our island environments.
But we cannot do that without having that engagement with our private partners and then see how it can be made affordable because on a per capita basis, you know, we’re not looking at large volume orders or even bulk ordering, for that matter. It’s still very small in the grand scheme of things, and so per unit costs for us tend to be very, very high and yet our disease burden is high.
So how do we have that dialogue with private enterprises to understand those economies of scale and whether there are potentials for price scaling appropriate to our context and to our affordability in terms of our economy?
So I don’t know if there can be sort of that concerted dialogue but I know it is happening. It’s just where is it really happening now to actually address the acuity of the situation that we’re seeing in climate change, right, in the Pacific.
MONAHAN: Well, Emi, thank you, and I’m going to have to bring this panel to a close.
As we said at the beginning, we have extraordinary people and extraordinary set of topics. To say the least, I think the new bureau—and, John, you have an enormous diplomatic agenda in this space and I do want to say thanks to Tom.
But, really, ask everyone to join me in a round of applause for our speakers. (Applause.)
ADZOGENU: A very good afternoon to you all and to those joining internationally and around the world. I believe it’s good—even, you know, good morning, depending on where you are. My name is Edem Adzogenu. I’m co-chair of AfroChampions. AfroChampions is a multistakeholder public-private innovative platform driving integration among institutions in Africa on common projects.
I’ve been given the very unique task of moderating a very interesting session. We’ve been having a lot of discussion about what to do in terms of global security, but resource mobilization—financing—is a very important one. I always say that great ideas, great innovations without financing is hallucinations. This task I have is to introduce to you very distinguished personalities to speak on the subject matter of financing, most of them coming from philanthropy—global philanthropy and DFIs, and to try to dig into their pockets and world to see how they can contribute a lot more beyond what they are doing currently in support of global health security.
I will start with introducing Professor Oramah. Professor Oramah is the president and chairman of Afreximbank. Afreximbank has been very instrumental in supporting the continent of Africa during the pandemic.
But before I go to him, I must do a little bit of framing. About 37.8 billion U.S. dollars was invested in terms of contributed to low- and middle-income countries during the pandemic. In fact, the first two years of the pandemic, the continent of Africa alone saw $37.8 billion in support. Now, that’s 810 percent more than the amount of money that has been contributed or invested in pandemic preparedness in the prior twenty years, from 2000 to 2019. So that tells me that the money’s there, you know. The money’s there. We can raise the money. How we sequence that money, how we distribute it, how we even raise more of those monies are some of the questions that I’m trying to delve into today.
And so I’ll start with Professor Oramah to start with telling us—part of the work, what did you fund during the pandemic? What are some of the lessons you learned going forward that will prepare us for the next pandemic? Over to you, prof.
ORAMAH: Thank you very much, Edem. I’m highly honored to have been invited to address this important gathering. I would like to thank Ambassador John Nkengasong for the invitation.
While it was always known that global health emergencies could be better managed through multilateral arrangements, it was the COVID-19 pandemic that demonstrated the grave risks of inaction and the extent of threat that pandemics pose to the world. The COVID-19 demonstrated the gross inadequacy of the existing global health security architecture and multilateral arrangements. These inadequacies opened the world to the rule of the jungle as the nations—as nations scrambled to procure containment supplies and, later, vaccines. In the circumstance, the weakest—in this case, Africa—suffered the most.
While Africa was indeed hard hit, the emergency was not due to limited financial capacity but because it trusted its rich developed-country partners to live by their words and behave honorably. When it dawned on the continent that this wouldn’t happen because as a consequence of the pandemic it was everyone for themselves, Africa had to act. And it acted and Africa demonstrated what could be achieved when a collaborative multilateral approach is adopted to deal with health emergencies.
Ahead of the pandemic, Africa was most disadvantaged with little or no capacity to procure PPE, test kits, vaccines, therapeutics, and so on. Africa was also fragmented to fifty-five countries when global manufacturers were only interested in dealing with large, well-resourced economies. The response that we had as a continent was to move to pooled procurement as the only way of dealing with the problem of size and limited resources. We also resorted to the pull of digital technology and created the Africa Medical Supplies Platform under the auspices of the Africa Center for Disease Control, in collaboration with Afreximbank, African Union Special Envoy for COVID-19 Mr. Masiyiwa, and the Intelligence (sic; Economic) Commission for Africa. Dr. John Nkengasong was very instrumental in getting this done.
We took a whole-of-Africa approach and then used the digital technology, the platform, to pool the demand of the entire continent. We then allowed our political leaders to negotiate the COVID-19 supplies up to—at up to 30 percent discount in price. The platform provided an opportunity for the medical supplies to be delivered in a pooled manner, which made logistics more efficient. What do I mean? It made it possible for smaller economies like Seychelles to procure materials almost at the same price as large economies such as Egypt and Nigeria. Payments were interacted through an overdraft facility offered by Afreximbank, with every supplier guaranteed payment once orders were placed. The platform has delivered supplies valued at more than $2.5 billion to date.
When vaccines became available, the same pooled procurement approach was adopted. African Vaccine Acquisition Task Team was created by the African Union, and mandated to find and negotiate vaccine procurement for 30 percent of the African population, and to raise the funding required for this, which amounted to about $2 billion.
The team—as I said, the African Vaccine Acquisition Task Team created the African Vaccine Acquisition Trust as pooled procurement vehicle, which entered into the contract with a vaccine manufacturer, in this case Johnson & Johnson, with corresponding back-to-back agreement with each African participating state. Afreximbank put in place an advanced procurement commitment facility amounting to $2 billion, which provided guarantees to the vaccine manufacturer on behalf of all participating African countries. The African Vaccine Acquisition Trust became a platform to bring together various stakeholders, including commercial banks, multilateral development banks, global foundations, governments, and others. In fact, another $1.8 billion we was raised through this arrangement. And we then got partners such as the World Bank, the MasterCard Foundation, and MTN, the telecom company in Africa, involved, providing funding around the platform.
That vehicle become became very effective, and African Union was then able to view it as credible, and began to—the process of institutionalizing it, because it saw it as a vehicle that could guarantee health security for Africa. It took a decision, that is the African Union, to institutionalize the scheme. But as we work with the African Union and African CDC towards this institutionalization, we see many challenges. And that is why we eagerly look forward to engaging the Pandemic Fund to see how we can collaborate in the implementation. We also hope that in all the discussions that some ideas may emerge on how a multilateral treaty may be brought to bear in dealing with these problems, because the world will be the worst for it if at every—during every pandemic everybody behaves as if we were in the jungle. Thank you very much.
ADZOGENU: Thank you very much, President Oramah, and giving us those insights into how Africa was also able to rise to the occasion and contributing, and not just been cap in hand, and being able to show that we could also see the prerogative to contribute and build foundations that we can learn from and rise on going forward.
So I’ll now turn to Priya. Priya Basu is the executive head of Pandemic Fund Secretariat of the World Bank Group. Priya, the Pandemic Fund—in fact, throughout the day, we’ve been hearing about Pandemic Fund, Pandemic Fund, and Pandemic Secretariat. So why don’t you—and the organization, the Secretariat was, incubated during the pandemic. It was birthed about a year and a half ago. And in a year and a half already, you spring forth into action doing amazing things. Why don’t you bring us up to speed on some of the work you’ve done so far, and maybe also persuade some of your panelists, you know, to sign the checks that you need to take it even further. (Laughter.)
BASU: Music to my ears. And thank you so much. And it’s really great to be here for this very timely and important discussion. And I’d like to thank Ambassador Nkengasong and his team for this invitation.
So, as you mentioned, you’ve been hearing about the Pandemic Fund throughout the day. In the wake of COVID-19, the international community came together to establish the Pandemic Fund, with the leadership from the United States, the European Union, and championed by Indonesia during its G-20 presidency. And we were established at record speed last—actually, formally, exactly a year ago last November, at the G-20 meetings in Bali, Indonesia on November the thirteenth.
So the Pandemic Fund is based at the World Bank, the Secretariat. And we work very closely with the WHO. I have staff from the WHO that are in my team. The Pandemic Fund is an innovative addition to the global health financing toolkit. It’s really the first of its kind, the first multilateral platform—multilateral financing mechanism that’s dedicated to investing in pandemic prevention, preparedness, and response in low- and middle-income countries. Investments during peacetime, that can make us better prepared for the next pandemic. And you’ve heard throughout the day today, it’s not a question of if, it’s a question of when that next pandemic will strike us. And the risks are higher and higher in the face of climate change.
So we are designed so that when the next pandemic hits, we will have the health workforce that can be rapidly deployed. We will have laboratories that can rapidly scale up testing. We will have the surveillance capacity already in place. And we will have the ability to do the kinds of surges that we were not able to do in the face of COVID-19. So some of it is getting ourselves prepared for the surge. But a lot of it is also, you know, investing now in things like surveillance systems, things like, you know, early warning systems. These can be invested in and tested along the way through approaches like 717, which is part of our results frameworks. We can—as we make these investments, we can see whether countries are getting better at detecting, at reporting, at containing ongoing outbreaks.
What makes us different? The Pandemic Fund is different. We have, first of all, a governance system that’s really based on principles of equity and inclusion. We have a balanced representation between countries that are contributing and the 144 countries that are eligible to receive funds from the Pandemic Fund. We have a balance between the Global North and the Global South on our board. We have civil society in voting seats. We have philanthropies that have contributed on our board. Secondly, we have the flexibility to work through a variety of institutions, complementing their assets and drawing in co-financing from those partner, what we call, implementing entities, which are multilateral development banks, U.N. agencies, and global health institutions, such as the Global Fund, Gavi, CEPI. And promoting coordination amongst those institutions to support country national action plans for health security, to support regional plans, and global plans as well. And, thirdly, and very importantly, we are set up to incentivize countries themselves, the recipient countries themselves, to prioritize this agenda and to increase their own levels of investment in pandemic prevention, preparedness, and response.
What makes us impactful is that we are a collaboration between governments, multilateral development banks, WHO and other U.N. agencies, global health institutions, philanthropies, and CSOs. And we’ve come together at record speed to deliver financing. So it really is a great example of what we can do when we work together towards a common goal. And really, it is multilateralism at work that you saw in the establishment of the Pandemic Fund. In less than a year, we’ve mobilized $2 billion in seed capital, thanks to the generous contributions of the United States, of the European Union, of G-20 countries, and beyond. And we’ve already awarded our first round of grant funding to strengthen capacity both within countries and across borders. With every dollar of grant funding that we’ve allocated, catalyzing $6 in additional funding for the projects we’ve supported.
We’ve already supported thirty-seven countries through this first round of grants. Seventy-five percent of it has gone to low- and lower-middle income countries. Thirty-two percent of that to Sub-Saharan Africa. All our projects are multisectoral. They take one health approach. And many of them look at AMR surveillance. When I say one health, that’s one health at the prevention level, preparedness, and response. So building capacity, you know, bringing ministries of health, finance, agriculture, environment, animal husbandry together, to sort of work out ways to build systems for prevention and detection. And there’s a lot of cross-country collaboration in the projects that we’ve supported.
So what we’ve achieved is impressive, if I may say so myself. It’s quite impressive. But we are falling short of where we need to be. Our first call generated demand that was eight times the amount that we had to allocate. A hundred and thirty-three countries applied. We were able to award money to thirty-seven of those. Our own analysis, the World Bank in the WHO prepared analysis for the G-20 last year, where we estimated that $10 billion of additional funding, international funding, is needed every year over the next five years to bring low- and middle-income countries to the levels of preparedness where we want them to be. And on top of that, twice as much in domestic financing is needed.
So to fulfill our promise of helping developing countries build resilience to future pandemics, the Pandemic Fund urgently needs more resources, both ODA and non-ODA. We also need strong partnerships around projects on the ground, so that the multilateral development banks, U.N. agencies, philanthropies, private sector, global health institutions that are implementing partners can bring not only their expertise to the project, but also co-financing. They’ve already brought co-financing in the first round, but we’re looking for much more. So this really is the moment to scale up efforts, you know, both in terms of raising more money and in delivering that money smartly, so that once and for all we can break that cycle of panic and neglect, and get the world prepared for the next pandemic.
ADZOGENU: Thank you. Thank you. And this really is the moment to go to home of the heavyweights of global philanthropy, who will share some perspectives. And I’ll start with Professor Senait Fisseha. Professor Senait Fisseha is the vice president of global programs at the Susan Thompson Buffett Foundation.
Professor Senait, you, without doubt, have been investing and contributing to so much, and has your fingerprints and footprints in so, much as far as healthcare is concerned—financing aspects of healthcare. Not only on the continent, but globally. But we saw you do even much more during the pandemic, which means you are able to dig even much deeper to find the resources. What would you say—because I would imagine that not—it didn’t dwindle the support you kept giving other things you were funding. So what would you say the pandemic has jolted you to now do that you’re proud of, that you funded, that you think will outlive the pandemic? And what lessons can we learn from that in preparation for the next pandemic?
FISSEHA: Thank you, Edem, for the opportunity. And, again, a shout out to John Nkengasong and his team for putting this day together.
I think during COVID, a lot of funders—and many of them on this call—really stepped up to address the acute crisis, which was absolutely necessary. But I think if we have to look at ourselves and others and pinpoint a couple of investments that I think will have the longest-standing impact, it would be those investments that were made to strengthen institutions, like Africa CDC, and investments to strengthen primary health care. When we are faced with a crisis like COVID, I think there can be a tendency to try and solve that problem in the future. But the reality is, we don’t know what the next pandemic or health crisis will look like. But one thing that we do know is countries with strong primary health care systems fared far better during COVID.
They were the ones that could detect outbreaks early and manage them through a health systems lens that is very close to communities. Similarly, they were—they were well-positioned to identify the next threat that could emerge and respond to them in a timely manner, regardless of what that looks like. So for me, investments in strong primary health care as well as institutions, especially in Sub-Saharan Africa, and this is an opportunity to give a shoutout to John Nkengasong, who led the pandemic response for Africa. You know, many of us stepped up our resources, particularly, you know, again, a shout out to Reeta Roy and the MasterCard Foundation, along so many others who give the resources needed to strengthen the institution, both to strengthen primary health and public health institutions in the continent, as well as the example Prof. Oramah gave about the Africa Vaccine Acquisition Platform, the surge in health workforce.
So if you look at these things, you see that we have a long way to go to address basic primary health care components in order to be able to tackle epidemics or pandemics like COVID. You know, these investments will also go a long way to address many other health crises countries are facing. You know, we are—we experienced COVID-like crisis or worse daily in African countries. Just, you know, take maternal mortality, for example. Seventy percent of all maternal deaths are happening in Sub-Saharan Africa. So strengthening primary health care systems is going to allow us to not only be well-equipped to tackle epidemics and pandemics, but also provide just daily services that are epidemic in this—in this continent. Importantly, the time to invest in primary health care and strengthen health system is now, not during a crisis.
So while, of course, we can bolster health systems during a crisis, those investments will go so much farther, and reach so many more people, if they are strong at the outset. And I think, finally, we really need to be considering how we make these investments. So for me, supporting primary health care system requires strong coordination and alignment with government system. And I fundamentally believe the only way to do that well is if we are willing to put governments at the center of decision making. And this is a shift we’ve made at the Buffett Foundation over the past five years, and one I know others on this panel are also focused on. So hopefully we have a chance to discuss this a bit more. But one thing we saw during the pandemic was because a lot of the global actors are not on the ground to implement, we were able to focus our attention on strengthening government and strengthening institutions.
So let me pause here, Edem, and I’ll be happy to add more if we have time.
ADZOGENU: No, we’ll definitely steal some time, because I want to come back to you on the government matter.
So let me turn to Yanzhong now. Yanzhong is the senior fellow of global health, Council on Foreign Relations. And we’ve been hearing—we’ve heard from the Pandemic Fund. We’ve also heard that there’s a commitment towards this discussion of global security, in finding the money and get the money where they need it. So the problem is really not the money. The problem is how we distribute the money, how do we ensure that sometimes the money is not going to just those who have—more money keeps going to people who have the money already, and not going to where the needs are. Or something that money goes to where the needs are, and then there’s also a lot of money now moving away from health, now that the pandemic is over. I mean, and we’re talking about ODA, into climate. From where you sit, how do we ensure that, you know, we keep the health aspect also very important so that we don’t keep—the resources are not leaving? And if you can tell a little bit also about what CFR is doing in that regard. Thank you.
HUANG: Well, we just published at CFR the—not corporate sponsor, social responsibility. The Council’s Special Report on Global Health Security, which actually we have a section talking about mobilizing resources to invest in this foundation or country-level capacity, in medical countermeasures, and these things. So if you’re interested, you’re welcome to take a copy.
I think when we talk about mobilizing resources, it is not just, as we say, increased funding. It’s also about better coordination, you know, better prioritization, right? So in terms of the coordination, you know, we talk about, right, how those vertical programs, you know, like those used to fight, you know, HIV/AIDS, TB, and malaria could be better coordinated to build an overall stronger—build a stronger health capacity, health systems, while still addressing the specific health-equity issues.
You know, this could be done through this building of the common platforms, you know, for concerns and processes, you know, such as disease surveillance, laboratory systems, and supply chains. But in the meantime, I think it is important to prioritize. When we talk about prioritize, you know, we already talk about investing universal health coverage, the primary health care, PHC.
But specifically in this, the report, we also highlight the importance of investing in health workers. If you can see there, that’s 60 percent of this cost required for sufficient capacity to prevent, detect, respond to major disease outbreaks, emergencies, actually tied to health workforce. You know, I think it’s important that we can see they’re using this health-related development assistance to support and pay health workers, right, in those low-income countries in particular, because traditionally donors—you know, they’re being reluctant to allocate funds for salaries because they perceive this to be a national responsibility. But if we fail to use this health-related development assistance to support and pay workers in those countries—recipient countries, I mean—then it’s going to cause that—contribute to that workforce shortages. It's not good also for us to support universal health-coverage goals. You know, so I think prioritization is important.
As to the issue of this shifting attention away from health because the climate—even though officially the pandemic is not over, but we’re already in the post-COVID era. I think, you know, it is important that we develop a strategy, you know, that certainly what we needs to advocate, you know, for more balanced allocation within ODA budget. But in the meantime, maybe we’ve got to be sophisticated, right, in terms of advocating for more integrated approach, including developing integrated programs that address climate change in conjunction with health, right.
So, you know, one thing we could highlight is that in the single-minded pursuit of climate-related goals may not—may hurt the pursuit of health goals. You know, for example, the investment in solar-panel production could cause, you know, the toxic waste. You know, that is going to defeat, actually the purpose, you know, of the global-health goals. You know, so I think that should also be taken into account in the way we are designing strategy for the future health funding, you know, in the post-COVID era.
ADZOGENU: Thank you. Thank you.
And so I will now turn to the president of Mastercard Foundation, Reeta Roy.
So Reeta, I mentioned earlier about the 810 billion (dollars) that came into middle- and low- and middle-income countries just in the two years of COVID. That was unprecedented, because prior to that, twenty years, we hadn’t seen, you know, that much money in entire pandemic preparedness efforts.
And I feel that a good portion of that money came from, you know, you as well, the organization you lead. What is it that—because your call does not really help, right? Your mandate is more on economic livelihood, development, among others. So something must have provoked and inspired you to come in and contribute handsomely.
What did you find, among many other things, that you feel proud of and you think will outlive and (sustain ?) the pandemic and that we can build upon? And what we should do, governments and multilaterals do, to convince you to stay invested in health and not just shift back to what you were doing before?
ROY: Well, first of all, thank you so much, Edem, for the question. Thank you to Dr. Nkengasong for inviting me, and just kudos to all my fellow panelists and many others in the audience here who play such an instrumental role in keeping all of us safe. So I just want to thank you. Thank you for your service and thank you for your leadership.
To answer your question, when I think about what was the single most important thing we could have done, it’s exactly what we did during COVID, and that is that partnership, an unprecedented partnership, between our foundation and the Africa CDC. And some of you know it was a $1.5 billion partnership put together pretty quickly to do four things—to purchase vaccines, to get behind the trust which President Oramah spoke of in terms of vaccine purchase, especially roll out vaccinations across the continent, to support a partnership on vaccine manufacturing on the continent, and then to obviously lay the groundwork for a workforce which could do vaccine manufacturing, and most importantly, to what Dr. Senait has spoken of, is to strengthen the institution that leads us, the Africa CDC, because it is Africa’s foremost public-health agency.
And it was a difficult time. It was a very stressful time. And when I look back now at the results of where we came, it’s remarkable. And so I want to say—if you allow me to speak for a minute of the results, and then I want to talk about what I think is the lasting impact from all of this.
So when we began, I think less than 3 percent of the population of the continent, the target population, had been vaccinated. And we stand at 52 percent in aggregate. And obviously there are countries which are at 70 percent or higher in terms of vaccinated populations. At the time there were less than two labs on the continent which could conduct genomic sequencing. Today, thirty-two labs can do that. Is it enough? Probably not. But it's a long cry from where we began. More than 35,000 health workers were trained or better equipped. And for us, interestingly enough, 22,000 jobs were created.
So when we take a look and we think these are real results which we can work on, the emergency may be over but the urgency to do exactly what Dr. Senait spoke of is not, and that is in the investment in preparing for what might be around the corner. And so for us at the foundation, it means following through with our commitments in this partnership, Saving Lives and Livelihoods, and that is to continue on the path of moving that public-health workforce, one around vaccine manufacturing, which is why we’re so proud of the partnership we have with the Pasteur Institut in Dakar, to really create a center of excellence for biomanufacturing, and then to work with many others, including many others on this stage and in the room, around investing in public health, the public-health workforce, particularly the community-health workforce, largely run by women, underpaid, overextended, and with recognition to the invaluable contribution that public-health workers make, community health workers make, to enable the professionalizing of that role, but also recognizing it with decent pay and with progression.
So when I step back, I think, OK, these are real results. And that work will need to continue. But what was the lasting impact, and what are the lasting shifts that have occurred? And so this is not my word, but this is what was told to us when we went out two years later and asked multiple stakeholders, what do you think is the real lesson? What do you think is the real ripple effect and multiplier effect of the work that has come to pass?
And what is interesting is people didn’t talk about numbers at all. In fact, the first thing they said was that partnership was bold, it was catalytic, it operated at a scale which before had been unprecedented, but it started to—and it has started to shift mindsets and it is shifting the narrative of how development should take place.
One, it’s about shifting power and resources to organizations which are closest either to their communities, closest to the challenge at hand. And for us in this partnership, it meant identifying African organizations which could undertake this work. And it was seating the Africa CDC, as it rightfully belongs, in a place of leadership, to lead and to direct effort.
I would say the third thing is to do with respectful collaboration. We use many words, that it’s co-creation, collaboration, engagement. But really, at the heart of it, it’s recognizing the role of many organizations to both drive strategy or implement strategy. And it’s recognizing their strengths and their particular capabilities.
And for us as a foundation, because we are an organization, as you said, Edem, which is not in the health-care arena, our work is all about dignified work for young people, dignified employment, entrepreneurship. And in our work, we put foremost—we prioritize African organizations and taking the lead. We set a bold target for ourselves; 75 percent—at least 75 percent of our partners must be African organizations. And we have work to do. We’re about 64 percent right now. So we have work to do.
But it does mean, for me, the lasting effect is that there is a different way of executing. There’s a different way of driving change and social transformation. And this must apply to health. And to your question about convincing us to stay, I don’t think there’s any need for convincing. For us it’s about taking a look at health as an economic sector, as a jobs destination, as an attractive place for careers to be built and contributions to be made by young people. And that is what we will be on the path of.
So thank you so much.
ADZOGENU: And thank you as well.
And I will quickly turn to Peter Sands. Peter Sands is the executive director of the Global Fund. And my question to him simply is how does the Global Fund maintain its focus on mission whilst adapting to new COVID and post-COVID realities, given that, you know, there’s competing interests in the space but it can be competing interests in mobilizing resources.
Over to you, Peter.
SANDS: Thank you. And thanks to the Council for Foreign Relations and to John Nkengasong for inviting me to participate in this panel. And it’s great to be with the others on the panel.
Just coming back to COVID, we first started making money available to countries to respond to the COVID-19 pandemic in late February 2020, and then, over the course of the pandemic, deployed about $5 billion due to the generosity of donors, led by the U.S., making the Global Fund the largest provider of grants to countries, low- and middle-income countries, for everything other than vaccines; so PPE, diagnostics, oxygen, and so on. That’s on top of what we, in a sense, do as our day job, which is fighting HIV, TB, and malaria.
But it’s important to recognize that as part of that, we are actually the largest multinational provider of grants for strengthening health systems. So of the roughly 5 billion (dollars) a year we invest, at the moment we’re spending about 1 ½ billion (dollars) a year on health systems, including for pandemic preparedness. And that is increasing to about 2 billion (dollars) a year. And note that all of this, in terms of the decisions on what to invest in, the prioritization of those investments, is determined by the countries at the country level.
The investments we are making in health systems are almost always dual purpose. They’re dual purpose in the sense that they’re fighting existing diseases, saving lives now, and they’re strengthening platforms, strengthening preparedness against future threats. And we think that is the most efficient way of going around protecting people better from pandemic threats. We also think that it’s more sustainable, because ultimately the Achilles’ heel of all previous efforts to build pandemic preparedness has been the fact that it’s really hard to sustain interest through the inevitable cycles of panic and neglect.
But it doesn’t have to be like that anyway. One can invest in systems in a way that delivers benefits to them, and not just for HIV, TB, and malaria. One of the biggest areas we invested in during the COVID response was oxygen, the provision of medical oxygen. And, in fact, now what’s happening is that that is actually having a significant impact on maternal mortality, neonatal mortality, and also survival rates of acute trauma, people who suffered traffic accidents and so on.
So by investing in health systems in a way that both delivers for people now and helps protect people from future threats, we think we can make—and this is primarily primary-health-care systems, to pick up on Senait and Reeta’s points—we can make people safer. And what does this actually mean? This is actual primary-health-care facilities, the touchpoints. It’s community health workers at scale. We’re investing about a billion dollars in community health workers. It’s laboratory networks. It’s disease surveillance. It's the provision of medical oxygen.
Of course, none of this is done by the Global Fund on its own. We work very closely, as we have done for many years, in partnership with the World Bank, with WHO, with Gavi, with Unitaid, and so on. And, obviously, we also work very closely with the U.S. bilateral agencies, so PEPFAR, USAID, PMI, as well as with private philanthropy, as Reeta and Senait are representatives up here, and particularly with partners on the ground.
And the core of that is governments, but it is also civil society and communities, and indeed the private sector, because I think one of the things we’ve learned through the COVID-19 experience is that trust is a key asset when you enter a pandemic. Too many countries, particularly in the richer countries, didn’t have the trust of their publics. And that meant their public-health measures were less effective than they wanted them to be.
You build trust by delivering people that. And that, again, is an argument for why it makes sense to build pandemic preparedness through interventions that simultaneously strengthen the resilience of the system and actually deliver for people now in terms of saving lives, reducing infections, improving health and wellbeing.
As we look forward, you’re right. There are many competing demands, not just in health, but due to climate change, due to conflict. But I think we need to remember that most of these are affecting the same people, the poorest and most vulnerable in the world. If you look at the overlap, for example, between the countries which are most affected by malaria, the countries which are most affected by conflicts in countries which are most affected by climate change, there’s a very high rate of overlap.
And as we look forward, we are very focused on the fact that we need to, in a sense, work outside the siloes of health or climate change or food and nutrition, because, ultimately, it’s the combined impact of those that are going to kill people. And so we need to craft new partnerships and find new ways of working to respond to this combination of crises.
So from the Global Fund perspective, we are hugely committed to continuing to work with the United States and the U.S. bilateral agencies, with our partners across the multinational space, and with other stakeholders, including private philanthropy, governments, civil society, and communities.
ADZOGENU: Well, thank you, Peter. And I was just told that the time I was hoping I could steal is not available to be stolen. (Laughter.) And so I’m sorry to say, you know, we’re not going to be able to take questions for these wonderful panelists.
But what I want to say, in asking you to join me in thanking Yanzhong, Priya, Professor Senait, Reeta, Peter Sands, and all of you who have joined virtually, is to say that we’ve heard these words being mentioned, right—co-creation, collaboration—all of them seem to be Cs, by the way—collaboration, communication, community, among others.
But we used to think—and I was hoping in this panel that I would be able to push these amazing funders to at least tell us how much they’re going to write on checks. (Laughter.) But Peter Sands summed it up, that the most important currency is trust. And I hope in this conversation we’ve been able to establish that there’s trust among the partners and, going forward, the money will flow.
Thank you very much indeed. (Applause.)
WEN: Good afternoon. So I have the honor of presiding over the last session of the day and to introduce a fantastic panel both in person here and virtually. So I’m Leana Wen. I’m a columnist with the Washington Post and a professor at George Washington University, and I will be moderating this very distinguished panel of five people.
I know that we have talked about this throughout the day of how we have many wonderful panelists on each panel and they know to do this in TV-style comments in terms of length of responses, but what I’m going to do is to introduce briefly our distinguished panelists. I’ll introduce them in turn and then ask them for their opening remarks on working across agencies to address reforms to global health security infrastructure. I would like them to touch upon the importance of doing so, best practices, and also to consider, as we have been throughout today, about how COVID has changed the landscape in terms of changing—in terms of changing, or not, our thoughts about these necessary reforms.
So I’m first going to start with Dr. Paul Friedrichs, who is the director of the Office of Pandemic Preparedness in the White House. Dr. Friedrichs?
FRIEDRICHS: Well, thank you very much, Dr. Wen, and thanks to all of you for the opportunity to be here. I’m sorry I couldn’t attend the morning session.
I’ll start by saying that it is an incredible privilege not only to be here today, but to be serving in this role as the inaugural director for this office, intended to be the integrating function across the many federal agencies involved in both domestic and global pandemic preparedness and response. And for those of you who are familiar with the genesis of this, this was a bipartisan effort within Congress recognizing that one of the areas in which many people felt our country had an opportunity for improvement was how we integrated that domestic and global response, and then how we brought the lessons from the global community back into what we were doing domestically, or vice versa.
So it’s a tremendous honor to serve in this role. We’re building out our team, and I see a few familiar faces in the audience here who are helping with us. And we look forward to partnering with each of you because the biggest thing that we’re trying to bring forward with this team is the sense that, as difficult as COVID was—to your point—where we succeeded, it was together. Where we struggled, it was when we did not partner well. And so we’re eager to partner with you and learn from the comments shared here today.
WEN: Thank you so much.
And next, I’d like to introduced Dr. Lester Martinez-Lopez, who is the assistant secretary for health affairs in the U.S. Department of Defense.
MARTINEZ-LOPEZ: Again, good afternoon. Thank you for having me.
I think when we look at health preparedness and really next to react, every agency of the government brings a different set of capabilities. The Department of Defense has shown that many, many times, Department of Health and Human Services. All the agencies bring different sets—the Department of State. So the issue is, how do we best work together?
And then I’ve had the opportunity to work on international disaster relief. And how do we work in the interagency, how do we work with the NGOs in such a way that we are—that we bring the best to the table and we execute in a way that will best serve the people we need to serve?
So I think—I’m looking forward to this young man’s leadership to really bring all of us to the table and help us achieve our best so we can serve the country and our friends and partners the best.
WEN: Excellent. Thank you.
And our last in-person panelist here is Nidhi Bouri, who is the deputy assistant administrator for global health in USAID. Welcome.
BOURI: Thanks so much.
I’ll just echo, actually, one thing that Lester just said, which is each of our agencies are just one piece of the pie. We’re each a tool in the U.S. government’s toolbox.
So at USAID, as the lead development agency for the U.S. government, the global health portfolio is about $8 billion in investment from USAID every year, 900 million (dollars) of which is in global health security, which I know because that’s our fastest-growing portfolio within the global health program. And a lot of what we look at is both vertical investments, such as our investments as an implementer of PEPFAR or in the space of malaria/tuberculosis, but also cross-cutting that helps us in strengthening, and how we can drive earlier and more robust investments in primary health care but in other aspects of health system capacity, and what role that has ultimately to support partner nations and regions in preparedness for different types of health threats.
But then we also work on the response side. And across the spectrum, that’s done hand in glove with other agencies, because what we look at is where our investments play to the strengths of our agency and where our partners at State Department or CDC or DOD or others may leverage the skills and tools that they have. But collectively, I think where this comes—where the rubber meets the road for kind of reform of the international system is we collectively look at the evidence and the lessons that we’ve learned from investments across the world, and particularly in response to different threats—whether that’s COVID but also Mpox or Ebola—and looking at how we collectively can help influence the international system to be fit for purpose with a lens on future threats and future needs.
And so that’s, really, I think, the effort that we’ve worked together, whether it’s with State and OGA through their different engagements looking at high-level partnerships and the institutional relationships with international organizations, but also looking at the engagements we have at the national level with governments.
WEN: Thank you.
And next I would like to introduce Dr. Mandy Cohen, who is the director of the Centers for Disease Control and Prevention, virtually—joining us virtually.
COHEN: Hi, everyone, Can you hear me?
AUDIENCE MEMBERS: Yes.
COHEN: OK. Terrific. Well, I’m sorry I’m not there in person, but thanks for the opportunity to just share a few words today.
I think the CDC does incredible work around the globe—sixty countries, four hundred plus diseases, health-threat conditions that are major causes of death, disease, and disability. And it is just incredible to work side by side with some of the world’s leading scientists and technical experts in epidemiology, in bio-detection, in informatics, lab systems, and other disciplines. And I think CDC really is on the ground helping so many countries fulfill what they need to do in terms of building a strong public health infrastructure for their country.
So CDC’s staff is on the ground every day. We’re working with countries and partnering with them to train disease detective and emergency responders; to improve the lab capabilities; to help innovate—whether it’s to fight HIV, TB; to immunize children; and, importantly, to implement and help countries stand up their own national public health institutes that are modeled after the CDC. So very much a partnership. And as others have echoed already, that CDC is one of a number of ways in which the U.S. government partners together to think about global health security and to partner with countries in a number of ways, whether it’s health work groups or others that have brought different parts and different strengths across the U.S. government together in service of health promotion and health strengthening for individual countries.
I think, importantly, CDC brings the opportunity to be close to the ground and make sure that we are adapting. The science to the individual needs of communities, and that is where each one of us across the government can play different roles as we partner together. I wanted to say USAID and CDC have been partners for quite a long time, and Atul Gawande and myself, you know, have really made sure to continue what he started with Rochelle Walensky before me to really make sure that we’re not just sharing information across the government, but actually planning together as we support folks around the world.
WEN: Thanks very much.
And last but not least, our final panelist for these opening remarks is Loyce Pace, the assistant secretary for global affairs in the U.S. Department of Health and Human Services. Welcome.
LOYCE PACE: Hi, Leana. Hi, friends onstage and in the room. I apologize I can’t be with you all as well. I’m with our partners here in the EU.
But I’ll just bring up the rear by saying our Office of Global Affairs is just really happy to be a part of this panel, obviously, and be teaming up with the new bureau, and—under Ambassador Nkengasong’s leadership. So congrats again to him and his team.
You know, our office, as well—it’s funny—was established back in 1945 at the request of State Department, I learned. And so at the time they were saying, look, we really need the Department of Health to be our spokesperson and representative in the world when it comes to these major health issues and priorities. I think at the time we were trying to tackle yellow fever and a range of other issues that came down the pike since then, so everything from infectious diseases to now NCDs and even climate change and other issues really fall into our—under our purview when it comes to how we liaise with health actors.
But as everyone’s saying, we couldn’t do that without the support of others across the department and across the USG. So just speaking of HHS, you have Mandy here from CDC but, importantly, we have our FDA, NIH, and other shops like our Administration for Strategic Preparedness and Response. We have our Substance Abuse and Mental Health Services Agency. We have our Office for Civil Rights and Indian Health Service. All these agencies really not only have a lot to share with partners around the world, but frankly, a lot to learn from partners around the world. So the job we play and the role we play at OGA on behalf of HHS and the USG is to try to bring those lessons home and ensure that we are learning not only for, say, pandemic preparedness and response, but also for maternal, newborn, and child health, right? Look at the mortality rates in this country for Black and brown women as an example of that.
I think beyond this sort of agency-to-agency or more bilateral approach, we really are looking at global policy work. And so whether we’re leading delegations to the World Health Assembly, or trying to negotiate agreements and amendments or otherwise working with G-7/G-20, at the regional level we’re working with APEC, OECD, and the like. And so, of course, that’s not just about HHS and what we’re able to do, but how we’re able to bring the power of USG to bear in those settings. And so it’s just really, I think, a strong showing of how we collaborate.
And just to bring it back full circle, one thing we’ve really learned from State is the power of health diplomacy. And so we get to have a handful of health attachés all around the world, whether that’s China and India or Mexico and Brazil, who themselves are really on the ground and leading the way in terms of our health policy and partnerships.
WEN: Thank you very much. I learned a lot from your framing remarks in terms of the work that all of your agencies do and in collaboration with one another, so thank you for that.
Building on that, Nidhi, if I could begin with you, can you tell us an example of a good collaboration, in your experience, between health, development, and diplomacy that you’ve been a part of?
BOURI: Sure. There are many examples, so it’s not that this is the only example. And I’ll do one that’s not COVID, but a more recent example.
Last year, the USG really came together—a lot of our agencies here on the screen and in the room—to support the government in Uganda in response to the Sudan ebolavirus outbreak—which I have to say within just three months, with no approved countermeasure used in that response, came to an end, which is pretty incredible. And I think the reason I note it is it’s an example of the type of coordination that has happened for years, but because we’ve improved how we work together and the way we pull resources together it really speaks to how we support countries hit that endpoint of an outbreak much faster.
So in this outbreak, we at USAID had worked with our colleagues at HHS, at CDC, DOD, and State to really look at all the different types of interventions that were needed for that response, whether it was case management, infection prevention and control, community engagement. And centered in all of that, obviously, was the need to engage the government. And our colleagues at the State Department, through the embassy and the chief of mission there, were really instrumental in opening up some of those channels so that us at USAID but also our colleagues at CDC, both of whom have very close operational ties, could do our work a little faster and have some connections into parts of the government where perhaps that went beyond the typical channels of engagement that we had.
But then at the same time we also had a real risk for spread or concern around travel, and so it spoke to the need to get to that endpoint of an outbreak much faster. So we again kind of leveraged that diplomacy channel with our colleagues at the State Department, not just here at headquarters but particularly through the embassy, to work with the government and also to open up channels for other governments and other types of donors who traditionally provide investment and support to all mobilize our resources a bit faster.
So I think it, ultimately, speaks to, I think, the reason why we need the power of partnership across the USG, not just for the resources that the USG brings to bear but how we, in turn, can help influence and leverage other types of partnerships that go beyond governments—a lot of times in international organizations, other types of financial investment but also resource mobilization, but all of which is centered in supporting a host nation in reaching a certain outcome. And we do that a lot on the preparedness and prevention side, too. It’s the part that people don’t see as much. But those relationships just come out a lot more, I’d say, in response.
WEN: Thank you.
Mandy, if I can turn to you next, I understand that you and your team just traveled to Brazil, and that this was your first international trip at CDC director. Can you tell us about what you experienced, what you learned, and in particular when it comes to interagency coordination and health security?
COHEN: Yeah. Well, yes, my first international trip as CDC director, and it was a special trip because, actually, Assistant Secretary Pace and I traveled together. So she and the minister of health in Brazil were co-hosting a forum there, and I got to participate in that. So, again, sowing the collaboration. And it allowed, actually, for me to see the CDC work, but also to understand the work across HHS.
So we actually toured together one of the manufacturing facilities for vaccines. FDA, obviously, has a big role in the vaccine regulatory space, and then CDC on the recommendations and the execution of it. And so it was a great way to think about, again, that holistic partnership.
I’d say the other part that came through loud and clear was the importance of data exchange and making sure that data exchange could be rapid and fast. And I think that’s where CDC brings a lot of expertise. We brought a number of data experts with us on that trip to start to facilitate a conversation about data exchange within Brazil, but actually across all South America. So that was exciting.
And then the last, we’re seeing a lot of countries, you know, as we come out of the pandemic, make larger investments in their public health infrastructure, which is fantastic. So, for example, Brazil is making a $2 billion investment in their lab infrastructure and capability. And we had the opportunity to share some lessons learned from our side as we built up some of our lab capability, and we look forward to ongoing technical assistance and ways we can partner and learn from them as they are building the newest investments in lab.
WEN: Sounds like a terrific trip. Thank you for sharing with us.
Paul, you had mentioned a bit about how you’re thinking about your new office. And I wonder, how do you consider the domestic versus international component of the work? And also, how do you think about COVID in relation to all the other potential new pathogens that we’ll be encountering?
FRIEDRICHS: Yeah. So the—you know, for those of you who have read the National Biodefense Strategy, you know that we bucket the threats in three big bins.
There are the naturally occurring threats, like COVID, and there’s a lot that we’ve learned from that, and a host of other naturally occurring threats that we should be preparing for. And so one of the things that our office is involved in is looking across the federal government and with academic and international partners to understand who’s doing what to develop the lab capabilities that Dr. Cohen was talking about so we can better detect future outbreaks, who’s doing what to develop medical countermeasures or new personal protective equipment or other capabilities so that we can contain an outbreak before it becomes a pandemic rather than respond to an outbreak after it becomes a global event.
Then we have the accidental biological events that are well-described in the Biodefense Strategy. And as we look at the explosion in the number of BSL-3 and -4 labs around the world and the number of people who rightfully are trying to do research in this area to protect their local or regional population, we recognize that there are opportunities to partner with them just as the CDC and other parts of the U.S. government does to help build that safe and appropriate environment in which to do those research efforts that are very important at the national and the regional level.
And then, lastly, we have to acknowledge that we’re at an inflection point in the practice of medicine today. If you look at the confluence of artificial intelligence, biotechnology, nanotechnology, it is not far-fetched to say that the practice of medicine is changing at a pace that we literally have not seen since the antibiotic era began, if not faster. And that creates the tremendous potential for good things to happen in the next five to ten years, and also the tremendous peril for those people in the world who want to misuse that technology to do so in a way that undermines the health security of countries around the world, undermines the global economy, and underlines (sic) the safety of individual families and workplaces.
So a big part of what we’re focusing on is: How do we knit all of that together? We’ve got tremendous investments that we’re making, tremendous efforts not only in the United States government but with allies and partners in all of those areas. But often, we find that they are very similar. Instead of being complementary, they’re even competitive. How can we help to build a more balanced portfolio that mitigates as many of those risks as possible at the global level, bring back the best practices domestically so that we are all better prepared and, more importantly, more resilient when the next pandemic occurs?
And the last thought that I’ll share on that. Even if we do all of that right, even if we have a perfect vaccine, we had flawless tests, we will struggle with biological outbreaks because we have a remarkable information environment right now in which many people no longer believe the formerly credible sources of information that they once turned to. Part of why events like this are so important and why I applaud CFR for and Ambassador Nkengasong and his team for putting this together, we will fail if we continue to speak with mixed messages from different parts of the federal government, or mixed messages between the federal and state government, or mixed messages between industry and government, or mixed messages between the United States and the EU, the African CDC, or other credible voices. When moms and dads are trying to figure out who to listen to, it complicates that decision if there’s four different answers to one question. And so what I would ask each of you to help with, and what our office is particularly pledged to do, is to partner with those who are willing so that we have consistent credible communication that families, employers, government officials, and others can turn to when they’re trying to make an informed decision. But that will take a partnership across not just the U.S. government, but around the world.
WEN: Sure. Misinformation/disinformation has had a very significant toll, so thank you for also addressing that point.
Lester, people may not always think of the DOD and the—in terms of the work with global health, but there’s a lot that the DOD does. And can you give us some examples of that?
MARTINEZ-LOPEZ: Well, typically when you think of lab work around the world, you think of CDC. But we do have a network of labs around the world. They’re doing research for the Department of Defense. Our main concern is that the health of our servicemembers is kept, right? So they’re going to be exposed to many things—malaria, dengue—and in response to that the Department of Defense for many, many years—hundreds of years, right, so—has been involved into—from Walter Reed Grugorgaz (ph) on yellow fever, to right now in the world all the drugs—I don’t know if it still is true—all the drugs against malaria, all but two were DOD discoveries. Of HIV work, the same things, a seminal work, because we are concerned for our servicemembers. We’re looking for solution sets for them.
But when we find those solution sets, we don’t keep it to ourselves; we give it to the world, right? So health security for the forces of the United States translate into health security for the people of the world, if you think about that. And that’s kind of how we deal with investment.
On top of that, you know, we—I’ll give you another example, When PEPFAR came about, the first site PEPFAR deployed was Kericho, Kenya. And it was Kericho, Kenya, because we had a lab in Kericho, Kenya, dealing with HIV. We were working the vaccine, trying to set up a place where we could test that vaccine, and we had the whole infrastructure to be able to deploy PEPFAR right on the spot. So we were taking care of the population, we were doing all that, so we partnered and we made it happen. Still today, we are in Africa link up with the other military ministers of defense, and we’re taking care of that part of the PEPFAR exercise.
And around the world, I mean, PEPFAR is not just—it’s one of many examples of how the Department of Defense engage in diplomacy, engage in the actual development of security measures that are deliverable to the world. And that we are very proud of and we take extremely serious.
I have personally been in Kenya. I’ve been—personally been in Peru. I’ve personally been in Thailand. I’ve seen those labs. And if you want to see missionaries, go visit with those people that are serving the Department of Defense that you would never dream of, and they’re doing God’s work. And true, even though they work for the Department of Defense, even though those solutions are geared to take care of the servicemembers, they know that they’re also doing it for the world. And by doing that, we win-win.
The other part on the Department of Defense probably you remember from COVID. We’re very good at logistic(s). We’ve very good at, you know, developing science. We’re very good at those kind—developing products. By the way, I brag one of the first mRNA applications of the vaccine, I was the commander of Fort Detrick in those days. We funded the Navy to start developing an mRNA vaccine against malaria. Didn’t pan out, but that was one of the seminal works to start working that platform, again, as a—as a vaccine platform.
So I guess I’m bragging a little bit. I need to brag because I’m extremely proud of the work the department does on behalf not just of the servicemembers that we’re bound to serve, but also on behalf of the world. So those are—I hope that that sprinkle of example gives an idea to why we’re in the game and what do—what do we do for a living.
WEN: Absolutely. The examples, I think, are illustrative and help us to gain a better understanding.
Loyce, can you talk to us about how HHS coordinates the various needs associated with vast and complex agendas of multilateral health bodies like the WHO?
PACE: Sure. Well, I mentioned in passing some of the negotiations taking place at WHO, like with the Pandemic Accord or Agreement, international agreement, and these international health regulations, and how we want to improve those.
Look, I think you and Paul were talking at the beginning about the lessons we’ve learned from COVID, and there were some bright spots, obviously. There, you know, was scientific cooperation. There was global surveillance. Those things, you know, did work in large part. And yet, there is a sense of failure around the world with regards to the access that they had to those innovations, the very innovations that Lester was just talking about, right? So it’s great that we can celebrate these things, and yet where did they go, and how were they used, and how did they help not just people around the world but Americans because of how they were distributed?
When we think about access to these innovations, of course it’s the right thing to do but it’s also the smart thing to do. We know that there were various variants that popped up around the world, and in large part because we weren’t able to vaccinate in time to keep up with the evolutionary emergence of those variants. And so I just—I still remember, you know, being on the COVID board end of 2020 and really being doggedly focused on how we could push for access from day one in this administration. And it’s still a feather in our cap to have distributed the vaccines that we did, again, as a U.S. government around the world. And we know that it wasn’t enough for the U.S. to do that alone in the way that we did, and while other countries pitched in there was still more that needed to happen for us to really get ahead or stay ahead of the virus.
And so that’s a big lesson learned that we’re trying to apply in these negotiations. And importantly, it’s really going to take all of us and not just the USG getting ready to either share or spend or otherwise help with scaling, but other countries coming to the table, too—which they are, which is—which is a good thing.
The last thing, though, I’ll say about that is it’s not just about charity. And that’s just really and important point for us to keep in mind, and that’s constantly driven home in our discussions. You know, countries’ governments themselves really want to be providing for their citizens in ways that they feel are meaningful and effective and aren’t reliant on donations, right, because it’s not necessarily the case that those will come through all of the time. And so it’s one of the reasons why we’re also really focused on ways that we can assist with manufacturing, otherwise providing technical assistance it not investments.
And so I’m sure others have talked about that throughout the day. You know, obviously, there are ways that HHS and our various agencies are able to work with other parts of USG to help make that happen, but the bottom line is it’s not a—it’s not a zero-sum game, right? It’s not we help us or we help them. We really have to keep in mind that our fates are inextricably linked and there’s really no health security without health equity. It’s not a nice thing to have, right? It’s not a nice thing to do. It’s essential to our work. And I think you’ve heard everyone from the president on down really make that case.
WEN: So the final question for all of our panelists—and, Loyce, I’m going to start with you and go backwards through our panel this time. And the final question is: Now that we have heard so much about what different agencies do and examples of what’s worked, can you—can you help us to look forward and say how can we better integrate health into foreign policy goals and structures, and vice versa? And what more can be done to promote interagency collaboration? Loyce?
PACE: I think remembering my role here is something that I start with every day. And I just really want to applaud and thank my colleagues, the ones I can see but even the ones that I can’t, who I think every day show up and say, look, what good do we want to be and do in the world, and how, and who can I show up with to make that happen.
I think that’s probably my answer to the second question, too, right? There’s, you know, a little bit of angst and anxiety about the fusion of foreign policy and health in some circles, right? There are some purists out there in the health space who say, oh my goodness, we don’t want to politicize what we do. And yet, of course, that is—that is often the case, and yet we want to take the good, right, and we want to ensure that we’re able to elevate the work that we do. There’s so much work to be done and there’s so much to go around, and I’d love help, frankly. So—(laughs)—I think that keeping that in mind is a way that we can move forward.
WEN: Thank you so much.
And, Mandy, to you next.
COHEN: Sure. Well, I’ll talk about the work I think we are doing at CDC first to be better integrated as one CDC team. Oftentimes, we have experts in TB or malaria or infectious—you know, respiratory diseases, or Ebola. And we need to make sure that we can bring that expertise together and speak with one voice so that when we are interacting with a country and understanding their needs, they don’t have to wade through the bureaucracy of either CDC or the USG. And so we are doing some important work within CDC both to make sure we have the support we need at the country level but to integrate as one team, and I think that we need to go beyond just—as I was mentioning before, beyond just sharing information across what each of us are doing in the government to actually planning together; to say here’s what we’re going to do here, so either we have shared expertise in this place so we’ll do it in different geographies, or to say we have different expertise and here’s how we have to layer these together, because it does take all of these different kinds of discipline in order to be truly good partners on the ground to some of our folks.
So I think there’s some work we, CDC, are doing internally. Some work, I think, needs to be done across USG, again, to be better partners and be more integrated.
WEN: Thank you.
I’ll turn to you next.
BOURI: Sure. Thanks.
So I would say especially for USAID’s perspective as a(n) agency that looks at health as part of our broader development priorities, investments in health don’t just pay dividends for health, I mean, and that’s because they pay dividends for human development. Essentially, when we invest in people not just to ensure that they’re healthy, those are also people who can go on to be contributing members of their economies. In areas that might have some element of fragility, it’s essentially assuring that people have access to the most basic needs. And so we do see very clear ties in every part of the world to the health and wellbeing of people to the broader health and wellbeing of communities.
And I think for that reason, we really look at how we leverage our investments, particularly in an increasingly challenging resource environment, where while we have immense resources at USAID, they’re, of course—like all of our interagency partners, they’re limited. And so I think to speak to some of the points that were made earlier, we really are trying to be quite thoughtful about where USAID’s comparative advantage can go the furthest, and a lot of that is aligning our resources to invest in certain areas that complement part of a holistic U.S. government approach so that we collectively can make more impact with the investments we make. But it also speaks to the way that we are refreshing how we’re looking at partnerships that go well beyond the U.S. government, and there are all types of resources that go well beyond financial that other partners really bring to the table. And I think particularly as we look at a development agenda in the next five to ten years—not even looking, you know, so much beyond that—ensuring that that agenda is set by the partners who we are trying to support, that we are being responsive to that, and that we are helping not just innovate but bring innovations to scale and bringing different types of interventions to scale in a way that address health needs before they become real challenges for communities.
WEN: Thank you.
MARTINEZ-LOPEZ: I think to achieve global health security—(inaudible)—it takes a village. The good ideas not necessarily will come from the States; they may come from abroad. We need to be minding and be understanding of that so we’re ready to accept those ideas and incorporate them into this, the set that is going to give us a solution set to take care of our patients, right? That’s how I approach this.
We have a lot of international agreements in biosurveillance, by the way. We have a big—all health-care systems have to have a surveillance system. That’s key to delivering health care. That’s not unique to the CDC. We have our own. The question is, do we link up right?
And an example of idea how do we link up, airplanes are going all over the world, and if they come with a respiratory infection we swab them year round, thousands and thousands of those samples, and test them to see if there is a flu. And those data are fed to the CDC, and the CDC then use that datapoint—those datapoints to figure out what will be the next year flu vaccine makeup, right?
So we need to really leverage what we all bring to the question, whether it’s research, whether it’s surveillance, whether it’s care, whether it’s new solution sets. Doesn’t care—it doesn’t matter. It could be from here. It could be from abroad. Quite often we think we’re giving. No. We need to think we’re also taking. So what—if we go and do close surveillance to a country, we share with them and they share with us. And then we share with the international community and we share with the government of the United States, with the CDC and everything else. We don’t just keep it to ourselves and go—that would be absolutely crazy because it work against what we’re trying to achieve when it comes to security. So I think there—as long as we understand that we don’t own all, that we’re not the smartest kids in the block, that there is a lot of other smart kids around, I think we’ll have a better chance to succeed.
WEN: Thank you.
And, Paul, you have the last word.
FRIEDRICHS: Well, thank you. And again, I’ll just say thanks to the Council for Foreign Relations and—Council on Foreign Relations and to Ambassador Nkengasong for putting this together. And I’ll end with a couple of thoughts.
First, 1918, the worst pandemic in nearly a millennia began right here in the United States. So when we talk about giving and receiving, that was a case in which we gave in a way that we would hope we would never do again. (Laughter.) And we learned from those overseas in how to mitigate the impacts of that pandemic. If you look at what happened after that pandemic, there were people who committed the rest of their lives to trying to leverage the lessons learned from that pandemic. The whole field of virology grew out of that pandemic because of the disagreements within the medical and the political community over what caused that pandemic. And people spent decades trying to learn from that, partnering around the world, sharing data so that we could understand that it was not just bacteria that existed in the world around us, but there were also viruses, and if you wanted to mitigate a biological threat you had to be prepared for both.
So the challenge for all of us in this room is how do we make that same commitment that our predecessors did a hundred years ago to partner to continue to look for the answers that will come out of this pandemic, to partner with those around the world who are looking at this and seeking to learn from it so that collectively twenty years from now we can look back on this and say, as horrific as the COVID pandemic was, it opened the door to great discoveries that have profoundly improved our ability to protect the health of people around the world? To Loyce’s point about equity, this can’t just be about people in New York or in New Orleans; it’s got to be about people in every country, in every village around the world, because all of us who work in this space understand that the next outbreak can happen anywhere, including here. And so whatever advances we make have to be advances that we are willing to share and that we then test and refine with our partners around the world.
And the last thought that I’ll leave with you is the one that I said before. The most powerful thing that we can do is recommit to regaining the trust of people around the world. Whatever else people do, that’s their business. But those of us who have committed to global health security, those of us who have spent our careers trying to help those when they needed health care or when they wanted to preserve the health of their unborn child or of their grandparent know that the great value that we bring is credible consistent communication that informs the decision that a mother makes about what to do for her child, that a son makes about what to do for his parent, that an employer makes about what to do for their workforce. We can no longer allow ourselves to be divided by those who want to pick apart our answers. We really have the opportunity to recommit that the greatest good to national security and to global health security is to speak with one voice about what we know and what we don’t know.
WEN: Thank you so much. And I hope that you will all join me in thanking our distinguished panelists and CFR—(applause)—as we welcome—(laughs)—thank you.
We’re thrilled to now welcome Ambassador John Nkengasong for your closing remarks. Thank you.
NKENGASONG: Thank you.
What a symposium. What a fascinating symposium. And I will try not to summarize the symposium, and I think that will be tasking myself in a manner that is not acceptable. I think we’ve all heard a lively and engaging conversation. We started off with a promise that this was going to be rich and this was going to be valuable, and I’m sure it has been rich, it has been valuable.
When Secretary Blinken launched the bureau on August the first, he said something he has said many times. He said global health security is national security. Global health security is national security. And he stated—he charged us with three goals. One was to elevate global health security as part of foreign policy. Second, to coordinate by leading with diplomacy all our assets. And lastly, to leverage our assets as much as possible. We’ve heard today in a remarkable way how that has all come to alignment.
Let me repeat some of what or share what I thought I heard today.
I heard the power of partnerships, partnerships all across the board, the need to coordinate our efforts. And that brings me to what Paul just said a few minutes ago. And thanks. Maybe you heard me saying, Paul, that he was coming in from the other side. Paul, in your words, you said, “we will fail if we continue to speak with mixed messages.” End of quote. I think that summarizes this meeting.
Secretary Blinken the other day raised a thinking or a concept called diplomacy variable geometry, which essentially says in this critical period where we face multiple challenges we need to identify what the problem is, identify the right partnerships in form and shape, and try to use that in solving the problem. Which means we must coordinate our efforts, cooperate, collaborate, and communicate. We’ve heard a lot about communication, including AI; the use of data diplomacy so that it’s evidence-based.
We’ve heard about partnership with the private sector and foundations. The panel that was moderated by Dr. Edem brought that to the fore. We heard from Professor Oramah how the bank in Africa leveraged about $2 billion in supporting health security threat.
So I will not try to, again, go past that, but rather to say that there are five things that the bureau will try to do.
One is to finish the fight against HIV-AIDS, which is to get PEPFAR reauthorized. And you heard those voices loud and clear, including and starting with Dr. Fauci.
Second is to make sure that we transform the structures that were put in place during the COVID response, the foreign ministry platform—(inaudible)—into global health security platform.
Thirdly is to ensure that we coordinate to move the coordination in the spirit of global health variable diplomacy, which is coordination and cooperation.
Fourthly, to strengthen the global health security architecture, including the Pandemic Fund—the Pandemic Fund, which I have been honored to join the board now representing the State Department—and the Pandemic Accord.
And lastly, global health diplomacy.
I think when we see what happened with the Ebola outbreak or the Marbug outbreak in Equatorial Guinea, it brought home the whole concept of what we are trying to do here, which is essentially get the State Department, the embassies that are out there in the field, to lead where we have the gaps and bring all the agencies together. Equatorial Guinea set that example where there was no agency—U.S. agency in the country. The U.S. ambassador there was outstanding—engaged with the government of the country, engaged with WHO, and—(inaudible)—everybody else to come in from the U.S. side to leverage their resources. That’s what we will continue to see in—with disease outbreaks and health security. We just don’t know when the next outbreak will happen.
We always thought that a disease threat would emerge from maybe the jungle of DRC or Cameroon and then spread all over the world. This time around, those viruses came from the airports and spread into remote areas. So we just don’t know what—where that threat will come from.
So with all of that, I just want to thank a couple of people.
The staff—the Global Health Security Bureau staff that have been working very, very hard, I would like them to stand up, please, if you can, George and all of you who have been—Hillary, if you are here, please stand up and be acknowledged. (Applause.) Please. George is here. He’s hiding behind you.
CFR, thank you for your partnership. If they are still here, if—yeah, OK. (Laughs.) Thank you so much for feeding us. Lovely food.
And those who have traveled far—I mean, I can see our colleague from the Pasteur Institute here, Dr. Sall; the Africa CDC delegation is here; Dr. Edem from the AfroChampions, and others who have truly traveled far from—and Peter, Peter Hotez, thank you. We met at—in Chicago, and I—over dinner, and I said: Peter, please, you really have to come and tell your story. And thank you for coming all the way. And many others.
So let me just also acknowledge our agencies, the different agencies that were on the last panel. Without them, we would probably not have or truly not have global health security coordination within the U.S. government. So thank you all for being willing to work with all of us.
We will use the comments that you’ve provided to complete a five-year strategic plan, which we’ll make public—a five-year strategic plan for the bureau which will capture all the suggestions, the wisdom that you’ve all imparted on all of us.
So let me then wish you safe travels. Those who have traveled far or those who just drove across the street, thank you so much. And this will be an annual event that the secretary himself—who actually wanted to be here today, but because of many things happening in the world he just has not been able to attend. So thank you all. (Applause.)