For the world to prevent the next crisis, the Independent Panel for Pandemic Preparedness and Response recommends a more independent World Health Organization, a new council that would maintain a political commitment to pandemic preparedness and response, and a financing facility that can disburse $50-$100 billion at short notice.
WHO Director-General Tedros Adhanom Ghebreyesus announced the establishment of the panel in May 2020, in response to a World Health Assembly resolution that called for an "independent, impartial, and comprehensive review" of the COVID-19 response and is expected to provide lessons learned and recommendations on how the world can be better prepared for the next crisis.
The panel — composed of prominent co-chairs, and its members include former government officials, aid organization leaders, economists, and health experts — is expected to draw a blueprint for how the world can be better prepared for the next crisis.
“The shelves of storage rooms in the U.N. and national capitals are full of reports and reviews of previous health crises. Had their warnings been heeded, we would have avoided the catastrophe we are in today. This time must be different,” said Ellen Johnson Sirleaf, panel co-chair and former president of Liberia, in a news release.
While the report identifies shortcomings and failures in the COVID-19 response, it stops short of holding accountable any government, organization, or individual said Georgetown University professor and global health law expert Lawrence Gostin.
“The Panel fails to call out bad actors like China, perpetuating the dysfunctional WHO tradition of diplomacy over frankness, transparency and accountability,” he said in a statement shared with Devex.
“If we see this as the Chernobyl moment of global health … then we see ... WHO needs the kinds of powers that we’re spelling out.”— Helen Clark, former prime minister of New Zealand
The panel had a mix of recommendations, from the immediate to the long-term. Immediate recommendations, which it hopes to take place in the coming months, focused on getting COVID-19 vaccine access to low- and middle-income countries. Its long-term recommendations meanwhile will require negotiations among countries.
A deadline on waiving IP rights
Countries should also adopt a Pandemic Framework Convention in the next six months that clarifies the responsibilities of states and international organizations during a crisis, and that could also include provisions on funding research and development and technology transfers. One of the recommendations of the panel is to ensure that agreements, where public funding is invested in R&D, should include provisions for technology transfers and commitments to voluntary licensing.
IP protections have been the subject of debate during the coronavirus pandemic. Country leaders, faith groups, and members of civil society have called for the suspension of intellectual property to help boost COVID-19 vaccine production and address vaccine inequities.
The independent panel recommends that high-income countries provide at least 1 billion doses of coronavirus vaccines to the 92 LMICs under the COVAX Advance Market Commitment by September. It also said the G-7 should commit to cover 60% of the Access to COVID-19 Tools Accelerator’s $19 billion financing gap for 2021.
But it also recommends that intellectual property rights be waived if major vaccine-producing countries and manufacturers fail to agree on voluntary licensing and the transfer of vaccine technology within three months.
The recent U.S. announcement that supports waiving intellectual property protections under the TRIPS waiver was important, but negotiations can take time, said panel co-chair Helen Clark, former prime minister of New Zealand, in a media briefing prior to the report’s launch on Wednesday.
“We say that if such an agreement can't be hammered out within three months then the TRIPS waiver should apply immediately. But of course the TRIPS waiver also then needs companies to collaborate in handing over the IP that they have,” Clark said.
A new council and pandemic financing facility
The world should establish a Global Threats Council “that will maintain political commitment to pandemic preparedness and response and hold actors accountable, including through peer recognition and scrutiny,” according to the panel report. It should have both state and non-state actors as members, with equal regional, gender, and generational representation.
The council could be in charge of allocating and monitoring funds from the panel’s proposed International Pandemic Financing Facility, envisioned to mobilize $5 billion to $10 billion per year to support pandemic preparedness efforts for a period of 10-15 years. Funding for the facility is to be based on an “ability-to-pay” formula, where wealthier nations pay the most and preferably in addition to their official development assistance.
Investing billions of dollars in preparedness would save the world trillions of dollars in the future, Clark said. According to the news release, the world already lost $7 trillion gross domestic product in 2020 and has had “devastating social and financial consequences” for disadvantaged populations.
A stronger WHO
The world should establish a new alert and surveillance system that allows WHO to publish information on outbreaks immediately without countries’ approval, and dispatch experts to investigate at short notice, according to the report. WHO should also take a more precautionary approach in advising countries on the nature and level of risk of an outbreak, especially with respiratory infections.
A proposed treaty is meant to tackle challenges exposed by the COVID-19 pandemic. But what exactly will be in the final framework is up to member state negotiations.
These will require changes to the International Health Regulations, which according to the report is a “conservative instrument” that serves to “constrain rather than facilitate rapid action.” Member states will need to negotiate and approve those changes. But if member states want WHO to be able to do its job, then they need to empower the U.N. agency, Clark said.
“It needs more powers. If we see this as the Chernobyl moment of global health, and then relate it to the new powers that the International Atomic Energy Agency got at the time of that nuclear safety disaster, then we see ... WHO needs the kinds of powers that we’re spelling out,” she said, adding that the challenge for member states is whether they will agree to empower WHO “just as in the dying days of the Cold War,” when they agreed to empower the IAEA.
In retracing what happened in the early days and months of the outbreak, the panel’s chronology of events showed it took more than a week from when doctors in Wuhan became suspicious of atypical pneumonia cases, and a series of repeated requests for information, before WHO received confirmation from China on the cases.
But while there were “clearly delays in China,” there were “delays everywhere,” Clark said.
WHO could have declared COVID-19 a public health emergency of international concern on Jan. 22, 2020, instead of on Jan. 30, 2020. Countries’ inaction in February 2020 after the declaration of a PHEIC was also a “lost month.” They could have taken more steps then to contain the spread of the virus.
But WHO’s actions, including its cautionary approach to confirming human-to-human transmission of the SARS-CoV-2 virus, which causes COVID-19, and advise against the imposition of travel restrictions, were guided by the IHR, according to the panel.
“If travel restrictions have been imposed more quickly, more widely, again, that would have been a serious inhibition on the rapid transmission of the disease, and that remains the same today,” said Clark, adding that some countries dependent on tourism that opened up their borders ended up with another wave of disease transmission.
The IHR discourages unnecessary “restrictions on travel,” but Clark said that requires a rethink.
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“We have to realize that we're living in [the] 21st century [and] not in medieval times. In medieval times, a disease traveled on foot and by donkey,” she said.
WHO’s funding model also needs a transformation. The panel recommends member states increase their dues to the organization to cover two-thirds of WHO’s base program budget. At present, the U.N. agency relies heavily on earmarked voluntary contributions, affecting its programs and its ability to keep and attract talent. It also proposes the WHO director-general position be limited to a single term expanded to seven years but with no option for re-election.
Sirleaf however said the recommendation is not about the current WHO chief’s “performance or lack of independence, but the nature of the work of WHO, an evidence-based organization, means that there must be no doubt about [its] independence and an election process is by nature always political.”
The panel expects the recommendation if adopted by member states, to take place after the current WHO leader’s term, which is set to end next year.