A world in disorder

| September 16, 2020

COVID-19 has taken advantage of a world in disorder, causing catastrophic health, social, and economic consequences and irreparable harm to humanity. The virus has killed close to a million people and many more may die as a result of its impact on health systems, food supplies, and the economy. The financial cost will be in the trillions.

This will not be the last global health emergency. The world simply cannot afford to be unprepared again, warns the Global Preparedness Monitoring Board (GPMB) in its second report ‘A World in Disorder’, released today.

Last year, the GPMB warned that the world was unprepared for the very real likelihood of a deadly pandemic spreading around the globe, killing millions of people, disrupting economies, and destabilizing national security. The Board called for urgent action to break the cycle of panic and neglect that has characterized the response to global health crises in the past.

In its new report, the GPMB provides a harsh assessment of the global COVID-19 response, calling it “a collective failure to take pandemic prevention, preparedness, and response seriously and prioritize it accordingly.” In many countries, leaders have struggled to take early decisive action based on science, evidence and best practice. This lack of accountability by leaders has led to a profound and deepening deficit in trust that is hampering response efforts.

“Transparency and accountability are essential in responding to the COVID-19 pandemic,” said Elhadj As Sy, co-Chair of the GPMB. “Trust is the foundation of government-community relationships for better health but that trust dissipates when governments and leaders do not deliver on their commitments.”

Responsible leadership and good citizenship have been key determinants of COVID-19’s impact, the report finds–systems are only as effective as the people who use them.

The report also finds that, while COVID-19 has demonstrated that the world is deeply interconnected through economics, trade, information, and travel, one of the greatest challenges of the pandemic has been faltering multilateral cooperation. Leadership by the G7, G20, and multilateral organizations has been hampered by geopolitical tensions.

The Board calls on leaders to renew their commitment to the multilateral system and strengthen WHO as an impartial and independent international organization. Weakening and undermining the multilateral action will have serious consequences on global health security, it warns. No-one is safe until all are safe.

“Viruses don’t respect borders. The only way out of this devastating pandemic is along the path of collective action, which demands a strong and effective multilateral system,” said H.E. Dr. Gro Harlem Brundtland, co-chair of the GPMB. “The UN system, which includes the WHO, was created after World War II and has helped make the world a better place for billions of people. It needs to be defended, strengthened, and revitalized, not attacked and undermined.”

The report highlights how the devastating social and economic impact of pandemics, especially for the vulnerable and disadvantaged, is often underestimated and ignored. COVID-19’s long-term socioeconomic impacts are predicted to last for decades, with the World Bank’s conservative scenario estimating a US$ 10 trillion earning loss over time for the younger generation as a result of pandemic-related educational deficits.

COVID-19 has demonstrated the importance of protecting lives and livelihoods and widening our understanding of preparedness to make education, social, and economic sectors ‘pandemic proof.’ ‘A World in Disorder’ reveals that the return on investment for pandemic preparedness is immense. It would take 500 years to spend as much on preparedness as the world is currently losing due to COVID-19.

“The pandemic has shown the fragility of not only our health systems, but also our global economy. The impact of COVID-19 has been huge in the world and particularly in my region, the Americas, with a sharp increase in health, social and economic inequities”, said Jeannette Vega, GPMB member and Chief Medical Innovation and Technology Officer, La Red de Salud UC-Christus, Chile. “Let’s hope that this time we finally learn the lesson and invest in preparedness and public goods for health to avoid similar tragedies in the future.”

The report highlights the actions that must be taken to end the COVID-19 pandemic and avoid the next catastrophe – to bring order out of chaos. It calls for responsible leadership, engaged citizenship, strong and agile systems for health security, sustained investment, and robust global governance for preparedness.

‘A World in Disorder’ identifies the specific commitments and actions leaders and citizens must take — boldly, decisively, and immediately. These include sustainable and predictable financing for global and national health security, and a call to hold a UN Summit on Global Health Security to develop an international framework for health emergency preparedness and response.

“We can no longer wring our hands and say something must be done. It’s time for countries to get their hands dirty and build the public health systems to ensure a pandemic of this magnitude and severity never happens again“, said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This will not be the last pandemic, nor the last global health emergency. But with the right political and financial investments now, we can prevent and mitigate future pandemics and protect our future and the future of generations to come.”

A World at Risk

The first GPMB Report, ‘A World at Risk’, released in September 2019, warned of the threat of a pandemic of a respiratory pathogen that could kill millions and wipe out 5% of the world’s economy, creating widespread havoc, instability and insecurity. The Board issued a stern warning of the danger of perpetuating the cycle of panic and neglect and called for urgent action to strengthen pandemic preparedness.

‘A World in Disorder’ builds on the first report, and on lessons learned from COVID-19. Its main conclusions are:

· The cycle of panic and neglect has had catastrophic health, social, economic and political consequences, especially for the vulnerable and disadvantaged.

· Systems are only as effective as the people who use them — responsible political leadership and good citizenship have been significant determinants of COVID-19’s impact.

· The return on investment in pandemic preparedness is immense. Sustainable and predictable financing at scale for systems of preparedness is urgently needed.

· No-one is safe until all are safe. Efforts to weaken and undermine the multilateral system will have serious consequences for global health security.

In ‘A World in Disorder’ the GPMB calls for:

1. Responsible leadership

· National leaders and leaders of international organizations and other stakeholders take early decisive action based on science, evidence, and best practice when confronted with health emergencies. They must discourage the politicization of measures to protect public health, ensure social protection, and promote national unity and global solidarity.

· Heads of government appoint a national high-level coordinator with the authority and political accountability to lead whole-of-government and whole-of-society approaches, and routinely conduct multisectoral simulation exercises to establish and maintain effective preparedness.

· National leaders, manufacturers, and international organizations ensure that COVID-19 vaccines and other countermeasures are allocated in a way that will have the most impact in stopping the pandemic, that access is fair and equitable and not based on ability to pay, with healthcare workers and the most vulnerable having priority access. Each country should get an initial allocation of vaccine sufficient to cover at least 2% of its population, to cover frontline healthcare workers.

2. Engaged citizenship

· Citizens demand accountability from their governments for health emergency preparedness, which requires that governments empower their citizens and strengthen civil society.

· Every individual takes responsibility for seeking and using accurate information to educate themselves, their families and their communities. They adopt health-promoting behaviours and take actions to protect the most vulnerable. They advocate for these actions within their communities.

3. Strong and agile national and global systems for global health security

· Heads of government strengthen national systems for preparedness; identifying, predicting and detecting the emergence of pathogens with pandemic potential based on a ‘One Health’ approach that integrates animal and human health; building core public health capacities and workforce for surveillance, early detection and sharing of information on outbreaks and similar events; strengthening health systems based on universal health coverage with surge capacity for clinical and supportive services; and putting in place systems of social protection to safeguard the vulnerable, leaving no-one behind.

· Researchers, research institutions, research funders, the private sector, governments, the World Health Organization and international organizations improve coordination and support for research and development in health emergencies and establish a sustainable mechanism to ensure rapid development, early availability, effective and equitable access to novel vaccines, therapeutics, diagnostics and non-pharmaceutical interventions for health emergencies, including capacity for testing, scaled manufacturing, and distribution.

· Heads of government renew their commitment to the multilateral system, and strengthen WHO as an impartial and independent international organization responsible for directing and coordinating pandemic preparedness and response.

4. Sustained investment in prevention and preparedness, commensurate with the scale of a pandemic threat

· G20 leaders ensure that adequate finance is made available now to mitigate the current and future economic and socioeconomic consequences of the pandemic.

· Heads of government protect and sustain the financing of their national capacities for health emergency preparedness and response developed for COVID-19, beyond the current pandemic.

· The United Nations, the World Health Organization, and the International Financing Institutions (IFI) develop a mechanism for sustainable financing of global health security, which mobilises resources on the scale and within the timeframe required, is not reliant on development assistance, recognizes preparedness as a global common good, and is not at the mercy of political and economic cycles.

· The World Bank and other International Financial Institutions make R&D investments eligible for IFI financing and develop mechanisms to provide financing for global R&D for health emergencies.

5. Robust global governance of preparedness for health emergencies

· State Parties to the IHR, or the Director-General, propose amendments of the IHR to the World Health Assembly, to include: strengthening early notification and comprehensive information sharing; intermediate grading of health emergencies; development of evidence-based recommendations on the role of domestic and international travel and trade recommendations; and mechanisms for assessing IHR compliance and core capacity implementation, including a universal, periodic, objective, and external review mechanism.

· National leaders, the World Health Organization, the United Nations and other international organizations develop predictive mechanisms for assessing multisectoral preparedness, including simulations and exercises that test and demonstrate the capacity and agility of health emergency preparedness systems, and their functioning within societies.

· The Secretary-General of the United Nations, the Director-General of the World Health Organization, and the heads of International Financing Institutions convene a UN Summit on Global Health Security, with the aim of agreeing on an international framework for health emergency preparedness and response, incorporating the International Health Regulations, and including mechanisms for sustainable financing, research and development, social protection, equitable access to countermeasures for all, and mutual accountability

About the GPMB

The GPMB is an independent monitoring and accountability body to ensure preparedness for global health crises. The Board monitors and reports on the state of global preparedness across all sectors and stakeholders, including the UN system, government, nongovernmental organizations and the private sector.

Created in response to recommendations of the UN Secretary General’s Global Health Crises Task Force in 2017, the GPMB was co-convened by the World Health Organization and the World Bank Group and formally launched in May 2018.