Aug 21Featured ArticleIssue

The last pandemic

Can reform of pandemic prevention and response systems prevent the next pandemic? The Independent Panel or Pandemic Preparedness and Response has called on the global community to end the COVID-19 pandemic and adopt a series of bold and essential reforms to prevent the next crisis

Recently, a global panel of leading experts called to end the COVID-19 pandemic by immediately implementing
a series of bold recommendations to redistribute, fund, and increase the availability of and manufacturing
capacity for vaccines, and to apply proven public health measures urgently and consistently in every country.
“Our message is simple and clear: the current system failed to protect us from the COVID-19 pandemic. And if
we do not act to change it now, it will not protect us from the next pandemic threat, which could happen at any time,” panel Co-Chair and former President Ellen Johnson Sirleaf stressed.

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“The shelves of storage rooms in the UN 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,” she added.

The Panel
The Independent Panel for Pandemic Preparedness and Response (The Independent Panel) was appointed
by the World Health Organization (WHO) Director-General in response to a World Health Assembly resolution,
73.1 issued in May 2020, calling for an independent, impartial, and comprehensive review of experiences
gained and lessons to be learned from the current pandemic. They were also asked to provide recommendations to improve capacity for global pandemic prevention, preparedness, and response.

The Panel released its findings and recommendations in its main report: COVID-19: Make it the Last Pandemic
which was released in May 2021. The Panel, co-chaired by the Rt Hon Helen Clark, former Prime Minister of
New Zealand, and Her Excellency Ellen Johnson Sirleaf, former President of Liberia, has spent the past eight months rigorously reviewing the evidence on how a disease outbreak became a pandemic, and on global and national responses.

The Independent Panel has a total of 13 members, selected by the Co-Chairs. The Panelists have a substantial mix of skills and expertise in infectious disease, global and national health policy and financing, outbreaks
and emergencies, economics, youth advocacy, and the wellbeing of women and girls. They also share knowledge of the international system, including of WHO, and experience from similar international processes.

The mission of the Independent Panel is to provide an evidence-based path for the future, grounded in lessons of the present and the past to ensure countries and global institutions, including specifically WHO, effectively address health threats. They have spent the last eight months independently, impartially, and rigorously reviewing evidence of the spread, actions, and responses to the COVID-19 pandemic. They have
conducted numerous literature reviews, original research and have learned from dozens of experts in roundtable
discussions and in-depth interviews.

The Panel has also heard directly from people working on the front-line of the pandemic in town-hall-style meetings and has invited contributions from anyone wishing to make one.

Failure to Respond
The report demonstrates that the current system—at both national and international levels— was not adequate
to protect people from COVID-19. The time it took from the reporting of a cluster of cases of pneumonia of
unknown origin in mid-late December 2019 to a Public Health Emergency of International Concern being declared was too long. February 2020 was also a lost month when many more countries could have taken steps to contain the spread of SARS-CoV-2 and forestall the global health, the social, and economic catastrophe that continues its grip.

The Panel found that the system as it stands now is unfit to prevent another novel and highly infectious pathogen, which could emerge at any time, from developing into a pandemic. “A key finding of the Panel is
that accountability for pandemic preparedness and response has been lacking across the system. National
governments are the primary duty bearer in pandemic response, and the lack of accountability has been
accompanied by a failure to learn from mistakes and take up the opportunity for learning between countries,” the
report said.

Key Recommendations
As the COVID-19 pandemic continues to devastate communities across the world, the Independent Panel is making a series of immediate recommendations to halt its spread. It recommends that: High-income countries with a vaccine pipeline for adequate coverage should, alongside their scale-up, commit to provide to the 92 low and middle income countries in the COVAX Gavi Advance Market Commitment with at least one billion vaccine doses by September 2021.

Major vaccine-producing countries and manufacturers should convene, under the joint auspices of the WHO
and the World Trade Organization (WTO) to agree to voluntary licensing and technology transfer. If actions on
this don’t occur within three months, a waiver of intellectual property rights under the Agreement on Trade-Related Aspects of Intellectual Property Rights should come into force immediately. The G7 should immediately commit to providing 60 per cent of the $19 billion required for the Access to COVID-19 Tools Accelerator (ACT-A) in 2021 for vaccines, diagnostics, therapeutics, and strengthening of health systems, and a burden-sharing formula should be adopted to fund such global public goods on an ongoing basis.

Every country should apply proven public health measures at the scale required to curb the pandemic.
Leadership from heads of state and government to achieve this is crucial. “Given the scale of devastation from
this pandemic and its continuing impact on people across the globe, the Panel resolved to document fully what
happened and why, and to make bold recommendations for change,” Panel Co-Chair Rt Hon. Helen Clark, said.

“The tools are available to put an end to the severe illnesses, deaths, and socioeconomic damage caused by COVID-19. Leaders have no choice but to act and stop this happening again,” she added. The report also shared recommendations for individual countries, including that heads of state and government should
appoint national pandemic coordinators who are accountable to them, and who have a mandate to drive whole-of government coordination for pandemic preparedness and response.

The Panel also released the report and recommendations together, with a range of background papers which
include the authoritative chronology of what happened. This is the culmination of multiple literature reviews, original research, discussions with experts in round tables and in-depth interviews, and dialogue with those working on the front-line, with women and youth in town hall-style meetings. It also received online contributions to its work.

The Panel has consistently raised its deep concern that the burden of the current pandemic is being unevenly
shared. It has had devastating social and financial consequences for those already disadvantaged. Up to 125
million more people are estimated to have been pushed into extreme poverty, while 72 million more primary
school-age children are now at risk of being unable to read or understand a simple text because of school closures.

Women have borne a disproportionate burden. Gender-based violence is at record levels, and child marriages have increased. In addition, the world lost $7 trillion in GDP in 2020 – more than the 2019 GDP of the entire African continent ($6.7 trillion). The pandemic has caused the deepest shock to the
global economy since World War II.

Prevention Strategies
The world must also urgently prepare to prevent a future outbreak from becoming a pandemic. To this end,
the Independent Panel calls for the engagement of heads of state and government to lead efforts to transform
the existing system. The Panel calls for a series of bold and forward-looking reforms, including:

• Establishing a Global Health: Threats Council that will maintain a political commitment to pandemic preparedness and response and hold actors accountable, including through peer recognition and scrutiny. Countries should also adopt a Pandemic Framework Convention within the next six months.

• Establish a new global system for surveillance based on full transparency. This system would
provide the WHO with the authority to publish information about outbreaks with pandemic potential
on an immediate basis without needing to seek approval and to dispatch experts to investigate at the
shortest possible notice.

• Invest in national preparedness now as it will be too late when the next crisis hits. All governments should
review their preparedness plans and allocate the necessary funds and people required to be prepared for
another health crisis.

• Transform the current ACT-A into a truly global platform aimed at delivering global public goods including vaccines, diagnostics, therapeutics, and supplies that can be distributed swiftly and equitably
worldwide—shifting from a market model to one aimed at delivering global public goods.

• Focus and strengthen the authority and financing of the WHO, including by developing a new funding model to end earmarked funds and to increase Member State fees.

• Create an International Pandemic Financing Facility, which would have the capacity to mobilise long
term (10-15 year) contributions of approximately $5-10B per year to finance ongoing readiness. It would also be ready to disburse from $50-100B at short notice by frontloading future commitments in the event of a pandemic declaration. The Global Health Threats Council would allocate and monitor the funding to institutions that can support the development of preparedness and response capacities.

• Heads of state and government should at a global summit adopt a political declaration under the
auspices of the UN General Assembly to commit to these transformative reforms.

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