A Pandemic Defined By Failures: Who Can Hold Nations Accountable?
Dr. Madhukar Pai, Professor at McGill University and
Canada Research Chair in Epidemiology & Global Health at McGill University
Last year, the Independent Panel for Pandemic Preparedness and Response was established to “initiate an independent, impartial and comprehensive evaluation of the international health response” to Covid-19. This week, the Panel, co-chaired by the Right Honourable Helen Clark and Her Excellency Ellen Johnson Sirleaf, released their second progress report.
The report, like similar reports in the past, dissects the biggest failures in the global response to the pandemic, and offers several solutions, even as the pandemic continues to wreak havoc. In fact, the United States just surpassed 400,000 deaths from Covid-19. An epic failure by one of the wealthiest countries in the world. If some of the key suggestions in the report were implemented, the US and rest of the world could still limit the damage. It’s never too late to act.
Key messages of the report
The report notes that “despite the myriad shining examples on every continent of human ingenuity in response to the virus, we have failed in our collective capacity to come together in solidarity to create a protective web of human security.” Key messages of the report are:
Less Trust, More Security: The New Model Of Cloud Operations
1. The world was not prepared, and must do better
2. The public health measures which would curb the pandemic need to be applied comprehensively
3. The pandemic response has deepened inequalities (e.g., access to Covid-19 vaccines)
4. The global pandemic alert system is not fit for purpose; critical elements of the system are slow, cumbersome and indecisive
5. There has been a wholesale failure to take seriously the existential risk posed by pandemic threat to humanity and its place in the future of the planet
6. The World Health Organization has been underpowered to do the job expected of it, and the incentives for cooperation are too weak to ensure the effective engagement of States (countries) with the international system in a disciplined, transparent, accountable and timely manner
The Panel believes that the Covid-19 pandemic “must be a catalyst for fundamental and systemic change in preparedness for future such events, from the local community right through to the highest international levels.”
I asked Joanne Liu, member of the Independent Panel, and former President of Médecins Sans Frontières (MSF), for her biggest takeaways from this ongoing investigation. “Collectively, in fighting Covid-19, we failed the solidarity test is the sad takeaway,” she said. “The race for resources to fight Covid-19 is an unfair predatory race. It’s shameful to see high income nations hijacking the bulk of vaccines available with a vaccination strategy to cover everybody while low- and middle-income countries need to do by covering only 20% of their population,” she added.
Fatima Hassan, Head, Health Justice Initiative, South Africa, echoes this outrage. She is skeptical about all the talk on global solidarity. “Solidarity means nothing. The world, and its institutions, and the companies claiming exclusive rights to make a vaccine during a pandemic, have all let us down, here in Africa,” she said. Her concerns are borne out by the fact that the African continent is yet to begin Covid-19 vaccination, even as North America and Europe have cleared out the shelves by purchasing a vast share of the global vaccine supply.
I also asked Sudhvir Singh, Special Advisor to Ms. Helen Clark, for his summary of the Panel’s findings. “The evidence the Panel has gathered thus far points to a sequence of failures at every step of the pandemic - by many countries, the WHO and the international system at large - and the opportunities and need for these to be addressed,” he said. He picked two key actions that countries could take to deal with the ongoing crisis: 1) stop the rising infection numbers and deaths by adopting proven public health measures (e.g., physical distancing, masking, early case detection, and contact tracing, even as vaccinations need to be scaled-up); and 2) tackle the inequities in the distribution of vaccines. “A principle of equity should guide such global public goods,” he emphasized.
Many reports, no takers?
Many reports and commissions have looked at global health security and pandemic response. “There have been 12 panels and 14 reports on pandemic preparedness. We are not short on recommendations. We are short on political will to act upon recommendations,” said Joanne Liu.
Others had similar opinions. “This Panel report could have been copied and pasted from the Independent Panel after the West African Ebola epidemic. Will we now learn that we need to continually invest in prevention and preparedness?” asked Ngozi Erondu, a Senior Scholar with the O'Neill Institute, Georgetown University. She explained that there were over 40 "post mortems" after the 2014 -16 West Africa Ebola epidemic, with critical recommendations that included strengthening the global pandemic alert system, as well as strengthening WHO. “If some of these recommendations had been acted upon, there could have been very different outcomes during this Covid-19 pandemic,” she added.
“I feel like I’m reading a lot of what academics in global health have been saying for decades: it’s all political - politics drives epidemics. While States play politics, WHO avoids politics to the detriment of health security,” said Clare Wenham, an Assistant Professor in Global Health Policy at the London School of Economics. “Why do we keep having new panels, rather than investing that people time in implementing recommendations from the last?” she asked.
How to ensure accountability of nations?
During this pandemic, we have seen epic failures in leadership and governance that have allowed the pandemic to destroy lives and livelihoods. Many countries have denied the pandemic and failed to implement a comprehensive set of interventions that are backed by science. And WHO has found it impossible to make countries comply with the best policies and regulations, even though International Health Regulations (IHR) exist.
China’s lack of transparency, the Trump administration’s disastrous leadership, Brazil’s denial of the pandemic, Britain’s mismanagement of the epidemic, and India’s reluctance to invest in health have all come at a terrible cost. These are merely a few examples.
The Independent Panel notes that WHO has limited ability to hold countries accountable, and countries are unwilling to hold themselves accountable. This results in a massive blame game, with no real action. Country leaders have found it more convenient to blame WHO or China than look inwards at their own dysfunctional responses.
Covid-19 has become the new excuse for authoritarian nationalism, isolationism, xenophobia, denial of science, and racism. These are not new trends, and had been predicted to create a fertile ground for pandemics to emerge. Indeed, the Independent Panel notes that Covid-19 emerged at a high point of geopolitical tension: “Those tensions have detracted from decisive and internationally coordinated responses to the pandemic. The virus has thrived on division, and the resultant pandemic has exacerbated tensions and undermined multilateral action just when it was most needed.”
“This pandemic has demonstrated how critical leadership, good governance, law, and politics are to global public health,” said Alexandra Phelan, an Assistant Professor at Georgetown Global Health Science & Security. “Many of the issues that arose in relation to the IHR were directly because of governance issues, including the norms and compliance with legal obligations under international law. The Independent Panel's reflection that leadership and politics were not accurately reflected in the pre-pandemic assessments is absolutely correct. It is critical that in its continued work, the Independent Panel builds on this to consider how reforms can address these normative, legal and governance issues and not just replicate them,” she said.
So, how to get countries to share information, act early, and cooperate across national boundaries are some of the biggest challenges for the Independent Panel, as they continue their work.
“Right now, I see a lot of buzzwords in the report and no entity is likely to be held accountable. The report touches on most things that matter, but we need to see the substance under the issues,” said Mosa Moshabela, Acting Deputy Vice-Chancellor of Research and Innovation, University of KwaZulu-Natal, and Chairperson of Standing Committee on Health, Academy of Science of South Africa.
Joshua Moon, Research Fellow at the Science Policy Research Unit, University of Sussex Business School, argues that with big reports in the past, advocacy for implementation started with the report release but then ended soon after. “At its core, reports and panels are political objects that need active political participation from inception, to reporting, through to implementation. Those are the main reasons we have such difficulty learning - reports are seen as an end point, not a starting point.”
Power asymmetry & inequities
“If the report is going to address global inequities, it will have to confront the asymmetry of power between richer and poorer countries,” said Mosa Moshabela. Indeed, inequality is worsening during this crisis. Even before Covid-19, annual reports warned us about how a small number of people own as much wealth as half the world’s population. These billionaires have become wealthier during this pandemic, even as an additional 200 million people could be pushed into extreme poverty by 2030.
Extreme economic inequities allow rich countries to hoard vaccines and deny others. Economic power asymmetry makes it possible for countries like the US to defund and exit WHO with impunity. It allows countries like China to get away with secrecy. Economic supremacy also allows some countries to prioritize patents over people’s lives even during a global crisis. Even the UN Security Council struggles to ensure accountability among nations.
The progress report calls for “a new global framework to support prevention of and protection from pandemics”. The Panel believes that such a global reset is achievable, and its report in May will set out recommendations to that end. While I am sure the recommendations will make a ton of sense (as they do in the second progress report), I too worry that countries that failed to act on previous such recommendations will continue to do what they have always done - prioritize their narrow self-interests ahead of global solidarity. It is, therefore, important for the final report to go beyond exhortations for equity and solidarity, and propose an actionable, implementable agenda to tackle the divisive politics that drives pandemics and also hampers action on other critical issues such as climate action.
Original post was published on Forbes
About the Author
Dr. Madhukar Pai is a Professor and a Canada Research Chair in Epidemiology & Global Health at McGill University, Montreal. He serves as the Associate Director of the McGill International TB Centre.
URL: http://www.paitbgroup.org/