Health security must take a bigger place on global agenda, says former WHO chief

Dr Gro Harlem Brundtland served three terms as prime minister of Norway and was Director-General (DG) of the World Health Organization (WHO) in 2003 when the severe acute respiratory syndrome (Sars) pandemic emerged in China.

She is now co-chair of the Global Preparedness Monitoring Board, which provides an independent appraisal for leaders, key policy-makers and the world on preparedness and response capacity for disease outbreaks.

Its inaugural report last year warned the world was “grossly unprepared” for pandemics and its second report, published earlier this month, said financial and political investments in preparedness have been insufficient. She spoke to the Telegraph about the global response to the disease.

In your report you talked about how the previous responses to disease outbreak had been characterised by panic and neglect. Do you think this is the pandemic that will make people sit up and notice?

I really hope so! Leaders and people are linked – in most countries we have the leaders that people elect. So people need to have enough information and leaders must take the action that we need. Leaders need to recognise the importance of health. Health security has to take a bigger place on the global agenda because up until now it has been underestimated.

How do you think the world has cooperated during the pandemic? Many rich countries, including the UK, have signed up to WHO’s vaccine sharing initiative, Covax, but the US has not.

I would have been shocked if the UK had not signed up. The UK, after all, has a history of understanding multilateralism and taking responsibility both in health and other situations. The US is different at this time. There have been very unhelpful decisions over the last four years.

When you have countries that don’t sign up to things like Covax you have a problem. It illustrates that multilateralism at the moment is  in a dangerous place. Not only the US but some others are trying to undermine multilateralism.

One of the suggestions from our report is that we have a global security summit and we won’t get that unless there is buy-in from countries like the US. In the coming weeks and months, we have to continue putting emphasis and pressure on the importance of this kind of initiative. It may help if there is a change in administration in the US. But in any case, even if there is not, you know, we have to continue working hard to convince leaders about global cooperation.

If every single country in the world signed up to the summit, except the US do you think that would work?

If you tried to create new commitments and new institutions without one of the major security council countries on board it wouldn’t make a lot of sense. You won’t get something that works.

What kind of new body do you envisage? Would it be linked to WHO or would it be solely focused on global health, security and pandemics?

We are not focusing on a new body but strengthening our existing institutions.

We have deliberately avoided giving concrete suggestions. There are clear indications about where the gaps are and what we lack. The problem at the moment is that our institutions are not sufficiently supported by the multilateral system of countries, which they depend on for policies and funding. And we are not naive enough to think that, if you design an ideal institution, then everything will be fine.

We have to convince enough countries to move forward on improving the International Health Regulations [that govern the WHO’s and individual countries’ response to international disease outbreaks] and improving the way the World Bank and the International Monetary Fund is able to act in a  health security situation like this one, because it will happen again.

We have seen over these past nine months that they have not been strong enough for what we need as a global society. All of these things need to be addressed in a global summit. 

Do you think there is a problem with terminology? The declaration of Covid-19 as a public health emergency of international concern was made in January and the WHO described it as a pandemic at the beginning of March. As soon as that word was used used it triggered a lot of action by countries.

There are public health institutions in all the OECD countries and even if you didn’t call the disease a pandemic at that time everyone saw that it was. So I was a little surprised that everyone needed to hear Dr Tedros [Adhanom Ghebreyesus, WHO director general] say the word pandemic. We already had a public health emergency of international concern. Why were they slow to act?

Are you surprised at how the pandemic has affected countries – the US and UK have been badly hit but places like Vietnam and Taiwan have managed well?

Taiwan reacted very quickly. They put measures into effect in the middle of January. They took seriously their experience from Sars in 2003 when they had many cases. And so I think that they had taken that seriously and they were in a better place. In Asian cultures, there is a much more collective mindset. In the west there is more individualism and people don’t always do what is necessary.

When you were Director-General of the WHO were you able to be more outspoken than Dr Tedros?

Back in 2003 the WHO was the only authoritative voice to speak on behalf of the whole of humanity. I knew it. I saw it in our constitution. And I did what I felt was necessary. There was no one else or no other institution that could speak on behalf of the world in global health.

So I knew my responsibility was to speak out. In 2005 the International Health Regulations were introduced which were being negotiated when I became director general. They became much more extensive.

A number of committees were set up to advise the director-general – I didn’t have that type of expert committee and I did not feel bound by anyone. But I think the present administration of WHO saw they needed to work with those parties and get consensus advice.

I think the committee took too long to declare a public health emergency. I’m not ready to criticise anyone, but I observe that may be paradoxically, some of the institutions set up after the international health regulations have limited the director-general’s direct authority.

When the world revises the IHRs they have to make clear the authority of the director-general.

Have you been surprised at how much the pandemic has affected the world.

Last year our report described the danger of a respiratory pathogen that had the potential to kill 10s of millions of people worldwide and undermine the world economy. We wrote about that in September and then two months later Covid-19 started spreading.

But the fact that this virus was so infectious and spread so quickly made it an even worse situation than even we had expected. The Sars virus was less infectious, but was more deadly so people were alert and ready to quickly respond. So in a certain way, this strong infectiousness that Covid-19 has, and the fact that it is not as deadly as Sars has meant the world was slower to act.

The world is very different today than 2003.

And China is a very different country than it was back in 2003. Now they have a centre for disease control  which is why they also were able to get the detection rates down and limit the virus within weeks. Also – there’s so much more travel today and the disease was spread airline by airline.

So how do you think this will all pan out?

We’ll be living with this next year and even when we get a vaccine there won’t be enough to vaccinate the whole population. Critical health personnel and those with pre-existing conditions will be covered first. Until we have billions of doses to give to the general population we won’t be able to get infection rates down. We’re going to have to learn to live with it and figure out a new way of living. But we’re also going to have to improve our preparedness.

And do you have faith that countries will do that?

I am hopeful. I never give up hope. I don’t think there is another path forward.

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