The writer, a former prime minister of Italy, is chair of the WHO’s pan-European commission on health and sustainable development
When the new coronavirus emerged in China and spread around the world, there was a sense of shock. For many governments, the scale of the required response seemed unimaginable. Yet it soon became reality. Today, thanks to the development of a range of vaccines, many countries are looking forward to life returning to normal. But is this what we should be aiming for? It was the old normal that created the conditions for the virus to emerge and spread in the first place. Surely we can do better.
Future generations will not forgive us if we fail to learn the lessons of this pandemic. So, last September, the World Health Organization’s European director Hans Kluge set up an independent commission to explore what a “new normal” might be. The commission comprises individuals from across Europe and from multiple disciplines, from politics and economics to health and science. In our interim findings, published on Tuesday, we call for a fundamental rethink of policy priorities and international governance along five main lines.
First, while we still do not know all of the details, it is clear that Sars-Cov-2 was only the latest micro-organism to jump from animals to humans. It was able to do so because we created the conditions that made this possible. Recent history — from the spread of HIV from chimpanzees to humans, to the repeated outbreaks of avian influenza — is replete with warnings of the importance of developing mechanisms that recognise the interdependence of human, animal and environmental health.
Yet we have failed to learn. Even now, our global systems are fragmented, with responsibilities lying across different UN agencies. They require much closer co-ordination, with less overlap. Taking a cue from the intergovernmental panel on climate change, we propose the creation of an intergovernmental panel on health threats. This would bring together scientists to assess the health risks that will continue to arise in our changing world and to propose feasible solutions. We also need a sustained programme of investment in early warning systems so that future emerging infections are identified and responded to as rapidly as possible.
Second, the pandemic has also shone a light on the fractures within our societies. Covid-19 struck hardest on the already disadvantaged, and exploited the precarious conditions in which too many fellow citizens live. Governments committed to tackle many of these challenges when they signed up to the UN’s sustainable development goals. But progress has often been slow and, given the financial challenges that lie ahead, risks going into reverse. We need better data systems to make the conditions of these communities more visible, and to build societies that are genuinely inclusive of everyone.
Third, we know that none of this can happen without changes to the global financial system. Governments are not entirely free to act as they please. Many are constrained by the decisions of regional and global financial institutions, credit rating agencies and others. Organisations such as the World Bank and the EU have long recognised the importance of economic, social, environmental and governance policies and practices in creating resilient economies. To that list, we have to add health. A country that fails to invest in its health infrastructure, thereby creating the conditions in which viruses can spread and mutate, is a threat to itself and the world.
Fourth, many of the things that we need to prepare for any future pandemic, such as a well-functioning early warning system, are global public goods. Yet unless the international community finds a way to create them, nothing will happen. Again, there is a model to draw on. After the global financial crisis, the G20 created a financial stability board to address vulnerabilities in the financial system and promote necessary supervisory policies to overcome them. A global health board would do the same for health, and could perhaps evolve towards becoming a global public goods board.
Last, we must learn from the success of the vaccine development. It is inexcusable that there are still neglected tropical diseases that go untreated, given that we have seen what can be done when the international community joins together. We need to do more to create a climate that encourages innovation — not only of vaccines, medicines and technology, but also the health systems and models of care that can deliver them equitably to everyone.
This is an ambitious agenda, and one that many might see as impossible. But, over the past year, governments everywhere have done things that only 12 months ago they also thought were impossible.
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