Experts Call for Sweeping Reforms to Prevent the Next Pandemic
The next time the world faces an outbreak of a fast-spreading and deadly new pathogen, governments must act swiftly and be ready to restrict travel or mandate masks even before anyone knows the extent of the threat, according to a pair of new reports delivered to the World Health Organization.
The studies are intended to address missteps over the past year that led to more than 3.25 million deaths, some $10 trillion in economic losses and more than 100 million people pushed into extreme poverty.
“Current institutions, public and private, failed to protect people from a devastating pandemic,” concluded one of the reports, released on Wednesday, which called the Covid-19 pandemic “the 21st century’s Chernobyl moment.”
“Without change,” it said, these institutions “will not prevent a future one.”
The reviews, released in advance of this month’s meeting of the W.H.O.’s governing assembly, were written by appointees who donated countless hours in the midst of their own countries’ pandemic fights to interview hundreds of experts, comb through thousands of documents, gather data and seek counsel from public and private institutions around the world.
Pandemics, the authors concluded, are an existential threat on the order of a chemical or nuclear weapon, and preparing for them must be the responsibility of the highest levels of political leadership rather than only health departments, often among the least powerful of government agencies.
The reviews also called for nations to provide predictable and sustainable financing to the W.H.O. and to their national preparedness systems.
“W.H.O. is underpowered and underfunded by its member states,” Helen Clark, a former prime minister of New Zealand and an author of one of the reports, said at a media conference this week.
Whether the recommendations lead to lasting change is an open question. Ms. Clark’s group, the Independent Panel for Pandemic Preparedness and Response, pointedly noted that since the H1N1 pandemic in 2009, there have been 11 high-level commissions and panels that produced more than 16 reports, with the vast majority of recommendations never implemented.
These reports “sit closed gathering dust in U.N. basements and government shelves,” said Ellen Johnson Sirleaf, another author of that report, who served as president of Liberia during the Ebola outbreak there in 2014 and 2015.
Under the current international health regulations, “there’s no enforcement mechanism,” said Dr. Lothar H. Wieler, president of the Robert Koch Institute in Berlin, who led the second major review, in which scientists scrutinized how those regulations functioned in the pandemic.
Both reports supported the creation of an international pandemic treaty that would establish consequences if countries failed to live up to their commitments. Those might include quickly sharing samples and sequences of emerging pathogens, providing rapid access to teams deployed by the W.H.O. for early investigation and response, and ensuring equitable distribution of vaccines, medicine and tests around the world.
Both reviews also noted that early in the coronavirus pandemic, many countries all but ignored the formal warning issued by the W.H.O., known as a Public Health Emergency of International Concern. Its unfortunate acronym, Pheic, is often pronounced “fake,” one of the reports noted. (Whether the proposal to change this to “Phemic” will prove more stirring remains to be seen.)
The independent panel also concluded that the warning could have been declared at least a week earlier than it was — on Jan. 22, 2020, instead of Jan. 30.
Even then, “so many countries chose to wait and see,” only taking concerted action once intensive care beds were filled, Ms. Clark said.
Her group contends that if its recommendations on political leadership, financing and surveillance systems had been in place, the coronavirus outbreak would not have become a pandemic. It also said that digital tools, such as those that scrape social media for rumors of new outbreaks, should be better incorporated into official responses.
Notably, the panel did not delve into individual countries’ failures in its report, determining that blame would not be “a very useful approach,” said Dr. Anders Nordström, who helped lead the effort.
But the group did commission a study of 28 countries with high, medium and low Covid death rates. Some of the countries with the lowest tolls had previously invested in outbreak control systems after experiencing SARS, MERS and Ebola, the report said. Successful countries acted quickly, coordinated across multiple government agencies, meticulously isolated people with the virus and quarantined those exposed to it.
The worst performing countries had underfunded, fragmented health systems and “uncoordinated approaches that devalued science.” Those with the highest death tolls, including Brazil and the United States, denied the seriousness of the pandemic and discouraged action, the panel members said in interviews.
On some key points, the reports came to different conclusions. The Independent Panel for Pandemic Preparedness and Response argued that the international health regulations governing how countries are supposed to prepare for and report emerging outbreaks “serve to constrain rather than to facilitate rapid action.”
But the other group, which spent months reviewing those regulations, found that many could have helped but were “simply not implemented by various countries,” Dr. Wieler said.
Some countries were not even aware that the regulations existed, his group reported. Others lacked laws vital to responding to outbreaks, such as those authorizing quarantines.
Changing those regulations would require “negotiations for years,” Dr. Wieler said, noting that the latest set took a decade to finalize. Instead, one of his committee’s major recommendations was to increase countries’ accountability for their obligations, including though a pandemic treaty and a periodic review of their preparedness that would involve other countries.
The independent panel also proposed creating an international council led by heads of state to keep attention on health threats and to oversee a multibillion-dollar financing program that governments would contribute to based on their ability. It would promise quick payouts to countries contending with a new outbreak, giving them an incentive to report.
“There’s only going to be the political will to create those things when something catastrophic happens,” said Dr. Mark Dybul, one of the panel members. These recommendations stemmed in part from his experience leading the President’s Emergency Program for AIDS Relief, known as Pepfar, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, he said.
But Dr. Wieler, who led the other international review, said that in general, creating new institutions rather than focusing on improving existing ones could increase costs, complicate coordination and damage the W.H.O.
The recommendations of panels after global emergencies have sometimes been embraced. The Ebola outbreak of 2014 and 2015 led to the creation of the W.H.O.’s health emergencies program, aimed at boosting the agency’s role in managing health crises as well as providing technical guidance. A report released this month noted that the new program had received “increasingly positive feedback” from countries, donors and partner agencies as it managed dozens of health and humanitarian emergencies.
The W.H.O. before the Ebola outbreak and after it are “two different agencies basically,” said Dr. Joanne Liu, a former international president of Doctors Without Borders and a member of the independent panel. Dr. Liu was one of the W.H.O.’s most trenchant critics during the Ebola response, and she noted a “marked improvement” in how quickly the agency had declared an international emergency this time.
Dr. Liu said her biggest fear was that as wealthier countries gained an upper hand on the virus because of vaccines, they would leave low- and middle-income countries behind, with Covid-19 becoming “a neglected pandemic because they are going to be the only ones fighting it — a bit like H.I.V. and T.B.”
To avert that, the panel released a slew of urgent recommendations and called for the world’s entire population to be immunized within a year.
Wealthy countries with a good vaccine pipeline should commit to making at least a billion doses available to the poorest countries by September through programs like Covax, a global effort to provide vaccines equitably throughout the world, the group said.