The World Was Not Prepared for Covid-19. We Should Learn the Lessons and Change.

The World Was Not Prepared for Covid-19. We Should Learn the Lessons and Change.

Commentary
Posted on: 5th May 2020
Tony Blair
Former Prime Minister of Great Britain and Northern Ireland and Executive Chairman of the Tony Blair Institute for Global Change

    Introduction

    Introduction

    We need radical changes to the global architecture for international cooperation arising out of the Covid-19 pandemic – in the field of health but also in the economy, education and food supply chains.

    We are living through a health and economic emergency unprecedented in modern times – one that has been called “the most challenging crisis we have faced since the Second World War” by the Secretary General of the United Nations and which the head of the IMF has warned will have “the worst economic fallout since the Great Depression.” As of the end of April more than 200,000 people across the world have died. 

    However, the collateral damage of failure to contain the disease is also a huge consideration. The World Food Programme has issued dire warnings that the pandemic could push 265 million people into acute food insecurity, nearly doubling the previous year’s total. And yet, existing global coordination structures in both the health sector and beyond have proved themselves inadequate and unable to respond to the challenges at hand. 

    In this paper, we identify five critical coordination failures exposed by Covid-19 and use these to suggest practical proposals to improve global coordination both in the current fight against this pandemic and for future pandemics. Our focus is on both the health and economic response, because it is clear the two are interdependent. Various other aspects of global coordination, such as national security, are also important but here we focus on the health and economic issues that lie at the heart of this crisis.

    Crisis points can be opportunities to do things differently. The end of World War II led to the creation of the global architecture as we know it today, from the United Nations to the Bretton Woods institutions. Since then, other international shockwaves, from the AIDS crisis in the 1990s to the 9/11 attacks to the financial crisis of 2008, served as catalysts for new mechanisms of cooperation and response. It is too early to tell how much the political space for improved coordination will open up in the aftermath of this pandemic, but the failures in the response to Covid-19 make one thing clear: With a world more interconnected than ever before and with the prosperity of nations dependent on global technology and supply chains, we need a global architecture fit for the 21st century. 

    The question is, what should this new architecture look like? 

    Our new briefing paper, detailed here and included in full below, aims to focus the debate on five major challenges and proposes improvements for future global coordination, both in the immediate term and in the years to come.  

     

    Global Coordination Challenges

    Global Coordination Challenges

    The five challenges in global coordination we believe Covid-19 has exposed in global pandemic response are:

    1.    Surveillance and control. Mass testing and contact tracing (as we have argued in previous papers) remain our best route out of the current crisis, but global capacity remains hampered by three barriers: a narrow country focus, regulatory barriers and a mismatch of demand and supply. We need rapid-result testing to allow for rapid isolation of those infected with Covid-19, for example before people enter a plane, nursing homes or a government building. Yet many countries are still struggling with limited testing capacity of any speed, while the contact-tracing technologies available – and which have been used effectively in East Asia – are not being rapidly deployed in other countries.

    2.    Access to medical equipment. We need to be prepared for outbreaks anywhere, so equipping health sectors around the world is essential. Many countries lack the capability they need. For example, Nigeria needs 300,000 PPE suits per month, but only had 31,000 in early April. Lack of global coordination has also led to multiple reports of equipment seizures. Export barriers, limited global production capacity (on multiple continents) and a lack of rapid-response mobile units are key concerns. And while some countries and blocs can adapt their industrial sectors quickly, others do not have local production capability they can use.

    3.    Standing up crisis response command structures. Ending the pandemic does not depend only on testing capability and the development of a vaccine. It also depends on effective crisis management by governments worldwide. The most critical part of every government now – especially those with weak health systems – is a response command structure that allows a strong handling of both the health and economic responses, simultaneously. Strong inter-governmental coordination is the key to success. Many countries around the world have struggled – or are still struggling – to set up response command centres due to lack of management capability. Others lack practical advice to quickly learn what’s working and what could work so they can roll out their health and economic response in a calibrated way. Many are struggling to balance WHO requirements with concerns about economic fallout, leading some to do nothing or too little.

    4.    Technology and data. A number of international agreements have been put in place to accelerate cooperation in this area over the years, including the G8 Open Data charter, a G20 commitment last year to improve worldwide data governance, and a Global Digital Health Partnership. Yet many major barriers remain. These include a lack of interoperability of data systems, a lack of standardisation and accreditation of datasets, privacy and security issues, and data access and reliability issues. Geopolitical barriers also remain. Coordination is needed on protocols for open data, open source and platforms for aggregation of data, as well as in the rapid transfer of global technological solutions from origin countries to others.

    5.    Managing the economy. The economic fallout of Covid-19 is unprecedented. Advanced countries have been able to afford their health-care responses (their issues were a cause of slowness, not lack of resources) and to roll out stimulus packages – even though some of these, such as the United States’ Small Business support facility, needed or need to be expanded. Yet many other countries around the world lack the fiscal space to respond in the same way. The average advanced country stimulus is 8 per cent of GDP, as of April 2020, but stood at only 0.8 per cent in Africa. Global economic coordination is essential – particularly for developing countries – in the following areas:

    1. The fiscal space of governments to put money where it needs to go
    2. Supply-chain bottlenecks, particularly for highly trade-dependent, low-income countries
    3. Food and agriculture coordination, to prevent catastrophic food insecurity and hunger, especially in net food-importing countries
    4. Industrial production to ensure the supply of critical goods, both medical and non-medical
    5. Rapid-response economic support programmes and technical assistance for countries with developing economies and deprived regions of countries with advanced economies.

    Global Coordination Architecture for the 21st Century

    Global Coordination Architecture for the 21st Century

    Covid-19 is here for the foreseeable future, so we need to learn to live with it. It is not like the flu, where the virus hits in waves. Covid-19 hits hard and overwhelms health systems. Multiple outbreaks will likely continue around the world as suppression measures are eased. So our societies need to become Covid-ready. We need to transform to a new state by transforming how we live, work, travel and socialise and the places in which we do these. Behaviour adaptation by people over the long-term will be essential. 

    We need to be able to test rapidly – within a few minutes – and humanely isolate people who test positive and their contacts. We need to adapt airlines, workspaces, living spaces, social spaces, and schools, while health-sector capacities need to be increased and adapted to be able to cope with future outbreaks.

    The end of World War II set the conditions for today’s global architecture. Among them, the IMF, World Bank, European Union and United Nations. As we come to terms with Covid-19 over the next few years, we will have the opportunity to adapt the global coordination architecture and make it fit for the challenges of today and of tomorrow. We must take it, both so that we can be better equipped to handle challenges such as pandemics, but also to help deliver the Sustainable Development Goals.

    This section of our paper sets out an agenda for global coordination reform, recognising that this crisis is not merely a health crisis, but also a food crisis, a global economic crisis and a crisis of global governance. This agenda is proposed with an eye to equipping each country and each continent of the world with the capability and tools they need to be able to better respond to future pandemics and other global crises. 

    Table 1: Seven Agenda Items for Global Coordination Architecture Reform
    01

    Health system: We need to recast the WHO. It has been set up to handle pandemics on a much smaller scale than Covid-19. The WHO needs to be recast such that it can effectively deal with pandemics like this one, while building long-term resilience of the global health system.

    02

    Agriculture & food system: We need an effective global body that can support, continent by continent, countries to transform their agriculture sector to be food secure, reduce large-scale poverty and become climate-smart.

    03

    Climate-smart economic transformation: We need a mechanism that can support each continent to deliver climate-smart and trade-friendly local productive capacity, including of medical equipment, spanning least-developed countries through to de-industrialised areas of advanced countries. This is key for challenges like job creation, migration, inequality, social protection, national security and illicit financial flows.

    04

    Education system: We need a proper overarching mechanism to actively assemble evidence and, with vehicles like GPE and others, support countries to reform their education sectors to deliver quality, terrorism-safe education fit for the 21st century.

    05

    Data: We need a mechanism for the coordination of data collection, sharing and use, oversight, privacy, open-source guidelines, patenting, internet access and cybersecurity so that the data exchanges needed to manage global challenges happen.

    06

    Fiscal & monetary system: We need financing limits for the IMF, World Bank and regional development banks (including via growth of SDR) and coordination tools (including emergency currency swap lines and debt management/relief frameworks) that are fit for purpose.

    07

    G20: We need to make the G20 an effective mechanism for critical international action in key areas, not least in the six areas mentioned above.

    We next propose a global coordination structure for the health sector, building on the core findings of our analysis. In the coming weeks and months we will focus on other key elements of the global coordination architecture.

    Recasting the WHO

    Recasting the WHO

    We need to revisit the global health architecture and the 2005 International Health Regulations in order to defeat this pandemic and be prepared for future ones, while strengthening the global health system. The WHO needs to be recast and be empowered to play its role as needed. It needs sufficient clout, capacity, flexibility and burden-sharing.

    At this moment the WHO requires full support in the urgent and necessary work it is doing to help countries in the poorest parts of the world fight Covid-19. The call for recasting the WHO in a new way in the face of the scale of this and other future crises is not a criticism of the organisation or its leadership, simply the realisation that as presently constituted, it has neither the firepower nor the structure to handle an issue of this global magnitude.

    The key functions that it needs to play and the various agencies that it needs to convene and coordinate to drive a global health agenda are captured in Table 2 below.

    Table 2: A Recast WHO Needs to Effectively Undertake These Functions and Convene These Actors

    World Health Organisation
     
     
     
     
    1. Function between pandemics 2. Functions during pandemics 3. Actors in architecture to convene
    Convene actors to lead global agenda Transparent Emergency Committees Global actors with specific role:
    • Global Fund, GAVI, CHAI, CEPI
    • WFP, UNICEF, BMGF,
    • Country Aid Agencies,
    • Save the Children, CRS, World Vision
    In-country advisory for health systems Clearing mechanism & funding platform for country capacity to:
    1. Stand up crisis response structures
    2. Conduct sufficient testing & isolation
    3. Access key supplies
    4. Access latest technologies, e.g. via Technology Transfer Fund
    5. Import specialist expertise, delivery advisory & health-care workers
    6. Access vaccines & therapeutics
    Equitable supplies & vaccine distribution Continental actors, such as: PAHO, Africa CDC, WAHO, European Medicines Agency
    Data sharing & report validation
    Pandemic response preparedness Country actors such as: Government Ministries of Health, US CDC, China CDC, Nigeria CDC, European CDC, etc
    Therapeutics & vaccine coordination
    Strengthen surveillance systems Private sector
    Industry liaison In-country non-state actors (need coordinated network)

    This pandemic has also shown the importance of coordinating certain non-health factors well during a pandemic, in effect to work as a support system for the global health response. This covers:

    Table 3: Critical Areas of Non-Health Global Coordination During Pandemics

    Fiscal & monetary

    1. Make additional allocation to IMF special drawing rights of at least $600 billion.
    2. IMF to allow countries to exceed their lending quotas so country stimulus packages can be adequate.
    3. Respond to UN call for $2.5 trillion for developing country health and economic responses.
    4. Central bank coordination, e.g. via emergency currency swaps.
    5. Debt coordination, e.g. via debt swaps and Paris and London Club coordination.

    Access to food

    1. Ensure planting season in each vulnerable country is not missed.
    2. Ensure three months strategic food reserves in food-insecure countries.
    3. Address key value-chain bottlenecks in food-insecure countries.
    4. Food relief to net importers of food.
    5. Farming, input provider and local market adaptation to social-distancing measures

    Social protection when measures such as cash transfers and food aid are essential to be packaged with suppression measures to ensure they work (and to ensure criminal or terrorist groups do not exploit government vacuums), and when countries lack the capacity to roll these out rapidly enough.

    Local production to rapidly retool local manufacturing to produce medical and other essential equipment in each regional bloc. Could be led by the development finance institution alliance.

    Supply chain to support adaptation to social-distancing requirements by global transport sector (e.g. airlines, ships, ports, customs, borders) and to address upward pressures to freight costs, particularly for countries highly dependent on imports of essential goods.

    Social mobilisation to adapt behaviours to the needs of pandemic response measures in a locally workable way. This requires international parameters (e.g. protocols or guidelines) for government engagement of key non-state actors, such as religious leaders and traditional rulers, during pandemics.

    Conclusion

    Conclusion

    Covid-19 is a global killer and it needs a global response. The failures of weak global coordination have been exposed, with huge, avoidable and tragic loss of human life and severe social and economic disruption the world over, as a result. Those bearing the brunt of this are the poor, the vulnerable, the sick and those living paycheck to paycheck. We cannot make the same mistake again and we cannot allow people to suffer in this way again.

    We need to urgently upgrade our global coordination architecture, starting with a recasting of the WHO and the global health system – which must include suitable pandemic preparedness planning and responses. Crucially, pandemic response needs to be given similar attention to national security and economic crises with associated profile, priority and domestic resources. In addition, global coordination reform should not stop in the health sector but cover other critical areas such as food systems, economic transformation and education.

    Finally, in the coming months and years, we need to seize this moment and upgrade our broader global architecture to make it fit for the 21st century, so that we can be ready to solve global problems like this pandemic with what they require: a truly global response. Such an upgrade is long overdue.

    Read our full paper here: Global Coordination Requirements for Covid-19 and Future Pandemics

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