A high-level forum on pandemics – no time for neglect
High-level Forum speakers and panellists / GIZ/Leon Kuegeler, photothek.de
The German Federal Ministry for Economic Cooperation and Development (BMZ) and Federal Ministry of Health (BMG) joined forces to host a high-level meeting on pandemics. Despite the challenges ahead, a sense of hope and determination prevailed that progress can be made.
On 28 September, a high-level forum in Berlin brought together leading representatives from the worlds of politics, civil society, international organisations, private sector, and academia to discuss how to move forwards in key areas of pandemic prevention, preparedness and response.
The forum comes hot on the heels of the UN General Assembly high-level meeting on Pandemic Preparedness in New York, where world leaders adopted a political declaration calling for stronger international collaboration and coordination at the highest political levels to better prevent, prepare for and respond to pandemics. The international negotiations on a new pandemic agreement – scheduled to be signed in May 2024 – and a Medical Countermeasures Platform both aim to create global structures needed for enhanced pandemic preparedness and response. The German government is actively involved in the negotiations and committed to their successful conclusion.
Health is a global public good
The message was clear that, although the COVID-19 pandemic may officially be over, the world remains at the start of a long journey to strengthen global health security. Setting the scene for the discussions to come, Federal Minister for Economic Cooperation and Development, Svenja Schulze, opened the meeting by focusing attention on the need for everyone – the global North and the global South – to do more to prevent and combat pandemics and infectious diseases.
Health is a global public good that must be accessible to all. If we take this seriously, then we must be very clear that a lot has to change in how we promote global health in the future. We must address health in a comprehensive, interdisciplinary way that is based on solidarity.Minister Svenja Schulze, BMZ
Demonstrating just such solidarity, Federal Minister of Health, Karl Lauterbach, responded by underlining the importance of the partnership between their respective ministries, saying ‘Preparedness for pandemics and global health have to go together – one is not possible without the other. Our cooperation is exactly the type of cooperation which is internationally needed’.
We have consistently forgotten the lessons of the past
An essential element of the changes required for tackling global health must be to learn the hard lessons of the past. Michael Ryan, Executive Director of the WHO Health Emergencies Programme, pointed out that, after a major global event such as the COVID-19 pandemic, we are having the same conversations that took place after swine flu, after SARS and after Ebola, saying ‘we have consistently forgotten those lessons’.
Trust must be a priority
The need to re-build trust was a recurring theme of many of the discussions. Michael Ryan pointed to the need for robust governance and accountability in addition to technological solutions. Without public trust in medicine and in science, and without global solidarity, little progress can be made. He drew attention to the fact that only three of the 106 countries that had national action plans for health security in place when the pandemic arrived, received any support from the international community.
Countries knew what was wrong and what was missing, but we simply did not have the architecture to help them to deliver – therein lie the seeds of the pandemic impact.Mike Ryan, WHO
Jeremy Farrar, Chief Scientist at WHO, said that new and innovative approaches are needed to tackle the scourge of public health misinformation that is spread through Artificial Intelligence (AI). Cornelia Betsch, Professor for health communication at the University of Erfurt, explained that approaches grounded in behavioural science should be used to train community and primary healthcare workers to dispel some of the misinformation people face when contemplating vaccination – an approach now supported by the WHO.
Johanna Hanefeld, Head of the Centre for International Health Protection at the Robert Koch Institute (RKI), highlighted the fact that building trust requires both time and investment in the trust architecture.
An important lesson for me is that you cannot rely on trust during a crisis – you have to build it before a crisis.Johanna Hanefeld, Robert Koch Institute
The importance of investing in the times between pandemics
Many of the speakers highlighted the need to invest during the times between pandemics – in basic science, in resilient health systems, and in the people, institutions and research science that will drive the delivery of future public health solutions. Jeremy Farar reminded the audience that the unprecedented, rapid development of COVID-19 vaccines in 2020 was only possible due to more than thirty years of prior investments in mRNA technology in the United States, Germany, and other countries.
We need to shift how we think from ‘this is something that frightens us in London, Berlin, and Paris’ to ‘this is something that is critically important for all of us all of the time’.Jeremy Farrar, WHO
Robust health systems are essential for strengthening health security but remain severely under-funded in most low- and lower-middle income countries. For example, according to Jean Kaseya, Director General of the Africa Centres for Disease Control and Prevention (Africa CDC), less than ten percent of African countries – just 4 out of 55 countries – have the human resources to deal with a major disease outbreak.
Climate change, increasing population growth, the loss of animal habitats and biodiversity, and worsening levels of poverty and inequality in many parts of the world are some of the interrelated factors fuelling the transmission of infectious diseases. And as Mike Ryan and Jeremy Farrar pointed out, many countries are struggling with the resurgence and reemergence of local epidemics of dengue, diphtheria and cholera, among other diseases.
To meet these and other challenges, the Pandemic Fund requires an estimated US$10.5 billion annually, while Carolyn Reynolds, co-founder of the Pandemic Action Network, drew attention to the US$2 billion committed to date, falling far short of this target.
The ‘golden gap’ between outbreaks and pandemics
Building trust and global solidarity, and supporting countries to develop more resilient health systems and strategies, will help countries to prevent, prepare for and respond to disease outbreaks, preventing them from becoming fully fledged pandemics. This is the so-called ‘golden gap’ for intervention, cited by several speakers.
Minister Lauterbach pointed to progress being made in developing the global structures and platforms needed to support countries to manage disease outbreaks as they arise, including the new pandemic agreement, which will establish clearly defined responsibilities of global stakeholders that are so urgently needed. The WHO Hub for Pandemic and Epidemic Intelligence, established in Berlin with support from the German Government in September 2021, will support the development and use of collaborative surveillance systems to minimise the impact of epidemic threats.
Pilar Hernandez, Managing Director of the SORMAS Foundation, explained that the open source software SORMAS (Surveillance, Outbreak Response Management and Analysis System) addresses precisely this ‘golden gap’ through facilitating the early monitoring and management of disease outbreaks.
Ensuring equitable access to vaccines, therapeutics, and diagnostics
Amadou Sall, Director of the Institut Pasteur of Dakar, set the scene for the discussion on vaccines, therapeutics, and diagnostics by reminding the audience of the importance of the triple A of availability, accessibility, and affordability of these products. The need for partnerships and alliances, particularly with the commercial and non-profit sectors, emerged as a key theme of the panel discussion. Girija Sankar, Head of Neglected Tropical Diseases at the Christian Blind Mission, talked of the success of long-standing public-private partnerships for moving towards elimination of NTDs, citing the roles of MSD in making Ivermectin for river blindness and Pfizer for Schistosomiasis.
Implementing partners have been able to leverage these donations, and to bring in new investments which really help countries advance towards the elimination of diseases.Girija Sankar, Christian Blind Mission
There was an animated debate on the issues of technology transfer and intellectual property rights. Talking about Research & Development, Yuan Qiong Hu, Legal and Policy Advisor of the Access to Medicines Campaign at Médecins Sans Frontières, called for more concrete conditions to ensure that countries whose citizens participate in clinical trials also get access to the final product.
Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), Thomas Cueni, agreed on the need for more equitable distribution of medical countermeasures, but disagreed on the means for achieving this. He cited the Biopharmaceutical Industry Vision for Equitable Access in Pandemics (known as the Berlin Declaration), which among other things calls for voluntary licensing and early voluntary technology transfer, as well as proposals to reserve an allocation of real-time production of vaccines and therapeutics for distribution to priority populations in lower income countries.
Svenja Schulze highlighted the need for increased cooperation with the private sector, for example in vaccine production. Since 2021, Germany has contributed Euros 550 million towards efforts of the African Union and its member states to develop production capacities in Africa. This contribution is embedded in the Team Europe Initiative on manufacturing and access to vaccines, medicines and health technologies in Africa.
Integrated surveillance means combining data for the common good
Chikwe Ihekweazu, Assistant Director-General, Health Emergency Intelligence and Surveillance Systems at the WHO, kicked off the final panel of the day by emphasizing the need for getting existing technologies into the health space, saying, ‘we need to take the sacredness out of health data and come to a common understanding of why this is necessary.’ Johanna Hanefeld added that more robust regulation, better standardisation, and networking between and across countries and regions will help partners to seize the opportunities for data sharing and exchange offered by digital solutions.
Simon Antara, Director of the African Field Epidemiology Network (AFENET) highlighted the lack of frontline health workers, and in particular of trained field epidemiologists, which poses a serious barrier for pandemic prevention and preparedness. The health workforce is one of five strategic pillars of the New Public Health Order: Africa’s health security Agenda launched by Africa CDC on behalf of the African Union in 2021. As Jean Kaseya mentioned, this Agenda will also address critical gaps in capacities for capturing data electronically for surveillance purposes.
Referring to the need to integrate data from disparate sources, Marion Koopmans, Head of the Erasmus University Medical Center, Department of Viroscience, emphasised that a One Health approach is critical for the success of efforts to prevent, prepare for, and respond to pandemics. She also talked of the potential of citizen scientists to enhance surveillance efforts.
We need a multi-partite partnership with the goal of combining data for the common good, which is challenging. A key lesson of past years is not to think that this can be solved from within the public health sphere.Marion Koopmans, Erasmus University Medical Center
Reasons for cautious optimism
Although the forum participants clearly described the gaps in trust, in capacities, in funding and in research among other things, many of them also sounded a note of cautious optimism. The UN High-Level meeting called for stronger international collaboration and coordination, and the Forum “Pandemics – no time for neglect” provides an excellent illustration of this. As Jeremy Farrar stated, ‘the political declarations do matter – political support is a prerequisite, even if it is not sufficient.’ And high-level political support must be followed by actions, as Minister Schulze summed up for everyone: ‘Our window of opportunity is now – before the next disease spreads across the globe – and we must use it’.