At midday on Wednesday, the Independent Panel for Pandemic Preparedness and Response released a comprehensive set of fact-based reports into the global response to Covid-19.

The Panel was appointed by the World Health Organization (WHO) Director-General in response to a World Health Assembly resolution in 2020 calling for an independent, impartial, and comprehensive review of experiences gained and lessons to be learned from the current pandemic. The review was also asked to provide recommendations to improve capacity for global pandemic prevention, preparedness, and response.

The Panel is made up of 13 members, whose levels of expertise and experience are enormous. It includes activists, economists, epidemiologists and people with experience at the highest levels of government and working in Health systems. To South Africa’s credit former director-general of the Health Department Malebona Precious Matsoso was one of those appointed. 

Its co-chairs are Helen Clark, former prime minister of New Zealand and Ellen Johnson Sirleaf, the former president of Liberia and winner of the Nobel Peace prize in 2011.  

When it started its work the Panel defined its mission as being  “to provide an evidence-based path for the future, grounded in lessons of the present and the past to ensure countries and global institutions, including specifically WHO, effectively address health threats.”

It promised to “provide a fresh assessment of the challenges ahead, based on insights and lessons learned from the health response to Covid-19 as coordinated by WHO as well as previous health emergencies.”

The Panel’s findings and recommendations are contained in a report titled: How An Outbreak Became a Pandemic, a report which is unusually frank and blunt in its assessment. It finds that “the system as it stands now is clearly unfit to prevent another novel and highly infectious pathogen, which could emerge at any time, from developing into a pandemic.” 

Precious Matsoso in an interview with Maverick Citizen on Wednesday morning, said “if we don’t change now, we will never change.” She said that “the risk of another pandemic on a scale of one to 10 was eight … we have to prepare for one.”  

The report describes “13 defining moments on which the response to the pandemic turned, starting with the recognition that despite warnings the world was not prepared.” 

It elaborates on each of these defining moments and under each one provides a set of summaries. There is little wriggle room or ambiguity about what needs to be done.

In the context of vaccine inequality and nationalism some of its more specific and immediate recommendations include that:

• “High-income countries with a vaccine pipeline for adequate coverage should, alongside their scale-up, commit to provide to the 92 low and middle-income countries in the Gavi Covax Advance Market Commitment with at least one billion vaccine doses by September 2021.”
• “That major vaccine-producing countries and manufacturers should convene, under the joint auspices of the WHO and the World Trade Organization (WTO) to agree to voluntary licensing and technology transfer.” In a bold move the Panel adds that “If actions on this don’t occur within three months, a waiver of intellectual property rights under the Agreement on Trade-Related Aspects of Intellectual Property Rights should come into force immediately.” This statement is likely to strengthen the hand of developing countries contemplating taking action to improve access to vaccines.
• “The G7 should immediately commit to provide 60% of the $19-billion required for the Access to Covid-19 Tools Accelerator (ACT-A) in 2021 for vaccines, diagnostics, therapeutics, and strengthening of health systems, and a burden-sharing formula should be adopted to fund such global public goods on an ongoing basis.”

The report notes the insufficiency of the global response, pointing to the different outcomes of countries that acted immediately and those that dithered or denied. “February 2020” it says “was a wasted month.” One of its 16 background papers is a 28-country study which concludes that:

“Countries that devalued science, failed to build trust in their response and pursued inconsistent strategies found themselves continually lagging behind the epidemic and have seen the consequences in high rates of infection and death.”

It also notes Covid-19’s impact on inequality with one of its “defining moments” being the recognition that “the pandemic affects everyone, but not everyone is affected equally”. Two of its background papers examine the evidence of this, finding that:

“Up to 125 million more people are estimated to have been pushed into extreme poverty, while 72 million more primary school-age children are now at risk of being unable to read or understand a simple text because of school closures. Women have borne a disproportionate burden. Gender-based violence is at record levels, and child marriages have increased.”

Covid is not the only health crisis the world faces or which kills millions of people (HIV, TB, malaria, non-communicable diseases didn’t disappear as we faced this threat), but without money and political will fixing the damage to health systems will be an uphill struggle.  Shockingly the report catalogues the “enormous physical and emotional toll on the world’s health workers.” Noting “a lack of globally representative data” it nonetheless records an estimate that at least 17,000 health workers died from Covid-19 in the first year of the pandemic “and that in addition, health workers have suffered extreme and sometimes debilitating stress”. 

“A recent analysis of 65 studies enrolling nearly 100,000 health workers in 21 countries found a high prevalence of moderate depression, anxiety and post-traumatic stress disorder. Research shows increases in substance abuse and even suicides. Experts predict the strain on caregivers during Covid-19 could result in high levels of burnout and exacerbate human resource shortages.”

It’s a desperate and dire picture.

What is to be done? 

The Panel recommend far-reaching institutional reform questioning ‘how fit for purpose the 2005 International Health Regulations are?’ and concluding that the IHR are “a conservtaive instrument as currently constructed that serves to constrain rather than facilitate rapid action” and recommending that “in future a precautionary approach be applied from the outset recognising that a respiratory disease may spread from person to person unless established otherwise”.

It also recommends strengthening the authority and financing of the WHO. “There is no alternative to multilateral cooperation. No nation acting alone can bend the negative climate curve, nor stop the spread of a deadly virus which does not respect national borders.”

When Maverick Citizen interviewed Matsoso about the report and its significance we noted the comment by Ellen Sirleaf that “The shelves of storage rooms in the UN and national capitals are full of reports and reviews of previous health crises. Had their warnings been heeded, we would have avoided the catastrophe we are in today. This time must be different.” 

I pointed out to Matsoso that the world is drowning in reports that do not get acted on — the reports of the Intergovernmental Panel on Climate Change is the best example — ‘so what would be different about this one?’ 

Matsoso acknowledges the problem and says that in South Africa this report needs to be sent to Parliament to be read and acted on at the highest level. She also emphasises the importance of human rights activists and civil society as a whole owning the report and pressing for action. As pointed out in the New York Times recently Covid-unpreparedness and inequality is a harbinger for climate crisis unpreparedness. That’s why, Matsoso says, that the Panel has deliberately pointed out that “this is not a health issue and that heads of state must take charge and responsibility for acting on its recommendations.”

It’s a long and ambitious to-do list. The report will be tabled at the World Health Assembly later this month, but it will also be tabled at the UN General Assembly. Matsoso says the Panel “wants a high-level meeting of heads of state.” In this regard, one of its recommendations is to establish a Global Health Threats Council that will “maintain political commitment to pandemic preparedness and response and hold actors accountable, including through peer recognition and scrutiny.” 

Specifically, the report says that “countries should also adopt a Pandemic Framework Convention within the next six months” and an International Pandemic Financing Facility. DM/MC

The full report is available here. Maverick Citizen will unpack the report and our government’s responses to its recommendations further in future articles.