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Leading the response to the next pandemic

Better national strategies and significant reform of the international system are needed to prevent a new health crisis

ENRIQUE FLORES

Outbreaks of highly infectious diseases are inevitable. However, in the 21st century, pandemics are not. This is one of the strong propositions contained in the report of the Independent Panel for Pandemic Preparedness and Response (IPPPR) released this week. This implies that the enormous human and economic cost caused by the coronavirus could have been avoided.

The very real threat of a new, rapidly moving, highly lethal respiratory pathogen that could potentially kill millions of people and wipe out a significant part of the world’s economy had been known about and warned against for many years. It was also known, in principle, what to do to prevent such a disease from becoming a pandemic. Despite this well-documented knowledge, Covid-19 became a pandemic that has so far caused the death of 3.3 million people and the destruction of as much as the equivalent of one-fourth of global gross domestic product (GDP) in 2019.

The Independent Panel, of which we are the two Latin American members, has concluded that the international system, including the indispensable coordination and cooperation put in place over the years to deal with the threats of pandemics, unquestionably failed to perform its role to deal with Covid-19. Simply stated, most countries did not prepare as stipulated and mandated by the International Health Regulations and other existing multilateral instruments. Furthermore, it is now clear that the existing mechanisms, even if they had been applied effectively which was clearly not the case, would not have been sufficient. Therefore, in order to prevent the next pandemic, significant reform of the international system must be undertaken at once.

It is painful and shameful that Latin America, which accounts for a little less than 8% of the world population, has registered almost 47% of the total number of deaths caused by Covid-19

Accordingly, the panel proposes elevating pandemic preparedness and response to the highest level of political responsibility by establishing a Global Health Threats Council led by heads of state and government. This council should spearhead the necessary changes in the international system, including adopting a Pandemic Framework Convention, strengthening the authority of the World Health Organization (WHO) and ensuring its financial independence based on fully unearmarked resources and a significant increase in member states’ mandatory contributions.

The WHO should use its reinforced capacities to, among other ends, establish a new global system for surveillance based on full transparency by all parties; be more agile and forceful to declare international public health emergencies and investigate pathogens with pandemic potential when there is short-notice access to relevant sites; and ensure that all national governments update their national preparedness plans against WHO targets and benchmarks and become effectively accountable. The council should also lead the creation of an international pandemic financing facility that will commit long-term contributions by all countries. It should also transform the existing Access to Covid-19 Tools Accelerator (ACT-A) into a permanent and sufficiently endowed mechanism to deliver vaccines, therapeutics, diagnostics and other essential supplies. In the very short term, the panel has recommended agreeing on a meaningful redistribution of surplus vaccines available in some countries towards places and populations at high risk.

Having a much better international system is important but not enough. Ultimately the responsibility to deal with the threat of a pandemic lies within countries themselves. This reality is being unquestionably proved during the ongoing pandemic. The Independent Panel found that there have been enormous differences across countries regarding both the way they have confronted the disease and the results each has achieved. Some countries were successful in suppressing the spread of the disease and containing its economic damage, whereas others have had very high rates of infection and mortality along with significant economic and social costs.

The difference between the bad and the good performers is truly abysmal. The bad ones have registered rates of infection and mortality that are hundreds, even thousands of times those of the good performers. Interestingly countries that effectively contained the disease also suffered the least economic pain.

Outbreaks of highly infectious diseases are inevitable. However, in the 21st century, pandemics are not

The panel has determined that the countries that have done much better were the ones that took early action without waiting to see whether the virus would be contained in other parts of the world. Their national governments were well organized to pursue coordination and consensus across the different levels of government – state and municipal, and civil society, with clear decision-making procedures. They proceeded swiftly to allocate more financial and human resources to public health and invested significantly in testing massively for the disease. The leaders of those countries displayed humility, full openness to and reliance on scientific advice, as well as an ability to change course in the face of new evidence and to recognize mistakes. They worked for building consensus rather than division and, very importantly, showed demonstrable empathy for the suffering of their citizens.

Very different was the response in the countries whose populations have suffered the most. In those cases, their national governments minimized or outright dismissed the threat, delayed effective action, refused to coordinate with other levels of government, rejected scientific advice, systematically misinformed their populations and generally failed to equip their health systems, and certainly those on the front lines, with the necessary resources. Protecting the health and lives of their citizens and demonstrating solidarity towards those most affected were not part of what happened in countries with the worst results.

Unfortunately, Latin American countries figure very prominently among those that have dealt poorly with the pandemic. Among the 15 countries with the highest Covid-19 mortality rate, six happen to be Latin American. It is painful and shameful that Latin America, which accounts for a little less than 8% of the world population, has registered almost 30% of the total number of deaths caused by Covid-19. It is also revealing that the Latin American region in 2020 had the worst economic results in the world. Whereas world output contracted 3.3%, in Latin America and the Caribbean the contraction was 7% and countries such as Argentina, Peru and Mexico recorded some of the highest reductions in GDP in the world. In just one year, progress made in previous years to reduce poverty and inequality in several countries of the region was undone. The damage is bound to be felt over the long term, demonstrated most obviously in lost education. The poor planning for the acquisition of vaccines, save for some exceptions, has led to a slower pace of immunization as compared with other countries and will be another cause of negative effects of the pandemic for many years to come in most of our region.

The risk of new waves of infection and mortality, with their accompanying social and economic destruction, will be a constant threat to our nations

The Latin American disaster cannot be attributed in any way to the conditions in which the pandemic found our economies or our health systems. Other countries with poorer economies and more modest health infrastructures have done a much better job in protecting the health of their populations and their economies. Consequently, the explanation of why our countries have the dubious distinction of being among the worst must be directed to the bad strategies and policies by incompetent governments that have failed their citizens miserably.

At the current pace of vaccination, the end of the pandemic in Latin America appears still remote, in some of our countries as far away as two years or more, which means that not even those now doing a bit better with their vaccination programs will be safe anytime soon. The risk of new waves of infection and mortality, with their accompanying social and economic destruction, will be a constant threat to our nations. Therefore, it is not too late for our governments to learn from the lessons, well documented by the Independent Panel, of the countries that have succeeded in protecting their people from the disease, and start acting with the intelligence, decisiveness, humility, transparency, honesty and empathy towards human suffering that sadly has been missing so far in most of our countries throughout the ongoing tragedy.

Ernesto Zedillo Ponce de León is a professor of economics and international politics at Yale University and was president of Mexico between 1994 and 2000. Mauricio Cárdenas Santamaría is an energy researcher at Columbia University and was finance minister of Colombia between 2012 and 2018. Both are members of The Independent Panel for Pandemic Preparedness and Response established by the WHO.

Errata

An earlier version of this article said that Latin America accounted for 47% of all covid-19 deaths. That figure covers all of the American continent, not just Latin America.

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