Leading After Emergency

After pages of goals and recommendations on responding to COVID-19 and preparing for the next pandemic, one thing is still lacking: leadership

In summer 2021, hundreds of world leaders came together in two Global Summits to address the COVID-19 crisis and preparation for the next pandemic. At one summit alone, virtual attendees included heads of state and representatives from over 100 governments. An additional 100+ leaders from global health organizations, major corporations, various philanthropies, civil society, academia, and other sectors also participated.

A set of ambitious goals were proposed to get us on top of COVID, including: vaccinating 40% of the world by end 2021 and 70% by September 2022; making $3 billion available in 2021 and $7 billion available in 2022 for vaccine readiness and deployment, including health workforce needs; expanding production of mRNA vaccines regionally; expanding testing capacity to reach a minimum per capita testing rate of 1 per 1,000 population; and ensuring access to quality therapeutics in all low- and middle-income countries by end 2021.

Unfortunately, not one of these goals was met.

A follow-up summit this summer has tried to reassess the system and to look toward how we will transition from the COVID-19 response to a more systematic approach for addressing pandemics.

In parallel, in September 2020, the Independent Panel for Pandemic Preparedness and Response (IPPPR) began its work to look at this very issue – how to be better prepared for the next pandemic. It was led by the eminent Helen Clark, former Prime Minister of New Zealand, and Ellen Sirleaf Johnson, former President of Liberia. Their inspired work produced, slightly less than a year later, a set of recommendations on key steps that must be taken in preparing for the next pandemic. This week, Ms. Clark and Ms. Johnson published their recommendations again in Foreign Policy (potential paywall) – with the implication that perhaps not everyone heard them the first time.

What is striking in the current moment in global health is the lack of clear plans by global decision-makers and national public health systems. The IPPPR’s report provides what could be the foundation of a plan, a set of clear needs for global preparedness that I can summarize:

• Appropriate ready funding

• A stronger WHO

• A real access “accelerator” effort that focuses on delivery & vaccinations in countries with limited access

• Real leadership globally on pandemics & health systems

Each of these is important. The push to get funds took time while COVID continued to spread; and by the time funds began to be available, rich countries had overpurchased vaccine doses. Having proper funding would mean having a fully functional pandemic preparedness fund established, with resources, ready to respond with support when outbreaks happen.

WHO will need new authority and better resourcing if it is to be decisive and effective in the next pandemic. This means key leadership positions in emergencies and health systems need to actually be filled and authority to investigate outbreak reports needs to be clear.

The global partnership formed to accelerate access to COVID tools during the pandemic had too many areas where it fell far short of expectations, with individual organizations fighting and competing with each other on funding and post-pandemic “positioning.” A real “accelerator” would have a clear governance structure and reporting lines and would focus not just on buying bulk vaccine but on ensuring delivery of both vaccinations and care for those who fall ill. 

But by far, the most important factor for our future in pandemic preparedness is leadership. Addressing the next global health threat, before it is launched, will take vision and focus from prime ministers and presidents to align their countries’ resources and agencies in a “whole of government” effort.

This leadership cannot come only through traditional emergency silos within global institutions or national public health organizations. It is time to recognize that the next generation of global health leaders will be individuals who understand both emergency response and the health systems in which those responses sit.

COVID-19 saw extraordinary efforts and massive resources in what were essentially vertical emergency responses. In many countries, there was little connection to civil society and “peacetime” health systems. We need to change that. Now, as countries start to envision both how they integrate COVID-19 into “regular business,” the recommendations from the IPPPR are sorely needed.

The question will be, can we find real leaders to take that advice?