By Joanna Nurse
The InterAction Council – a group of former world leaders - co-chaired by HE Bertie Ahern from Ireland and HE Olusegun Obasanjo from Nigeria, recently published a COVID-19 Policy Framework in response to the current pandemic. This report builds upon the longstanding emphasis of the InterAction Council to promote global security. The Council’s global health focus in recent years, including during its plenary session in Beijing in 2018, has been on enhancing the links between human and planetary health to secure the wellbeing of future generations. The COVID-19 Framework aims to provide a comprehensive, multi-sector approach to assist global, national and community responses now, as well as to promote constructive recommendations for the recovery process.
The world is watching China with anticipation as the first country to respond to the COVID-19 outbreak, and consequently to draw an end to a period of lockdown and initiate a recovery process. China has played a key role throughout the COVID-19 outbreak, from the initial identification of this new infection in the later part of 2019, its realisation of the impact upon health, followed by massive mobilisation of community and public health efforts to prevent the spread of the virus across China and to protect its population from harm. Over 70% of new infectious diseases are the result of animal to human transfer, and emerging infections frequently take some time to be recognised, described and brought under control.
At the end of January 2020, following over 200 deaths, the World Health Organization (WHO), in close liaison with China, officially declared a Public Health Emergency of International Concern. Whilst in mid- February, China worked in close collaboration with partners including the WHO on the Joint Mission on Coronavirus Disease. As the first country affected by the COVID-19 outbreak, this report provided valuable lessons to share with the rest of the world on the nature of this new disease, and the public health responses that China took to contain it. (WHO: Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19): 16-24 February 2020: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf)
Although a crude indicator, the total number of hospital deaths from COVID-19 has provided an early indication of the progress of the epidemic. As with many countries, China initially struggled to provide community data on deaths attributable to coronavirus, and has recently revised its estimated deaths by 50% from COVID-19 to over 4,600. As the world struggles to deal with this new disease and overwhelming pandemic, we need to share experiences and resources between countries as well as to co-operate globally in order to co-ordinate our responses and protect vulnerable populations.
Many of these early lessons from China have been used to inform and illustrate the framework, which provides a series of lessons from China to share with the wider world. The main purpose is to inform national, multilateral and global responses - to address the COVID-19 pandemic now, with a view to enhancing co-ordinated global, regional and national responses. The framework outlined below provides a comprehensive multi-sector response that can potentially be adapted for national and multilateral planning processes.
The initial COVID-19 Framework:
Since the outbreak, the government of China, along with Chinese philanthropists, have proactively shared clinical guidelines, expertise, and provided healthcare equipment, including respirators and significant resources, rapidly and at scale to over 150 countries in response to the pandemic. These actions reflect the increasing leadership role China is taking in providing global responsibility to protect vulnerable populations across the world from the impacts of this pandemic.
Aside from sharing experiences and providing resources across the world, President Xi Jinping has taken China’s global responsibilities seriously, by emphasising a vision of building a community with a shared future for humanity. Additionally, President Xi has articulated the role that China has in strengthening global solidarity and cooperation in responding to the COVID-19 Pandemic. Furthermore, China has the opportunity to play an even more ambitious global role, by working in collaboration with multilateral organisations, countries and wider partners to further develop, resource and advance the initial recommendations in the framework, outlined below:
Initial Recommendations for Future Pandemic Preparedness and Emergency Responses:
- Build Back Green – as part of the recovery process, invest in solutions that address the climate crisis and enable progress towards the Sustainable Development Goals including: nature based solutions, renewable energy, low carbon infrastructure, climate change adaptation.
- Enable the Digital Transformation – continue the rapid digital shift during the pandemic to create connected communities that are able to share learning, find solutions and respond at scale to building back green; ensure digital governance to prevent misinformation, hacking and scams; and enhance efficient ways of working, with reduced travel, with the creation of digital health systems for Planet, Place and People for a common future for all.
- Courageous and Collaborative Leadership – for the wellbeing of future generations, in order to apply learning from the pandemic, re scaling up emergency processes and unified efforts to address the climate and environmental crisis; empower young people with the skills and experience required to address emergencies and to secure a healthy planet for all.
- Establish an Independent Global Emergency Mechanism – tasked with enhanced surveillance and monitoring, risk assessment and detection, with rapid alert and response systems; such an organisation needs to be able to establish a global and multi-sector response at speed, communicate freely, have independent governance and be able to collaborate and mobilise action across the international community.
- Invest in Emergency Preparedness and Response – the Commission for a Global Health Risk Framework for the Future recommends an annual global investment of US$4.5 billion for pandemic preparedness, including public health preventative measures and research. Such an organisation could have wider responsibilities, including relevant aspects to address the Planetary Emergency.
- Strengthen Public Health and Health Protection – invest in and enhance essential public health operations and services within every country– a weak link anywhere is a weak link for us all – ensure that this is embedded within national health systems to enable national, regional and local coordination and surge capacity during outbreaks.
- Enhance links with multi-sector emergency mechanisms – ensure that health risks and planning, including for pandemics are incorporated across global, national, regional and local emergency planning systems and governance mechanisms – building upon the Sendai Framework for Disaster Risk Reduction.
- Increase Research into Prevention and Preparedness - the Commission for a Global Health Risk Framework for the Future recommends an annual global investment of US$1 billion for research into pandemic preparedness; investing in research on the effectiveness of preventative and health protection measures provides the most scope for reducing avoidable deaths, whilst maximising economic savings, and reducing global security impacts.
In the course of history, as tragic as this pandemic will be seen to have been, we will look back on this catastrophe as a wake-up call of our wider global responsibilities to prevent future pandemics, as well as in responding at speed to our impending climate and environmental crisis. Going forward, the success or failings of our collective efforts will be measured by our ability to learn the deep lessons from this experience. During the recovery process, China, as with the rest of the world, has to rise to this challenge, by rapidly transforming the way we respond and reshape our world to create a secure and sustainable future for all.
Dr Joanna Nurse is a Strategic Advisor to the InterAction Council on global health issues and author of the initial COVID-19 Framework