Une meilleure gouvernance pour un monde en paix
Une meilleure gouvernance pour un monde en paix
The Paris Peace Forum co-organized with the Bill & Melinda Gates Foundation and the Learning Planet Institute a policy conversation around Bill Gates during his trip to Paris on May 6. The discussion focused on pandemic preparedness and response, exploring what shifts in global health governance – including those proposed in Bill Gates’ new book – could help us be better prepared for future pandemics.
As PPF’s Director-General Justin Vaïsse noted in his introductory remarks, the Covid-19 pandemic illustrates a tension between the global nature of a pandemic and the insufficiently coordinated nature of the international response, both to quickly detect outbreaks and to enable an efficient response to a pandemic. Factors hindering such joint action are primarily political, and improving our collective preparedness will require us to think and act creatively to overcome this tension.
Covid was an eye-opener for many people about the need to prepare for pandemics given the potential costs of unpreparedness. After Covid, we know there is a reasonable chance that humanity will witness other new pandemics, likely over the next 20 years. To face this risk, according to Bill Gates, we must mirror our efforts to have firefighters prepared to respond to fire hazards across the world, by building a full-time team of epidemiologists, medical doctors and rapid response workers, dedicated to helping detect and respond to outbreaks: the GERM (Global Epidemic Response and Mobilization). This GERM team should be funded and operated by member-states within the WHO, be on standby for deployments, and run regular drills – much like firefighters.
A key challenge preventing the type of international cooperation we require, according to speakers, was insufficient political leadership and trust from the population whose day-to-day choices and actions are key to the successful implementation of public health recommendations. Leaders and populations are tired of Covid, and global attention is being diverted from pandemic preparedness by other issues on the international agenda (Dr. Ilona Kickbusch: “we are constantly in the cycle of panic and neglect with pandemics, and we already entered the next “neglect” phase”).
But a strong pandemic response capacity relies on their engagement and willingness to track, monitor & respond to future outbreaks. A global mechanism such as GERM can only operate through functioning health systems and community-based surveillance to rapidly identify threats such as outbreaks or dead animals – which in turn require significant funding and capacity-building effort from decision-makers to average citizens (Pr. Samba Sow: “There is pandemic fatigue. Governments have responsibilities, and they need to invest in their health systems”).
Strengthening health systems takes investments, but also mainly trained & protected frontline health workers, who are the first responders and, alas, also often the first victims of a pandemic. Building a strong health workforce is decisive to fight an outbreak, and health workers require adequate equipment to protect themselves and the rest of their community (Dr. Sylvie Briand: “When you lose one doctor, its thousands of people who have no access to care”).
To foster the kind of trust and engagement needed for better international preparedness, we need to learn lessons from the striking inequities of the Covid response (such as on vaccine access), and address the increasing distrust from the Global South in the current responses modalities that all but entrenched deep inequities between high-income countries and low and middle-income countries. We also need to change our common understanding of public health involving actors beyond the health sector, to build trust among the population and make relevant international frameworks more inclusive. The conversation reflected the need to integrate those ideas into the ongoing global health architecture reforms, and to develop different forms of financing to “move away from a development mind frame and finance [health as a] global public good” (Dr. Ilona Kickbusch).
Beyond Covid-19, discussants also highlighted the importance of addressing “hidden outbreaks” which are interrelated, such as obesity or antimicrobial resistance.
In the words of Mr. Gates, civil society will be decisive in preventing the next pandemic by drawing on the tools created for other outbreaks and engaging political leadership and communities.
