‘Equitable distribution is vital’

The pandemic has hit the whole world. Yet, it seems industrialised countries are somehow affected worse than the developing world. Is that impression correct?
No matter the income group, we have seen that some countries have managed their national responses well, and some have not. Some did well because of their ‘muscle memory’ – relying on experiences of the past. It is not by chance that countries in the Mekong Delta, neighbouring China, demonstrated strong responses to COVID-19, built on lessons learned and systems developed due to outbreaks like SARS.

What about Africa? Where is the continent in terms of dealing with the pandemic?
Since July, we have seen promising trends from some countries in Africa, where cases have been declining. These are fragile wins, however, and we must work unrelentingly to maintain them. During the week of 18 September, Africa was the only region to report a decline in deaths. But we must also remember that Africa is a continent of 55 countries, and it is possible to see variations across borders. But in the main, we have observed that many countries took special measures early and benefited from experience from other diseases like wild poliovirus, yellow fever, cholera and the Ebola outbreak. The challenge is not to take the response lightly and become complacent. We are still in the middle of the pandemic.

‘To safeguard communities from future shocks, we must increase investment in our health systems and emergency preparedness.’

Due to lockdowns, challenges such as fighting hunger or poverty are suddenly in competition with health issues. What is the best way of dealing with this trade-off?
We do not see this as a trade-off: we do not need to choose between health, hunger and poverty. We need to work across all fronts. We continue to urge countries to focus on four essential priorities so that they are able to safely resume activities while keeping people’s health at the front of their minds. First, we must prevent amplifying events, like sports events and religious gatherings that bring large numbers of people together. Second, we need to protect the vulnerable in all countries, including the elderly, people with underlying conditions and health workers. Third, we need to educate, empower and enable communities to protect themselves and others, using every tool at their disposal. And fourth, we must get the basics right: find, isolate, test and care for those who are infected, and trace and quarantine their contacts. This is what works.

What is more challenging for developing countries – the medical, social or economic impacts?
COVID-19 has shown us how interconnected our world is and how a health crisis can cause major upheavals across all aspects of our lives. It has underscored more clearly than ever the critical importance of public health when it comes to protecting and advancing peace and development. To safeguard communities from future shocks, we must increase investment in our health systems and emergency preparedness.

What long-term consequences do you expect for developing countries?
The potential long-term consequences of the pandemic exist for all nations. But the impact could be higher in developing countries. The terrible prospect exists of half a million more people in Africa dying of AIDS-related illnesses, and an estimated 10,000 children and other vulnerable people could die from hunger every month. On the financial front, the International Monetary Fund predicts a 4.9 per cent contraction in the global economy this year. But these impacts can be prevented through continued global solidarity and national unity.

Once vaccines are available to treat COVID-19, how long will it take until all people around the world have access and can be vaccinated?
Work is underway across the globe to find effective vaccines. WHO is working with companies and sponsors, as well as vaccine alliances like Gavi and CEPI, to speed up this process. We are also trying to scale up manufacturing capacity. However, there are many unknowns. It is hoped that if a successful vaccine is found by the end of the year, there will be enough doses available for countries by the end of 2021.

How should the vaccine be distributed across the globe?
The first priority must be to vaccinate those most at risk, including the elderly, people with underlying conditions and health workers, in all countries, rather than all people in some countries. Global equity is critical for the distribution of a safe and effective vaccine.

What could be the role of WHO in this?
WHO is working with partners to speed up the development and manufacturing of a vaccine. In dialogue with the Member States, we are also developing a global allocation framework for vaccines and other tools, including treatments and diagnostics, based on the principle of fair and equitable access. The proposal is to allocate the vaccine doses to all participating countries simultaneously, in the proportion needed to cover 20 per cent of the population. This is expected to reduce overall risk and protect most-at-risk groups from the virus everywhere and at the same time.

Can you assure the public that a vaccine will be ‘safe’?
We take vaccine safety very seriously. Accelerating the timeline for vaccine development does not mean we are compromising safety. We are engaging with vaccine developers and others to ensure that we have standard end-points and data-collection mechanisms to regularly monitor both the efficacy and safety of vaccine candidates.

‘The first priority must be to vaccinate those most at risk.’

WHO has been accused of not reacting quickly enough at the beginning of the outbreak. How do you react to this kind of criticism?
I think the criticism is not justified. We reacted rapidly to the first reports of cases of ‘pneumonia of unknown cause’ in Wuhan on 31 December. On 1 January, we activated our three-level emergency incident management team. We provided a detailed summary of the situation on 5 January. We issued a comprehensive package of guidance, covering key topics related to the management of an outbreak of a new disease, starting on 10 January, and we briefed the public and media in mid-January. Furthermore, we convened an Emergency Committee on 22 to 23 January, and again on 30 January I myself and my senior management team visited China. On 30 January, we declared a public health emergency of international concern, our highest level of alert, when there were less than 100 cases and no deaths outside China.

How has this pandemic strained your organisation?
The response to COVID-19 has been an immense undertaking, involving all staff at WHO. I am so proud of how my colleagues have responded. We had already undertaken an extensive transformation of WHO’s emergency programme after I became Director-General in 2017. The changes we instituted primed WHO to be able to implement a robust and rapid response to COVID-19 from 31 December 2019 onwards. During the many months of fighting COVID-19, WHO staff have worked around the clock, driven by the need to learn about this virus, provide life-saving guidance, build partnerships and communicate what we know to the world.

What does your working week as Director-General of WHO look like these days?
The increased demands caused by COVID-19 have posed major challenges for each and every person working for WHO. But, at the same time, it has brought us closer together. One colleague was recently asked by friends how he was doing. He responded: ‘We work in good faith and have faith in each other, and this faith has now been tested under very trying circumstances.’ The determination shown by my colleagues inspires me to keep striving day in and day out in my work.

published in akzente 3/20