This article is part of a series in which OECD experts and thought leaders — from around the world and all parts of society — address the COVID-19 crisis, discussing and developing solutions now and for the future. Aiming to foster the fruitful exchange of expertise and perspectives across fields to help us rise to this critical challenge, opinions expressed do not necessarily represent the views of the OECD.
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The COVID-19 pandemic continues, and leaders can and must take measures to end the worst of it—including by reducing the risks of severe illness, deaths and long COVID. Leaders have a responsibility and an opportunity to work together and implement doable changes that will stop the next health threat from becoming a pandemic.
For COVID-19, daily reporting has ended in many places and testing rates in high-income countries have fallen by half since March—but the direct health, social and economic effects of the pandemic continue to reverberate.
SARS-CoV-2 has not been predictable, but nonetheless there are tools to protect people against the worst of its effects. But are people in OECD countries sufficiently protected?
About 1,400 people died due to COVID-19 each day of May, according to reports by the World Health Organization. Most of these recorded deaths occurred in OECD countries—tragedies in themselves, and a terrible strain on intensive care units and their exhausted workers. Of the 6.3 million people recorded to have died globally to date due to COVID-19, almost 3 million lived in OECD countries.
Even “mild” COVID illness may have knock-on health and economic effects. Family members continue to fall ill and require care and support for several days. Colleagues call in sick, perhaps infected a second time, requiring time off work. The newest summary of evidence on long COVID suggests that up to three in ten people may suffer a huge range of symptoms months after infection; many require health care and significant leave from work, and a number resign from their jobs. The longer-term implications, which are disproportionately affecting women, are cause for alarm.
This is no time for complacency. Experts consulted as President Ellen Johnson Sirleaf and I prepared our latest report, Transforming or Tinkering? Inaction lays the groundwork for the next pandemic, warned that countries in the northern hemisphere should be ready to deal with new surges of the virus and that these are already occurring in the Americas. Many countries in the southern hemisphere have been managing large numbers of cases and continued deaths in recent months. Omicron subvariants are highly transmissible, and a new and more deadly variant could still arise.
Find out more about Transforming or Tinkering? Inaction lays the groundwork for the next pandemic by Rt Hon. Helen Clark and H.E. Ellen Johnson Sirleaf
SARS-CoV-2 has not been predictable, but nonetheless there are tools to protect people against the worst of its effects. But are people in OECD countries sufficiently protected? Save for Chile, reported vaccine booster dose uptake in OECD countries ranges from 30% to 73% of populations, with an average closer to 50%. Depending on the timing of that booster dose, even that protection may now be waning—leaving people vulnerable to severe illness and death. The health workforce—already insufficient in numbers before COVID and depleting as a result of it—will struggle to cope with another severe wave, together with the continued pressure on it to catch up on the missed screenings, treatments and surgeries of the last two-and-a-half years.
Leaders must proactively advocate for and invest in protective measures, such as vaccination (including boosters) and improved ventilation, before another surge of Omicron or a new variant appear. They must also prepare their populations for the potential need for mask mandates, distancing recommendations and isolation or quarantine measures as required by any new COVID-19 wave. Protocols for the antivirals that keep people out of hospitals—and graves—must be clear and ensure accessible supplies for all in need. People must also be primed to accept new COVID vaccines when they are available, and community engagement for this is critical.
OECD leaders must also use this window to prepare for the next pandemic threat. There are national measures to take, including thorough reviews in-action and after-action, which can inform ongoing efforts against COVID and readiness to respond to a new pathogen. To this end, OECD countries have learned much from one another, and will benefit from continuing to do so.
Transformative global reforms are also essential. The Independent Panel’s main report, COVID-19: Make it the Last Pandemic, released in May 2021 to the World Health Assembly, proposed an evidence-based package of actionable recommendations for leaders to take to transform the global system for pandemic preparedness and response.
Bold change is required in several areas: first, about USD 10.5 billion per year in new finance is required both for readiness and to leverage from for surge action in the face of a crisis. Committing a few billions to save trillions to the global economy and protect the lives and well-being of the global population is not a big ask.
Second, the system for surveillance is neither well-connected nor modern enough. The current legal instrument—the International Health Regulations (IHR)—hinders rather than helps the speed of alert required. These matters require urgent attention.
Third, at the heart of this surveillance system must be a strengthened World Health Organization, with the authority to alert the world rapidly to any new threat using the precautionary principle. It needs sustained, reliable finance for its base programme that will enable it to play the roles Member States expect of it effectively.
Fourth, the charity-based distribution of market-sourced pandemic tools—which in reality are essential global public goods to fight pandemic threats everywhere—does not work. Fewer than 15% of people in low-income countries have received two doses of COVID-19 vaccines. The current system is unfair, and does not support good public health. Instead, a pre-negotiated platform with equity at its heart must be created—and should be built on lessons from the experience of the current Access to COVID-19 Tools Accelerator (Act-A) and its COVAX arm.
The Haves and Have-Nots: The geopolitical dilemma of COVID vaccine equity by Dr. Ayoade Olatunbosun-Alakija, Member, African Union's African Vaccine Delivery Alliance; Global Advisory Board Member for WomenLift Health; Chief Strategist, CONVINCE Africa
There is some progress, at least on process, regarding changes in line with the Independent Panel’s recommendations. In May at the annual World Health Assembly, Member States agreed to provide more sustainable finance to the Organization.
But overall, changes are happening far too slowly, are too process-driven and, critically, are lacking the inclusion and cohesion required. Processes to amend the IHRs and create a new pandemic legal instrument—form and content yet unspecified—are underway through World Health Assembly-mandated processes. But they are not set to seek global agreement until the Assembly meets in May 2024, and then would not come into force until well after that. The two separate tracks of legal change have some worried about clashes or overlaps; and lower-income countries, with small missions in Geneva, are worried about the bandwidth they have to take part in each process on an equal basis.
On establishing a dedicated financing mechanism, a new pandemic Financial Intermediary Fund to be hosted at the World Bank is in the works, but its proposed design does not yet suggest an inclusive approach to financing and governance. Given that pandemic readiness and response are global public goods—and that preparedness in every country benefits every other country—all countries should contribute to this Fund on an ability-to-pay assessed formula, with allocations supporting those with the least capacity and fiscal space. Early plans, however, suggest that a donor-led Fund is being designed. Such a model has not delivered during the current pandemic, and is unlikely to be effective in the future.
Lower-income countries have suffered grievously during this pandemic, and will take the longest to recover. As well, they are facing the crippling and fatal burdens of energy and food price spikes and shortages brought about by the invasion of Ukraine, and of climate change. For COVID-19, they asked for support in the form of voluntary licensing and a TRIPS waiver, and have been stymied at every step. Countries on the African continent are now planning to be more self-reliant and to manufacture their own supplies, including vaccines. OECD countries will be on the right side of history if they support Africa to do just that, including by facilitating and not hindering TRIPS waivers in order to save lives during emergencies.
OECD leaders have an opportunity to end this pandemic and prevent the next one—and provide future generations with a strong example of how multilateralism can work.
A major challenge now is marshalling the global leadership needed to give momentum to the transformative change required to end COVID-19 and to prevent future pandemics.
The establishment of an inclusive, leader-led, Global Health Threats Council, given legitimacy through the UN General Assembly, was at the heart of the Independent Panel’s recommendations in May 2021—and we continue to argue that it is required. As we’ve learnt, health is just one of many sectors affected by a pandemic. A UNGA High-level Meeting—ideally this autumn—could agree a Political Declaration setting out a roadmap for transformative change in the global architecture and provide for the establishment of the new Council. The Council should be independent of WHO because of the cross-cutting, multisectoral impacts and implications of pandemics.
At the current pace of change, real transformation remains years away, and risks leaving lower-income countries out of decision-making.
OECD leaders have an opportunity to end this pandemic and prevent the next one—and provide future generations with a strong example of how multilateralism can work. They can lead transformative change rather than merely tinker around the edges.
The alternative is continued, preventable suffering today, and a reliance on the same faulty international tools that were available in December 2019 when the world first learned of a new respiratory pathogen in Wuhan. We risk the catastrophe of this pandemic happening all over again if we fail to act to make change now.