Covid-19 left around 15 million people dead globally; millions with the Long Covid condition; an estimated $12 trillion economic impact, which, even if is hard to be precise, puts the cost at least in the trillions, not billions; a massive effect on lost years of education especially for the poorest communities; and a stack of untreated or uncared for other illnesses, whose consequences are now coming home to roost.
In addition, there was huge inequity in the treatment of the disease, in the manufacture and distribution of vaccines, and in the ability of health-care systems to cope.
So, the world survived Covid-19 but at a vast cost. Predictions of future pandemics range from the possible to the probable, but no one assesses the risk as negligible. Because of the possibility that any such future pandemic could involve a virus more deadly than Covid-19, it is recognised that we should ensure the capability, globally, to act much faster and more effectively than we did for Covid.
All this is clear. And it is clear to most political leaders I speak to. Therefore, the case for action is extraordinarily strong. But, these leaders, particularly if they're operating in democratic systems, also have a cost-of-living crisis to deal with, a war in Europe, energy prices, climate change, supply-chain challenges and a host of other very proximate issues upon which their people demand action and usually with money attached. A year ago, talking to them about pandemic preparedness was a relevant conversation, which stimulated a fair amount of interest. Today, very frankly, not so much. And that is a big problem.
Moreover, the main forum which should coordinate global health action – the G20 – has a fundamental political schism at its centre. The G7 is the Western world, not the world. And the UN is, well, the UN with its attendant advantages and disadvantages.
So, here is my take from a political perspective: the only way to get political traction and the action this summit should recommend, the only route I can see to put in place the measures of pandemic preparedness that we undoubtedly require, is to prove to the political class: first, that there is an immediate case for action, not a contingent one; second, that this action will be politically popular and beneficial; and third that it will yield a health and therefore an economic gain which, if not immediate, will not seem impossibly distant either. This is the "here and now" argument for political leaders to act.
It has credibility because Covid-19 had one other unlooked-for positive, along with all the obvious negatives. It heralded significant, possibly game-changing advances in medical science. Some of these were happening anyway but have been accelerated; some were invented as a byproduct of intensified medical research as a result of the Covid-19 crisis; and some completely new ones are at least now within sight.
These treatments – vaccines, injectables and drugs – are either available now, or will shortly become available. mRNA technology alone has stimulated a plethora of new possibilities. And we can identify them.
There are new drugs on the way for TB, malaria, dengue and HIV – all highly applicable to the developing world; but also for influenza, high cholesterol and non-communicable diseases such as cancer, heart attacks and strokes – applicable everywhere. Existing vaccines for HPV have been shown to reduce the risk of cervical cancer in the UK and US by around 90 per cent. But this disease is just as prevalent in the developing world. Estimates are that just expanding the age groups of girls receiving these vaccines could save up to 1.7 million lives in 73 low- and middle-income countries.
All in all, we estimate that at least 10 million deaths per year, and probably more, are attributable to diseases with existing or forthcoming adult vaccines and preventative injectable therapies.
We are standing at the frontier of a new rich and diverse field of medical science, which potentially revolutionises global health care saving lives, and trillions of dollars in lost output, quite apart from the impact on stretched government budgets.
To access this potential needs a concerted international effort, to switch our health-care systems from preparing for the next crisis, whose advent is uncertain and whose effects are unknown, to an "always on" network of enhanced capability globally that can both spring into action immediately should we be gripped by a fresh pandemic, but which in any event can mobilise these changes in medical science to treat and prevent disease here and now.
To achieve this requires at least the following elements to be in place:
Obviously the investment in new treatments, vaccines and research from private, public and philanthropic sectors.
A much better and faster system of clinical research.
Genomic-surveillance capacity spread evenly around the world.
The infrastructure nationally and globally to capture the data, and to register vaccination and treatment.
The harmonisation of standards and regulation to quicken the approval process.
The establishment of manufacturing and distribution capability in the developing world, as Africa is seeking to do with its PAVM (Partnerships for African Vaccine Manufacturing) initiative.
And the reform of government systems to permit the effective implementation of this "always on" network.
All these elements can be accelerated significantly today through technology. Many of the present instruments of international action are either focused on specific diseases or on children. This is mirrored in the modus operandi of many health-care systems. We need to think through what change they need to accommodate adult vaccination at scale, with multiple doses, and where several conditions can be treated at the same time.
My Institute works in almost 40 countries now worldwide but with special emphasis on Africa and the Far East. There is enormous appetite among the governments with whom we work for embracing these changes as part of a radical reorganisation of health care.
In respect of every one of the elements listed above, there are individual examples of countries successful implementation.
We know there are large funds from the donor community directed towards health care.
The challenge is how to organise the development of the necessary changes so that we are indeed "always on". My Institute, which together with scientists from University of Oxford and the Ellison Institute for Transformative Medicine form the Global Health Security Consortium, launched what we call the One Shot campaign, setting out the steps vital for "always on".
I believe the political will can fructify, if political leaders can see a viable plan. So, here is my suggestion. There exists in this room, and in the organisations represented by you, the expertise to create such a plan. We each have different roles to play. But in combination, nothing that is needed is beyond the knowledge of those present.
From this summit, we should work out a process for pulling the plan together. We can then individually and collectively and of course through the WHO touch the various points of power within the global political system to show today’s leaders that there is both the opportunity for a whole new era of disease treatment and prevention and on a timescale that should be visible and practically achievable even with a short-term political horizon.
In a world marked at present by deep geopolitical division, it would show that global action remains open to us, in health care as in climate change, if we have the way and the will. At this moment, it would bring a welcome light of hope at the end of an otherwise gloomy global tunnel.
The great thing about this audience is that by and large we are people who like to do rather than debate. We're not cynical because we all have experience of how problems can be solved. But we are frustrated because we know there is so much more that needs to be done and which can be done. This cause – the creation of an "always on" global infrastructure for fighting preventable disease and death – is one which motivates us because we know that although it is in the realm of the ambitious, it is not in the realm of the impossible.
So, from here, we should give ourselves a call to action. All acting in our different ways. But all in pursuit of the same cause.