Sub-theme 1   What Has the World Learned/Is Learning from COVID-19?

Now that some countries have successfully managed to bring the first wave of COVID-19 under control, it is time to take an early look back and consider what could have been done differently to improve outcomes in all countries. In advance of COVID-19, a series of infectious threats --SARS, highly pathogenic avian influenza virus infection, MERS, and the first pandemic of the century, 2009 H1N1 influenza – had already established a pattern of potential but imminent pandemic emergence, and adoption of IHR (2005) by all Member States should have pushed development of core capacities for detection, reporting, and mitigation to the top of the priority list for national and international leaders and their communities. However, countries have often failed to deliver on this mandate due to other pressing priorities and, notably, a lack of financial commitment: response overrides preparedness. How did these lapses affect countries’ readiness for and response to COVID-19? Sessions will address lessons learned so far -- and particularly what went well to improve preparedness for future events.

Since 2011 and the launch of the Pandemic Influenza Preparedness Framework, preparedness for the emergence of novel influenza viruses with pandemic potential has gained momentum. The PIPF approach was also considered generally adaptable to any other emerging respiratory viruses, including the hypothetical ‘Disease X.’ COVID-19 fits the Disease X paradigm perfectly, complemented as it is by the opportunities provided by the R&D Blueprint to add diagnostics, vaccines, and therapeutics. The core PIPF components have informed the COVID-19 response at national and global levels, including a whole-of-society approach, use of non-pharmaceutical public health interventions, the important role of communication, and the cross-sectoral partnerships among faith-based organizations, industries, labor/employers, and occupational and trade unions. The Global Influenza Surveillance and Response System (GISRS), covering 122 countries, has equipped countries with diagnostic capacity, along with the contributions of other major disease programs, e.g., HIV, TB, and malaria, that have enabled local laboratories to perform PCR tests for COVID-19 diagnosis.

In one of the first speeches after his appointment, Tedros Ghebreyesus, the WHO Director-General, noted that ‘in an interconnected world, we are only as strong as our weakest link.’ No country is safe if disease transmission is active in some parts of the world. COVID-19 hit the wealthiest countries hard, with effects far beyond health, while some middle- and lower middle-income countries managed to get their situations under control. 

In addition to the levels of pandemic preparedness, the disparities reflect the characteristics of the various health systems, such as emphasis on primary health care, extent of public funding for health care, public-private mix in healthcare delivery and adequacy of human resources in health. COVID-19 is confirming the importance of community engagement and ownership, and informed and community-supported self-directed health and hygiene behaviours of each individual in controlling the pandemic. 
‘Solidarity’ has become a symbol of the COVID-19 response – from the global level and down to the grassroots. One remarkable achievement has been demonstrated in healthcare facilities. To save lives when the flood of patients was overwhelming hospitals and ICUs, national and international aid teams were sent – either voluntarily or through their organizations -- to create and maintain surge capacity.

Another issue to explore is the international connectivity among megacities and their roles as trade, traffic, and disease propagation hubs. As shown during SARS, the 2009 influenza pandemic, and this time again, when an emerging pathogen starts its global propagation, it hits the big cities first, then amplifies and spreads to other international hubs. These cities are often more connected to each other than to other places in the same country. Urbanization is another critical factor to explore if we want to prepare better for future epidemics and pandemics.

Finally, efforts are ongoing to identify the SARS-CoV-2 animal source, investigate the human-animal interface (HAI), and determine how this virus was introduced in humans. To manage and control the future risk of emergence of Disease X, the public health and human health security communities must further strengthen HAI work, including the environmental component (i.e., the ‘One Health’ approach)as well as the potential for deliberate or accidental release of engineered organisms (i.e., synthetic biology).

Thus, as we look to the near future, we will use this opportunity to identify the urgent problems yet to tackle and the ways in which we can and should augment readiness. Countries will be invited to relate their experiences with preparedness, containment, and mitigation during both the early phases of the pandemic and continuing as the situation evolves, as well as their assessment of the recovery measures implemented by governments. We will also examine the role and contributions of international organizations and communities in aiming to draw lessons for the world and lessons for countries.

Sub-theme 2   How are we dealing with COVID-19?

The COVID-19 pandemic has undeniably challenged the status-quo of the world order. We will see its tremendous repercussions on health, lifestyles, economy, society, environment and others particularly over the next two to three years. Even as the world tries to deal with the pandemic, there are experiences that need to be shared and lessons that need to be learnt.

The trans-border nature of the virus highlights the need for collective actions and international cooperation. A globalized world advances international travel and transnational communication, but it also accelerates the spread of infectious disease such as COVID-19. Regional cooperation and multilateralism are essential at this time to ensure equitable distribution of resources. However we are seeing the disruption of regional cooperation in some parts of the world. We see some countries engage in philanthropic diplomacy, while others adopt more conservative and self- serving policies to manage the pandemic. The geopolitical impacts of COVID-19 also challenge the balance of power between the West and the East.

The interconnected global supply chain, once viewed as an asset, is now viewed with suspicion. The shortages of PPE, test kits etc. show just how precarious the supply chain is. Many countries have also used this as an opportunity to foster local innovation and production and global institutions need to promote this by facilitating free sharing of technology and knowledge. The issue of access to medical products for the prevention and treatment of COVID-19 remains, especially for poor people and poor countries remains.

While the pandemic underscores the importance of global and regional cooperation, it has also heightened the crisis in governance for health. The WHO is expected to play an important role in this crisis, with countries dependent on it for technical advice and guidance and many low-income countries dependent on it for supplies of medical products. It remains to be seen how it overcomes the current governance and funding crisis and is effectively able to support countries. In dealing with the pandemic, many countries have used the police force and coercion, and attacks on civil liberties have been on the rise. There are concerns related to transparency of Covid-19 data and privacy. The WHO and the UN Human Rights have stressed on the need for a human rights approach in dealing with the pandemic.

The health systems of most countries have struggled to respond to the crisis, though there are those that have shown exceptional resilience. The pandemic has once again brought to fore the importance of investing in public health, strong public health systems, comprehensive primary health care and the role of health workers and other frontline workers. However, health workers and other frontline workers in many countries have faced problems in accessing adequate protective equipment. There have been other challenges in dealing with the pandemic. Discourses by politicians in some countries contradict the established public health practices of restricted travel, physical and social distancing to curb the spread of diseases.
 

The implications of social determinants of health on people’s wellbeing have never been so starkly illustrated. Within countries, the pandemic has exacerbated inequalities, with the more vulnerable groups suffering either due to the disease or due to the steps taken to curb the pandemic. Migrant workers, refugees and asylum seekers, prisoners, indigenous communities, people of colour and ethnic minorities have especially borne the brunt of the crisis. Access of these groups and communities to healthcare has made them extremely vulnerable to deaths due to the disease. We are also seeing a humanitarian crisis in many countries, due to the lockdown which is affecting the poor, women and unorganized sector workers the most. The ensuing economic crisis has forced us to reconsider the current economic model.

This sessions will provide an opportunity to discuss how the international community is managing the pandemic. It will aim to provide evidence and insights on the role of governments and the global community in dealing with this crisis and its implications for the most vulnerable.

TOPICS TO BE COVERED

• How have health systems responded to the pandemic and what is the impact of COVID-19 on health systems?
• How is COVID-19 using and reshaping infectious disease/global health security governance and mechanisms?
• What has the experience of the pandemic shown in terms of the need for a new economic order?
• How has the pandemic brought focus to the social and economic determinants of health?
• How is the pandemic changing geopolitics, global supply chains, regionalism and multilateralism? How is this affecting supranational health-related actions?
• Which groups and communities have been most affected by the pandemic and its response and what have governments done to ameliorate the situation?
• What should a human rights based response to the pandemic look like? How close or far are countries from it?
• What are the issues we have to grapple with in the next 1-2 years and what needs to change right now? Examples of issues: production and distribution of vaccines and therapeutics, economic issues, access to housing and water, strengthening public health systems, social inequality and discrimination.

Sub-theme 3   Investing in the Future: Ensuring the World Will Never Be Vulnerable to Another “COVID-19” Threat

The ongoing COVID-19 pandemic has laid bare our collective weaknesses in being able to effectively respond to the emergence of a highly contagious and lethal microbial threat. Despite extraordinary advances over the past century in science and unprecedented improvement in global health standards, as evidenced by the COVID-19 pandemic, we still live in a world where the threat an infectious agent can emerge without warning and spread rapidly to every household and every community and every household without regard to national borders or to social and economic standing.

Over the course of the remainder of this century, the likely frequency of epidemics and pandemics will continue to increase, driven to a large extent by demographic trends, including urbanization, and environmental degradation and climate change, persistent social and economic inequalities, and globalized trade and travel. The burden of these diseases is not equally distributed across the world; the economically disenfranchised, displaced populations and people living with pre-existing conditions are disproportionately impacted.

Importantly, the drivers underlying the emergence of novel disease threats are complex human behaviors and their impact on animal populations and the environment are understood to be central to their emergence. Changing environmental and climatic conditions have been closely linked to the emergence of novel infectious diseases and the redistribution of those already existing. Their aggregate impact will continue to increase over the course of this century.

While the upgrading of the health security apparatus over the last decade has been welcomed COVID-19 underscores that these processes and institutional arrangements are not sufficient to responding to events like SARS-COV 2. Compliance with the International Health Regulations (2005), that provide a normative framework for surveillance, preparedness, notification and international support and coordination has also been shown to be inadequate. The experience of the COVID-19 pandemic underscores that new efforts need to be made to craft global strategies, policies and regulatory frameworks that more directly address the multi-sectoral aspects of disease emergence in order to improve our collective capacities to prevent, detect and respond to threats. Key is strengthening key multi-sectoral systems, increasing policy coherence, including in health technologies access and innovation, and reducing risks of new disease threats.

The failure of the world’s response to the COVID-19 pandemic, however, is not simply about the virus’s biology and its ecology, nor the inadequacies of our multi-sectoral partnerships. The erosion of support over the past decade for multilateral institutions and partnerships, a growing mistrust between citizens and their leaders, and the rise of “anti-science” have further complicated the ability of nations to mount an effective coordinated global response to global events like COVID-19. We need to thoughtfully examine the causes underlying these trends, including the expanding impact of social media, if we are to understand their contributions to the failure of an effective response to the COVID-19 pandemic; and based on this insight develop new strategies to re-invigorate our commitment to multilateral partnerships, build more trustful relationships between governments and their citizens, and re-affirm the centrality of evidence-based solutions to future threats.

IN THE FACE OF SUCH CHALLENGES, WE NEED A UNIFIED GLOBAL ACTION PLAN THAT

• is built on a bold multilateral vision that embraces a commitment to address the multi-sectoral threats posed by emerging infectious diseases.
• is fully aligned and reinforcing of the commitments made in the 2030 Agenda for Sustainable Development, including to leave no one behind.
• facilitates full, universal and sustained compliance with the International Health Regulations of 2005.
• aggressively adopts strategies and approaches that recognize that our responses need to be as multisectoral as the forces underlying the emergence of new viral and microbial threats.
• removes the political, professional and cultural barriers, as well as the obstacles inherent within social, economic and political processes, that silo human health, animal health and the environmental sectors from effective multi-sectoral partnership, and at the same time reaches across the public and private sectors to fully harness their collective power for change.
• invests in building an evidence -base to improve our understanding of the drivers of diseases emergence, including climate change, environmental degradation and urbanization, and for tracking progress towards bringing control of these threats under control.
• reaches across the public and private sectors and civil society to fully harness their collective power for change, and invests in research to develop new, affordable, available and more effective countermeasures and health technologies to prevent, diagnose, treat and minimize the impact of these threats ensuring a full public return on public investments.
• invests in research and development to develop new and more effective countermeasures to minimize the impact of these threats.
• invests in strengthening the multi-sectoral systems required for the prevention, early detection and effective response and treatment to emerging infectious disease threats and anti-microbial resistance. The achievement of universal health coverage acknowledges these as fundamental.
• builds a workforce in all relevant fields, including in health, agriculture, food production and environmental sectors, that demonstrates the core competencies necessary tothe future challenges posed by these emerging threats.
• invests in the policies and financial resources essential to empower this workforce to be effective.
• realizes inclusive partnerships spanning global, regional, national-and community stakeholders that ensure strong coordinated and equitable action.
• “INVESTING IN THE FUTURE: ENSURING THE WORLD WILL NEVER BE VULNERABLE TO ANOTHER “COVID-19” THREAT” WILL FOCUS ITS WEBINAR SESSIONS ON ADDRESSING FIVE CRITICAL QUESTIONS
• What are the multi-sectoral systems and capacities required to “prevent, detect and respond” to future emerging threats?
• What policies, partnerships and investments are required to enable the success of these capabilities?
• How do we ensure that all populations have equitable access to critical, life-saving interventions?
• How do we make sure we build systems that are able to cope with future trends that will likely disrupt the world’s social, political and economic dynamics?
• How to maximally invest in advances in science and technologies to accelerate our ability to “prevent, detect and respond” to future threats
   

Sub-theme 4   Protecting and Improving Human and Planetary Health - A Syndemic View

The "COVID-19 moment" is poised to be a turning point for the world in terms of the megatrends of geopolitics, population, technology, climate change and environmental factors. The pandemic has underscored the importance of solidarity among nations and people even in a time when the disease requires isolation. It has also proven that action across society is possible when the objective is to save lives. This momentum must be maintained to enable people not merely to survive but to make healthy choices and lead healthy lives even without a global pandemic. Health is more than healthcare and preventing disease and promoting wellbeing should be a primary goal of any society.

Half the world’s population is under 30. Youth must be properly represented and actively involved in solving today’s complex problems, especially since these problems are related to their future and their work opportunities.

The unprecedented global health crisis we are facing is affecting all parts of society and changing lives and livelihoods. In all types of crises and times of need, from climate change to armed conflict or political unrest, young people and youth-led organizations have been quick to take action and respond, in particular due to inequalities and threatened human rights. The same is happening now during the COVID-19 pandemic.

While attention is currently focused on those most immediately affected by the virus, there are many indications that the COVID-19 pandemic will have long-lasting social, cultural, economic, political and multidimensional impacts on the whole of societies, including on young people, as highlighted by the Secretary General’s Report “Shared Responsibility, Global Solidarity” (March 2020).

While a large portion of the world’s resources will need to be redirected toward the fight against the virus and the post-pandemic recovery, youth development should remain a top priority. For the world to recover from the COVID-19 pandemic in a sustainable and equitable manner, young people need to be supported to reach their full potential and thrive.
 

Sessions will explore the effect of COVID-19 on megatrends.

The damage to health and well-being caused by the pandemic is substantial with profound social, economic and political consequences reshaping geopolitics and the global health architecture. There is a given strong need for global collaboration during a pandemic, to minimise the increased risk of threats against international peace and security and further deepening inequalities and poverty as probable consequences. Post COVID-19 must build on resilient green recovery, ensuring a peaceful society with social protection, embracing democratic constitutions, inter- and multidisciplinary collaboration, as well as multilateral institutions. The current crisis presents a number of policy windows- areas where there are clear challenges and solutions and where political will is growing. There are thus opportunities to build back better. The plenary will bring in lessons learnt from given megatrend effects by COVID-19 webinars and discuss Global Health Security in a post-COVID world.

With changing population dynamics, the world population is currently subjected to a larger, older, more mobile and concentrated population. While societal transitions and economic development have enhanced health they have also caused inequities, challenges and risks to people’s health and well-being. The disease burden is evolving, with shifting causes of global mortality and a rising proportion of NCD related deaths, while simultaneously our way of living causes emerging infectious disease. Webinars will explore the effects COVID-19 has had on fertility and aging patterns, urbanisation and migration, as well as on health outcomes recognizing the interconnection between people, animals, plants, and their shared environment.

New technologies and early warning systems can be a game changer for health as they have brought about mayor health improvements; nevertheless they have triggered discussions around priorities, privacy, ethical challenges, equitable access and environmental consequences. Webinars will explore the shift in delivery of global health care through available healthcare technologies and advances in early warning systems.

Climate change and environmental effects bring about serious challenges to health, for example through extreme weather events which directly and indirectly affect people’s health and well-being and create both acute challenges for the public health system and the need for long-term adaptation measures within society at large. While environmental and social determinants of health shape people’s health and well-being, tackling determinants of health will require coordinated multisectoral actions using global and regional governance methods to address their systems dimension. Failing to consider health impacts or implications of the policies of non-health sectors, such as energy, agriculture and fishery, environment, transport, education and labor represent missed opportunities. Webinars will look at climate change impacting health and see to how we allow building back better regarding both adaptation and mitigation, with lessons learnt from the COVID-19 effects on greenhouse gas emissions.

A healthier tomorrow is possible. The pandemic has put health is at the center of attention for all mankind and proven that decisive action is not only needed but possible. It is both an opportunity and an obligation to act now to renew the global health agenda. The crisis can be used as a lever for transformative change.