Latest / Book Club with Jeffrey Sachs / Season 2, Episode 7: SPECIAL EDITION: The COVID-19 Lancet Commission Report

Transcript

Season 2, Episode 7: SPECIAL EDITION: The COVID-19 Lancet Commission Report · Book Club with Jeffrey Sachs

• 0:00
  SPEAKER_01: Hello, I'm Jeffrey Sachs.
• 0:01
  SPEAKER_01: Welcome to Book Club, a monthly conversation with world-leading authors who have written scintillating, inspiring, and remarkably important books about history, social justices, and the challenges of building a decent world.
• 0:17
  SPEAKER_01: This podcast is a special edition because we're going to speak today with two of the members of the Lancet COVID-19 Commission, which I've been fortunate to chair.
• 0:32
  SPEAKER_01: So we'll have three of us from the Lancet Commission talking about the final report of the Lancet COVID-19 Commission.
• 0:40
  SPEAKER_01: Let me introduce my two colleagues briefly and then we'll get started in a conversation.
• 0:45
  SPEAKER_01: Maria Fernanda Espinoza is a world-leading diplomat.
• 0:51
  SPEAKER_01: She was the president of the United Nations General Assembly during 2018 to 2019.
• 0:58
  SPEAKER_01: She's from Ecuador and has been a leader in her country, a minister of defense, minister of foreign affairs, and she is well known throughout the whole world for promoting multilateralism and social justice.
• 1:16
  SPEAKER_01: Dr.
• 1:16
  SPEAKER_01: Srinath Reddy is another extremely distinguished member of the Lancet COVID-19 commission.
• 1:24
  SPEAKER_01: He is president of the Public Health Foundation of India, a leading cardiologist of India, and is also globally renowned for his leadership in public health and has served as an advisor in many capacities to the World Health Organization and to other global health activities and panels.
• 1:50
  SPEAKER_01: Thank you for joining today, Srinath and Maria Fernanda.
• 1:54
  SPEAKER_01: It's great to be with you.
• 1:56
  SPEAKER_01: We're at the end of long labors releasing the Lancet Commission report after two years of work.
• 2:05
  SPEAKER_01: I think it's right to say that when the Lancet Commission was launched in the summer of 2020, a few months after the start of the pandemic, we thought we'd have perhaps a year of work and the pandemic would be over and we would do a wrap-up, do a review of what had happened.
• 2:27
  SPEAKER_01: After all, when SARS broke out in 2003-4 in China, that pandemic was also very frightening, but it was controlled within a year, more or less.
• 2:42
  SPEAKER_01: And I think I thought that this one would be something similar.
• 2:47
  SPEAKER_01: Well, here we are more than two years after the launch of the Lancet Commission, and the pandemic continues rather strongly with new variants, with thousands of deaths every day, by one estimate, around 3,600 deaths per day worldwide, with an estimate of perhaps 15 million people currently infected with one or other variant of this virus, SARS-CoV-2.
• 3:20
  SPEAKER_01: We're not done with this, but we did decide to issue our report so that we could gain some lessons and make some recommendations to the world.
• 3:31
  SPEAKER_01: The Lancet, for those who don't know, is one of the world's leading medical and public health journals.
• 3:38
  SPEAKER_01: The editor of the Lancet, Richard Horton, a very esteemed leader in public health, invited me to chair this commission now a bit over two years ago.
• 3:51
  SPEAKER_01: And I reached out to Dr.
• 3:53
  SPEAKER_01: Srinath Reddy and to Maria Fernanda Espinoza and to about 26 other commissioners to join this effort.
• 4:03
  SPEAKER_01: And in addition, we invited experts to be participants in a dozen special task forces on COVID during this period to give advice to the commissioners and to provide invaluable inputs into the final report.
• 4:23
  SPEAKER_01: Well, here we are with the final report, but not a finality of the pandemic.
• 4:29
  SPEAKER_01: And Srinath, maybe I will turn to you first.
• 4:32
  SPEAKER_01: You have been a leader worldwide in confronting this pandemic and also a key leader in India, making recommendations, sometimes listened to, sometimes not, but watching very, very closely, day to day, we can say, the dynamics of the pandemic.
• 4:51
  SPEAKER_01: Could I get your general thoughts as we get started?
• 4:55
  SPEAKER_01: Then I'll ask Maria Fernanda, then we'll turn to the Commission itself.
• 5:00
  SPEAKER_00: Jeff, as you said, we thought that the pandemic could be discussed in the past tense by the time we finish the report.
• 5:08
  SPEAKER_00: But it is actually very much with us.
• 5:11
  SPEAKER_00: And to some extent, it's a valuable lesson because we know that there are only two viruses which were actually in a sense eradicated smallpox and uh the rinder pest.
• 5:28
  SPEAKER_00: And other than these two, we have not seen any virus eradicated.
• 5:33
  SPEAKER_00: And we know that respiratory viruses tend to stay around.
• 5:37
  SPEAKER_00: The principal objective of this effort to combat the virus would have been to try and reduce the transmission so drastically so that people who are otherwise vulnerable to severe disease and death could have been best protected.
• 5:56
  SPEAKER_00: And for that we needed to control the transmission and also protect people with vaccines.
• 6:03
  SPEAKER_00: And these two were the two efforts that should have been made very energetically right from the very beginning.
• 6:09
  SPEAKER_00: But because of several faltering steps initially and some level of indecision even midway and then also seeing a considerable amount of politically motivated misinformation, misleading people's responses, we have seen the pandemic out of control in many countries.
• 6:32
  SPEAKER_00: Now we have gained a fair amount of success, but there are many lessons to be learned from this pandemic as to how we could have handled it better.
• 6:40
  SPEAKER_01: Thanks a lot, Srinath, for getting us going.
• 6:43
  SPEAKER_01: And uh Maria Fernanda, let me uh ask you for your overall view, more than two years into our work and going on two years, uh nine months uh into the global pandemic itself, how you see things.
• 6:58
  SPEAKER_02: Well, first of all, I think that as Srinath mentioned, there are so many lessons that we can learn from the way humanity handled the pandemic.
• 7:09
  SPEAKER_02: I think it was a stark reminder that we are as humans interdependent and vulnerable, and that we need each other, and that solidarity and concerted action and multilateral solutions are key.
• 7:23
  SPEAKER_02: We have weakness that go-it-along responses do not work, regardless of how powerful a country is.
• 7:30
  SPEAKER_02: Your own country, tech, the most powerful country in the world, you know, have had so many challenges in addressing and managing the pandemic.
• 7:40
  SPEAKER_02: We also learn that strong healthcare systems and universal health coverage are critical, that we need to be better prepared.
• 7:48
  SPEAKER_02: In terms of the actors, we also learn that it's not only about government, it's about local governments and cities, it's about civil society, it's about the role of the private sector playing a decisive role.
• 8:01
  SPEAKER_02: And we also learned that science matters.
• 8:04
  SPEAKER_02: And if there is one thing that worked during the pandemic, is scientific operation, even cross-border scientific cooperation in a historical quick development of the vaccine, but again, the governance structure, how to deploy the vaccine, how to make sure that we had vaccines for all, leaving no one behind kind of model did not work.
• 8:28
  SPEAKER_02: And we also knew that it was not only about having access to the vaccines, but also a deployment, health infrastructure as critical.
• 8:37
  SPEAKER_02: And we also learned that regions play a critical role, regional cooperation and integration.
• 8:44
  SPEAKER_02: We have seen also good examples coming out of the African Union, of ASEAN a little later in these two years, but Latin America and the Caribbean also came up with a well-orchestrated plan.
• 8:57
  SPEAKER_02: And when we look at the global architecture, we have learned that we need a lot of retooling, a lot of restructuring, giving more authority to WHO, having a better orchestrated choreography among UN agencies and programs, and we learn that we need more resources, more money, and a better equipped and funded WHO.
• 9:23
  SPEAKER_02: At the end of the day, I think that we are in the process of rethinking the global health architecture.
• 9:30
  SPEAKER_02: Just last week, there is a new intermediary fund that was approved by the World Bank.
• 9:35
  SPEAKER_02: The World Health Assembly has mandated for the negotiation of a new pandemic treaty.
• 9:42
  SPEAKER_02: But the problem is that time is of essence, the sense of urgency.
• 10:11
  SPEAKER_02: We really need to build an overall multi-level governance, choreography, a better equipped UN.
• 10:18
  SPEAKER_02: Let's recall, Jeff, that the UN General Assembly did not have a plan B in terms of the working metrics, even of the assembly under lockdown conditions.
• 10:31
  SPEAKER_02: So there is a lot of lessons learned, some success stories, like the scientific cooperation to develop the vaccine, but we really need to retool our institutional scaffold to deliver better and to be better prepared.
• 10:47
  SPEAKER_01: Let me put some numbers on this.
• 10:49
  SPEAKER_01: Our report is pretty negative in terms of response for one overwhelming reason, and that is that the current estimate is that around 18 million people have died so far from this pandemic.
• 11:03
  SPEAKER_01: So we're talking about a staggering burden of disease, a shockingly high level of mortality, and we know how much disease has gone along with that mortality, and how many people are struggling with long COVID till today.
• 11:18
  SPEAKER_01: So this is a disease outbreak that was not effectively controlled after a few hundred people died or a few thousand people died, were in the many millions.
• 11:32
  SPEAKER_01: And while there are uncertainties about the numbers, because it's not the case that each death from COVID is reported, it's not the case even today that there is a standardized reporting system and that we have truly accurate and precise numbers.
• 11:51
  SPEAKER_01: Best estimates are something on the order of 18 million deaths.
• 11:57
  SPEAKER_01: So you emphasized, Maria Fernanda, and I think our report really turns to this on almost every page.
• 12:05
  SPEAKER_01: A pandemic intrinsically is a global interconnected phenomenon in which what happens in one country affects what happens all over the world.
• 12:19
  SPEAKER_01: We first observed the outbreak of COVID in Wuhan, China.
• 12:25
  SPEAKER_01: It's not absolutely sure that that was the first place of the pandemic, but was the first place that an outbreak was observed.
• 12:33
  SPEAKER_01: And the observations are from December 2019.
• 12:38
  SPEAKER_01: I think it's right to say that by the time this was declared to be a public health emergency of international concern, that phrase of art adopted by WHO towards the end of January 2020, the virus had already spread quite widely.
• 12:59
  SPEAKER_01: It was already in many places in the world, and we know that within a few months after that, the virus was already in all parts of the world.
• 13:11
  SPEAKER_01: The response from the start, I would characterize as each country basically on its own.
• 13:18
  SPEAKER_01: WHO, the World Health Organization, made an announcement warning the world that there was a crisis, and it made that announcement in the final days of January 2020.
• 13:31
  SPEAKER_01: But then, to my surprise, rather than high-level officials quickly consulting each other, putting together working groups that would work together on this, we had national leaders doing whatever they felt they would do.
• 13:51
  SPEAKER_01: And in some countries, the national leaders ignoring this news altogether, so that whatever was done was even left up to local officials or individuals.
• 14:03
  SPEAKER_01: I recall vividly the early days of this news in the United States.
• 14:09
  SPEAKER_01: Donald Trump, who was president then, told the American people don't worry, it's nothing.
• 14:15
  SPEAKER_01: Won't bother us, won't affect us.
• 14:18
  SPEAKER_01: Well, that's now in a perspective of an estimated 1.2 million deaths in the United States.
• 14:27
  SPEAKER_01: Of course, I'm referring to the estimates, not the recorded deaths, but a huge number of deaths, absolute disaster.
• 14:37
  SPEAKER_01: And for several weeks it was mass confusion.
• 14:41
  SPEAKER_01: There was also mask confusion because we were told, don't worry about face masks, which is quite interesting.
• 14:48
  SPEAKER_01: Even our public health officials said, don't worry about face masks.
• 14:53
  SPEAKER_01: Now they say they didn't want to run on them.
• 14:56
  SPEAKER_01: There was a limited supply.
• 14:57
  SPEAKER_01: They wanted the health workers to get them, not the public, but there was a lot of confusion.
• 15:02
  SPEAKER_01: And that confusion triggered a lot of conflict and consternation that has lasted until today, except more or less in one region, and that is the Asia Pacific region, or what WHO calls the Western Pacific region.
• 15:19
  SPEAKER_01: Maybe because that region had experienced SARS directly.
• 15:25
  SPEAKER_01: People first were very suspicious from the start.
• 15:29
  SPEAKER_01: Some countries said, you know, there's something going on in China.
• 15:33
  SPEAKER_01: We're going to limit travel right from the beginning.
• 15:36
  SPEAKER_01: And flights were stopped.
• 15:39
  SPEAKER_01: Screening took place very rapidly.
• 15:42
  SPEAKER_01: Some of the countries in the Asia Pacific came up with test kits very, very fast.
• 15:48
  SPEAKER_01: China went into an early lockdown.
• 15:51
  SPEAKER_01: And throughout the region, people put on their face masks because they had been used to it in the SARS period and some other epidemics of flu and some other epidemics that had hit the Asia Pacific region.
• 16:08
  SPEAKER_01: I mention all of this because in the Asia Pacific, more or less what Srinath said and recommended back then and just now, lower transmission rates dramatically actually were achieved in one part of the world: China, Taiwan, Hong Kong, Australia, New Zealand, Korea, Japan, not perfectly, but the transmission rates were kept quite low, and the death rates kept quite low.
• 16:40
  SPEAKER_01: Let me ask you, Srinath, how it was in India.
• 16:43
  SPEAKER_01: Of course, a vast, complicated society, many poor people, many slum regions, a lot of variation across a vast country of 1.4 billion people.
• 16:56
  SPEAKER_01: But you were watching and making recommendations from the start.
• 17:00
  SPEAKER_01: So how did it play out in India?
• 17:02
  SPEAKER_00: It is a mixed experience in terms of some things which were done well and some things which were not done very well.
• 17:08
  SPEAKER_00: Fairly early on, there were flight restrictions from China, but then again, there were some superspreader events.
• 17:16
  SPEAKER_00: But a very prolonged national lockdown was imposed in end of March 2020, and that was eased only in June 2020.
• 17:27
  SPEAKER_00: That did enable the central and the state governments and the health systems to really prepare for a possible spread of the virus in a much larger area in terms of a much larger dimension.
• 17:42
  SPEAKER_00: We saw that the first wave was reasonably well controlled and there was very good coordination between the central government and the state governments, but we experienced the shortages of masks, shortages of personal protection, other equipment as well, test kits and of course ventilators and oxygenators.
• 18:05
  SPEAKER_00: So India decided that we were going into a self-reliance mode so that we'll actually step up our production.
• 18:11
  SPEAKER_00: And to that extent, I think India continued to go that path with some success.
• 18:16
  SPEAKER_00: But where we landed into problems was by early January when it appeared.
• 18:22
  SPEAKER_01: January 2021, if I didn't.
• 18:24
  SPEAKER_00: January 2021.
• 18:26
  SPEAKER_00: When it appeared that the virus had indeed faded out, despite the fact that now the Alpha variant had already landed in India, there was a feeling that we could go ahead with life as normal.
• 18:42
  SPEAKER_00: A number of super spreader events were permitted, whether it was elections to the local bodies of the state assemblies, religious gatherings, sports tournaments, and unrestricted travel, and very little emphasis on COVID-appropriate behavior at this point in time, though that advice was given during the first wave in the latter part.
• 19:04
  SPEAKER_00: And this resulted also in the delta virus variant emerging in India and having a devastating effect in March to May 2021.
• 19:15
  SPEAKER_00: Millions of deaths.
• 19:16
  SPEAKER_00: And therefore, with a lockdown being followed by laxity, that meant that we gave the virus and the emerging variants a super highway to travel.
• 19:27
  SPEAKER_00: And the rural areas which were not initially affected in the first wave were now open for the virus to spread very fast.
• 19:35
  SPEAKER_00: And we saw the virus really claiming territory everywhere and claiming lives everywhere in India.
• 19:41
  SPEAKER_00: And that was the problem.
• 19:43
  SPEAKER_00: But then we managed to get our act together later on, and by the time Omicron came in, I think we had a much better response nationally organized.
• 19:54
  SPEAKER_00: But this has been still a little patchy across the country.
• 19:58
  SPEAKER_00: Some states have done exceedingly well throughout, some states have done somewhat well in the first wave and later in the Omicron wave.
• 20:07
  SPEAKER_00: But most states faltered during the Delta wave.
• 20:12
  SPEAKER_01: Maria Fernanda, can you give a perspective from Latin America?
• 20:16
  SPEAKER_01: Again, a large region with a lot of variation, but it was a pretty heavy hit throughout Latin America.
• 20:22
  SPEAKER_02: Well, it was like a movie of horror, I have to say, Jeff.
• 20:27
  SPEAKER_02: Even in my own country in Ecuador, the first wave hit so hard because we have weak health systems, because of the austerity policies that we all know governments were cutting down in healthcare workers even before the pandemic.
• 20:43
  SPEAKER_02: Of course, there are better situations than others, but let's recall the horror movie of Brazil, the horror movie of Ecuador at the beginning, dead bodies in the middle of the street, staying there for days, the infrastructure was not right, but also the protocols, the decisions on time.
• 21:02
  SPEAKER_02: And that brings me in the regional integration mechanisms, were so weak at the time.
• 21:08
  SPEAKER_02: There was no like regional response.
• 21:11
  SPEAKER_02: For example, regional procurement for the scarcity on protective equipment, and there was no regional orchestration of the response.
• 21:20
  SPEAKER_02: And countries are small in Latin America, most of them, you know, excluding Mexico and Brazil basically.
• 21:27
  SPEAKER_02: We were incapable to share experiences, good practices among us.
• 21:31
  SPEAKER_02: It came a year and a half later, unfortunately, a strong response from Celeb, the community of Latin American and Caribbean countries, shaping this public health self reliance plan.
• 21:45
  SPEAKER_02: But that was a year and a half later, after so many hundreds of millions of deaths.
• 21:51
  SPEAKER_02: So the point here, in just following up to Srinath comment, during a pandemic, I mean, a virus does not respect national borders.
• 22:00
  SPEAKER_02: So clear.
• 22:01
  SPEAKER_02: So what we need is global protocols, global responses.
• 22:06
  SPEAKER_02: We need international health regulations to be bold and mandatory for everybody.
• 22:13
  SPEAKER_02: Otherwise, for the next pandemic, we will say, oh, that was a success story.
• 22:18
  SPEAKER_02: This was an interesting case in New Zealand or this particular city.
• 22:22
  SPEAKER_02: We need international health regulations that are binding, protocols that everybody follows, and not only in terms in the case of COVID, in the terms of the social behavior, the social distancing, the equipment we had to use, the use of masks, but also in terms of the supply chains, the shipping companies, the airlines, and there are organizations, multilateral organizations, that have to deal with this.
• 22:49
  SPEAKER_02: The International Maritime Organization, it's a UN organization.
• 22:54
  SPEAKER_02: The International Civil Aviation Organization, it's a UN entity.
• 22:59
  SPEAKER_02: And WHO should be on top and to say airline companies should behave this way and not leave to the freedom of each airline company to have their own protocols, to invent their own rules.
• 23:12
  SPEAKER_02: Same goes for schools, for example.
• 23:15
  SPEAKER_02: So what we have learned is that regional integration is extremely important.
• 23:20
  SPEAKER_02: Global orchestration is important.
• 23:22
  SPEAKER_02: It's important that during a health emergency, WHO keeps its authority role on top of everybody else, including on top of the multilateral financial institutions, to ensure proper supply chains, to do what the international health regulations should be doing right now.
• 23:41
  SPEAKER_02: Thank God now we are in a profound review process of international health regulation as part of the pandemic treaty development process.
• 23:49
  SPEAKER_01: I think it's really worth underscoring this rather striking fact that after the pandemic broke out, after the world was notified of the pandemic, after the early wave was seen worldwide, the actual decision making was not multilateral in almost any case, but rather went to national governments and depended on the personalities or the vagaries or the understandings or the misunderstandings of national leaders, with very little role of international guidelines, much less international protocols taking effect, absolutely dependent on personal or political agendas of national leaders with very little content, I would say, from systematic public health or international guidelines.
• 24:49
  SPEAKER_01: I recall, as part of our commission's work, speaking with the global civilian aviation authorities, and there were no rules.
• 24:59
  SPEAKER_01: They were basically making them up as we went along.
• 25:02
  SPEAKER_01: I think the clear point of all of this is both a lack of preparedness, and that meant that most regions were not only not ready, but not especially informed, and the public's even less informed about what to do.
• 25:21
  SPEAKER_01: Again, with the Asia Pacific standing out probably because of SARS having hit the region 15 years earlier.
• 25:29
  SPEAKER_01: And so for a lot of that region, it seemed like a sequel.
• 25:34
  SPEAKER_01: The protocols were a bit better understood, but also because of the vagaries of national politics.
• 25:42
  SPEAKER_01: We all know that the debates over lockdowns became ferocious in most of the world.
• 25:49
  SPEAKER_01: I think it's uh worth following up on Srinath's discussion of India to make a logical point, which is not so logically understood, I would say, not so often understood.
• 26:01
  SPEAKER_01: When an epidemic disease or a pandemic, meaning that it's an epidemic in all parts of the world, breaks out, there will be stages.
• 26:10
  SPEAKER_01: And even in the best public health response, there will be stages.
• 26:13
  SPEAKER_01: First the outbreak itself, then some spread within the community.
• 26:19
  SPEAKER_01: Now, then came lockdowns in many places, including, I think rather heroically, in India, for example, where a lot of poor people faced a lot of hardship, but the government said we have to lock down to slow the transmission.
• 26:34
  SPEAKER_01: But many people until today have attacked lockdowns as something that is absolutely devastating and destructive without understanding a basic point.
• 26:46
  SPEAKER_01: And that is that lockdowns are meant to be temporary measures to be lifted once the transmission is down, not giving up on control, but using other more precise methods of control.
• 27:02
  SPEAKER_01: And I think this is a point not well understood.
• 27:06
  SPEAKER_01: The idea is to go from lockdowns to other public health measures like testing, tracing, and isolating people who are infected, using the public health system to identify outbreaks, and continuing with masks and control of the so-called super spreader events or huge events.
• 27:33
  SPEAKER_01: If you do a lockdown and keep it, it is devastating.
• 27:37
  SPEAKER_01: If you do a lockdown and eliminate it and just go back to business as usual, the virus comes back, business as usual.
• 27:46
  SPEAKER_01: The full epidemic comes back, business as usual.
• 27:50
  SPEAKER_01: So the error of a lot of countries was first to ignore the virus or to pretend it would go away or to pretend that there's nothing to do.
• 28:01
  SPEAKER_01: Second, to have a lockdown, usually a quite controversial step, but to fail to follow it up with the appropriate controls for the longer term that are more targeted, more precision-oriented, less onerous, but still present.
• 28:20
  SPEAKER_01: And Srinath mentioned the fascinating and really sad part of India having gone through a tough lockdown, having gotten the virus really under potential control, but then because of the reduction of transmission, the feeling in early 2021, a year after the start, that one could go back to normal life.
• 28:47
  SPEAKER_01: And then came new variants, especially the Delta variant in the spring of 2021 and the devastation that followed.
• 28:56
  SPEAKER_01: Now, all along the idea was that these public health measures, whether it's a lockdown, whether it's testing and tracing and isolating, whether it's wearing masks, whether it's stopping superspreader events, were to be followed by more openness once vaccines and medicines and treatments would come as soon as possible.
• 29:23
  SPEAKER_01: And there we had good news because the vaccines that came along came faster than ever before.
• 29:30
  SPEAKER_01: And that was a very positive sign.
• 29:33
  SPEAKER_01: But I think we all can add some reflections on the fact that when the new vaccines came, the world once again was not ready for cooperation on ensuring the proper reach of those vaccines, even for vulnerable people within countries that had developed or produced the vaccines, much less for poor people in other parts of the world that were not producing or developing vaccines, but depended on the rest of the world for the vaccines.
• 30:08
  SPEAKER_01: Maybe Srinath, you could reflect on that phase of the epidemic when the vaccines really started to be available in 2021.
• 30:19
  SPEAKER_00: I believe it's absolutely important to have had global solidarity manifest itself at that point in time.
• 30:27
  SPEAKER_00: The vaccines did become available, but mRNA vaccines, for example, were hoarded, the cost was prohibitive, the conditions for providing them to low and middle income countries were sometimes exploitative in terms of asking for sovereign assets to be pledged, permanent indemnity to be granted, reluctance to share technical expertise and technology transfer.
• 30:58
  SPEAKER_00: India, of course, managed by producing its own vaccines.
• 31:02
  SPEAKER_00: But that doesn't mean that countries will have to always depend upon their own resources, especially since vaccine production capacity is not well distributed across the world.
• 31:14
  SPEAKER_00: It's not just the capacity to receive vaccines from elsewhere and distribute, but I believe the scientific ability and the technological capacity to produce a number of these vaccines and drugs also must be well distributed across the world.
• 31:28
  SPEAKER_00: That's where global solidarity would come in.
• 31:31
  SPEAKER_00: And some of the high-income countries which hoarded the vaccines and were reluctant to share them learned the lesson also that the variants that develop in under-vaccinated populations will sneak through their defenses and re-enter their populations and cause fresh outbreaks again.
• 31:50
  SPEAKER_00: So truly, it is absolutely necessary for all countries to be together in containing the virus when a pandemic strikes.
• 31:59
  SPEAKER_00: And the vaccines have had an impact in terms of preventing severe death, hospitalization and severe illness, hospitalization and death.
• 32:10
  SPEAKER_00: And we should have made the best use of them initially when they were in short supply.
• 32:15
  SPEAKER_00: The people who were most vulnerable, whether they were the elderly or those with comorbidities or those in confined uh group crowded conditions, they are the people who should have been protected.
• 32:27
  SPEAKER_00: But once they became available in abundant supply, we should have actually ensured that the scaled-up distribution was globally available and would have protected the global population so that the weaklings do not really now begin to produce variants that get back into other populations and recycle the entire infection all over again.
• 32:49
  SPEAKER_00: I think it is absolutely essential that this scientific capacity is also well distributed and not treated as a matter of charity.
• 32:58
  SPEAKER_01: Maria Fernandez, why has this been so hard?
• 33:01
  SPEAKER_01: Why aren't we much farther along on the equitable access to the medicines and vaccines and other commodities, to the sharing of scientific capacity and production capacity?
• 33:15
  SPEAKER_01: What's going on, if you can help listeners to understand?
• 33:20
  SPEAKER_02: Well, I would say sometimes it's very difficult to explain human behavior.
• 33:26
  SPEAKER_02: We knew that a vaccine for all formula was the big protection against the pandemic.
• 33:33
  SPEAKER_02: And we use this phrase that is being repeated millions of times that no one is safe until everybody's safe.
• 33:40
  SPEAKER_02: And in spite of that, we saw rich countries hoarding on vaccines, buying four and five vaccines per person in their countries, wherein the time for the poorer countries that will have access to the vaccines was huge.
• 33:57
  SPEAKER_02: In many, many months in that we could witness that poorer countries could not even have access.
• 34:03
  SPEAKER_02: And once they have access, then it comes what you need to deploy the vaccines on the ground, the health infrastructure that is so weak in so many countries of the global south.
• 34:15
  SPEAKER_02: As we know, there was a multilateral mechanism that was established to guarantee the access of vaccines to all, especially the developing countries, to the COVAX facility, which was a multilateral fund with the participation of the private sector, of the pharmaceutic companies.
• 34:32
  SPEAKER_02: And basically, this COVAX facility was chronically underfunded.
• 34:37
  SPEAKER_02: They didn't have enough money and they didn't have enough supplies.
• 34:42
  SPEAKER_02: And there were fights among countries who to give the vaccines to.
• 34:47
  SPEAKER_02: Is Ecuador more important than Bangladesh?
• 34:50
  SPEAKER_02: Who is more important?
• 34:52
  SPEAKER_02: The discretion of providing the vaccines to one country or another.
• 34:55
  SPEAKER_02: Meaning, again, the multilateral response to the COVAX facility did not work in the way we would have liked.
• 35:04
  SPEAKER_02: It means that we need an improve COVAX plus facility, both to resolve the problem of underfunding and to resolve the problem of distribution and deployment.
• 35:17
  SPEAKER_02: And the other issue you mentioned, technology transfer, the issue of intellectual property rights.
• 35:23
  SPEAKER_02: Some countries said it's worthless to remove intellectual property rights on vaccines because countries do not have a manufacturing capacity.
• 35:32
  SPEAKER_02: And it's partially true, what we need is proper technology transfer when we are dealing with a health emergency worldwide.
• 35:40
  SPEAKER_02: So the trade, the finance sector, the health sector, and the political sector have to come together to ensure that the solutions are accessible by all, regardless of your income and regardless of the place of the world where you are, if you are female or you're a man, if you're an indigenous person or a person with a disability.
• 36:03
  SPEAKER_02: I think that the moment we're leading, the shaping of a new pandemic treaty or agreement, the review of international health regulations, this intermediary fund that was just established last week under the umbrella of the World Bank.
• 36:18
  SPEAKER_02: I think that we need to learn from experience.
• 36:22
  SPEAKER_02: We need to do things better, and we know what to do.
• 36:25
  SPEAKER_02: The issue is the political real, the generosity, a new culture of multilateralism, Jack.
• 36:32
  SPEAKER_01: Well, our report is really grounded on this case for global cooperation in many specific areas that we have discussed.
• 36:42
  SPEAKER_01: I want to close our discussion with one of the most contentious and still unsolved issues, just to bring everybody up to date.
• 36:50
  SPEAKER_01: We looked also in the Commission at the question how this pandemic arose in the first place.
• 36:58
  SPEAKER_01: We didn't reach any conclusions because nobody has firm conclusions to this moment.
• 37:05
  SPEAKER_01: We still don't know where the virus, SARS-CoV-2, that causes COVID-19 disease, how it arose, where it came from.
• 37:16
  SPEAKER_01: And I think that it's worth pointing out that this is not only a scientific and practical puzzle of the highest urgency, but another case where there hasn't been adequate global cooperation to find out something that we need to find out.
• 37:32
  SPEAKER_01: I'll just do a quick summary of this and ask either of you to jump in on any of these points, but to summarize what we learned in two years.
• 37:43
  SPEAKER_01: We learned that there really are two viable hypotheses.
• 37:47
  SPEAKER_01: One is that this virus also emerged like SARS from an animal that infected a human.
• 37:55
  SPEAKER_01: This is certainly a possibility.
• 37:56
  SPEAKER_01: It's how many new diseases emerge, a so-called zoonotic transmission.
• 38:05
  SPEAKER_01: And we know that ultimately SARS-CoV-2 is a kind of virus, a coronavirus, that is in bat populations, a sarbocovirus.
• 38:17
  SPEAKER_01: So, in some sense, the ultimate progenitor of this virus is in nature.
• 38:23
  SPEAKER_01: But then there's a second hypothesis that must not be dismissed because unfortunately it is also quite real.
• 38:30
  SPEAKER_01: What we have come to understand better in the last two years is that there was a tremendous amount of laboratory research on SARS-like viruses and manipulation of those viruses in ways that were not safe or overseen, and in conditions that were not adequate in terms of biosafety.
• 38:58
  SPEAKER_01: Dealing with the very dangerous pathogens, scientists manned those bodysuits that you see in pictures, but that was apparently not the case in working on the SARS-like viruses in the research leading up to 2020.
• 39:16
  SPEAKER_01: Now we know that teams of U.S.
• 39:19
  SPEAKER_01: scientists and Chinese scientists were working together on this.
• 39:23
  SPEAKER_01: So this was not China alone or the U.S.
• 39:26
  SPEAKER_01: alone or any other place alone.
• 39:28
  SPEAKER_01: It was a global collaboration, which we generally like.
• 39:32
  SPEAKER_01: But what we have found, unfortunately, is that some of this research was clearly quite dangerous and at least potentially could have given rise to the pandemic.
• 39:46
  SPEAKER_01: Well, suffice it to say, we are stuck till today with two hypotheses, both of which are viable, and we heard a lot in the commission from scientists who said keep open the investigations on both hypotheses because neither is settled.
• 40:07
  SPEAKER_01: We also found that governments have not been forthcoming.
• 40:12
  SPEAKER_01: We heard a lot of controversy inside the Commission from outside the Commission.
• 40:17
  SPEAKER_01: I think we reached the right decision by emphasizing you can't even put a clear probability on this.
• 40:24
  SPEAKER_01: Both hypotheses are viable, both need openness and transparency by all governments involved, China, the United States, and others, to get to the bottom of this.
• 40:37
  SPEAKER_01: One of the things we surely said, though, even without knowing what happened in this case, we do know that dangerous research is underway that needs biosafety scrutiny and regulation.
• 40:53
  SPEAKER_01: And so this was one of the very clear recommendations that we do make in the report about this origins issue.
• 41:01
  SPEAKER_01: Maria Fernanda or Srinath, I don't know if you'd like to add anything to that.
• 41:07
  SPEAKER_00: Well, I can come in initially and let Maria close it.
• 41:10
  SPEAKER_02: Okay.
• 41:12
  SPEAKER_00: I believe this gain of function studies can be very dangerous.
• 41:18
  SPEAKER_00: We know that scientists are in their curiosity to try and to find out whether manipulating the virus in the laboratory to increase infectivity, to increase virulence, to study immune escape is not necessarily to produce weapons of biological warfare.
• 41:39
  SPEAKER_00: But even assuming that they were trying to find out what might happen if the virus changes its nature.
• 41:45
  SPEAKER_00: This kind of a dangerous play in the laboratory is something that should not go unsupervised by responsible agencies with a lot of public accountability as well.
• 41:57
  SPEAKER_00: You cannot have a laser fare approach in a freewheeling manner that you can play around with viruses, which can result in accidents.
• 42:04
  SPEAKER_00: Even if it has not happened in this case, it can happen in the future.
• 42:08
  SPEAKER_00: I think it's absolutely necessary for us to have proper global regulatory frameworks for this so that we do laboratory research in a very well-guarded, supervised manner, with accountability both to the wide scientific community which is there globally and also most importantly to the public.
• 42:31
  SPEAKER_01: Fantastic.
• 42:32
  SPEAKER_01: Thank you so much for very important words.
• 42:35
  SPEAKER_01: Maria Fernanda.
• 42:36
  SPEAKER_02: Well, I would say three messages, Steph.
• 42:39
  SPEAKER_02: The number one is that science matters.
• 42:42
  SPEAKER_02: And when we are dealing with a health emergency, with a pandemic, I think that independent science should be at the top.
• 42:51
  SPEAKER_02: That's why I think that a form of the scientific council of WHO should have a stronger voice, a sort of IPCC, the Intergovernmental Panel on Climate Change Forum, but for global health.
• 43:04
  SPEAKER_02: So I think that we need a body of authority looking also into the biosafety protocols for this kind of research.
• 43:12
  SPEAKER_02: The number two message is why is that we need to know about the origins?
• 43:18
  SPEAKER_02: Why we need to know.
• 43:20
  SPEAKER_02: And I think because to be better prepared, because to be more sophisticated in the way we respond in terms of treatment of the vaccines, but we have a moral responsibility here with the families of the millions of people that died.
• 43:33
  SPEAKER_02: And I think we owe it to them in a way.
• 43:36
  SPEAKER_02: And perhaps my third message here that is connected somehow is that 2023 is going to be a very important year for global health.
• 43:46
  SPEAKER_02: We will have two summits, the Universal Health Coverage Summit and the pandemic summit.
• 43:53
  SPEAKER_02: People are starting to have summit fatigue in a way.
• 43:57
  SPEAKER_02: And I really hope that this year of preparation of these two summits are going to bring to the fore some of the key governance challenges, some of the key moral and ethical questions surrounding the COVID pandemic, and that we are really going to be responsible at all levels in the way we prevent, we prepare and respond to future pandemics.
• 44:24
  SPEAKER_02: Thank you.
• 44:25
  SPEAKER_02: And back over to you, Jeff.
• 44:27
  SPEAKER_01: Well, thank you for reminding us of the full diplomatic timeline ahead.
• 44:33
  SPEAKER_01: We've released our report.
• 44:35
  SPEAKER_01: I think the three of us, and I know the rest of the commissioners, will be raising their voices exactly on the way to these uh global meetings where we can get things straight and really put in place the kind of global cooperation that we've been talking about and the kind of sensible response systems.
• 44:56
  SPEAKER_01: We've seen that being unprepared leads to disaster.
• 45:02
  SPEAKER_01: We can be sure that there's going to be more threats and risks and surprises ahead.
• 45:08
  SPEAKER_01: Preparedness is the sine qua non for us to be able to manage what lies ahead.
• 45:16
  SPEAKER_01: Let me only add to your wise words a great thank you to both of you for the incredibly important leadership both of you have provided and for the very hard work and tremendous efforts for the Lancet COVID Commission.
• 45:34
  SPEAKER_01: For listeners, please go to the Lancet website to download our Commission report.
• 45:42
  SPEAKER_01: I think it's a good read of a pressing and ongoing challenge.
• 45:46
  SPEAKER_01: And I would say to all of the listeners, we need your voices, your responsibility, and please also your care for yourselves and your family, being prudent and making good choices and good decisions in an ongoing, tremendous public health challenge.
• 46:05
  SPEAKER_01: Thank you for joining today, Book Club, with Jeffrey Sachs, this special edition on the launch of the Lancet COVID-19 Commission report, and I look forward to being together with you on another podcast in the following month.
• 46:21
  SPEAKER_01: Thank you very much.
• 46:22
  SPEAKER_00: Thank you.
• 46:23
  SPEAKER_00: Thank you.
• 46:25
  SPEAKER_01: Thank you for joining in the conversation.
• 46:27
  SPEAKER_01: Please subscribe, rate, and write a review on whatever platform you listen for your podcast.
• 46:34
  SPEAKER_01: I would love to hear your thoughts as we continue to develop the series.