1
00:00:07,900 --> 00:00:13,870
[Auto-generated transcript. Edits may have been applied for clarity.]
To clear. Pandemic, as we saw, has impact on the economic development of the world.

2
00:00:14,200 --> 00:00:20,530
Does it mean that you'll react the same way? But 911 is we all have seen it, you know, so it's synchronised at the moment.

3
00:00:20,770 --> 00:00:27,280
Covid, but they might differ. The shocks that were considered real shocks internal for the organisation.

4
00:00:27,400 --> 00:00:35,620
Then what might be the global shocks. Welcome to Global Shocks, the podcast of the Oxford Martin program on changing global borders.

5
00:00:36,070 --> 00:00:39,700
My name is John Aitken and I'm a research fellow in international relations.

6
00:00:40,240 --> 00:00:44,800
And in this podcast we're going to explore how international organisations deal with global shocks.

7
00:00:45,580 --> 00:00:51,250
Global shocks are all around us, from humanitarian emergencies to war, financial crises to pandemics.

8
00:00:51,700 --> 00:00:57,160
So how can international organisations respond to them, adapt to them and survive such turbulent times?

9
00:00:57,670 --> 00:01:05,350
To find out, we are entering the conversation with leading figures from these organisations to find out how they're affected by crisis and turbulence,

10
00:01:05,590 --> 00:01:09,490
what lessons they draw from the past and what future prospects they have.

11
00:01:21,200 --> 00:01:24,830
Meeting for the first time. On July 24th, 1948,

12
00:01:25,250 --> 00:01:34,070
the World Health Organisation short W.H.O. became the specialised agency of the United Nations responsible for international public health.

13
00:01:34,990 --> 00:01:40,000
The fact that public health challenges across borders had, of course, long been recognised before this.

14
00:01:40,360 --> 00:01:44,980
And indeed, the show has a long history that spans the League of Nations Health organisation,

15
00:01:45,250 --> 00:01:51,610
as well as even further back the International Sanitary conferences of the 19th century, created to tackle the spread of cholera.

16
00:01:52,120 --> 00:01:59,830
Today, the W.H.O. is located in Geneva, Switzerland, with a further six regional offices as well as 150 field offices.

17
00:02:00,280 --> 00:02:05,530
Its main body is the World Health Assembly, the central meeting place of its 194 member states.

18
00:02:05,530 --> 00:02:11,080
Delegates. The Assembly in turn, elects an executive board of 34 health experts.

19
00:02:11,770 --> 00:02:16,210
Over the years, the organisation has played a pivotal role in shaping global health policy,

20
00:02:16,690 --> 00:02:22,090
responding to epidemics and pandemics, and advancing efforts to achieve health equity worldwide.

21
00:02:22,900 --> 00:02:29,350
Its achievements include major contributions to the eradication of smallpox and the development of an Ebola vaccine.

22
00:02:30,340 --> 00:02:34,900
But of course, most recently, it's played a more controversial role during the Covid 19 pandemic.

23
00:02:35,530 --> 00:02:40,329
Critics have pointed to its inability to ensure international cooperation and its in

24
00:02:40,330 --> 00:02:44,890
efficacy in the face of national and regional divides in the fight against Covid 19.

25
00:02:45,220 --> 00:02:50,980
So today, let's discuss a couple of key questions. What is the W.H.O. do exactly?

26
00:02:51,250 --> 00:02:56,230
How has it dealt with past public health crises, and how can it learn from its own experience?

27
00:02:56,680 --> 00:03:04,090
To find out, I'm joined by Ilona Kate Bush, a global public health expert with many years of experience working for the W.H.O.

28
00:03:13,730 --> 00:03:16,280
I'm delighted to welcome Professor Eleanor Bush,

29
00:03:16,700 --> 00:03:23,180
who's a global public health expert with several decades of experience working at the World Health Organisation.

30
00:03:23,630 --> 00:03:28,730
Professor Bush was responsible for the Ottawa Charter for Health Promotion in 1986.

31
00:03:29,060 --> 00:03:34,010
She took the lead in the first comparative study by the W.H.O. on women's health in Europe,

32
00:03:34,520 --> 00:03:38,509
and she has worked academically on global health programs at Yale University,

33
00:03:38,510 --> 00:03:45,110
the University of Saint Gallen, and today at the Graduate Institute of International and Development Studies in Geneva.

34
00:03:45,710 --> 00:03:53,410
Since 2018, Professor Bush has also served on the Joint world Bank W.H.O. Global Preparedness Monitoring Board.

35
00:03:53,420 --> 00:04:00,320
In short, a leading global public health policymaker with extensive experience both in the policy world and academically.

36
00:04:00,650 --> 00:04:04,490
So hello and welcome to Global Shocks. Elena, it's an honour to have you.

37
00:04:05,120 --> 00:04:07,970
Well, I'm very pleased and look forward to the conversation.

38
00:04:08,180 --> 00:04:14,590
In your own words, why would you say, from your perspective, does thinking about global shocks matter to us?

39
00:04:14,600 --> 00:04:20,960
Why is it important for us to think about global shocks? Well, to think about global shocks is important.

40
00:04:20,990 --> 00:04:30,860
Uh, first of all, because they are global and a shock in one place of the world, as we have seen, can, in this day and age, go global very quickly.

41
00:04:31,280 --> 00:04:41,090
And therefore, practically every part of the world needs to be prepared, needs to work on resilience, and, uh, needs to think how to respond.

42
00:04:41,120 --> 00:04:48,770
And of course, in our health world, that has been particularly the case with the infectious disease outbreaks.

43
00:04:49,070 --> 00:04:55,100
And, uh, most recently, obviously with the Covid 19 pandemic, uh, through that,

44
00:04:55,100 --> 00:05:05,840
this whole notion of preparedness that we are also looking at in the Global Preparedness Monitoring Board has become very much more, uh, in focus.

45
00:05:05,870 --> 00:05:09,679
And it's something that, of course, it's inter sectoral.

46
00:05:09,680 --> 00:05:13,160
You can't just have, you know, the health world prepared for this.

47
00:05:13,340 --> 00:05:17,360
It has impacts on so many parts of society as we've seen.

48
00:05:17,780 --> 00:05:24,259
So this notion of global shocks, I think, is something that everyone needs to think about.

49
00:05:24,260 --> 00:05:30,200
And it's not just a shock, you know, it comes and goes. A lot of these shocks stay around for quite some time.

50
00:05:30,560 --> 00:05:36,930
During your time working for the World Health Organisation, what was the most challenging shock that you and your colleagues were,

51
00:05:36,950 --> 00:05:43,490
were facing or dealing with, and what were its practical consequences for the mission of the World Health Organisation as such?

52
00:05:43,850 --> 00:05:52,579
Well, the biggest shock and a shock one was duly unprepared for was HIV Aids, starting in the early 1980s.

53
00:05:52,580 --> 00:05:55,760
Um, still with us 100%.

54
00:05:55,820 --> 00:06:03,740
And it's actually interesting to see how little one talks about HIV Aids when one talks about Covid 19,

55
00:06:04,190 --> 00:06:12,350
because one could have learned some lessons from HIV Aids and applied them around Covid 19.

56
00:06:12,710 --> 00:06:18,560
So W.H.O., of course, was not really prepared for such a new pandemic.

57
00:06:18,560 --> 00:06:26,600
And similar to Covid 19, for a long time, one didn't know what was actually happening when first,

58
00:06:26,600 --> 00:06:33,620
you know, like with Covid 19 had to discover the virus, one had no response to it.

59
00:06:33,620 --> 00:06:37,580
Basically no medical response, no medical countermeasures.

60
00:06:37,700 --> 00:06:47,359
And there's a big difference here. We still obviously don't have a vaccine for HIV Aids, which we did get with Covid 19,

61
00:06:47,360 --> 00:06:55,160
but I think this really led to a revolution within the World Health Organisation itself.

62
00:06:55,250 --> 00:07:04,909
How do we respond to such a new challenge, particularly when it became clear that this was a challenge also for the developing countries?

63
00:07:04,910 --> 00:07:07,490
Because, I mean, this was before you were born.

64
00:07:07,940 --> 00:07:16,849
But initially people thought this was a strange disease of gay people who one didn't like to talk about it anyhow.

65
00:07:16,850 --> 00:07:20,989
But at one point it became clear that this was much larger.

66
00:07:20,990 --> 00:07:24,860
This was much bigger and truly a global pandemic.

67
00:07:24,860 --> 00:07:28,969
So W.H.O. had to respond. It had no such program.

68
00:07:28,970 --> 00:07:35,990
It did establish such a program. Then there was a lot of divisiveness within W.H.O.

69
00:07:36,050 --> 00:07:39,490
Finally, you know, a lot of donors were mobilised.

70
00:07:39,490 --> 00:07:52,459
The big new W.H.O. Aids program was created, but it started to run sort of parallel to the W.H.O. itself and led to a number of problems.

71
00:07:52,460 --> 00:07:56,810
When it became clear that W.H.O., in the way it was set up,

72
00:07:56,990 --> 00:08:04,850
could particularly not deal with the financial issues and the implementation issues around HIV Aids,

73
00:08:04,850 --> 00:08:11,120
we saw this totally new phase of global health emerging with the new global.

74
00:08:11,440 --> 00:08:17,800
Organisations that were created. So the first step was creating UNAids.

75
00:08:18,070 --> 00:08:21,990
Because it was clear this was not just a health issue.

76
00:08:22,000 --> 00:08:25,300
This was a social issue. This was a discrimination issue.

77
00:08:25,390 --> 00:08:33,820
This was a development issue. And so that was the start of six U.N. organisations working together on a pandemic.

78
00:08:34,270 --> 00:08:38,740
Some of those things were then mirrored later on in the HIV Aids.

79
00:08:39,100 --> 00:08:44,930
And of course, a real break through of the role of civil society in public health.

80
00:08:45,010 --> 00:08:54,040
That was the time that the HIV Aids movement started again, first in the developed world, then picked up in the developing countries.

81
00:08:54,550 --> 00:09:06,820
The conflict that we have today around pandemic response, medical response, vaccine inequity, the whole issue of patents came up in the very same way.

82
00:09:06,850 --> 00:09:14,230
Who would have access to the medicines? The discrimination of the Global South was there just as we have it today.

83
00:09:14,530 --> 00:09:19,540
So then it was clear, you know, we needed a lot of money in this system.

84
00:09:19,930 --> 00:09:25,720
And that's when the Global Fund for Aids, then Tuberculosis and Malaria was created.

85
00:09:26,050 --> 00:09:35,320
So we entered this new phase of global health with many new organisations being created, public private partnerships emerging.

86
00:09:35,500 --> 00:09:42,820
The role of the civil society becoming really, really central and that individual countries.

87
00:09:42,940 --> 00:09:48,330
Remember, of course, other political things happened like the Iraq War.

88
00:09:48,740 --> 00:09:58,959
And it was then that President Bush created the big global Aids program called Pep four, which made an enormous difference,

89
00:09:58,960 --> 00:10:07,930
saved many, many lives, but is presently and was one of the bipartisan programs in the United States that was,

90
00:10:07,930 --> 00:10:14,100
you know, continued for decades and is now in the polarised political situation,

91
00:10:14,110 --> 00:10:21,010
threatens to continue, which basically means the death of many, many people in the developing world.

92
00:10:21,250 --> 00:10:26,409
What comes with these shocks is they are a medical issue,

93
00:10:26,410 --> 00:10:33,700
a problem that also needs medical solutions, but they are linked to equity, to big social issues.

94
00:10:34,030 --> 00:10:37,420
And finally, of course, always to politics.

95
00:10:38,320 --> 00:10:42,790
I'm curious to hear from your own experience what it means for an organisation.

96
00:10:42,790 --> 00:10:45,940
And this is a very general question, but I think related to what you just said.

97
00:10:46,300 --> 00:10:55,030
How does an organisation such as the W.H.O. practically respond to something like the HIV Aids, public health threats emerging?

98
00:10:55,120 --> 00:11:01,380
What is involved practically? You've been working there for a long time, and you worked at the W.H.O. at that particular time.

99
00:11:01,420 --> 00:11:03,070
What was that like? What did that look like?

100
00:11:03,460 --> 00:11:12,700
Well, it has various dimensions because the organisation is, of course, you know, the authority, the global authority, technical authority on health.

101
00:11:13,210 --> 00:11:18,160
It means, uh, obviously being able to say, what is this disease?

102
00:11:18,160 --> 00:11:21,900
You know, what is it? Right. Uh, how can one respond to it?

103
00:11:21,910 --> 00:11:26,010
It means setting standards for how one responds to the disease,

104
00:11:26,020 --> 00:11:34,730
approving medicines that are used in the context of the disease, even defining the disease itself if it's a new disease.

105
00:11:34,750 --> 00:11:41,210
So there's a whole lot of that technical work of the W.H.O., which is related to science, to innovation.

106
00:11:41,230 --> 00:11:47,680
It then means, you know, giving suggestions to member states how they should respond to the disease.

107
00:11:48,160 --> 00:12:00,459
And here already you get more than a medical response, because with HIV Aids, what became very clear is that one dimension of the WTO Constitution,

108
00:12:00,460 --> 00:12:07,270
that health is a human right, suddenly moved to the forefront and said, people have a right.

109
00:12:07,600 --> 00:12:13,960
People have a right to treatment. People should not be discriminated because they have this disease.

110
00:12:14,470 --> 00:12:18,040
And, you know, there were countries where people were locked up.

111
00:12:18,040 --> 00:12:22,660
There were, you know, dreadful occurrences around this disease.

112
00:12:23,080 --> 00:12:26,110
Um, both in developed and developing world.

113
00:12:26,200 --> 00:12:35,019
So also here, something we experienced with Covid was usually one has this idea, you know, everyone likes health.

114
00:12:35,020 --> 00:12:39,490
Everyone wants everyone to be healthy. And health brings people together.

115
00:12:40,180 --> 00:12:46,750
But with Covid and with HIV Aids, we experienced that health pulled people apart.

116
00:12:46,930 --> 00:12:55,000
And so the whole issue of health and human rights, also through the NGOs, was brought forward with enormous force.

117
00:12:55,360 --> 00:13:03,280
And so also W.H.O. had to be much more prominent and make very clear statements,

118
00:13:03,280 --> 00:13:11,080
even though this was not popular with some member states about, you know, how you handle this disease in a social manner.

119
00:13:11,820 --> 00:13:21,940
And then, of course, when the whole issue of HIV Aids and drug use started to come together, that became even more difficult.

120
00:13:21,960 --> 00:13:30,390
And W.H.O. played an incredibly important role and had to reorganise itself accordingly to find, you know, a humane,

121
00:13:30,390 --> 00:13:38,850
a human rights based approach which also has additional problems because there is a U.N. agency in relation to drugs in Vienna,

122
00:13:39,240 --> 00:13:43,590
which was so much more conservative on these issues.

123
00:13:43,710 --> 00:13:51,450
What was a problem is, of course, that W.H.O. is not a development organisation, it's a technical organisation.

124
00:13:51,540 --> 00:13:59,880
And one of the things that was needed was loads of money to be able to make those available in low and middle income countries.

125
00:14:00,270 --> 00:14:07,110
And that's of course, when the Global Fund was created, and initially over the next ten, 20 years,

126
00:14:07,410 --> 00:14:13,950
a sort of competitive environment started to emerge in global health, people saying, you know,

127
00:14:13,950 --> 00:14:20,939
these new types of organisations that are not member state driven but have the private sector on their boards,

128
00:14:20,940 --> 00:14:26,340
have civil society on their boards, etc., they are much more forward looking.

129
00:14:26,820 --> 00:14:36,330
And so that was a very tough time for W.H.O., particularly also when the financial crisis hit and when the budgets for W.H.O. were reduced.

130
00:14:36,450 --> 00:14:49,410
But that's where we learned. And you remember that in 2014 to 16, there was the next crisis, which didn't get as serious.

131
00:14:49,530 --> 00:14:56,129
And W.H.O. was severely criticised for its response to Ebola, saying this was much too late,

132
00:14:56,130 --> 00:15:04,800
etc., etc. so I was on the group that was tasked to evaluate the W.H.O. response,

133
00:15:05,010 --> 00:15:10,560
and this is where my involvement in the Aids response became so important,

134
00:15:10,860 --> 00:15:18,960
because we were able to learn from that mistake that the W.H.O. built up a program, then wasn't able to run it.

135
00:15:19,140 --> 00:15:22,440
And, you know, a new organisation had to be created.

136
00:15:22,440 --> 00:15:29,459
And actually, early on, after Ebola also, and during Covid, you might remember some people said, you know,

137
00:15:29,460 --> 00:15:37,770
create a new organisation that deals with outbreaks, etc., but we sort of said, no, W.H.O. needs to be reorganised.

138
00:15:38,160 --> 00:15:46,350
It needs to have a new big department which is there for pandemic preparedness and response.

139
00:15:46,470 --> 00:15:54,840
And because of that follow through from Ebola, W.H.O. was much better prepared to respond to Covid.

140
00:15:54,840 --> 00:15:58,170
So there was learning in the end. Mhm.

141
00:15:58,260 --> 00:16:08,690
Whereas, you know, I would still say the Covid response neglected many of the social learnings of the Aids pandemic.

142
00:16:08,700 --> 00:16:16,470
Definitely W.H.O. learned through this period Aids, SARS, Ebola and then Covid.

143
00:16:16,620 --> 00:16:22,679
Fascinating. The comparison and the the sort of lessons from the HIV Aids situation to the Ebola

144
00:16:22,680 --> 00:16:26,549
situation and then how that carries over into kind of an institutional memory,

145
00:16:26,550 --> 00:16:30,990
as it were, because the next question was going to be whether these kinds of threats,

146
00:16:30,990 --> 00:16:37,620
these public health threats can also, in some sense be opportunities for the organisation to readjust,

147
00:16:37,620 --> 00:16:44,010
to learn and to gradually accumulate experience that will make it better prepared for the next public health threat.

148
00:16:44,020 --> 00:16:49,469
So in a sense, it sounds like what you're saying is, yes, the crisis is one series aspect that needs to be tackled.

149
00:16:49,470 --> 00:16:54,630
At the same time, though, the organisation needs to learn. Is that a correct characterisation of what you just said?

150
00:16:55,020 --> 00:17:03,530
Absolutely. And you know, the willingness to learn, of course, would be a very, very important component in W.H.O.

151
00:17:03,540 --> 00:17:12,089
That, of course, brings with it a complexity, let's say, compared with the private sector, that this is a multilateral organisation.

152
00:17:12,090 --> 00:17:16,530
It's basically run by its member states, 193 of them.

153
00:17:16,950 --> 00:17:27,389
So whenever you want to reform the organisation, also, you would need the full approval and a consensus among the member states who at the same time,

154
00:17:27,390 --> 00:17:33,810
of course, and rightly so, expect leadership from the Director general of the organisation,

155
00:17:34,200 --> 00:17:36,839
expect that the organisation, as you know,

156
00:17:36,840 --> 00:17:46,770
W.H.O. has a headquarters and six regional offices that all parts of the organisation then work together, particularly in a period of crisis.

157
00:17:47,070 --> 00:17:51,230
So on the one hand, what we can see is that, um,

158
00:17:51,570 --> 00:18:01,200
the Aids was a real shock for the organisation because there was a strong feeling that W.H.O. was losing credibility,

159
00:18:01,200 --> 00:18:10,170
W.H.O. was losing in importance, and definitely W.H.O. was losing money because, you know, of these other organisations that were created.

160
00:18:35,820 --> 00:18:41,340
Also in the early 2000, following the Soros outbreak,

161
00:18:41,780 --> 00:18:50,910
W.H.O. was able to reform the Sanitary Regulations, which became the International Health Regulations.

162
00:18:51,180 --> 00:19:01,140
So that was another historical point. And now, following Covid, one has seen they two need to be reformed again.

163
00:19:01,680 --> 00:19:06,990
The International Health Regulations and then also countries said, look,

164
00:19:07,230 --> 00:19:19,590
we need to make use of the possibility that the WTO Constitution gives us to actually have a legal framework for action when a pandemic strikes.

165
00:19:20,040 --> 00:19:28,049
And so two things that happened following the Covid 19 was to say we must reform the international health regulations,

166
00:19:28,050 --> 00:19:35,560
and there are working groups and all kinds of things going on, and we should be negotiating a pandemic treaty.

167
00:19:35,580 --> 00:19:41,460
And that would be only the second treaty that W.H.O. negotiated.

168
00:19:41,490 --> 00:19:44,730
The first was the Framework Convention on Tobacco Control.

169
00:19:45,390 --> 00:19:54,240
And it's very, very tough negotiations because of the issues I mentioned, particularly because of the North-South divide,

170
00:19:54,630 --> 00:19:59,550
because, as you know, vaccines were not available in many parts of the world.

171
00:19:59,550 --> 00:20:07,740
Intellectual property issues stood in the way, and it indicates the increasing need to involve other agencies,

172
00:20:07,740 --> 00:20:10,860
in this case the World Trade Organisation, etc.

173
00:20:11,130 --> 00:20:15,810
So those are two big things where the organisation is trying to learn.

174
00:20:16,290 --> 00:20:24,240
Another area where the organisation is learning is to ramp up the whole area of science and innovation,

175
00:20:24,840 --> 00:20:30,630
because of course, uh, nobody expected we would have a vaccine so quickly.

176
00:20:31,170 --> 00:20:36,030
Uh, and in a way, the world wasn't ready to have a vaccine so quickly.

177
00:20:36,120 --> 00:20:41,159
You know, the organisations actually these organisations that had competed,

178
00:20:41,160 --> 00:20:47,610
you know, Global Fund, the Gavi, W.H.O., etc., Bill Melinda Gates Foundation.

179
00:20:48,030 --> 00:21:01,290
So they started to work together. They created Covax, they created other initiatives, the Act accelerator, new organisational mechanisms were created,

180
00:21:01,860 --> 00:21:10,140
but they were created overnight and suddenly the vaccine was there and these organisations weren't ready for it.

181
00:21:10,770 --> 00:21:20,099
And then, of course, there was the political pressure in the developed world to vaccinate everyone, um, all the other issues that flowed from that.

182
00:21:20,100 --> 00:21:27,510
So the treaty is trying to resolve some of that WTO negotiations are trying to do that.

183
00:21:27,840 --> 00:21:37,020
So this, uh, being involved, being ready, being able to assess where are we in terms of science and innovation in these areas?

184
00:21:37,350 --> 00:21:41,040
Are we working together with the best scientists in the world?

185
00:21:41,670 --> 00:21:46,110
Of course, some science is always, um, unexpected.

186
00:21:46,140 --> 00:21:53,040
That's clear. Uh, but still, uh, you know, there was a time when W.H.O. ramped down its research program.

187
00:21:53,520 --> 00:21:55,860
We couldn't imagine this today.

188
00:21:56,460 --> 00:22:06,150
And the whole issue of science and technology, you know, again, a new way of working with the private sector emerged in this context,

189
00:22:06,150 --> 00:22:11,610
both in terms of the vaccines but particularly in terms of misinformation.

190
00:22:12,210 --> 00:22:17,940
So this was the beginning of W.H.O. being in contact with the big tech companies, you know,

191
00:22:17,940 --> 00:22:28,079
Googles of this world, to ensure that health information by the W.H.O. would always be on top of a search query.

192
00:22:28,080 --> 00:22:35,070
If somebody said, what is Covid 19? You know, you would get the official W.H.O. information first.

193
00:22:35,610 --> 00:22:45,510
So a lot of new things have emerged out of that, where the organisation is shifting and changing and trying to sort of really be,

194
00:22:45,960 --> 00:22:49,170
uh, hopefully ready should anything like this happen again.

195
00:22:49,740 --> 00:22:54,240
I was very intrigued when you mentioned a couple of times that there are these knee jerk responses,

196
00:22:54,240 --> 00:22:59,340
in a sense, of creating new institutions or new actors adding to the landscape of global health,

197
00:22:59,340 --> 00:23:06,150
uh, responses, but that that might not actually be the most effective way to to be better prepared for the future.

198
00:23:06,390 --> 00:23:09,450
And that instead, the really important thing is,

199
00:23:09,720 --> 00:23:18,630
is to evaluate carefully and to really try and learn from past experiences through things such as new international health regulations,

200
00:23:18,960 --> 00:23:22,500
really fine tuning the main organisation that we already have,

201
00:23:22,500 --> 00:23:30,630
rather than trying to reinvent the wheel or invent many other new organisations that potentially even sort of, uh, make it harder to coordinate.

202
00:23:31,800 --> 00:23:37,200
Yes. At least that's my position. You know, there are people that would take different positions here,

203
00:23:37,590 --> 00:23:43,379
and there's been a lot of talk around that, you know, is W.H.O. politically influential enough?

204
00:23:43,380 --> 00:23:54,450
Is it strong enough? What does it mean if an organisation that is in principle run by health ministers, is that an organisation that strong enough?

205
00:23:54,940 --> 00:23:58,890
Uh, definitely. It's an organisation that, uh, isn't rich enough.

206
00:23:59,550 --> 00:24:08,120
And uh, so, uh, also following the long standing negotiations about increasing the regular budget of W.H.O.,

207
00:24:08,130 --> 00:24:15,480
the assessed contributions was taken up again and a positive, uh, decision was taken to at least,

208
00:24:15,510 --> 00:24:20,040
uh, increase the s contributions by 50%, which is nowhere enough.

209
00:24:20,280 --> 00:24:27,090
But something is on the trajectory that people, despite criticisms that also came up, you know,

210
00:24:27,390 --> 00:24:34,140
was it clear enough, uh, soon enough, about airborne transmission, you know, all those kinds of issues.

211
00:24:34,500 --> 00:24:43,049
That's how more on the scientific front, how quickly can an organisation give, uh, the, uh, scientific recommendations?

212
00:24:43,050 --> 00:24:48,510
You know, how sure does one have to be? How quickly, uh, does one have to react?

213
00:24:48,840 --> 00:24:57,569
So all those things, uh, do remain, but yes, uh, again, in this case, there were the suggestions, you know, let's create something new.

214
00:24:57,570 --> 00:25:05,580
There was also the suggestion to have a so-called Global Threats Council, which would meet at the United Nations,

215
00:25:05,580 --> 00:25:13,980
because supposedly, if you had the threats Council of Heads of state, they would act more quickly and with more determination.

216
00:25:14,310 --> 00:25:20,850
My view was if we had a problem during Covid 19, it was with heads of state and, uh,

217
00:25:20,850 --> 00:25:25,560
people not taking the political and financial decisions they should have taken.

218
00:25:26,100 --> 00:25:33,450
So, you know, the all this is obviously driven by the wish to do better next time.

219
00:25:33,960 --> 00:25:37,380
But I agree with you. A lot of this was knee jerk.

220
00:25:37,380 --> 00:25:40,740
And it's also related to another issue.

221
00:25:40,770 --> 00:25:45,209
On the one hand, W.H.O., together with many global health advocates,

222
00:25:45,210 --> 00:25:51,630
has been successful in saying, first of all, you know, health is a political choice.

223
00:25:52,080 --> 00:25:58,890
And because it's a political choice, it should be part of many other negotiations and many other bodies.

224
00:25:59,400 --> 00:26:08,040
And it was seen as a tremendous progress to have health on the agenda of the G7, to have health on the agenda of the G20,

225
00:26:08,400 --> 00:26:13,469
and to have health regularly discussed in New York, at the U.N. General Assembly,

226
00:26:13,470 --> 00:26:19,290
to have high level meetings, etc., etc. also have some bodies and councils in the UN.

227
00:26:19,410 --> 00:26:26,070
I served on one of them. You know, to have that in that non-health sphere, let me put it that way.

228
00:26:26,250 --> 00:26:33,390
But one of the things that has emerged is that, of course, everyone that organises a meeting like that,

229
00:26:33,420 --> 00:26:39,000
um, you know, in a G7, G20, you have a different organising country every year.

230
00:26:39,360 --> 00:26:48,360
Once you have a tangible outcome. And what's more tangible than creating something new, you know, if you say, well,

231
00:26:48,360 --> 00:26:55,050
our outcome is we will support the World Health Organisation or, you know, I said, My God, you know how boring.

232
00:26:55,620 --> 00:27:02,820
If you say we will create a pandemic fund, then everyone says, wow, they're really ready to go and do something.

233
00:27:03,030 --> 00:27:07,740
And then big promises are made. We do have a pandemic fund now, as you know.

234
00:27:07,830 --> 00:27:16,050
Um, uh, but it has no where. The amount of money that was actually assessed that people said needs to help countries.

235
00:27:16,380 --> 00:27:21,120
And at the same time, you know, so you have a pandemic fund with 10 billion at this stage,

236
00:27:21,480 --> 00:27:27,420
and you have W.H.O. that has a budget of, you know, the Geneva General Hospital.

237
00:27:27,420 --> 00:27:30,930
So it is, you know, it's very, very imbalanced.

238
00:27:31,050 --> 00:27:42,420
But the tendency remains that it is more attractive in our world, in our political world, to be able to say, look, we created something new.

239
00:27:42,600 --> 00:27:47,070
And at the same time, of course, saying we need to reform W.H.O.

240
00:27:47,520 --> 00:27:56,100
There is an imbalance here, and it's definitely a political issue about, you know, how you position yourself, uh, in the international arena.

241
00:27:56,490 --> 00:28:04,170
It sounds like I mean, we're faced with this complexity of intersecting crises all happening at the same time, mutually compounding each other.

242
00:28:04,350 --> 00:28:07,050
And it gets hard to really know where to focus our attention.

243
00:28:07,350 --> 00:28:14,160
Another thing is, of course, if everything is so complex, we really need to understand the problems that we're facing very, very well.

244
00:28:14,490 --> 00:28:23,490
And so there's a 2021 report on the Covid 19 response by the 13 member Independent Panel for Pandemic Preparedness and Response,

245
00:28:23,970 --> 00:28:31,260
which argues that information flows under the existing international health regulations had proven to slow during the.

246
00:28:31,310 --> 00:28:35,300
A pandemic and your own experience is more and faster information.

247
00:28:35,330 --> 00:28:38,899
Another key to better preparedness? Most definitely.

248
00:28:38,900 --> 00:28:43,340
But you know, the starting point of it is transparency.

249
00:28:43,370 --> 00:28:48,649
If you look at the International health regulations, uh, countries which you know,

250
00:28:48,650 --> 00:28:58,280
are subject to these regulations should be transparent and should inform W.H.O. the minute they see something that out of the

251
00:28:58,280 --> 00:29:07,850
ordinary and the long and short of it is because disease has such geopolitical consequences in terms of trade movement of people,

252
00:29:08,150 --> 00:29:16,310
the way you are looked at in the world, etc., whether you're a failure or not leads countries not to report,

253
00:29:16,460 --> 00:29:25,550
you know, despite the fact that the air applies to all countries, not all countries report or report quickly.

254
00:29:25,550 --> 00:29:32,690
That has in a way always been the case, but has been absolutely extreme in relation,

255
00:29:32,690 --> 00:29:38,330
uh, to, uh, Covid 19 and the countries that have reported quickly.

256
00:29:38,360 --> 00:29:49,909
Take South Africa, for example, with a variant, then, uh, get punished and no, we will we will cut travel, uh, we will cut to economic relationships.

257
00:29:49,910 --> 00:29:54,739
And in a globalised world, that, of course, has tremendous consequences,

258
00:29:54,740 --> 00:30:04,310
which is also why because then in this case, also the global flow of medical countermeasures comes in.

259
00:30:04,700 --> 00:30:11,900
This is why now, as one of the follow through, the whole issue of local production has become so critical.

260
00:30:12,290 --> 00:30:17,749
You know, within our region, within our country, what can we produce ourselves.

261
00:30:17,750 --> 00:30:28,909
But at the same time, how can we be guaranteed that we get the constituent components, uh, for whatever medicine or vaccine we are trying to develop?

262
00:30:28,910 --> 00:30:33,530
And as we know, many of those components are all in one big country.

263
00:30:33,800 --> 00:30:41,480
So it then becomes economic and geopolitical again very quickly, which is why, uh, the panel,

264
00:30:41,480 --> 00:30:50,810
uh, said we need to find measures that ensure the transparency and the rapid reporting.

265
00:30:51,200 --> 00:30:56,270
So there's been a lot of discussion around can be sanctioned countries.

266
00:30:56,600 --> 00:31:00,080
What kind of pressure can exert?

267
00:31:00,290 --> 00:31:03,590
Can W.H.O. exert pressure? Actually not.

268
00:31:04,010 --> 00:31:13,850
But could the pressure then, for example, come through the World Trade Organisation or could it come through the financial institutions?

269
00:31:14,030 --> 00:31:21,019
So it's quite clear that the pressure in all probability needs to be both economic and political,

270
00:31:21,020 --> 00:31:27,559
but that it cannot be exerted by the World Health Organisation, what the World Health Organisation needs to do.

271
00:31:27,560 --> 00:31:31,400
And of course, this is what it then gets criticised for.

272
00:31:31,820 --> 00:31:42,320
It's got to try and cajole countries, its own member states, who actually decide about the organisation, to jolly well share their data.

273
00:31:42,620 --> 00:31:48,679
So it is a world also for the W.H.O. for whom, you know, politics is not new.

274
00:31:48,680 --> 00:31:51,530
It's had to work during the Cold War and all of that.

275
00:31:52,100 --> 00:32:01,730
But this extreme polarisation of the world makes the work of the World Health Organisation more difficult, but also much, much more important.

276
00:32:02,060 --> 00:32:05,180
Now, the W.H.O. was, of course, in the spotlight throughout the pandemic.

277
00:32:05,180 --> 00:32:10,729
We've already talked about that, and it's received its share of criticism regarding its effectiveness in the face

278
00:32:10,730 --> 00:32:14,210
of precisely those geopolitical tensions that you were just talking about.

279
00:32:14,510 --> 00:32:18,050
And this question emerged, really, of our countries collaborating here at all.

280
00:32:18,080 --> 00:32:21,740
Are they putting enough of their efforts into making global public health work?

281
00:32:22,070 --> 00:32:28,040
And a 2022 report by The Lancet called the Global response, and I quote, a massive global failure.

282
00:32:28,370 --> 00:32:32,030
And it spoke of a failure, in particular of international solidarity.

283
00:32:32,060 --> 00:32:36,860
Can the W.H.O. do more to foster international solidarity, and should we expect it to?

284
00:32:37,160 --> 00:32:42,950
Well, that's actually W.H.O. is bread and butter to try and establish that global solidarity.

285
00:32:42,950 --> 00:32:51,020
Of course, you know, if you have 193 countries who don't talk to each other, uh, then you have a big job to do.

286
00:32:51,440 --> 00:32:58,909
And, you know, one of the attempts to create that global solidarity are international agreements,

287
00:32:58,910 --> 00:33:08,210
treaties, accords, etc., etc. and, ah, well, regulations, rules, norms that everyone subscribes to.

288
00:33:08,510 --> 00:33:12,860
So that's in a way as much as W.H.O. can do.

289
00:33:12,860 --> 00:33:17,840
Because and that's of course, also a criticism. People say W.H.O. has no teeth.

290
00:33:18,020 --> 00:33:22,640
Some wants W.H.O. to call out individual countries.

291
00:33:22,880 --> 00:33:29,390
We had a director general at WTO at one stage who did that, but she could not serve more than one term.

292
00:33:29,540 --> 00:33:38,790
So that was Gro Harlem. I'm Brundtland to, you know, with the sun's outbreak not only cold out China but cold out Canada, for example.

293
00:33:38,880 --> 00:33:43,050
So a lot of that is what we tend to call global health diplomacy.

294
00:33:43,590 --> 00:33:53,370
And it's not always visible. So that's another tricky part of the work of the organisation and the role of the Director-General.

295
00:33:53,380 --> 00:33:54,390
I know you know,

296
00:33:54,390 --> 00:34:03,150
somebody like Richard Horton at The Lancet would like to see the director general call out individual countries or even individual leaders.

297
00:34:03,600 --> 00:34:09,989
The minute you start doing that, you could probably close down your organisation because that's not the role.

298
00:34:09,990 --> 00:34:17,460
And it of course, you know, for anyone who's an advocate who wants to move things forward, people do get upset.

299
00:34:17,470 --> 00:34:22,710
But it's not the role of multilateral organisations to do that.

300
00:34:23,550 --> 00:34:30,810
What would you say is the best way for the W.H.O. to learn from past experiences, in order to actually improve its preparedness for the future?

301
00:34:31,080 --> 00:34:37,980
What I find so interesting is actually how many times the organisation has reinvented itself,

302
00:34:38,040 --> 00:34:49,830
how often it has been more innovative than some people give it credit for, but also the new areas that are being discussed in the treaty.

303
00:34:50,370 --> 00:34:56,309
Really the whole issue of the production of medicines and where that is and the equity,

304
00:34:56,310 --> 00:35:00,360
there was not so much an issue of the World Health Organisation.

305
00:35:00,360 --> 00:35:05,260
And now, you know, smack. It's right in the middle of supply chains and everything.

306
00:35:05,280 --> 00:35:09,250
The cooperation with the other organisations is really critical.

307
00:35:09,270 --> 00:35:12,870
The other health organisations and obviously, you know,

308
00:35:12,870 --> 00:35:26,009
every organisation needs to reform all of the time and it also has to look out to survive because we see that in very difficult geopolitical times,

309
00:35:26,010 --> 00:35:29,010
the organisation tends to become more technical.

310
00:35:29,190 --> 00:35:41,130
And uh, then, you know, it sort of moves forward as things become a bit clearer, it moves forward into more political arenas again.

311
00:35:41,640 --> 00:35:52,110
But it can't be a geopolitical player, but it has to draw attention to the fact where health is subject to geopolitics,

312
00:35:52,140 --> 00:35:57,210
um, where health is, as the organisation says, a political choice.

313
00:35:57,270 --> 00:36:03,059
And that's the message to the member states. You know, we, the Secretariat, can do this much.

314
00:36:03,060 --> 00:36:06,660
Sometimes we'll fail, sometimes we're not good enough.

315
00:36:06,750 --> 00:36:12,570
Uh, sometimes we actually told you we should do X and you didn't approve it, right?

316
00:36:12,600 --> 00:36:15,929
It needs that. That's constant back and forth.

317
00:36:15,930 --> 00:36:21,150
And as you said, definitely as simplistic as it sounds, it does need a bit more money.

318
00:36:21,690 --> 00:36:27,990
Right. Well, on that note, all that's left for me to say is thank you for your time and for generously sharing your insight and experience.

319
00:36:28,380 --> 00:36:34,230
It's been really great to have you here at Global Shocks. Thank you. Well thank you, it's been fun and thank you for your questions.

320
00:36:34,290 --> 00:36:44,780
Bye bye. You've been listening to Global Shocks, the podcast of the Oxford Martin programme on changing global orders.

321
00:36:45,410 --> 00:36:50,420
My name is Yannick. I'm a postdoctoral research fellow in international relations.

322
00:36:50,570 --> 00:36:58,250
And I'm the host and producer of this podcast. If you enjoyed this episode, make sure to follow us and subscribe wherever you get your podcasts.

323
00:36:58,490 --> 00:37:04,520
Do have a look at the show notes for further reading on today's topic, as well as links to our website and social media channel.