Evidence-based Leadership Is more Important than ever before!

A Reflection by Public Health Leadership Coalition’s Member – Prof. Walter Ricciardi

The COVID-19 pandemic acted like a global tsunami, exacerbating the existing challenges and focusing attention of new ones and demonstrating the weaknesses of our interconnected world. Governments and citizens have had deal not only with health issues, but also with social, economic, political challenges: the great challenges since the Second World War.

We are living in a rapidly changing world, on one hand there is the planet: we must put attention on planetary health and climate changes, and on the other hand the world created by humans: we must manage the digitalization processes in a fair way and address the great inequalities existing. To date, for instance, 49% of the world population has received at least one dose of a COVID-19 vaccine (6.94 billion doses administered globally), but, alarmingly, only 3.1% of people in low-income countries have received at least one dose. In such a context, effective and evidence-based leadership is more important than ever before.

As recognized from the World Health Organization (WHO) also, a lack of coordinated and global leadership in difficult times bring to a bad management of the current challenges and prolong the coronavirus pandemic.

The pillars to act in the right direction are: to enforce the preparedness, also by sharing reliable and standardized data, at global, regional and national level, ensuring learnings from the COVID-19 pandemic help inform other public health crises, for example climate change, to make the decision making processes driven by robust evidence, to strengthen one health approaches, to improve health/digital/media literacy and to ensure fair access to health and healthcare services and goods, including medicines and vaccines, by reducing inequalities and injustices.

In September 2021, the Health Ministers from G20 Countries, have united to pledge global action to improve future health security, increase vaccine confidence and tackle antimicrobial resistance in a Health Declaration agreed in Rome: an important pact to afford health issues, but not only, all together.

Interestingly, the OECD Ministers that have endorsed a new initiative to promote safe international travel during the COVID-19 pandemic at the OECD’s annual Ministerial meeting in Paris. The Initiative involves a safe travel blueprint and a temporary international cross-sectoral forum for knowledge sharing.

The World federation of Public Health Association is supporting international initiatives, such as the development and implementation of the WHO proposed Global Pandemic Treaty. In a global word, only with a global approach we can afford such great deal, there are no other possible ways.

Nutrition, Alcohol, and Environmental Impact Labels Should Protect Public Interests

The WFPHA has signed “Nutrition, Alcohol, and Environmental Impact Labels Should Protect Public Interests, Not Sell Foods that are Harmful to Humans and the Planet” statement urging the Codex Committee on Food Labelling (CCFL) and its member states to implement several reforms.

Toward the “Next Normal”

An Editorial by Public Health Leadership Coalition’s Member – Dr. Alejandro R. Jadad

“Perhaps a pandemic was needed for us to give ourselves permission to notice new possibilities to live our lives.”

In the editorial “Toward the “Next Normal”: An Opportunity to Unlearn and Reflect about Life, Death, and Our Mental Health during the Pandemic”, we can learn more about “the Next Normal” concept.

Pandemic Treaty: A Public Health View

The World Health Assembly (WHA) will meet in a special session from 29 November – 1 December 2021 to consider the benefits of developing a World Health Organisation (WHO) convention, agreement or another international instrument on pandemic preparedness and response.

As countries are preparing for discussions at the special session, the Global Health Centre (GHC) at the Graduate Institute of International and Development Studies in Geneva offers to support governments and other actors with knowledge and evidence in the process. This is part of a broader project exploring options and benefits of a pandemic treaty, which includes also, inter alia, a series of policy papers by lead experts, dialogue with diplomats, policymakers, and stakeholders.

Against this backdrop, the WFPHA and the GHC called for a meeting for WFPHA members and all allied partners on options and benefits of a pandemic treaty. The meeting took place in a virtual format on 20 October 2021.

The meeting was comprised of two sections: An introductory presentation on key global and public health/role of civil society aspects of the subject matter by the GHC and the WFPHA, followed by a Q&A session. The second section was an informal exchange and discussion between participants under the Chatham House rule. The knowledge gained, and the informal dialogues convened can contribute to WFPHA’s members and partners’ cooperation with governmental and non-state actors on the subject matter and may lead to a follow-up statement.

During the meeting, a Guide on key aspects and frequently asked questions on a pandemic treaty developed at the GHC was made available to the registered participants.

Functioning of the International Health Regulations during COVID-19

An Article by Public Health Leadership Coalition’s Member – Dr. Jean-Marie Okwo-Bele

International Health Regulations (IHR), which came into force in 2007, aims to enable the prevention, detection, and containment of health risks and threats, the strengthening of national capacities for that purpose, and the coordination of a global alert and response system.

During the COVID-19 pandemic, the IHR have been criticized. However, the Review Committee on the Functioning of the IHR (2005) during the COVID-19 Response, which consists of 20 experts with diverse health expertise from around the world, found different results and provided 40 recommendations in 10 areas to strengthen implementation of the IHR.

What Went Wrong?

A Reflection by Public Health Leadership Coalition’s Member – Prof. Martin McKee

What went wrong? In 2019 the Global Health Security Index ranked the United States and the United Kingdom as first and second respectively in their preparedness for a pandemic. Yet, when the pandemic came, these were two of the countries that were hit hardest. It wasn’t that they lacked scientific expertise. By any measure, their research was world beating, a status that was confirmed by the incredible speed with which they developed SARS-CoV-2 vaccines. Nor did they lack experience in the broader aspects of public health, with both countries making significant contributions to our understanding of the determinants of health and, globally, to the control of infectious diseases such as Ebola.

What was lacking was political leadership. Both countries had the misfortune to go into the pandemic led by politicians that were unfit for high office. Donald Trump and Boris Johnson were the poster children of the post truth era. It didn’t matter that what they said was untrue. Rather, what mattered was whether people believed them. They appealed to deep seated prejudices, whether against the Chinese or Mexicans in Trump’s case or the “Brussels bureaucrats” in Johnson’s. They needed to find someone else to blame for the misfortunes affecting so many of their voters, those who had been left behind by the policies promoted by their political backers.

Yet, despite their similarities, there were also important differences. Few would claim that Trump had an understanding of the science necessary to combat the pandemic. His ramblings on the possible benefits of putting bleach or ultraviolet light insight the human body are a testament to his ignorance of the basic laws of physics and chemistry. Johnson, on the other hand, is educated. His problem is an unwillingness to engage with the issue at hand, illustrated by how he missed the initial meetings where the UK’s early response to the pandemic was planned. Sir Jeremy Farrar, a key adviser to the UK government, described “organisational mayhem, with a combination of an absent prime minister, dysfunctional state apparatus and multiple departmental fiefdoms”. Failures of leadership can have many causes.

Faced with a vacuum of political leadership, what can public health leaders do? No-one should pretend it is easy. Should those in government stay the course, doing what they can to limit the damage being done by the politicians? Or should they resign lest they be considered complicit in the mistakes? Dr Tony Fauci has described the dilemma well – “I felt that if I stepped down that would leave a void. Someone’s got to not be afraid to speak out the truth”.

The problem is not new. Ibsen described it well in his play “An enemy of the people” as the hero, Dr Stockmann concludes that “that considerations of expediency turn morality and justice upside down.” Those of us who work in public health face many ethical quandaries. The experience of the COVID pandemic is a reminder that while our traditional association with government brings many opportunities, especially given the important role played by public health law, it also places a responsibility on our shoulders when the government in question is failing to act in the interests of the public to whom we are, ultimately, accountable. There are many ways of displaying leadership in public health but, ultimately, history will judge whether we made the right choice.