SHYAM BISHEN: A multilateral approach to global health is the only way to manage pandemics

The worldwide response to the Covid-19 pandemic highlighted how working together enabled us to deal urgently with the crisis. We should now learn from this multilateral approach to better prepare for any future global health crises.

At the start of the pandemic, there was unprecedented global collaboration that resulted in diagnostic and vaccine development within record time after the viral sequence was shared — a multilateral approach that was to be celebrated.

Covid-19 highlighted global health inequities

However, as the pandemic progressed, nationalism kicked in and multilateralism eroded in many areas to the detriment of many communities, particularly in the developing world.

The most visible consequence of this was the inequitable rollout and distribution of Covid-19 vaccines across the world, with low and middle-income countries the last in line to receive them.

Even as recently as July 20, nearly three-quarters (72.4%) of people in high-income countries had received a vaccine, compared to just one in five in low-income ones, according to the UN Development Programme (UNDP).

This inequitable distribution of vaccines is reflective of other major global health inequities, with two-billion people worldwide still lacking access to basic medicine.

We need to seize the opportunity to tackle the drivers of such imbalances. Scientists have repeatedly warned that global-health threats are likely to emerge more often, spread more rapidly and take more lives.

Climate change alone is a looming health challenge, with impacts including respiratory and cardiovascular disease; injuries and premature deaths related to extreme weather events; changes in the prevalence and distribution of food, water and vector-borne illnesses; and threats to mental health.

Indeed, infectious diseases represent the primary international challenge of our times and Covid-19 may well be just a preview of more, and possibly worse, pandemics to come.

Now is the time to take multilateral action, along with other sectors, to address global health inequities and build resilience for communities around the world.

Lessons to be learnt from pandemic response

To succeed in averting or mitigating the effect of future pandemics, we must learn from the positives of the global Covid-19 response and strengthen multilateralism.

We must organise and rethink how we collaborate internationally to mitigate its profound consequences on people’s livelihoods, social cohesion and global order. The world may not be able to avoid outbreaks, but we can definitely reduce the risk of them turning into pandemics.

The world has the scientific capabilities and the financial resources to do this, but to mobilise these resources, we need a new way of thinking about multilateralism or international co-operation.

Here are three things we need to do to vastly improve our pandemic preparedness:

• We need a scaled-up network of genomic surveillance that integrates national, regional and global capabilities. This is critical to detecting and instantly sharing information on pathogens that could cause infectious disease outbreaks, identifying their genome sequences and accelerating the development of medical countermeasures.
• We need to build global capacity to radically speed up supplies of vaccines, diagnostics and treatments to avoid prolonging a pandemic and repeating the staggering inequalities of access that Covid-19 has revealed.
• We need a globally distributed adaptive manufacturing and delivery ecosystem that is kept in use in normal times and can quickly adapt to provide the medical countermeasures specific to any pandemic. In the absence of this, nations with manufacturing capacity will remain open to nationalism over wider global needs.

Multilateralism key to improving pandemic preparedness

However, any solution needs to be rooted in the needs of those communities that are affected by health inequities. The world can only build the necessary supply ecosystem through multilateralism and major public-private investment initiatives, not just governments working together.

So we need different ways of working — with inclusive multi-stakeholder partnerships that include civil societies, international organisations and the private sector — to really learn from what happened and build resilience for the future.

We should work with major financial institutions such as the World Bank, the International Monetary Fund (IMF) and regional development banks in a way where they are investing to build infrastructure and manufacturing capacity in Africa and other low- and middle-income countries, and not just lending money to nations.

How to build a more resilient future

At the World Economic Forum (WEF), we are concerned that society will remain increasingly vulnerable to future outbreaks and pandemics if we do not strengthen essential pathogen surveillance systems and if vaccine, diagnostics and treatment drug markets are not redesigned and strengthened via global multilateral approaches.

To help address these issues, we have designed multi-stakeholder approaches around two of these areas — pathogen surveillance and vaccine manufacturing — to identify and advance multilateral solutions to learn from the global response to Covid-19.

Accordingly, we urge countries across the world to participate in the pathogen surveillance programme and share any resulting data — at both regional and international level — as soon as it is available. We also urge them to keep supply chains open in case of a pandemic and ensure that any export restrictions and trade bottlenecks are tackled quickly.

By taking such actions through a multilateral approach, we can not only avoid mistakes made during the Covid-19 pandemic, but also build a more equitable, inclusive and sustainable future for all.

Bishen is head of health & healthcare at the World Economic Forum.