| | Interview

WHO, the pandemic and Europe’s new global health leadership role

Ilona Kickbusch at the 2019 European Health Forum (Gastein). Credit: Health Policy Watch

Billions of dollars in vaccine investments are needed to beat back Covid-19. But on the bright side, Europe is playing a more active global health leadership role. Geneva’s ‘dean’ of global health speaks to Geneva Solutions ahead of next week’s European Health Forum (Gastein).

Geneva Solutions: The World Health Organization (WHO) says the world needs $35bn to fund the manufacture and equitable, worldwide distribution of two billion Covid-19 vaccines, as well as tests and treatments. But so far, only $3bn has been raised. Can we raise that kind of funding – and how?

Ilona Kickbusch: Stepping back, I think it shows us that the whole system of funding for these initiatives is totally insufficient. We are moving in global health from a situation where we were looking for millions to looking for billions and in some cases even trillions. And that means we need other sources. That is why there has been so much talk about linking up with various development banks and finding other types of funding from governments.

Very clearly, $35bn is actually peanuts, if you look at the trillions being discussed by the finance ministers of the G20. Many of the rich countries, if they got their act together, plus some of the middle-income countries could actually contribute, together with the development banks, and maybe even some of the philanthropists. If you look at the amount of money Mark Zuckerberg made during the Covid-19 pandemic, some of these sums pale in comparison. It shows that our whole system of financing is wrong- and bankrupt.

Ursula von der Leyen, European Commission President, also proposed that there should be a  European version of BARDA, the US agency in the Department of Health and Human Services, that has invested billions in vaccine research and development. Do you agree?

Absolutely. That would be another mechanism.  It is clear the European Union has defined itself as a geopolitical actor in the global health conversation. And that has two dimensions - stronger cooperation between the European countries so they act as one, and then acting jointly in terms of global responsibility. That is reflected in the EU joining Covax [the WHO-led Covid-19 vaccine pool], supporting the World Health Organization, and making European institutions more fit for purpose for a global role.  And the EU moves have also been made towards other regions, like the African Union, which I think is important.

Why?

Because you could say the global north is telling everyone else what to do. And this is not what the European Union wants to do. It wants to move away from an old-fashioned “leadership” model in global health to a “partnership-and-responsibility” model.

So can these regional initiatives help fill the gap that's been left by the US withdrawal from the global health arena?

The old model of multilateralism is one that always had this notion of countries like the United States or the United Kingdom showing leadership. The new notion of multilateralism is particularly important for smaller countries. That is why Germany and France created this alliance for multilateralism. And there are regional organisations, the African Union being a really important one. But there are also Asian groupings, all kinds of different constellations. And we are finding that regional organisations are going to be even more important in global health. And that also means stronger WHO regional offices.

So you see some hopeful signs in terms of regional actors stepping in to fill the gap – or reshape the paradigm?

It has to change. The US has to change in its approach and the rest of WHO member states need to change. This is an organization of 194 countries, and that cannot be driven by three or four major donor countries. So I don’t want to even talk about a gap, I want to say we need a different kind of partnership based on common goods, based on multilateralism and not one or two countries thinking they should call the shots and tell everyone else what to do.

And WHO?  We’ve seen countries reaffirming WHO’s leadership role in the recent UN General Assembly resolution on the pandemic. But we also know that WHO is a big bureaucracy with lots of warts.  So what can WHO do to reform from the inside?

I am a political scientist and I just do not understand why being a bureaucracy, per se, is considered a negative element. Bureaucracy is a form of organization, and if you have 196 member states...you need rules. And those rules are described as a bureaucracy. Obviously, I think digitalization will contribute to greater democratisation of WHO.  Tedros has also been working on a transformation. He has tried to streamline processes and be much more in direct touch with his staff, to have better cooperation between regions and headquarters, and have better staff in the country offices.  So I think there is a lot happening.

But if you are supposed to make use of digitalization, do you have the resources? And can you ensure continuity of work if you do not have the resources to hire staff for years, but only for months. So, as per the German and French initiative, you have to increase the assessed contributions of the WHO.  You have to address the budget to make it a well-functioning organisation.

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Global and regional player: Ilona Kickbusch at Berlin's World Health Summit, 2019 (Credit: Flickr/World Health Summit)
You have put up a strong defence of WHO, but at key moments in the pandemic, it moved very slowly. Why was WHO often behind rather than out front?

What we need now is to strengthen the science part of the emergency response. There needs to be a good interface between the Health Emergencies programme and all of the science. Remember, many years ago, WHO had all kinds of research committees and they were closed down. Expanding that work, working together with key science organizations around the world is one of the things that needs to be a lesson from this pandemic. But it needs resources. I hope the WHO independent review panel would provide recommendations, just like we did after the Ebola.

Returning to the European Health Forum, Gastein, where you will be a keynote speaker next week, what role can this forum play now in regional health diplomacy?

I think Gastein has an enormous opportunity this year to shape the agenda for the European Union. And through that for global health. The fact that the President of the European Commission has said very clearly we need a European health union - this is an issue that has been raised in Gastein very frequently. There are always high-level policymakers meeting linked to Gastein, and we have had discussions about how we would like to focus that meeting on what, beyond the slogan, is a European Health Union, and what is it in very concrete terms?

What are additional health competencies that the Commission should have? How can one strengthen the European Centre for Disease Prevention and Control? What should the European Medicines Agency look like?   What about social protection throughout the union? There are also many issues that relate to the social determinants of health – such as trade agreements that the European Union enters, European agriculture policy, and are they health proof? And now there is an opportunity for these to come together in a clear agenda. There is a closing panel which I am going to moderate, which will say ‘okay if we are to go to Ursula von der Leyen and the European Parliament and the Council, what should a European health union look like?’ So I think that is an extraordinary opportunity which must be used.

You have talked about a new sense of European solidarity but you also see the UK leaving the EU, and eastern European countries not as enthusiastic about multilateralism as France or Germany?

Well, call it health diplomacy but if you have 26-27 countries, you have to reach agreements along the way.  And I think it's been quite intriguing how with very hard negotiations, around the budget and everything else, in the end, there is a consensus. That is what the European Union is about. I would also urge us not to think you know there is one eastern Bloc and they are not interested. It is diverse and complex. And then there are the questions about positions the UK is going to take on global health and what alliances it will enter, as well as other non-EU countries like Switzerland and Norway.  Even here [in Switzerland], there are many common global health agendas and, sometimes agendas that you know the global south would be critical of, like around [access to] medicines.

As for Switzerland, where you have lived and worked for many years, what would be your single piece of advice to the Swiss Government about how it could position itself?

Switzerland is the host country of a whole range of international health organisations. I would like to see Switzerland very active in ensuring the financial base of all these organisations, particularly the World Health Organization.

‘Leadership’ from a host country that is both a middle-sized power and a country committed to multilateralism should be important for Switzerland. It's also important in terms of all the related economic issues and being the centre for multilateralism in Geneva. And we know that quite regularly there are issues around whether all of these organisations should really stay in Geneva. There are all kinds of support; I'm not trying to minimize that. But I think coming out very strongly politically for multilateralism is something that can be strengthened. I think that this is at the forefront for me. Because as a host country, while these are not necessarily your adopted children, you also have a kind of caretaker function for the organizations.

You have served in many high-level roles, but are still perhaps best known as the founder of the Geneva Graduate Institute’s Global Health Centre. What was your single biggest accomplishment there, and what is your biggest priority now that you have left the director’s post?

We created a centre that brings political science and international relations dimension to the global health governance debate. We gave that the term ‘global health diplomacy’. After ten years, I am delighted that I have been able to hand it over to such committed new co-chairs who are strengthening that political dimension, as well as focusing also on new issues, like access to medicines.

Now I'm involved in trying to shape the global health agenda in the European Union. I also work with the German presidency. I am involved with the World Health Summit in Berlin; that has become you know a major forum for debate. I have been part of the Swiss national health report. What I always try and do is to work at three levels, national, regional, and global and then see how those levels interface.

The UN Global Preparedness Monitoring Board, of which you are also a member, projected last year that the world could soon face a pandemic? What can you say now?

Tedros has repeatedly said “health is a political choice,” we've seen very clearly in this year’s GPMB report, that political choices were either made too late, or the wrong political choices were made. There is a sort of negative extreme politicization - what is happening right now between the US and China. But one mustn’t fool oneself that global health is not political. Global health and global health diplomacy are always political. I hope that the [WHO] independent review panel with Helen Clark and Ellen Johnson Sirleaf will be able to take up the political decisions that were not taken, or were wrong, as well as show us those decisions that helped us move ahead –and keep the people secure.

Professor Ilona Kickbusch is the Founding Director of the Global Health Programme at the Graduate Institute of International and Development Studies in Geneva. She is a member of the Global Preparedness Monitoring Board and the WHO High-Level Independent Commission on NCDs and co-chair of Universal Health Coverage 2030. She has been involved in German G7 and G20 health-related activities, and the development of the German global health strategy.

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