The Covid-19 ‘moment’: Ilona Kickbusch reflects on our window of opportunities

Ilona Kickbusch, founding director and chair of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva.

Ilona Kickbusch is part of the Global Preparedness Monitoring Board (GPMB) and a well-respected consultant to health organisations and policy makers. Involved in the WHO Task Force against the Ebola virus in 2015, she hopes countries will favour the “cosmopolitan moment” – willingness to work together and put new rules in place – that usually characterises the start of every epidemic, over counter-effective nationalistic reflexes. A vision which resonates particularly strongly as Trump suspends funding to the World Health Organization.

The GPMB was set up by WHO to give recommendations on what countries need to do in order to be ready to fight against epidemic diseases. In September 2019, they published their report, World at Risk. Their main warning flagged what people called “the disease X”: something new, which our societies are not prepared for, was most probably going to happen. Long time frame observers have long ago predicted that a potential pandemic outbreak could shake our world once every five years.

Would you say that not enough measures were taken since the Ebola outbreak in 2015?

Everybody was afraid of Ebola at first and then it became clear it was only going to hit Africa. There were one or two cases our health system had to deal with but otherwise it was not here. SARS, Bird flu caused great nervousness and a number of Western countries revised their pandemic plans. In Switzerland, an analysis in 2018 about the level of preparedness of the Swiss system identified a number of critical areas. Each crisis brings in some actions in terms of health regulations. The Global Health Security Agenda tried to work with countries to increase their level of preparedness. The Global Health Security Index also. But even the best prepared countries only fulfil about 50 per cent of the preparedness index. There has been a big unwillingness to invest in the systems needed: surveillance systems, centres for disease control, strong decentralisation of public health system, training in public health, simulations, all the things you need to do stockpile. We run our health systems counting every single penny. Hospitals don’t stockpile. These are all the things that will have to be revisited including the supply chains and production lines. If everything is produced in China, you will have a big problem if you have a pandemic and China is faced with the same problems and needs the stock for its own population.

Could this crisis be a threat to multilateralism? Induce a nationalistic fallback?

It can really go in two ways. On one hand, we have experiences in the past where major health crisis have led to a cosmopolitan moment - notice the word “moment” – a very short window of opportunity where countries are willing to work together and put new rules in place. So, we are seeing of course right now, organisations like the G7 and G20 are getting very active. The World Bank is issuing possibilities for the African countries in terms of financing. The EU is exploring new ways of cooperating, etc. One the other hand of course, you have this feeling that each country has to be well-prepared for itself. I mentioned the supply chains and the discussion of a potential vaccine and who would have access to it if it is created in country X. Would it be only available in country X and then to everyone else?

There are also very good examples of solidarity?

Yes, German hospitals are taking in French patients and Switzerland as well. After nationalistic response, after a day or two, people have become sensible again, opening borders and making sure that the masks are for everyone. The European Commission has been, behind the scenes, incredibly active in trying to motivate European countries to share and work together particularly in science where the vaccine initiative is so important. Whatever vaccine or treatment is developed, that’s considered a public good made available broadly. Of course, you have the production issue first: how quickly and how much you can produce. But from the very start it’s not a US, German or UK vaccine but something we share. That will be absolutely essential. The joint WHO clinical trials that have started and what is really developed right now is an extraordinary cooperation in science and research of sharing information.

You really do witness such cooperation?

Absolutely. It’s never been there to this extent before.

What about coordination, is it efficient?

There is an amount of coordination through the WHO, first of all. They have initiated clinical trials all over the world. There’s been a research platform that WHO has put in place. A year ago, the Director General appointed a chief scientist, Soumya Swaminathan, the head of the Indian medical research council, who is now coordinating all this. Many journals have changed their publication policies. There’s been a change in the peer review process, in making research available before it is thoroughly checked so people can debate and draw each other’s attention to weaknesses and mistakes. It’s quite extraordinary. There’s much more open access. There are, of course, existing research initiatives like the CEPI (The Coalition for Epidemic Preparedness Innovation- new vaccines for a safer world) which is involved in vaccine development in general. It started two years ago.

Is the global health diplomacy you always wished for getting a boost in this crisis?

We will have to see because at the same time there was a discussion about Covid-19 within the UN Security Council and they did not get an agreement on the statement. So, you can see how political and geopolitical all of this is. The US speaks about the “Chinese virus”; the Chinese say the US brought it to China. There is a lot of politics and positioning going on. Now that China is in a better shape, it’s helping a lot of countries while the US is still concentrating on itself. In terms of diplomacy, the question is also about who is trying to position itself in the global arena now. Are the countries and their actors willing to fund WHO better or willing to strengthen it? We will have to see all these things in the next two years.

How would you define Genève internationale’s role in this crisis?

We have the WHO, the other multilateral organisations that contribute to health globally, their advice. We have the very strong health system of Geneva. At the Graduate Institute there is a lot of academic work done on the economic impact of the crisis. The new heads of the Global Health Center help the students do analysis. In a lot of ways Geneva International is bonding together. There is also a lot of diplomatic work that still goes on, looking for the most up to date information from WHO. And, of course, the practical cooperation with France. A lot of people in the university are internationally active in advisory groups, involved in projects in developing countries. There’s a lot where International Geneva can contribute, particularly in the long run like The Human Rights Council. Many will play an important role.