Evidence for Foreign Affairs Committee: Global Health Security (GHS0011) Dr Clare Wenham (Department of Health Policy, LSE) has 10 years + experience of research and teaching in global health security and outbreak response. Her research has focused on the politics and policies of health emergencies including on pandemic flu, Ebola, Zika & COVID-19. Her research examines the global governance of health security, and the role of the International Health Regulations (2005) and WHO. She is an associate academic at Georgetown University Center for Global Health Science and Security, the Vice-Chair of ISA global health section. At LSE she is the Programme Director of MSc Global Health Policy and sits on the board of LSE’s Global Health Initiative. She has consulted for European Union, UN Women, Wellcome Trust, Asian Development Bank and formally worked in policy at an NHS Trust and the Faculty of Public Health. For COVID-19 she is co- PI on 2 projects funded by CIHR and Bill and Melinda Gates Foundation to understand the gendered effects of the outbreak. COVID-19 reminds us of the importance of global health security Global health security: transnational efforts to prevent, detect and respond to emerging pathogenic threats, relies on international cooperation. States, international organisations, non-governmental organisations and the private sector need to work together to ensure that appropriate surveillance, disease control and surge capacity mechanisms are in place across the whole life cycle of an epidemic, from preparedness through to after action review to ensure that population and economic health is protected. COVID-19 has brought this point home most acutely. We need global cooperation for; sharing data about the outbreak transparently; clinical learnings to have benefit elsewhere in the globe; treatment and vaccine candidates to be trialled, latterly distributed and implemented; and most fundamentally, each actor in the global health security landscape must realise that cooperation is the only way to have the most pertinent information and data available to decision makers to design and implement appropriate and effective strategies to respond to a pandemic. Perhaps more importantly, given globalised capitalist flows, COVID-19 has also demonstrated that even if you eradicate the virus in your borders, you remain at risk of reintroduction of the virus (as seen in Australia, New Zealand, Thailand, Vietnam), and global trade will continue to be limited until COVID-19 is controlled globally. Remarkably, in spite of such knowledge, many governments (including the UK) have sought to turn their back on the cosmopolitan ideals of global health security during COVID-19, to shy away from WHO advice and chart their own course domestically. This has been at a cost of a significant number of lives and perpetuating widespread economic chaos. UK’s current approach to global health security Over the last decades the UK has provided a vital role in global health security. The UK was at the forefront of recognising health as a security issue during HIV/AIDS, and notably launched the Health is Global Strategy in 2008,1 which was the first global health protocol published by a government which expressly recognised that epidemics occurring overseas can prove a security risk to national and international economic security. This has been a blueprint for many policies from other states in their global health activities2. This leadership of the UK to date in global health security is mirrored in the myriad of activities which the UK undertakes with frequency in preparing, detecting and responding to outbreaks globally. This includes, (but is not limited to): - Public Health England’s global health team engaged in numerous bilateral projects with low- and middle-income states to build capacity for surveillance and laboratory facilities (and more areas of global health security efforts)3 - NHS offering (and indeed exporting) a model of universal health coverage and working to support low- and middle-income states strengthen health systems, as well as sharing technical expertise, human resource and management guidance – all of which forms a key part of infection control protocols elsewhere - Second largest state funder to WHO (and indeed with US suggested withdrawal would become largest)4. Second largest donor to Global Fund for HIV/AIDS, Tuberculosis and Malaria5. Significant support to CEPI, COVAX and other multi- lateral efforts - Significant support to Sierra Leone during Ebola (2014-6) including deployment of PHE epidemiologists; UK military deployment to build Ebola treatment units; NHS volunteers as healthcare workers during crisis; DFID supported clinical trials of Ebola vaccines (in collaboration with UK universities and funding bodies) - Creation of UK Public Health Rapid Response Team (UKPHRRT) to deploy to support outbreak response globally However, there is a tension between UK’s activity to date in global health security and domestic failures during COVID-19. Firstly, despite being a major funder to WHO, the UK government decided to depart from WHO advice in March 2020, and that the WHO’s recommended policy based on test, trace, isolate did not apply to the UK6. This is also contrary to findings of the Public Accounts Committee and International Development Committee in 2015/6 which found that UK delayed response during Ebola was as a result of WHO’s delayed activity (with the inference that WHO was only following WHO guidance)7. 1 HM Government (2008). Health is Global: a UK Government strategy 2008-13. London Retrieved from https://webarchive.nationalarchives.gov.uk/20130105191920/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPo licyAndGuidance/DH_088702 2 Gagnon, M.L., Labonté, R. Understanding how and why health is integrated into foreign policy - a case study of health is global, a UK Government Strategy 2008–2013. Global Health 9, 24 (2013). https://doi.org/10.1186/1744-8603-9-24 3 Public Health England,(2015). PHE’s Ebola response – the people behind the scenes. Retrieved from https://publichealthmatters.blog.gov.uk/2015/02/03/feature-phes-ebola-response-the-people-behind-the-scenes/ 4 Wintour, Patrick (2020). UK to become WHO’s largest state donor with 30% funding increase. The Guardian. https://www.theguardian.com/world/2020/sep/25/uk-to-become-whos-largest-state-donor-with-30-funding-increase 5 Global Fund. (2019). Global Fund Donors Pledge US$14 Billion in Fight to End Epidemics [Press release]. Retrieved from https://www.theglobalfund.org/en/news/2019-10-10-global-fund-donors-pledge-usd14-billion-in-fight-to-end-epidemics/ 6 Walker, A. (2020, 14th April 2020). England coronavirus testing has not risen fast enough - science chief. The Guardian Retrieved from https://www.theguardian.com/world/2020/apr/14/england-coronavirus-testing-has-not-risen-fast-enough-science-chief 7 Public Accounts Committee. (2015)>. The UK's response to the outbreak of Ebola Virus Disease in West Africa https://publications.parliament.uk/pa/cm201415/cmselect/cmpubacc/868/868.pdf; International Development Committee. (2016). Ebola: Responses to a public health emergency, Second Report of Session 2015–6 During the early months of COVID, the decision to move rapidly into “delay” and rather than push for “contain” is the antithesis of the approach the UK government had been promoting over the last decade within global health security rhetoric, whereby the aim of health security is to limit the outbreak at the source before it becomes an epidemic. This strategic wrong decision was compounded by consistently reduced spending in public health because of austerity measures8, multiple years without an outbreak in UK and thus a sense of complacency and indeed by Brexit planning9. It remains to be seen how these decisions made during COVID-19 might affect UK’s standing in global health security leadership in the future, or whether low and middle income settings which have responded more comprehensively to the outbreak may feel challenges in accepting advice. To re-establish leadership in global health security, the UK government has renewed its commitment to GAVI,10 increased funding for WHO, continued to fund CEPI, and hosted a virtual global vaccine summit in summer 2020. This all fits within the broad mandate of “Global Britain”. Indeed, continuing to demonstrate leadership to global health security is vital for the success of “Global Britain”. However, this remains a crucial time for UK within global health security to demonstrate that it understands effective global health security and commits to the normative agenda. Reforms to IHR One of the areas that the Prime Minister announced would be a focus of the UK’s G7 leadership was to devise protocols for what governments must do in the event of an outbreak with global reach in future. Such protocols exist already within WHO: The International Health Regulations (2005)11 lay out clear protocols as to how governments must develop or strenghten core capacity to “prevent, detect, respond” to epidemics through building surveillance and laboratory facilities; report emerging outbreaks to WHO in a timely manner; what governments should do at borders and within the transport industry to minimise spread; and what provision there is for WHO to make recommendations for trade or travel restrictions to minimise global disease transmission, doing so within efforts to reduce any potential impact on trade (that finely account for the balance between public health and the economy that is continuing to dominate policy decisions during COVID-19). A problem with these regulations is that, like many areas of international law, they are hard to enforce. The only punishment that states face for failing to adhere is to be “name and shamed” by WHO (which indeed rarely happens) and there are no meaningful deterrents (such as WTO sanctions). For some governments this is enough12, yet we have seen governments flouting IHR in previous outbreaks13, and during COVID-19 where many governments not only implemented travel and trade restrictions without WHO advice, but https://publications.parliament.uk/pa/cm201516/cmselect/cmintdev/338/338.pdf 8 The Kings Fund, (2017).