COVID-19: Make it the Last Pandemic
The Independent Panel for Pandemic Preparedness and Response
May 2021 :: 86 pages
The Independent Panel was established by the World Health Organization (WHO) Director-General in response to the World Health Assembly resolution 73.1. The mission of the Independent Panel is to provide an evidence-based path for the future, grounded in lessons of the present and the past to ensure countries and global institutions, including specifically WHO, effectively address health threats.
Rt Hon. Helen Clark Co-Chair
H.E. Ellen Johnson Sirleaf Co-Chair
Main Report: COVID-19: Make it the Last Pandemic – PDF, 5.1 MB
From the Introduction
…Seized by the gravity of the crisis, in May 2020 the World Health Assembly requested the Director-general of WHO to initiate an impartial, independent, and comprehensive review of the international health response to COVID-19 and of experiences gained and lessons learned from that, and to make recommendations to improve capacities for the future. The Director-General asked H.E. Ellen Johnson Sirleaf and the Rt Hon. Helen Clark to convene an independent panel for this purpose and to report to the World Health Assembly in May 2021.
The Panel has taken a systematic, rigorous and comprehensive approach to its work. It has sought to listen to and learn from a wide range of interlocutors. Since mid-September 2020, the Panel has reviewed extensive literature, conducted original research, heard from experts in 15 round-table discussions and in interviews, received the testimony of people working on the front lines of the pandemic in town-hall-style meetings, and welcomed many submissions from its open invitation to contribute.
The Panel has examined the state of pandemic preparedness prior to COVID-19, the circumstances of the identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease it causes, coronavirus disease (COVID-19), and responses globally, regionally and nationally, particularly in the pandemic’s early months. It has also analysed the wide-ranging impact of the pandemic and the ongoing social and economic crisis that it has precipitated.
This report presents the Panel’s findings on what happened, the lessons to be learned from that, and our recommendations for strategic action now to end this pandemic and to ensure that any future infectious disease outbreak does not become a catastrophic pandemic…
[Excerpts; Editor’s selection/text bolding]
The Independent Panel makes the following urgent calls
I. Apply non-pharmaceutical public health measures systematically and rigorously in every country at the scale the epidemiological situation requires. All countries to have an explicit evidence-based strategy agreed at the highest level of government to curb COVID-19 transmission.
II. High income countries with a vaccine pipeline for adequate coverage should, alongside their scale up, commit to provide to the 92 low and middle income countries of the Gavi COVAX Advance Market Commitment, at least one billion vaccine doses no later than 1 September 2021 and more than two billion doses by mid-2022, to be made available through COVAX and other coordinated mechanisms.
III. G7 countries to commit to providing 60% of the US$ 19 billion required for ACT-A in 2021 for vaccines, diagnostics, therapeutics and strengthening health systems with the remainder being mobilised from others in the G20 and other higher income countries. A formula based on ability to pay should be adopted for predictable, sustainable, and equitable financing of such global public goods on an ongoing basis.
IV. The World Trade Organization and WHO to convene major vaccine-producing countries and manufacturers to get agreement on voluntary licensing and technology transfer arrangements for COVID-19 vaccines (including through the Medicines Patent Pool). If actions do not occur within three months, a waiver of intellectual property rights under the Agreement on Trade-Related Aspects of Intellectual Property Rights should come into force immediately.
V. Production of and access to COVID-19 tests and therapeutics, including oxygen, should be scaled up urgently in low- and middle income countries with full funding of US$1.7 billion for needs in 2021 and the full utilization of the US$3.7 billion in the Global Fund’s COVID-19 Response Mechanism Phase 2 for procuring tests, strengthening laboratories and running surveillance and tests.
VI. WHO to develop immediately a roadmap for the short-term, and within three months scenarios for the medium- and long-term response to COVID-19, with clear goals, targets and milestones to guide and monitor the implementation of country and global efforts towards ending the COVID-19 pandemic.
5. The Independent Panel’s recommendations for transforming the international system for pandemic preparedness and response
The Panel believes that system-level change is needed to overcome the manifest failure of the international system to prevent, contain, and mitigate the impact of a pandemic. Pandemic preparedness and response have to function at national, regional and global levels, across different sectors of social and economic life, and include government, business and community.
The current pandemic needs to be stopped as quickly as possible. Then measures in the recovery phase must be taken to ensure that such a pandemic never happens again, by building forward better. The lost ground in progress towards the Sustainable Development Goals needs to be made up by redressing the interlocking impacts of the pandemic on health, livelihoods, and inequality.
The Panel’s recommendations follow from the diagnosis we have made of what went wrong at each stage of the pandemic, in preparedness, surveillance and alert and early and sustained response and from our view of the leadership required to transform the system.
There is a need for:
:: Stronger leadership and better coordination at national, regional and international level, including a more focused and independent WHO, a Pandemic Treaty, and a senior Global Health Threats Council.
:: investment in preparedness now, and not when the next crisis hits, more accurate measurement of it, and accountability mechanisms to spur action;
:: an improved system for surveillance and alert at a speed that can combat viruses like SARS-CoV-2, and authority given to WHO to publish information and to dispatch expert missions immediately;
:: a pre-negotiated platform able to produce vaccines, diagnostics, therapeutics and supplies and secure their rapid and equitable delivery as essential global common goods;
:: access to financial resources, both for investments in preparedness and to be able to inject funds immediately at the onset of a potential pandemic.
The Panel calls on Member States to request the United Nations Secretary-General to convene a special session of the United Nations General Assembly to reach agreement on the reforms needed to ensure that the world can prevent the next outbreak of a new pathogen becoming another pandemic…
2. Focus and strengthen the independence, authority and financing of the WHO
The Panel recommends
I. Establish WHO´s financial independence, based on fully unearmarked resources, increase Member States fees to 2/3 of the budget for the WHO base programme and have an organized replenishment process for the remainder of the budget.
II. Strengthen the authority and independence of the Director-General, including by having a single term of office of seven years with no option for re-election. The same rule should be adopted for Regional Directors.
III. Strengthen the governance capacity of the Executive Board, including by establishing a Standing Committee for Emergencies.
IV. Focus WHO’s mandate on normative, policy, and technical guidance, including supporting countries and regions to build capacity for pandemic preparedness and response and for resilient and equitable
V. Empower WHO to take a leading, convening, and coordinating role in operational aspects of an emergency response to a pandemic, without, in most circumstances, taking on responsibility for procurement and supplies, while also ensuring other key functions of WHO do not suffer including providing technical advice and support in operational settings.
VI. Resource and equip WHO Country Offices sufficiently to respond to technical requests from national governments to support pandemic preparedness and response, including support to build resilient equitable and accessible health systems, UHC and healthier populations.
VII. Prioritize the quality and performance of staff at each WHO level, and de-politicize recruitment (especially at senior levels) by adhering to criteria of merit and relevant competencies.
4. Establish a new international system for surveillance, validation and alert
The Panel recommends
I. WHO to establish a new global system for surveillance, based on full transparency by all parties, using state-of-the-art digital tools to connect information centres around the world and including animal and environmental health surveillance, with appropriate protections of people’s rights.
II. WHO to be given the explicit authority by the World Health Assembly to publish information about outbreaks with pandemic potential on an immediate basis, without requiring the prior approval of national governments.
III. WHO to be empowered by the World Health Assembly to investigate pathogens with pandemic potential in all countries with short-notice access to relevant sites, provision of samples and standing multientry visas for international epidemic experts to outbreak locations.
IV. Future declarations of a PHEIC by the WHO Director-General should be based on the precautionary principle where warranted, as in the case of respiratory infections. PHEIC declarations should be based on clear, objective, and published criteria. The Emergency Committee advising the WHO Director-General must be fully transparent in its membership and working methods. On the same day that a PHEIC is declared, WHO must provide countries with clear guidance on what action should to be taken and by whom to contain the health threat…
Background documents represent the Panel’s in-depth research including an authoritative chronology of the early response. Additional background papers will be posted in the month of May 2021.
Background Paper 1: Building on the past – PDF, 952 KB
Background Paper 2a: The authoritative chronology – PDF, 19.9 MB
Background Paper 3: From science to policy – PDF, 1.8 MB
Background Paper 5: Access to vaccines, therapeutics and diagnostics – PDF, 3 MB
Background Paper 6: Scaling up vaccination, legal aspects – PDF, 609 KB
Background Paper 7: Access to essential supplies – PDF, 1.3 MB
Background Paper 8: Impact on essential health – PDF, 1.1 MB
Background Paper 9: Social impact – PDF, 1.5 MB
Background Paper 10: Community involvement – PDF, 1 MB
Background Paper 11: Human rights – PDF, 940 KB
Background Paper 13: Economic impact – PDF, 1.4 MB
Background Paper 14: Financing Pandemic Preparedness and Response – PDF, 1.6 MB
Background Paper 15: WHO institutional review – PDF, 1.6 MB
Background Paper 16: International treaties – PDF, 1 MB