Keynote speech at the G20 Health Ministers’ Meeting
Dr Margaret Chan
Director-General of the World Health Organization
Your Excellency, Chancellor Dr Angela Merkel, honourable ministers of health, ladies and gentlemen,
I am honoured to address this G20 meeting of health ministers as you consider ways to strengthen global health security, especially as these meetings can have such a strong impact on international policies.
You are exploring better ways to cope with the two biggest threats to health security: severe and poorly contained outbreaks with a potential for international spread, and the continuing rise of antimicrobial resistance.
I appreciate, in particular, the emphasis you have given to health systems and the SDG target for universal coverage. Many researchers and participants at high-level meetings see a convergence of the agenda for health security with the agenda for universal health coverage.
Strong, resilient, and inclusive health systems are a first line of defence against the threat from emerging and re-emerging diseases.
Your agenda fits well with the three main pillars of Germany’s G20 presidency, namely building resilience, improving sustainability, and assuming responsibility.
Global health security is one of the best examples of a universal threat that demands global solidarity. A more secure health situation serves the self-interests of every country, though added responsibility for collective action falls on the governments of major economies.
Constant mutation and adaptation are the survival mechanism of the microbial world. New human pathogens will always emerge, with around 75% of them arising from contact with domestic or wild animals. The volatile microbial world will always deliver surprises.
Prior to Zika’s arrival in the Americas, no one could have imagined that a mosquito bite during pregnancy can cause severe neurological complications in newborns. Prior to the emergence of MERS in the Middle East, most disease experts expected the next new pathogen to come from Asia’s crowded wet poultry markets, not from camels in an arid desert setting.
The revised International Health Regulations moved away from the previous passive approach, which aimed to block disease spread through barriers at borders, to a proactive approach that aims to quickly detect and contain outbreaks at their source, before they have a chance to spread internationally.
As abundant research has shown, efforts to block outbreaks at borders do not work given today’s phenomenal volume of travel and trade. The approach set out by the revised IHR is sound, but as background documents for this meeting have noted, IHR performance needs to improve on many levels.
Health systems that reach everyone, also in rural communities, have the best chance of picking up outbreaks causing unexplained deaths early. Moreover, a well-performing health system with a good surveillance system provides background data on what is usual for a given area or season. Knowing what is usual helps spot the unusual.
The importance of having strong health systems in place is easily illustrated. WHO is currently monitoring 36 outbreaks in sub-Saharan Africa. The causes of these outbreaks range from cholera in countries devastated by famine and armed conflict, to the Democratic Republic of Congo’s eighth Ebola outbreak confirmed earlier this month.
Countries were vulnerable before these blows hit, with extremely impoverished populations and extremely fragile health systems. Collapse of health infrastructures comes easily when no resilience is built in.
Ladies and gentlemen,
The response to the 2014 Ebola outbreak has had a number of spillover effects.
During the outbreak, WHO acquired extensive experience in facilitating R&D for new medical products, but poor coordination lost too much time. To speed things up, WHO and its many partners finalized an R&D blueprint in 2016.
By setting up collaborative models, standardized protocols for clinical trials, and pathways for accelerated regulatory approval in advance, the blueprint cut the time needed to develop and manufacture candidate products from years to months.
The expert consultations that designed the blueprint led to the establishment of the Coalition for Epidemic Preparedness Innovations, announced in January 2017 with initial funding of nearly $500 million. The Coalition is building a new system to develop affordable vaccines for priority pathogens, identified by WHO, as a head-start for responding to the next inevitable outbreak.
In 2013, WHO created the first stockpile of oral cholera vaccines for use during emergencies. The stockpile generated multiple benefits well beyond saving lives.
It improved reporting, as the promise of assistance is one of the strongest incentives to report an outbreak promptly and transparently. It opened the first opportunity for preventive vaccination in hot spots where cholera is known to recur. It attracted new manufacturers to the market, with vaccine supply is set to double in 2017. But supplies are still inadequate.
The same is true for yellow fever vaccines. Last year, supplies ran short during Africa’s most severe outbreaks of urban yellow fever in three decades.
We are running short again this year, especially given the yellow fever threat in Brazil. The lapse is hard to explain. The world has had a safe, low-cost vaccine that confers life-long protection since 1937.
Political concern about the crisis caused by antimicrobial resistance increased dramatically following last year’s high-level meeting at the UN. As your background documents note, many new initiatives have been launched, also to implement the WHO global action plan.
One new initiative is the Global Antibiotic Research and Development Partnership, a joint initiative of Drugs for Neglected Diseases and WHO. The partnership, established last year, is a needs-driven R&D initiative initially focused on the development of new antibiotics for treating sepsis and sexually transmitted infections, most notably gonorrhoea.
The partnership has two distinctive features: it aims to ensure that prices are affordable, and it does so by delinking the costs of R&D from new product prices.
Ladies and gentlemen,
The world is better prepared for the next severe outbreak, but not nearly well enough.
I compliment Germany’s Federal Ministry of Health and various national institutions for your design of the table top exercise. Conditions and challenges mapped out for your fictitious Anycountry, its dependence on tourism, its reluctance to report or accept a WHO assessment team, and its weak and quickly overwhelmed health system look deeply familiar to me.
The imagined new respiratory virus has all the properties needed to strike terror in the hearts of health officials. Nor would I like to be the minister of health in the country named Nexdoria. The fact that the new virus originates in a mountainous area admirably mirrors the way both old and new pathogens can behave in unexpected ways.
I am certain that the simulation exercise will yield lessons about preparedness and response that are vitally important in the real world, and thank you for the opportunity to participate.