Dear President Bollinger, my brother Professor Sachs, distinguished colleagues, ladies and gentlemen,
Before I begin my address, let me first express my deep personal concern for the people of the Caribbean islands, as they suffer this relentless wave of hurricanes.
This is a further reminder of the merciless consequences of our changing climate – shattered homes, shattered lives. WHO stands ready to do all we can do to assist.
But now let me take you on a journey.
It starts with a single case. In a military camp in Kansas, a cook reports to the medical centre complaining of fever, a sore throat, and aches and pains.
Within minutes, a second soldier is admitted with similar symptoms. By lunchtime the count has reached more than 100, and more than 500 by the end of the week. The following week, the virus reaches New York. Manhattan.
Battalions from the camp are sent to fight a war in foreign lands. There, confined living quarters and massive movements of troops provide the ideal conditions for the virus to spread.
Within months, the epidemic sweeps across five continents.
Its symptoms include nausea, diarrhea and dark spots on the cheeks. As the virus takes hold, patients turn blue and suffocate as their lungs fill with blood.
There are no vaccines to stop the virus, and no drugs to treat it. Many of its victims are young, cut down in their most productive years.
Schools, places of worship, theatres and other public places are closed. Here in New York, business closing times are staggered in order to avoid congestion on public transport. Funerals are limited to 15 minutes. There is a shortage of coffins.
And then, as suddenly and inexplicably as it started, the pandemic ends.
One third of the world’s population has been infected, including 25% of the U.S. population. Fifty million people are dead.
This is not some future apocalyptic scenario. This happened, as you may know, 100 years ago. The so-called Spanish flu, which may in fact have started here in the U.S., killed more people than the First World War itself.
And yet it was overshadowed by the war, and faded quickly from public awareness.
Its lessons are just as relevant today as they were then: that a devastating epidemic can start in any country at any time, and kill millions of people, because we are not prepared.
But we do not have to stretch back that far to be reminded of the fearsome consequences of epidemics. Just this century, we have witnessed outbreaks of SARS, H5N1, H1N1, MERS and H7N9.
Each of these has resulted in deaths, sickness, fear and economic loss.
Of course, the most dramatic epidemic of our time was the Ebola outbreak of 2014 and 2015.
Although it affected three poor West African countries, it exposed faultlines in global health security that put us all at risk.
Its severity was caused in large part by weakness of the health systems, which were ill-equipped to detect or track Ebola, and were soon stretched beyond their limited capacity to respond.
It was not just the Ebola virus itself which killed. In Liberia, the epidemic contributed to a 61% decline in outpatient visits. Sierra Leone experienced a 39% drop in children being treated for malaria, and a 21% drop in children receiving basic immunizations. You know what could happen to these kids.
In Guinea, primary medical consultations and hospitalizations dropped by more than half, and vaccinations by one-third compared to 2013.
In short, the whole health system collapsed.
The shockwaves of epidemics are always felt well beyond the devastated families, and long after the last survivors leave treatment centres.
In 2003, SARS caused losses of up to US$59 billion, according to the Asian Development Bank.
In 2009, the H1N1 pandemic wiped US$2.8 billion off Mexico’s tourism industry, and led to a pork trade deficit of US$27 billion.
As a result of the Ebola outbreak, the International Monetary Fund reduced its growth projections for all of sub-Saharan Africa by 10%. Ebola also caused commodity prices to plummet and led to higher unemployment and fiscal deficits.
Ebola taught us a valuable lesson: global health security is only as strong as its weakest link. I repeat: global health security is only as strong as its weakest link.
Let’s put it another way: No one is safe until we are all safe.
This means all countries need to have resilient and robust local health systems to prevent, detect and respond to public health emergencies at national level.
We must support governments to build that capacity.
Every month, WHO screens around 5000 signals of new outbreaks across the world. We monitor these carefully because ignoring any one of them can be the difference between global spread of a deadly disease and rapid interruption of transmission.
Every day, somewhere in the world, WHO is out in the field with local health officials investigating a potential outbreak. When an alert is sounded early enough, as when Ebola broke in the Democratic Republic of the Congo earlier this year, we can move quickly to support governments and stop the outbreak at its source. That outbreak in the Democratic Republic of Congo was contained in just a few weeks.
All too frequently, the tragedy of war creates the perfect conditions for disease to spread. When health infrastructure is damaged or destroyed; when health workers are targeted and killed; when essential medicines cannot get through to the people who need them most, the world’s defences against epidemics start to crumble.
It was no coincidence that Spanish flu – the greatest epidemic – erupted in the middle of what was then the greatest war the world had known. It was no coincidence that Ebola spread in countries that have suffered from years of war. It is no accident that cholera is sickening thousands in Yemen as we speak.
Of course, epidemics are not the only threat to global health security. Natural disasters, biological and chemical attacks, food insecurity and the effects of climate change all have the potential to put people’s health at risk.
That is especially true for antimicrobial resistance. The world’s ability to respond to infectious diseases has been seriously undermined by its failure to ensure that medicines remain effective. Many common diseases have now become resistant to the drugs we have, and few replacements are in the pipeline.
In fact, today we are launching a new report about the state of research and development for new treatments against some of the bacteria that pose the biggest threat to human health. It shows that the cupboard is disturbingly bare. We have nothing.
Urgent investments in research and development are needed, but we also need new thinking about ways to incentivize our partners in the pharmaceutical industry to make those investments.
But R&D is not a panacea. Action is needed across all sectors. For example, we are working closely with the camel industry to understand how MERS is crossing from animals into humans. We collaborate with the agricultural sector to detect, monitor and respond to influenza viruses with pandemic potential.
But at the same time as we prepare for outbreaks and other health emergencies, we must address one of the most pervasive root causes of health insecurity: the lack of access of the most vulnerable people to essential health services.
Without universal health coverage, there can be no global health security – they are two sides of the same coin.
Universal health coverage is based on the moral conviction that health is a human right; that we refuse to accept a world in which people get sick and die simply because they’re poor.
It means, simply put, that everyone can get the health services they need, when and where they need them, without facing financial hardship.
It sounds obvious. If only it was. But the reality is that more than 400 million people around the world lack access to essential health services. There are some people who argue that the estimate is actually more than 400 million.
And at least 100 million people are pushed into poverty every year because of the costs of paying for care out of their own pockets.
It’s important to emphasise that universal health coverage is more than universal health care. Yes, it includes care. But it also means that people can get care without risking financial ruin. After all, what good are health services if people don’t use them because they can’t afford them?
But universal health coverage also goes beyond individual health services to those that promote health and prevent disease at the population level. Many of these do not even need health infrastructure or health workers to be effective, such as tobacco taxation, and promoting healthy eating.
A health system that is delivering universal health coverage also includes periodic services such as immunization and screening, a strong network of primary care clinics for everyday health needs, and the ability to provide more complex care in hospitals.
When we describe health systems in these terms, our minds may immediately jump to the wealthy economies of Western Europe. But we should also think of countries such as China, Rwanda, Chile, Thailand and Turkey, all of which have made giant strides both in improving access to health services, and in making those services affordable for their people.
Take China. In the past 20 years, China has made large investments in its health infrastructure, making health services more equally accessible to its vast population. The result has been large declines in child and maternal mortality, improved health outcomes, and increased life expectancy.
In Rwanda, health system reforms over the past 15 years, including the provision of preventive services free of charge to the entire population, have also meant that more mothers survive childbirth, and more children get to celebrate their fifth birthdays. Rwanda’s Community-Based Health Insurance Scheme covers more than 80% of the population, in a country where 90% of people work in the informal sector.
Here’s the point: far from being a luxury that only rich countries can afford, evidence and experience both show that universal health coverage is within reach for all countries, at all income levels. Every nation can do more with the resources it has.
A recent WHO study shows that 85% of the costs of achieving the health targets in the SDGs can be met from domestic resources.
Those investments would prevent 97 million premature deaths globally by 2030, and add as much as 8.4 years to life expectancy in some countries.
Yes, some of the poorest countries will continue to need aid. But for the majority, universal health coverage is affordable and achievable.
More than that, universal health coverage is politically smart. Because just as epidemics can cripple an economy, universal health coverage can help it grow. Strong, resilient health systems are integral to strong, resilient economies.
The logic is clear: when people are healthy, entire communities and nations thrive. When children survive to adulthood, they become productive members of society. When women survive childbirth, they can return to working or caring for their families. When communities are free from pollution, harmful products and other causes of disease, they prosper. Simple. And everybody knows this.
Too often governments see the health sector as a cost to be contained, and this is wrong, rather than health as an investment to be nurtured. But the return on investment in health is very compelling: the world’s top economists estimate that every single dollar spent on health yields up to US$20 in full-income growth within a generation.
The health sector is also a growing source of jobs. Among OECD countries, employment in the health and social sectors grew by 48% between 2000 and 2014, while jobs in industry and agriculture declined. And because 70% of the global health workforce is female, jobs for health workers are jobs for women.
All of this means that for most countries, the only real barrier is political will. Without exception, every country with universal health coverage, or something close to it, has got there because at some point in its history, its leaders acted with foresight, courage and moral conviction. That is making a difference between countries, not resources.
There is no single path to UHC. Every country must find its own way, in the context of its own social, political and economic circumstances. But the starting point is a determination to create a health system that on one hand protects individuals and families from incapacitating illness and financial catastrophe, and on the other guards against health threats that can hobble an entire economy.
So, what can we do? In my first week as Director-General I was honoured to be invited by Chancellor Angela Merkel to address the G20 in Hamburg on this very topic of health security. I’ll tell you what I told them.
First, we need to support countries to make progress towards universal health coverage, by strengthening health systems, especially in the most fragile and vulnerable parts of the world, and those in the grip of conflict. This is what WHO does all around the world every day. It is not always glamorous work, but it is extremely important.
Second, we must prioritize research and development of new medical counter-measures through WHO’s R&D Blueprint, which identifies the pathogens that are the most likely to spark an epidemic. Developing new vaccines and drugs is not the whole solution, but it is an important part of it.
Third, it is vital that we map global capacities for emergency preparedness and response. Unless we know which countries have which capacities, it is impossible to deploy them quickly. When a fire starts, it is the wrong time to ask where the extinguishers are.
Fourth, regular exercises are needed to stress-test our plans, refine our processes and check logistics. This is like military drilling or simulation exercises. Again, an epidemic is the wrong time to discover our preparations have not been sufficient, or that we have overlooked crucial components of the response.
Finally, we need to sustainably finance the global health security system to prevent, detect and respond to threats. Governments must walk the talk to ensure a guaranteed level of contingency financing for health emergencies. Financing when there is panic doesn’t help. We have to finance during normal times and prepare for it.
Delivering on these priorities will cost money, but only a fraction of what remaining unprepared will cost.
Ladies and gentlemen,
We do not know where or when the next global pandemic will occur, but we do know that it will exact a terrible toll, both on human life, and on the global economy. It may even cause political instability.
But we do not have to stand idly by and wait for disaster to strike. We can be prepared. Outbreaks are inevitable, but epidemics are preventable.
This is not only a job for those of us in the health sector. Everyone has a role to play, from those who ensure the safety of our food, to those who strive for safety in our world. Preventing conflict helps prevent disease too. Peace and security is important.
Guarding against epidemics and building resilient health systems requires determined souls and bright minds, to prevent disease, and to prevent conflict too. You know how the world is profoundly changing in a very negative way.
For those reasons, I am tremendously encouraged a university with the stature of Columbia is launching a Global Health Security and Diplomacy programme, to equip future health leaders with the knowledge and skills to solve the complex challenges we face.
I wish you every success, and look forward to working with you very closely.
I thank you.