Media briefing on WHO Council on the Economics of #HealthForAll financing brief

00:00:00

GA          Hello, everybody, and thank you for joining this media briefing. I’m Gabriella Stern; I’m the Director of Communications at the World Health Organization.

I’m moderating this presser from Geneva. And in Berlin, at the World Health Summit, we have Dr Tedros Adhanom Ghebreyesus, the Director General of the World Health Organization, with Professor Mariana Mazzucato, who is the Chair of the WHO Council on the Economics of Health For All. But, she is also professor in the Economics of Innovation and Public Value at University College, London, where she's also Founding Director of the UCL Institute for Innovation and Public Purpose.

We have 30 minutes for this press briefing, which is really going to focus on the Economic Council's new financing brief and the timing of the brief is quite important as we have the G20 meeting coming up later this week.

00:01:07

Following the remarks from Dr Tedros and Professor Mazzucato we'll have time for some media questions and when I come to you in the Q&A I'll ask you to raise your hand in the Zoom and write in your name and the name of your outlet so we know who you are and can call on you.

We will be taking questions on the Council and the brief. If you have unrelated questions we have a presser planned later this week on broader COVID topics and you can ask unrelated questions at that time.

So without further ado, Dr Tedros, the floor is yours. Thank you.

TAG        Thank you. Thank you, Gabby. Dear colleagues and friends, today I'm pleased to join you for the presentation of the second policy brief by the WHO Council on the Economics of Health For All.

We're joined by the Council Chair, Professor Mariana Mazzucato, who has led this distinguished group of diverse experts from around the world in their important mission.

00:02:30

Their new brief on financing health for all comes at a critical time with the upcoming G20 summit in Rome where Professor Mazzucato will present there Council's findings. It's important to start by defining health for all and I would like to quote one of my esteemed predecessors as Director-General of the World Health Organization, Dr Hafden Mahler, who said, health for all - I quote - implies the removal of the obstacles to health - that's to say the elimination of malnutrition, ignorance, contaminated drinking water and unhygienic housing - quite as much as it does the solution of purely medical problems such as lack of doctors, hospital beds, drugs and vaccines - end of quote.

A landmark commitment to health for all was made at the Almada Conference of 1978 and more recently there was the high-level political declaration on universal health coverage at the UN General Assembly two years ago.

In the face of this powerful commitment huge challenges remain. The COVID-19 pandemic has thrown a harsh spotlight on the inequities both within and between countries. This includes the vast disparities in vaccine allocation where just one-quarter of the 6.7 billion vaccine doses distributed globally have gone to lower and low-income countries although they make up more than half the global population.

Addressing the structural inequalities that keep us from achieving health for all is not a job for the health sector alone. The COVID-19 pandemic has taught us that the impact of health crises resonates throughout economies and societies.

00:04:50

It's clear that this goes well beyond the health ministry. Ministries of finance, trade, labour, infrastructure, environment and so many others including heads of state, including international financial institutions and the private sector must be at the table, must take responsibility and tackle the great challenge of health for all together.

We need a new narrative. We can no longer see health as a cost but as an investment that's the foundation of productive, resilient and inclusive economies. The task of the Council is not only to come up with innovative economic approaches to improve health and well-being.

They must also be practical and applicable to countries of all income levels. The Council released its first brief on health innovation this past June. The new policy brief released today on financing health for all proposes a radical shift in economic thinking for global health.

Instead of looking at health as a piece of the economy it's time to look at how the economy can support the societal goal of health for all. This new finance brief shows that neither existing market mechanisms with their focus on short-term returns nor development funds alone are enough.

They do not provide the global public goods on which we all depend such as vaccines, nor do they address the major inequities undermining equitable access. The Council is proposing bold, concrete actions for governments and multilateral organisations in three major areas, creating fiscal space, the direction of investment and the governance of public and private financing for health.

00:07:15

This does not just mean more money. It means making the better, smarter and sustained investments that are needed to achieve health for all so more money plus better money, not only the quantity but also the quality.

It's time for a new paradigm. We have to consider financing for health as a long-term investment, not as a short-term cost. My thanks to Professor Mazzucato and all Council members for their work. I hope that this powerful report reaches policymakers in all sectors and at the highest levels. Thank you and, Gabby, back to you.

GA          Thank you, Dr Tedros. Now we're going to turn to Professor Mariana Mazzucato. Mariana, the floor is yours.

MM        Great. Thank you, Gabby, and thank you so much, Dr Tedros, for your leadership and the words that you just had for the WHO Council on the Economics of Health for All. This is, as you said, our second output. The first one was really how can we innovate towards the common good, how can we structure the mechanisms of production and innovation itself in order to actually reach the health for all objective.

00:08:36

This one is really focused on financing mechanisms on the back of the G7 meeting and the upcoming G20 meeting this week when finance ministers and health ministers talk about what needs to get done.

We're a council currently composed of ten women economists from all five continents. We're about to let in some men. I hear that Gordon Brown is our waiting list. The women themselves are myself, [names].

We formed the Council in May and we are quite driven to make sure that the messages come at the right time and again this is an incredibly important moment to make sure that we're not just filling the system with finance and with liquidity as we did after the financial crisis, when most of that finance just went back into the financial sector.

How can we make sure the finance actually lands in the real economy, strengthens global health systems but also that the financial structures themselves are redesigned? Because we have to learn the mistakes from the past.

00:09:45

Really this is the core point of the council. We don't think that there's been any lack of thinking about the relationship between health and economy. The problem is that often the logic has not been the right one. The logic has been investment health and it's also good for the economy.

We say no, investment health for all, that's the mission and then back-track and ask, what does it actually mean for all the different types of economic structures and the social and economic fabric of society, what does it mean for how we govern innovation, how we direct and restructure finance, how we use tools like outcomes-based and participatory budgeting, how we can use it to really drive innovative procurement.

Procurement budgets are huge within every single government in terms of the percentage of government spending and yet it's often a static instrument instead of a dynamic instrument fostering new solutions for public goals.

What does it also mean in an era like the one we're living in where there're these huge recovery funds and also bail-outs for different types of companies, how can we create a real conditionality at the centre of that creation of money so we truly do what the world is talking about, which is building back better or building forwards better?

00:11:00

As with climate the cost of inaction is actually greater than not acting today [sic] and it really requires seeing the kind of investments that we talk about as investments in the long run and not costs in the short run. By cutting costs today we're going to create a huge mess that's actually going to cost us more later.

So what does it actually mean to build back better? One of the things that we're very clear on in this moment where there is a call for more finance is that we really, as Dr Tedros already highlighted, have to be careful, we have to better understand how the current structure of the financial system and of the economic system got us into this mess in the first place, including also the climate crisis, the health crisis, the financial crisis.

On that however we should also be pushing for more finance. We're not just going to say that we need better finance but on the more finance it's very important to listen to the G20 report of the high-level independent panel which currently is calling for an investment in pandemic preparedness as a global public good, such an important concept I'll repeat it - a global public good.

00:12:05

They call for a minimum commitment from governments for pandemic prevention and preparedness to be at least $75 billion over the next five years in addition to, not instead of, existing development support, the ODA.

What our Council says is yes, yes, yes, we have to increase the finance. We have been starving global health systems. However we have to do it in new terms. Finance and financial structures are not neutral. They're not just greasing the world of commerce. How we structure the financial systems and the public/private partnerships actually matter and they affect the direction where the finance actually goes and also the outcomes.

So we really believe that the existing paradigm of economic thinking itself needs to change. This is why we brought together these amazing women, many of whom are actually professors of economics, to actually ask, what is the new economic thinking that also needs to be underpinning better economic policy.

A lot of the problems have been that the focus on short-termism, which has then led to cost-cutting, profit maximisation, has also really dismantled vital capabilities on the ground that have undermined the strengthening of health systems and the social determinants of health.

00:13:21

So we can't just continue to put in vast amounts of money without actually questioning what has gone wrong and how can we improve it and these deep structural issues that need to change.

So we set basically three different pathways that we think are crucial for rethinking the structures of the financial system itself and I'm going to briefly review those. First we argue that we need to stop saying that there is no money.

We need to actually create the fiscal space for health for all and we can't do it when it's too late. Money has come out of the woodwork during COVID-19 but it's too late if we're not continuously investing in all those very important areas that then lead to the mission of health for all.

We argue that internal constraints on government budgets are not insurmountable and governments have always actually more room for increasing the fiscal limits on investments for health than they're led to believe.

It's not just a matter of political choice but also one of political will, whether a country can mobilise all of the resources and levers it can to maximising financing for health such as innovative monetary policy but also, as I mentioned before, procurement policies, using all the different levers - grants, loans, procurement - to really catalyse new solutions that we need for health for all, which has to be the objective itself.

The bottom line is that countries must reverse the harmful effects of an austerity approach to public administration and public finance reforms. It's quite interesting if you look around the world. The countries that have fared better have also fared better if you look at...

For example Kerala, a region in India, did better based on those investments that it made within its public administration and there's indeed external constraints, almost false constraints that have been imposed on governments' fiscal spaces often by - and let's call it out - multilateral organisations like the IMF and the World Bank.

00:15:07

Actually the IMF has put out some very important writings in recent years saying, actually austerity didn't work and it itself has to change in terms of what kind of conditions it puts on the loans. So let's remember that mea culpa call that we've seen in recent years with some very important papers that have come out of the IMF.

The rules of the game are a product of what is often called the Washington consensus. These are no longer fit for purpose and they must change to create a much more enabling fiscal environment for long-term equitable growth and enable social spending to improve individual and collective health security and ensure progress towards health for all.

Specifically we also propose multilateral organisations should negotiate debt relief for low and middle-income countries in such an important moment as the one we're living through, redirecting special drawing rights towards investment in health and especially vaccines, push for enforcing a minimum global corporate tax of at least 15% and advance the G20 reform of sovereign credit ratings.

00:16:07

So that first area's really again creating the fiscal space and going beyond the myth that there's no money. When we go to war money is found and during a health pandemic money has been found but that is too little and too late. We need to rethink the myths themselves.

Second, we need to direct investments towards health for all to reorient economic activities around health. We need to forge symbiotic public-private relationships. We need business, we need public actors, we need philanthropies but they need to work together in a different way.

A way to do that is really to bring together some conditionalities at the core of a new social contract so conditionalities, incentives and regulations which have the objectives themselves at the core. This can be done by redesigning the terms and the conditions structuring contracts, grants, transfers, loans and partnerships between public and private actors.

What we focus on also in the first brief on innovation is that this point is particularly important in health innovation precisely because the public sector puts in so much of the money, especially in the early stage when it's more risky and more capital-intensive, uncertain.

00:17:15

So these critical markets shaping public investments should surely ensure conditionalities around pricing to make sure that we have access at the core, that we have vaccines that are globally accessible but also how we structure intellectual property rights that truly reflect the public interest including the possibility of consistent and long-term financial return and ownership of research, in other words, that we also share in both the risks and the rewards instead of what we often find, which is socialisation of risk but privatisation of rewards.

The issue of structuring intellectual property rights is important because what we in the end want with innovation is collective intelligence and so making sure that patents are not too wide, too strong, hard to license and to upstream are core ways to govern the patent system.

It's not about getting rid of patents. We have to govern innovation and the patent system with objectives in mind and more broadly we need to shape a conducive regulatory, tax, industrial and economic policy environment and create a normative framework to crowd in all sorts of different sorts of finance at the same time, ensuring that we get the greatest multiplier effect and the greatest impact on health for all.

00:18:25

Only a truly global end-to-end health innovation platform governed collectively and shifting from a model where innovation is left to the market to a model aimed at delivering global common goods - again a very important word that has also been used by the independent G20 panel.

Third and lastly we say that we need to govern public and private finance for health for all. Private finance has been an important source of financing for health products and services but we need better regulations of private finance to help to ensure that health markets are better aligned with public health imperatives including universal access to good-quality provision, prevent excessive charges and rent extraction through monopolies and, as already discussed, setting intellectual property rules that do not inhibit critical access and innovation, reducing information asymmetries and preventing conflicts of interest.

A key action point right now given the gross inequity in the vaccine distribution, which Dr Tedros has sometimes called a vaccine apartheid and a huge moral failure in the global system, is to redouble the efforts to strengthen and invest in existing mechanisms for global vaccine distribution like COVAX and technology transfer, for instance the COVID-19 Technology Access Pool, where it's needed, transforming them and they way they are governed to be more inclusive and able to deliver health for all.

00:19:44

Can I just again thank you, Dr Tedros, for your leadership. Thank you for allowing us to set up this inspirational panel. We will continue to put out output. Our next one will actually be on value and it's quite important right now that while we have these calls by the IMF, the World Bank, the G20, the G7 for increased financing for pandemic preparedness and response we have to constantly remind ourselves that more money is important but it's not enough if we are to change the underlying economic thinking, policies and inequalities that keep getting us from one crisis to another.

Thank you very much for your time. I'm happy to answer questions.

GA          Thank you, Mariana, thank you, Dr Tedros. Journalists, please raise your hand in the Zoom if you want to ask a question and again put your name and the name of your news outlet. We have a few minutes left and while we're waiting for hands to be raised I'm going to ask you, both of you or whichever of you would like to take the question, a question that really reflects a lot of discussion in media and in social media.

During the pandemic there has been, as you alluded to, relatively little progress in equity and financing issues along the lines of what the Council is proposing. The brief that you've summarised is very idealistic and it proposes really transformative steps.

But give the fact that the market economic is so deeply embedded in most powerful nations is a radical re-engineering really possible? Don't you think that after the pandemic capitalist societies and most powerful private and public-sector leaders and players will just go back to their old ways, will revert to the same-old-same-old and the new social contract you propose will just be left behind?

00:21:46

MM        Can I take that, Dr Tedros? We can do it together. Maybe I'll start. It's a really good question and I think there're two parts to your question which are, are we going to go back to the old way? The answer is we can't, we can't afford to.

But the bigger question is, is this just pie-in-the-sky and is this just some sort of utopian ideal? I think the answer is no and this is why the second year actually of the Council - this is still just our first six-month period - is really going to be focused on implementing these ideas.

One of the ways to do that is actually to start working with different partners globally who have already begun but just in too much of a peripheral way to experiment with new structures of finance.

It's quite interesting. Even with the COVID-19 funding globally some countries like France were quite bold in putting strong conditions attached to the money that flowed for example to airlines and the automobile industry. They had to commit to lowering their carbon emissions over the next five years in order to get that public subsidy.

00:22:47

There's something about that conditionality that we need to be just normalising. It shouldn't just happen in a period of crisis precisely because the sector, the health area has so much collective effort and collective value creation.

What does it mean to design within these partnerships goals and conditions attached so that we don't just use the word, the market economy, but actually remember that markets are outcomes of how we govern all the different actors but especially how we govern the relationship.

That's why in the brief we talk about mutualistic and symbiotic relationships and not what frankly sometimes in the health area is a parasitic relationship. Look at the United States where you have $40 billion a year going in via the national institutes of health and health innovation and somehow the intellectual property rights don't get governed with respect to that, the pricing of the drugs again don't take that into account.

So this is actually a global phenomenon that because health is so important we think that it's enough just to put money in without then governing it to make sure it actually benefits people.

00:23:53

Another example I'll bring out is the military. The military also invest in health, soldiers get sick in the war but because we put war as an urgent battle to win somehow organisations like - again in the US - the Department of Defense and DARPA, when they fund medicines they make sure actually that the soldiers get access to the medicine that they actually finance.

It's because we don't treat as urgent our social problems that we don't actually get real to make sure that we have global access to these innovations that we're financing. So I don't like to use the military as an example because I don't think we can rule by fear but it's interesting that when we put our minds to it and actually treat things in an urgent way with what I call a mission orientation we can learn a lot about what has happened in other sectors.

We need to use COVID-19 as a real wake-up call to do things differently.

GA          Right, thank you. Anything to add, Dr Tedros? We do have a question from...

00:24:52

TAG        I think Mariana had already said... but the pandemic is unprecedented and if we're not going to learn lessons from this I think we will repeat the same mistake. This COVID pandemic has affected the whole world and actually taken the whole world hostage and destroyed lives and livelihoods, affected our social fabric and impacted our politics, economy.

I think the world should come back to its senses and learn from this and implement. Gabby, you said this is idealistic. I wouldn't say that. I would say this is the right thing to do in order to prevent the next pandemic and prevent all the crisis that's happening now and still is happening, by the way.

It has shown health is central and should not be treated as a cost but should be treated as an investment so everybody has seen it now, there's direct experience and I hope the world will listen and act.

These recommendations, especially the three pathways are very clear, creating fiscal space, directing investment to health for all and also governing the public and private sector.

The commitment to health for all has been there since the establishment of WHO at the end of the 1940s. In our constitution it's clearly put there.

00:26:53

I think the world had agreed even then but I don't think it was serious enough. Probably the lessons we have learned now will - still the same health for all, nothing has changed but I think will now add seriousness into what the world agreed in the 1940s.

So health for all is the answer and I think we have learned our lessons the hard way and we have to listen to the Council that's already proposing the pathways to a better world. Thank you, Gabby. Back to you.

GA          Thank you. We have a question from Andanaya Ashur of Development Today. Can you ummute and ask your question, please.

AN         Yes, hello. Can you hear me?

GA          Yes.

AN         Thank you. You mentioned COVAX in your presentation and you mentioned one of the recommendations of the G20 report on pandemic preparedness to invest at least $75 billion over the next five years in addition to ODA.

What I'd like to ask you about is, in two days the ACT Accelerator, of which COVAX is a part, will launch a new strategy and budget for 2022. I have not seen the final version yet but the total bill for high-income countries will probably be in the region of 40 to $50 billion if we include the funding gap from this year.

The argument has been made by the IMF and WHO and many others that it makes economic sense to help low and middle-income countries out of this pandemic and yet the ACT Accelerator remains badly underfunded.

00:28:53

So what arguments can be made, in your opinion, for high-income countries to make this funding available and in a timely fashion? Thank you so much.

GA          Thank you. Which of our distinguished speakers would like to take this question?

MM        I think you gave the answer in your very eloquent question, which is of course that the high-income countries have to be helping the low-income countries. One of the things that we talk about in both briefs is that we also need to, at least in the long run, better understand why it is that the capacity on the ground in the low-income countries has become so weak. How can we actually change the business models, the way we innovate and create industrial capacity globally precisely so we have to rely less on charity at moments like these?

So even though immediately we need solidarity, we need the high-income countries to do exactly what Dr Tedros set out in his early remarks, I think in the long run we have to realise that this donor mentality is actually part of the problem and that lots of the conditionalities that were set in the past on the loans provided to developing countries precisely made them weaker actually and they weren't allowed actually to create that kind of fiscal space that we highlight as the first key pillar.

So over time - because this will not be the last pandemic. As the permafrost melts apparently there're going to be all sorts of other viruses that come about so climate change and this health crisis are really interlinked unfortunately.

00:30:34

So we have to be better-prepared and that preparedness needs to be a long-run preparedness that really is built on ability to have a distributed manufacturing capacity and industrial capacity globally and focusing on the continent of Africa, I think, is going to be extremely important in that light.

That is why we call out things like the Washington consensus conditionalities that actually led to that weaker global system in the first place. So I would say that your recommendation is exactly the right one and again echoes what Dr Tedros mentioned at the beginning

But it's not enough of itself otherwise we will constantly have to rely on someone filling the gap and a donor-type mentality, which unfortunately doesn't actually make the global economic system stronger in a distributed way.

TAG        Thank you. I think it's covered but just one dimension. We were discussing about the ACT-A financing plus the G20, be it 25 billion or US$50 billion and I think the world knows also how much money it's spending on austerity, trillions.

Some finance ministers said what ACT-A is asking is actually a rounding error for many countries. So 75 billion for five years is really small, not really big compared to the austerity funding which we see in especially high-income countries.

00:32:11

So is it because of lack of money? I don't think so. It's not. Then what is it? I think many colleagues during this World Health Summit have been saying it. Yesterday also we had a meeting. It's lack of commitment. There is no real commitment to really act and based on the recommendations implement and then get the necessary result that we're expecting.

It's actually very disappointing that the ACT-A is not fully financed because, as the Ministers of Finance said, it's a rounding error, the amount of money which is being asked and collectively for those to have the resources it's actually even small because no-one is expecting the funding to come from one country or two or three countries. It's from all that can afford to contribute, especially the high-income countries.

So again if there is real commitment there is a way because you asked me, how can they finance, what are the mechanisms? The mechanism is not an issue. There are mechanisms that you can use to finance. The problem is the lack of willingness and commitment to act or low commitment to act.

00:33:42

So we have, as you said, our presser on Thursday when we launch the strategy, where we can discuss the same thing again if you're joining. Thank you.

GA          We have two more questions and then we'll wrap up. One is a written question from Gustavo Captidila of Interpress Service. He asks to you, Mariana, what do you specifically refer to when you mention - quote - artificial constraints imposed by outdated economic assumptions - end quote?

MM        Sorry. Were you finished, Gabby? Yes. This idea that government budgets are the same things as household budgets... A household if it gets into debt must pay back that debt or it will go bankrupt. That is not the same thing as a government budget.

Governments do, especially those with sovereign currencies, have the ability to create finance but it's more than just the activities through bond markets. It's the point that if you can then create a multiplier effect, which is really what we talked about, the need to have ambitious, bold public policies that are mission-oriented, that increase also the expectations in the business community of where future opportunities lie but with strong conditions attached to make sure there's a common goal, that has a multiplicative power of creating finance that of course again households don't have.

00:35:20

So this confusion between government budgets and household budgets is what I'm referring to, that creates this false idea that there's no money, that you actually have to, say, raise taxes, which of course is important. We should have a progressive taxation system.

But the actual constraint is often the lack of imagination of what to finance in the first place. This is why it's important to go back to Roosevelt's New Deal and the Green Deal that is being talked about today and really to focus a lot also on the word, the deal.

But really to remember something that Roosevelt talked about, which we talked about, Dr Tedros, in a meeting recently, which is the need to experiment and to try, Roosevelt often talked about. Just try something, for God's sake.

So this is really what both our briefs so far try to do, to reimagine a different way to structure an economy with health-for-all goals attached to it which can foster new types of public-private partnerships which then galvanise more finance towards really important goals around the social and economic determinants of health as opposed to always pretending that there's no money.

00:36:27

And then actually money comes again out of the woodwork, lots of it during crisis when it's too late because this crisis ended up being much, much worse than it had to be because we didn't properly finance our global health systems.

GA          Thank you. We have a question and our last question because we are beyond time is from Elaine Fletcher at Policy Watch. Elaine, can you unmute yourself, please.

EL          Yes, thanks. As Gabby mentioned, this is a very far-reaching brief and a lot of it could be considered rather pie-in-the-sky so my question would be, as this is coming out just ahead of the G20 meeting, what would be the three top asks that you'd like to put to the G20 around these issues, what would you like to see in their final statement?

I'm wondering if this also revolves around the issues of debt relief and special drawing rights, which we haven't heard much elaboration about. I think maybe closing the circle a little more tightly to the health issue on those questions would be a good connection to make.

00:37:45

GA          Excellent. Over to you, Mariana.

MM        Yes. You just named two of the very important ones which again in the brief we go more into, which are the debt relief is also because we know... The debt relief that we called for, which I discussed, is related to this need for new economic thinking, that just increasing the amount of debt into the system without actually realising that it's precisely also the conditions that were tied to that debt which reduce the capacity on the ground is something we have to reflect on.

This, by the way, is also true more globally in terms of the loans that have been provided to different types of companies globally. This has only increased private debt and the ratio of private debt to disposable income right now globally is back to the level it was with the financial crisis.

So the mechanisms themselves that are often used at moments like these to try to get to of the crisis just start laying the groundwork for the next crisis so that's a bigger point but it's a very important point because unfortunately what we're seeing in many different countries is an increase in private debt.

But in terms of the public debt we call for debt relief precisely so this fiscal space in such a crucial moment can be created and we make very specific points around that.

00:39:07

In terms of SDRs, do you want to mention them? No? Being able to actually direct the SDRs that are created by these large multilateral institutions is very important. This point that we need to be directing the finance towards particular objective is crucial because otherwise you have SDRs, which in theory are there to help lower-income countries, but if they are not structured in such a way and targeted in such a way around making sure that we have globally accessible vaccines and not the current situation of vaccine apartheid, that requires structuring those SDRs in a much more rounded and specific way than simply assuming that the fact that they exist will help us out of the crisis.

But I think this point of also realising, if we look at the vaccines for example, there're lots of different vaccines out there but they were actually structured in different ways and I don't think there's been enough discussion about that.

The fact that for example - and I don't want to call out specific ones or make reference to good versus bad but just the attention to the design detail matters and we need to make sure we're learning from the positive experiences.

The fact that the AstraZeneca vaccine for example represented actually strong negotiation between the public researchers at Oxford University and the company, keeping costs low and making sure that we didn't have storage systems that just made them inefficient and hot countries but also that the IPR is much weaker and so on.

These are all lessons that we should be learning from in terms of, going forward, what works, what doesn't and it's just important in a G20 moment that we don't just use big words like vaccines - and remember that the actual mission is not just having a vaccine, it's making sure that it's again globally accessible.

00:41:03

That means not just the solidarity that's required, that we were just talking about, in terms of making sure that they are sent to countries that haven't had the first and second jabs, but also that we produce and innovate in fundamentally different ways in the first place, which limits the kind of rent-seeking that we've seen in the past.

GA          Thanks, Mariana. Dr Tedros, any thoughts on the upcoming G20 and beyond?

TAG        Yes, on the G20 of course we have to focus on ending this pandemic so one focus area should be on how to finance the vaccination targets. We have to vaccinate the world. The target is 40% by the end of this year and 70% by the middle of next year in each and every country.

So the G20's commitment to this will be very important. If we cannot be serious about ending the pandemic and at least financing the vaccination campaign I don't think anybody will trust us if we commit about the future or investments, about preparedness for the future.

If we're serious we start from fulfilling this immediate need. So real commitment to that, to achieve the 40% by the end of this year and 70% by the middle of next will be crucial and should be the focus.

00:42:48

Of course in addition to that discussions for the future pandemic treaty and agreement on a pandemic treaty or a pandemic agreement will be very important. Then of course the centrality of health is now clear. Investment in emergency preparedness, investment in health systems in general, commitment to health for all as per this brief will be very, very important, and of course agreeing or committing to financing those.

One thing that's put forward specifically again is the recommendation from a high-level panel organised by the G20 countries that came up with a set of recommendations and to form a health and finance board which can mobilise resources to fund pandemic preparedness and response.

This is a very good idea and WHO supports this fully and I hope the G20 countries can agree on this proposal. I had many rounds of discussions with the panel of experts and we're convinced that this could be a good support to global health in general and also to emergency preparedness and response in particular.

00:44:31

So I think these are the areas among others but if you ask me in terms of immediate it's the vaccine now, finance and achieve the targets, end the pandemic, open the world - that's one.

Second is to agree on the G20 health and financing board which is proposed by the high level, which can help us mobilise more resources as per the proposal already set forward. These two could be at the centre and of course the rest of what we have discussed [unclear] will show if there is a real commitment there because these are the immediate - do them today and show that you are serious, is the issue. Thank you.

GA          Thanks, Dr Tedros. Thank you, Professor Mazzucato. To quote you, Dr Tedros, if not now when? With that I'll wrap up the press conference. To reporters who joined, thank you. We will send you by email the audio file from this presser.

Later today there is a session at the World Health Summit in Berlin on the Council for the Economics of Health for All, which will be live-streamed, which our two distinguished speakers will join and other VIPs. I hope you can tune into that, which we will also be live-streaming on our accounts.

Last but not least, we will have a press conference on Thursday and, as Dr Tedros and one of our reporters from Development Today indicated, ACT Accelerator will be a topic of conversation at that time.

So see you there. Thank you again and goodbye and have a great day.

00:46:18