Your Excellencies Ambassadors,
Governor of Uppsala County, Stefan Attefall,
Vice-chancellor Anders Hagfeldt,
Director of the Dag Hammarskjöld
Foundation, Björn Holmberg,
And my dear friend, former Deputy Secretary-General, Jan Eliasson,
Faculty and students of the university, dear colleagues and friends,
God eftermiddag.
I thank Uppsala University and the Dag Hammarskjöld Foundation for the invitation to deliver this lecture today.
It’s an honour for me to be back in Sweden. You may not know this, but Sweden played a very important part in my career.
Although I did my PhD in the UK, it was funded by the Swedish International Development Association, and I also did some coursework at Umeå University.
So I am living proof of Sweden’s commitment to capacity building, and I owe Sweden a debt of gratitude for investing in me.
It’s also an honour for me to come to Uppsala University, which has such a rich history, and has made many contributions to health.
Of course, we are here to pay tribute to Dag Hammarskjöld, but I would also like to use this opportunity to honour one of Uppsala’s other most famous sons, my friend the late Hans Rosling, who studied statistics and medicine at this university.
Given he made such a significant contribution to global health, it's perhaps fitting that Professor Rosling was born the same year WHO was founded, in 1948.
Uppsala University played a central role in his life and work, as it has done in so many other areas.
I was impressed to discover that the Celsius thermometer, the pregnancy test, medicines to treat Alzheimer’s disease, and rapid diagnostic tests for antibiotic resistance all derive from research here at Uppsala University.
And of course you have many Nobel Prize winners to be proud of:
Svante Pääbo, who sequenced the genome of Neanderthals;
Allvar Gullstrand, for his contributions to improving eye health;
And of course, perhaps Uppsala’s most famous son, and the reason we are here today, Dag Hammarskjöld.
I am reminded of him every time I visit the World Health Organization office in New York, which is on the 26th floor of One Dag Hammarskjöld Plaza.
In fact, the Permanent Mission of Sweden to the United Nations is 20 floors above us in the same building.
So it’s a real privilege for me to deliver this lecture in honour of Dag Hammarskjöld’s memory and legacy.
The values he advanced, of peace and multilateralism, are just as important now – or even more so – than when he served as Secretary-General of the United Nations.
And indeed, he saw that health and peace are connected.
Just one month after he became Secretary-General in April 1953, the first specialized U.N. agency Hammarskjöld visited was the World Health Organization in Geneva, where he addressed the closing of the World Health Assembly.
He said this: “The work of the World Health Organization and the other specialized agencies for the improvement of the social and economic standards of mankind is part of the political work for the maintenance of international peace and security.”
So today I would like to reflect on these themes of multilateralism, health and peace, through the lens of WHO: its past achievements, present difficulties, and future hope.
First, past achievements.
Like the UN of which we are a part, WHO was born in the aftermath of the Second World War, and the realization that the only alternative to global conflict was global cooperation.
For more than 77 years, WHO has been where the world meets to discuss shared health threats, and find shared solutions.
WHO’s most famous achievement is the eradication of smallpox.
The WHO Smallpox Eradication Programme began officially in 1959, but suffered from lack of funds, personnel and political commitment. Sounds familiar, doesn’t it?
Eight years later, in 1967, the Intensified Smallpox Eradication Programme began, with renewed political commitment, vaccine donations, and the efforts of hundreds of thousands of local surveillance officers and health workers.
It was a stunning success. Smallpox was eliminated from Latin America in 1971, Asia in 1975 and Africa in 1977.
In 1980, the World Health Assembly declared “that the world and all its people have won freedom from smallpox”.
Smallpox remains the only human disease to be eradicated.
But today we stand on the threshold of eradicating two more diseases: polio and Guinea worm.
When the Global Polio Eradication Programme was launched in 1988, there were an estimated 350 000 cases a year. So far this year there have been just 39 cases in two countries.
And when the Guinea Worm Eradication Program began in 1986, there were an estimated 3.5 million human cases in 21 countries. So far this year, just 10 cases have been reported from three countries.
The success of smallpox eradication showed what could be achieved with vaccines.
So in 1974, WHO established the Expanded Programme on Immunization – known as EPI – to expand the lifesaving power of vaccines to other diseases including measles, tetanus, diphtheria and pneumonia.
At the time, less than 5% of the world’s children were immunized. Today, that figure stands at 83%.
We estimate that over the past 50 years, EPI has helped to save an estimated 154 million lives. This is how vaccines made a huge difference in the last few years, helping our children to survive.
For most of the first 50 years of its history, WHO’s work was focused mainly on infectious diseases afflicting low-income countries.
But throughout those decades, a new pandemic was spreading almost unchecked, fuelled by the deadliest non-infectious agent in history – tobacco.
The link between smoking and lung cancer was proved in 1952, but smoking prevalence continued to climb for decades.
Indeed, some of the photos from WHO’s early years show men in offices – and yes, they were mostly men – sitting at their desks, smoking.
It was not until 1988 that the Director-General at the time, Dr Halfdan Mahler, banned smoking inside WHO buildings and smashed his own ashtray with a hammer in the WHO lobby.
After years of discussions, in the mid-1990s the World Health Assembly finally adopted a resolution calling for an international treaty on tobacco control.
But it was not until 2000 that negotiations began on the WHO Framework Convention on Tobacco Control, it was not until 2003 that it was adopted, and not until 2005 that it finally entered force as international law.
The WHO FCTC is a perfect example that multilateralism can be hard, slow work, but it’s worth it.
In the 20 years since it entered force, tobacco use has dropped by one third globally.
The adoption of the WHO FCTC coincided with the first of a series of outbreaks, epidemics and pandemics that have marked the first two decades of the 21st century, and that have been significant in shaping the WHO of today.
In February 2003, the first cases were reported of a strange new respiratory disease caused by an unknown pathogen that later proved to be a coronavirus. Sound familiar? It was the SARS outbreak.
Around the same time, the first human cases of H5N1 avian influenza were reported, sparking fears of an influenza pandemic caused by a virus that killed 6 in 10 it infected.
Although SARS and H5N1 both caused global panic, neither caused a global pandemic.
But in 2009, a new influenza virus emerged that did: H1N1.
While H5N1 was highly pathogenic but not highly transmissible, H1N1 was the other way round. Although it spread rapidly around the world, it caused largely mild disease and, for a pandemic, relatively few deaths.
Nevertheless, H1N1 exposed a dangerous breach in the world’s defences against pandemics.
Vaccines were developed rapidly, but by the time the world’s poor got access, the pandemic was over.
That experience led to the development of the Pandemic Influenza Preparedness Framework – a historic commitment between Member States to work together in the face of a flu pandemic to share virus samples and vaccines.
But the ink was barely dry on the PIP Framework when a new and deadly epidemic erupted, caused not by influenza, but by one of the most feared viruses on earth – Ebola.
For more than two years, the world watched in horror as Ebola laid siege to West Africa.
And although it never became a global pandemic, the West African Ebola outbreak highlighted the need for substantial reforms of WHO’s work to prepare for and respond to emergencies.
That led, in 2015, to the creation of the WHO Health Emergencies Programme.
Each of these outbreaks, epidemics and pandemics taught the world new lessons and resulted in new agreements and new tools to keep the world safer.
But even so, the world was taken by surprise and found unprepared for the COVID-19 pandemic, the most severe health crisis in a century.
COVID-19 turned our world upside down.
Officially, it killed 7 million people, but we know the true toll is several times higher – at least 20 million.
The pandemic caused severe economic, social and political upheaval, wiping an estimated US$ 10 trillion from global GDP.
COVID-19 also exposed and exacerbated gaps in the world’s health security defences.
In response WHO and our Member States have taken many measures to ensure a more coordinated, coherent and collective response to future pandemics.
Most significantly, in 2021 the nations of the world agreed to negotiate a new international accord on pandemic prevention, preparedness and response.
Just as the world has international treaties against shared threats such as nuclear weapons, climate change and tobacco, nations agreed they needed a similar instrument of international law to ensure a common response to the common threat of pandemics.
For three and a half years, our Member States engaged in difficult negotiations. There were those who said they could not succeed, and those who did not want them to succeed.
But in May this year, they reached consensus and at the World Health Assembly, they adopted the historic WHO Pandemic Agreement.
They are now negotiating an annex to that Agreement, the Pathogen Benefit and Access Sharing system, which aims to ensure faster sharing of pathogens with pandemic potential, and equitable access to the medical products needed to respond to them.
We expect these negotiations to be concluded in time for next year’s World Health Assembly in May.
After that, the Pandemic Agreement will be open for ratification by countries, and for its ultimate entry into force as international law.
The adoption of the Agreement was truly historic, not only because of what’s in it, but also because of the context in which it was negotiated.
In a divided, divisive and fractured world, countries demonstrated they can still find common ground for a common purpose.
They showed that multilateralism is alive and well and that – to borrow an expression from Mark Twain – reports of its death are greatly exaggerated.
And yet there is no denying that multilateralism is under threat, which brings me to present difficulties.
As you all know, this year has been one of the most difficult in WHO’s history.
The announcement by the United States of its intention to withdraw from WHO, combined with funding cuts from other countries, left us with no choice but to significantly reduce the size of our workforce.
Of course, WHO is not alone. Many other multilateral agencies, within and outside the United Nations system, have also been impacted.
Most worryingly, many countries have been severely impacted by cuts in bilateral aid.
At the same time, we are all painfully aware of the extent to which our world is riven by conflict and displacement, in Gaza, Sudan, Ukraine and elsewhere.
And where war goes, disease follows.
It’s no coincidence that polio reemerged in Gaza last year, 25 years after the last case was seen there.
It’s no coincidence that there are outbreaks of measles, dengue, malaria, diphtheria and cholera in Sudan;
It’s no coincidence that the final frontier for eradicating polio is in the most insecure regions of Afghanistan and Pakistan.
And this is not a new trend. Indeed, war and disease are old friends.
In both the Napoleonic wars and the American Civil War, more soldiers died from disease than in battle.
The 1918 influenza pandemic – the greatest pandemic – erupted during what was then the greatest war the world had known – the First World War.
War and violence lead to direct injuries, but they also create an environment where healthcare systems collapse, diseases spread, and mental health deteriorates.
Communities torn apart by violence face obstacles in accessing basic health services, leading to higher rates of mortality and suffering.
The scars of conflict can persist long after the fighting has ceased, creating a cycle of despair that is difficult to break.
In recent years we have also seen a disturbing new trend in conflicts around the world: the intentional targeting of health workers and health facilities in conflict.
So far this year, WHO has verified 1200 attacks on health care in 16 countries and territories, resulting in more than 1800 deaths and 1000 injuries to health workers and patients.
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Sometimes the troubles of our world seem overwhelming. They can cause us to lose heart, and to lose hope.
Which brings me to my conclusion: future hope.
Albert Einstein said, “In the middle of adversity there is great opportunity.”
Although many countries are facing a health financing crisis, many leaders from developing countries have told me they see this crisis as an opportunity to leave behind the era of aid dependency and transition to a new era of health sovereignty. And many developing countries, especially in Africa, said that what they need are fair terms, not charity.
Likewise, although WHO is facing a very difficult situation, I also see it as an opportunity to make it stronger, sharper, more independent, more focused on our core mandate, and more empowered to serve the nations and people of the world.
Since WHO was founded in 1948, the health of the world’s people has improved dramatically.
Global life expectancy has increased from 46 to 71 years, with the greatest gains in the poorest countries.
Smallpox has been eradicated, polio is on the brink, and the epidemics of HIV, malaria and tuberculosis have been pushed back.
In the past 25 years alone, maternal mortality has fallen by 40% and child mortality has more than halved.
Of course, WHO cannot claim sole credit for any of these achievements.
And that’s the point: all of the achievements I have described were only possible because of cooperation between countries, under the umbrella of the World Health Organization.
Smallpox was eradicated because at the height of the Cold War, the Soviet Union and U.S. worked together to pursue a common goal.
The Framework Convention on Tobacco Control was adopted because countries came together to find a shared solution to the shared threat of tobacco.
The WHO Pandemic Agreement was adopted this year only because countries saw that a global threat demands a global response.
WHO itself was created because in 1948, countries came together to recognize that health threats do not respect borders, and that health is one area in which countries can work together across ideological and geopolitical divides to achieve common goals.
The WHO Constitution was the first instrument of international law to affirm that the highest attainable standard of health is a fundamental right for all people, without distinction. It is also a means to development and prosperity.
Not health for some; health for all.
But the writers of the Constitution went further, in affirming that the health of all peoples is fundamental to the attainment of peace and security, and is dependent on the fullest co-operation of individuals and States.
They knew that there is no health without peace, and no peace without health.
In other words, the best medicine is peace.
Like health, peace is always at risk, and must always be defended, protected and fought for.
Dag Hammarskjöld said it best, in 1954:
“The pursuit of peace and progress cannot end in a few years in either victory or defeat. The pursuit of peace and progress, with its trials and its errors, its successes and its setbacks, can never be relaxed and never abandoned."
I ask you all to take those words to heart. We may face setbacks and disappointments, but we are never defeated in our quest for peace, health and a better world.
That is the vision for which I continue to strive each day.
Tack ska du ha. Tack så mycket.