Special

Article 2

A Preventable Disaster: The Findings &Recommendations of the Independent Panel for
Pandemic Preparedness & Response on Covid-19
Author Jillian YorkeBy Jillian Yorke
The Age of Pandemics“At the dawn of the 21st century, the world finds itself in an age of
pandemics. Covid-19 is not the first pandemic – it will not be thelast. It may not be long before the world faces the next one. The task
at hand is to learn lessons at this stage of Covid-19 to strengthen theworld’s response to its next stage – and ensure we are all better
prepared for future pandemics.”(Dr. Raj Panjabi, in a background paper for the IPPPR, presented
in September 2020.)

Introduction
The Independent Panel for Pandemic Preparedness and Response(IPPPR), co-chaired by Helen Clark, former prime minister of New
Zealand, and Ellen Johnson Sirleaf, former president of Liberia, wasestablished by World Health Organization (WHO) Director-General
Tedros Adhanom Ghebreyesus on July 10, 2020, in response to
World Health Assembly Resolution 73.1. The Panel’s mission was toanalyze how a disease outbreak became a global pandemic; evaluate
the national and global responses to the current pandemic, including
those of the WHO; review lessons learned; and makerecommendations on how to both better respond to the current
pandemic, and prepare more effectively for future global healththreats. The evaluation was fact- and evidence-based and the Panel,true to its name, is impartial and fully independent.
The Panel has 11 other members, who were appointed by the
co-chairs and have considerable expertise and experience in areas
such as infectious diseases, public health policy, outbreaks andemergencies, economics and financing, and gender issues. They
represent neither their governments nor their institutions. The IPPPR
also drew on the research, knowledge and skills of many otherexperts and concerned parties throughout the world. In its quest fortruth, justice and reform, the Panel’s mandate was vast and broadranging. Its final Report and recommendations are clear and bold,
and will surely be transformative if fully implemented.
At its second meeting, in October 2020, the Panel laid out its fourinterconnected areas of focus:“i. Build on the past: Learn from previous epidemics andpandemics and the status of the system and actors preCovid-19.
ii. Review the present: Determine an accurate and verified
https://www.jef.or.jp/journal/

chronology of events and activities in relation to the Covid-19
pandemic; analyze recommendations made by the WHO andresponses by national governments.
iii. Understand the impact: Review how health systems andcommunities responded, and assess the direct and indirect
impacts of both the pandemic and response measures.
iv. Change for the future: Develop a vision for a strengthened
international system ideally equipped for pandemic
preparedness and response including both the WHO and theinternational system at large.”
Over eight months, the IPPPR has conducted rigorous studies,utilizing multiple methods such as a review of existing literature,
town hall-style meetings open to all, roundtable discussions, original
research, the welcoming of submissions and contributions, andhearing directly from frontline workers. As a result, it “now has themost authoritative analysis of events yet produced”. I have been
following the Panel’s work closely, and am impressed by its
comprehensive scope, willingness to listen to and learn fromnumerous viewpoints, transparency, unstinting efforts, and evidencebased yet compassionate stance.
On May 12, 2021, the co-chairs presented the Panel’s Main
Report, Covid 19: Make it the Last Pandemic. A summary of thereport, several background papers, and a detailed chronology ofevents were also released. At the end of May, the Panel presented its
findings to the World Health Assembly. Below I highlight some of thefindings and recommendations (Image).

Lessons from the Past not Learned
The Panel calls the Covid-19 pandemic “a disaster which could
have been averted”. Over the last 12 years, since the 2009 H1N1
influenza pandemic, there have been numerous high-level reports
warning of an inevitable pandemic threat and urging improvements
in global preparedness. Suggestions have included strengthening therole of the WHO and securing its better funding, and reforming theimplementation of the International Health Regulations (IHR) –exactly what the current Panel recommends. However, theseprevious warnings and recommendations were mostly not
implemented, and there was inadequate funding and preparedness
testing, despite the increasing rate of zoonotic diseases. EllenJohnson Sirleaf stressed that this time must be different: “Theshelves of storage rooms in the UN and national capitals are full ofJapan SPOTLIGHT • July / August 2021

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health action.” This delay has had devastating consequences. As oflate May 2021, there have been 164 million cases of Covid-19, and3.4 million deaths.
Even after the declaration of the PHEIC, in a “cycle ofcomplacency”, there was no coordinated global response. It was
only after Covid-19 had spread internationally and the number ofcases increased substantially that governments took thorough-goingaction to prevent transmission. Further, while WHO advised of thepossibility of human-to-human transmission in the period until it was
confirmed, and recommended measures that health workers shouldtake to prevent infection, the Panel’s view is that it could also havetold countries that they should take the precaution of assuming thathuman-to-human transmission was occurring.

IMAGE

What Worked, What Didn’t

The IPPPR’s report, Covid-19: Make it the Last Pandemic, contains numerous concrete
recommendations for better global preparedness.
Source: The IPPPR’s report, COVID-19: Make it the Last Pandemic(https://theindependentpanel.org/wp-content/uploads/2021/05/COVID-19-Make-itthe-Last-Pandemic_final.pdf )reports and reviews of previous health crises. Had their warnings
been heeded, we would have avoided the catastrophe we are intoday.”

February 2020: The Lost MonthIn its comprehensive, detailed chronology of events since thepandemic started, the IPPPR describes February 2020 as “the lost
month”. Although the WHO knew of the emergence of a new virus in
Wuhan, China in December 2019, it was not until Jan. 30, 2020 thatit declared a public health emergency of international concern(PHEIC). At the time, outside China, there were fewer than 100 cases
and no deaths. The Panel found that the WHO could have declared a
PHEIC eight days sooner, in its earlier meeting. Moreover, it was only
on March 11, 2020 (when there were a reported 118,000 cases in
114 countries) that the WHO, stating that it was alarmed by theextent of both the spread of the disease and the level of inaction in
response, characterized Covid-19 as a global pandemic. Most
countries did not take the threat seriously before then. The Reportclarifies, “The failure of most countries to respond during February
was a combination of two things. One was that they did not
sufficiently appreciate the threat and know how to respond. The
second was that, in the absence of certainty about how serious theconsequences of this new pathogen would be, ‘wait and see’ seemeda less costly and less consequential choice than concerted public
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The Panel says, “The shared learnings about the successes in
responding to Covid-19, and the hard-won lessons from failings,
represent a once-in-a-lifetime opportunity to get preparedness rightto prevent a catastrophic pandemic from arising again.” It conducted
in-depth analysis of the responses of 28 countries, and identified
three strategic approaches: aggressive containment, suppression,and mitigation. Countries with aggressive containment include China,
New Zealand, South Korea, Singapore, Thailand and Vietnam.
Effective national responses featured clear decision-making
authority, coordinated cross-sector efforts, adaptability, and theability to provide timely science-based advice that was then followed.
Leadership and competence have proved more important than acountry’s wealth.
Meanwhile, “countries with the poorest results in addressing
Covid-19 had uncoordinated approaches that devalued science,
denied the potential impact of the pandemic, delayed comprehensive
action, and allowed distrust to undermine efforts. Many had healthsystems beset by long-standing problems of fragmentation,
undervaluing of health workers and underfunding. They lacked thecapacity to mobilize quickly and coordinate between national andsubnational responses. The denial of scientific evidence wascompounded by a failure of leadership to take responsibility ordevelop coherent strategies aimed at preventing community
transmission. Leaders who appeared skeptical or dismissive of
emerging scientific evidence eroded public trust, cooperation andcompliance with public health interventions.”
The IPPPR’s analysis of over 80 countries found that orders tostay at home reduce the number of cases only when households
have sufficient income to survive, people are able to work remotely(i.e., have digital access), and there is enough trust in thegovernment for its orders to be obeyed. In regard to the WHO, thePanel says, “WHO staff worked extremely hard to provide advice andguidance, and support to countries, but Member States had
underpowered the agency to do the job demanded of it.”Reform of the WHO
The Panel found that “the way the WHO is financed today has
serious impacts on the quality of the organization’s performance.
Global health is inevitably a politically charged domain and it is vitalthat the WHO is strong enough to be able to perform with maximum
independence.” Among other things, the Panel recommends
establishing the WHO’s financial independence, strengthening theauthority and independence of the director-general, empowering the
WHO to take a leading role in an emergency response to a pandemic,
equipping WHO Country Offices sufficiently to respond to technicalrequests from national governments to support pandemic
preparedness and response, including support to build resilient
equitable and accessible health systems, universal health care (UHC)and healthier populations, prioritizing the quality and performance ofstaff at each WHO level, and de-politicizing recruitment.
Regarding the pandemic alert system, the Panel states, “The biasof the current system of pandemic alert is towards inaction – steps
may only be taken if the weight of evidence requires them. This bias
should be reversed – precautionary action should be taken on a
presumptive basis, unless evidence shows it is not necessary. Inchanging the system of alert to orient it towards speedy action, theincentive structures need to be addressed. At present, from local up
to international level, public health actors only see downsides fromdrawing attention to an outbreak that has the potential to spread.
Incentives must be created to reward early response action andrecognize that precautionary and containment efforts are aninvaluable protection which benefits all humanity.”

Inequalities Revealed
Covid-19 has starkly revealed and exacerbated the existing
problems and deeply embedded inequalities in our societies andhealth systems. It has had a disproportionate effect on women andvulnerable or marginalized groups. Up to 125 million more people
are estimated to have been pushed into extreme poverty. Millions ofchildren, especially the most disadvantaged, have had theireducation terminated. Social problems such as domestic violence,
sexual abuse, and child marriage have all worsened considerably. In
addition, the world lost US$7 trillion in GDP in 2020, the deepest
shock to the global economy since World War II.
It has been a challenging time for those with non-communicablediseases (NCDs), such as diabetes or cancer. According to the NCD
Alliance, more than one in five people have an underlying condition
that gives them a greater risk of experiencing severe symptoms ifthey contract Covid-19. Charity Muturi of the NCD Alliance of Kenya
says, “People have not realized that NCDs are just a slow pandemic.”
Moreover, access to medicines and hospitals for vital ongoingtreatment has often been drastically curtailed by the pandemic. Manynations’ health systems were already struggling to manage NCDs
competently, even before the current pandemic. In a Zoom town hallstyle meeting on NCDs organized by the Panel that I participated in

on March 25, local communities and organizations all over the world
shared their concerns as well as some of the many new public healthinitiatives that have been set up in response. These included
addressing obesity, improving palliative care, building resilience,
ensuring safe water supplies, expanding connectivity, bringing
medications to patients’ homes, and offering medical advice bytelephone.
Another deeply disturbing issue brought up during this Zoom
discussion was the relationship between “unhealthy commodity
industries” (such as the tobacco, gun, and alcohol industries) and
Covid-19. A report dubbed “Signalling Virtue, Promoting Harm” thatanalyzes the tactics and strategies that have been employed by suchindustries during the pandemic can be seen on the NCD Alliancewebsite (https://ncdalliance.org).

Changing the Way We Eat
Another urgent area for reform is the way we produce food. In
particular, according to many experts, industrial farming is a disasterwaiting to happen, and a major risk factor for the occurrence of new
pandemics, both viral (such as the coronavirus) and bacterial types(such as the bubonic plague). The way we cram food animals into
tight spaces and their generally bad conditions increase their stress,
while the overuse of antibiotics given to such animals leads toantimicrobial resistance, meaning that previously effective drugs
may no longer work. Moreover, because they have been geneticallybred for specific traits, these animals tend to be identical, enablingviruses to spread more easily. Indeed, there have been many
examples in the past of zoonotic transmission to humans originating
in animals bred for food, such as the H1N1 swine flu in 2009, whichbegan in pig farms, and resulted in the deaths of hundreds ofthousands of people. Sonia Shah, author of Pandemic (2017), calls
crowded factory farms “ticking time bombs” because they could
easily give rise to both virulent avian influenza and highly drugresistant bacterial pathogens. Currently, about 90% of the global
meat supply comes from such factory farms, which are also
problematic in terms of climate change, cruelty to the animals they
process, and harm to human health. For more on this topic, see The
Omnivore’s Dilemma by Michael Pollan (Bloomsbury, 2006), a book
I found both highly informative and deeply disturbing.

The Chernobyl Moment
The Panel calls this “the Chernobyl moment for public health”. In
the same way that the Chernobyl nuclear disaster eventually led tomore information exchange and openness on nuclear issues, andincreased power being given to nuclear regulatory agencies, thecurrent pandemic is a fundamental crisis that must produce greater
global collaboration and data-sharing, as well as a strengthening of
the WHO. “Our message for change is clear: no more pandemics. If
we fail to take this goal seriously, we will condemn the world tosuccessive catastrophes. At the same time, our careful scrutiny ofJapan SPOTLIGHT • July / August 2021

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the evidence has revealed failures and gaps in international andnational responses that must be corrected. Current institutions,public and private, failed to protect people from a devastating
pandemic. Without change, they will not prevent a future one. That is
why the Panel is recommending a fundamental transformation
designed to ensure commitment at the highest level to a new systemthat is coordinated, connected, fast-moving, accountable, just, andequitable – in other words, a complete pandemic preparedness andresponse system on which citizens can rely to keep them safe andhealthy.”
The Panel’s recommendations fall into two categories: immediate
measures to halt the current pandemic, and urgent global action andsweeping systemic change to prevent future pandemics. As well as
every country applying proven public health measures “at the scalerequired to curb the pandemic”, with strong leadership from headsof state and government, the Panel recommends that:• 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 in the COVAX Gavi
Advance Market Commitment with at least one billion vaccine
doses by September 2021 (Chart 1).
• Major vaccine-producing countries and manufacturers should
convene, under the joint auspices of the WHO and the World
Trade Organization (WTO), to agree to voluntary licensing andtechnology transfer. If actions on this don’t occur within threemonths, a waiver of intellectual property rights under the
Agreement on Trade-Related Aspects of Intellectual Property
Rights should come into force immediately.
• The G7 should immediately commit to provide 60% of the $19

billion required for the Access to Covid-19 Tools Accelerator(ACT-A) in 2021 for vaccines, diagnostics, therapeutics, andstrengthening of health systems, and a burden-sharing formula
should be adopted to fund such global public goods on an
ongoing basis.

An Equity-Centered Global Public Health
Perspective
To prevent future pandemics, the Panel calls for a fundamental
transformation of the global pandemic preparedness and response
system through a package of bold reforms, including the following:• Establishing a Global Health Threats Council that will maintain
political commitment to pandemic preparedness and response
and hold actors accountable, including through peer recognitionand scrutiny. Countries should also adopt a Pandemic
Framework Convention within the next six months.
• Establish a new global system for surveillance based on fulltransparency. This system would provide the WHO with theauthority to publish information about outbreaks with pandemic
potential on an immediate basis without needing to seek
approval and to dispatch experts to investigate at the shortest
possible notice.
• Invest in national preparedness now as it will be too late when
the next crisis hits. All governments should review their
preparedness plans and allocate the necessary funds and people
required to be prepared for another health crisis.
• Transform the current ACT-A into a truly global platform aimed
at delivering global public goods including vaccines, diagnostics,

CHART 1

Total Covid-19 vaccine doses per 100 people as of April 21, 2021

Note: Ongoing worldwide inequalities are reflected in the huge disparity in countries’ vaccine dosing rates.

Source: The IPPPR’s report, World Health Organization Coronavirus (Covid-19) Dashboard. Data as of April 21, 2021

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CHART 2

Personal protective equipment prices (as of July 15, 2020)

Note: There were dramatic increases in PPE prices during the pandemic.

Source: The IPPPR’s report, UNICEF Global Covid-19 Special Interim Report, August 2020

therapeutics, and supplies that can be distributed swiftly andequitably worldwide – shifting from a market model to one aimed
at delivering global public goods.
• Focus and strengthen the authority and financing of the WHO,
including by developing a new funding model to end earmarked
funds and to increase Member State fees.
• Create an International Pandemic Financing Facility, which
would have the capacity to mobilize long-term (10-15 year)
contributions of approximately $5 to $10 billion per year tofinance ongoing readiness. It would also be ready to disbursefrom $50 to $100 billion at short notice by front-loading futurecommitments in the event of a pandemic declaration. The Global
Health Threats Council would allocate and monitor the funding toinstitutions which have the capacity to support the developmentof preparedness and response capacities.
• Heads of state and government should at a global summit
adopt a political declaration under the auspices of the UN
General Assembly to commit to these transformative reforms.
The Panel believes that it is in countries’ own best interests toimplement these recommendations. Helen Clark said, “The tools areavailable to put an end to the severe illnesses, deaths, and socioeconomic damage caused by Covid-19. Leaders have no choice but
to act and stop this happening again.” Other experts mentioned theimportance of getting private industry involved in reforms, the needfor more equitable data-sharing, greater emphasis on global
common goods, and the requirement to change from charity-driven
models to models based on social justice (Chart 2).

Conclusion
Finally, the Report concludes: “The transformation of theinternational system for pandemic preparedness and response which
the Panel recommends will fail if it is approached piecemeal. The
lesson from previous recommendations for change following earlier
pandemics is that change will only result from the adoption andimplementation of inter-linked and interdependent measures. Just as
pandemic preparedness itself is undone by failure in the weakest linkin the chain, so too recommendations for change will fail if thehardest problems are set aside. The Panel has assessed the set ofrecommendations it has proposed against one criterion only: if they
had been in place, would they have stopped the Covid-19 pandemic?
We believe the answer is yes, and therefore urge theirimplementation as a whole and in a timely manner. The Panel’s
recommendations aim to equip countries and the international
system to prevent an outbreak from becoming a pandemic and, if apandemic does occur, to prevent it becoming a global health andsocioeconomic crisis.”
Note: To read the IPPPR Main Report, see: COVID-19: Make it theLast Pandemic (https://theindependentpanel.org/wp-content/
uploads/2021/05/COVID-19-Make-it-the-Last-Pandemic_final.pdf)
The Image and Charts are taken from the IPPPR Main Report. The
author would like to thank the Panel for its kind assistance.

Jillian Yorke is a translator, writer and editor who lived in Japan for many
years and is now based in New Zealand, where she is the Curator of the Japan
Library: Pukapuka.

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