 Good morning ladies and gentlemen on behalf of the Institute of International European Affairs I'm delighted to welcome you to today's webinar entitled a conversation with Dr David Navarro which forms part of the Irish Aid Development Matters series. This is a public event in other words it is fully on the record. For those of you who would like to ask Dr Navarro some questions or make comments, interventions, I would direct your attention to the Q&A function at the bottom of your screen. My name is David Dunhu I should have added and I've had the pleasure of working with David Navarro in several capacities over recent years. It's a particular pleasure that David has accepted the Institute's invitation to speak to us this morning. He is the special envoy of the WHO Director General for COVID-19 and has had this role since February of this year. He has unique experience and competence really on all issues relating to international public health and sustainable development and the challenges which go with each. He previously served as the UN Secretary General Special Envoy for the Ebola crisis a number of years ago and as the Irish Ambassador to the UN at the time I witnessed it more or less at first hand his remarkable impact both at UNH quarters and in the field in responding to that global challenge. David also served previously as the UN Systems Senior Coordinator for Alien and Human Influenza. He's also had experience of other epidemics such as the SARS. David is in addition a leading international authority on issues around nutrition and food security and he played a key role in the UN's scaling up nutrition initiative. He was also appointed as the Secretary General as one of the key staff working for the Secretary General to prepare the climate summit which took place at the UN last September and the capacity which I know David Best is that he served as the Secretary General Special Advisor on the 2030 agenda for sustainable development. That appointment came in the immediate aftermath of the signing of the adoption of the new agenda so really he had the key role to oversee implementation across the world of this new agenda to oversee its communication and the impact it would have and to try to knit together the UN system itself to reform it in response to the new challenges. Most recently as I say he has been involved with climate and he is involved in a range of other activities. It's in his capacity as special envoy in relation to COVID-19 for the WHO Secretary General that I now invite David to speak. He will speak for about 20 minutes first of all and after which he would be happy to take questions so I look forward to a very engaging and lively discussion as always with David Navarro. David it's over to you. Thank you very much indeed David thanks to everybody in IIEA for setting this up. I'm so pleased to be here with you all. This is my second time participating in a IIEA event my first time in doing it through this new way of working and I'm just overjoyed to be here and to be connected with you. I'm going to focus on what COVID is doing for us individually and for our societies and for our institutions around the world. So that means that I will try with you to show you where I am in my own thinking as I engage with more and more business leaders government leaders and civil society leaders everywhere as they come to terms with the new reality of COVID and COVID being amongst us. That's because in my role as WHO special envoy my job is to amplify the World Health Organization's guidance to interpret it in different settings to accompany decision makers as they are seeking ways to implement that guidance and then to feedback on what I am seeing and hearing to the World Health Organization. So being involved with all of you in a two-way discussion today with a focus on but not only the local and the national dimensions of COVID but also the regional and the international dimensions will be super helpful to me because through you I will be able to glean the challenges that you're all facing and the issues with which you're wrestling and then to feed that back. Of course each one of us is at a different place in our understanding about the virus, the pandemic, where it's taking us and the consequences for people everywhere and of course each one of you will be in a different place and what I'm going to try to do at the beginning is to connect with each view in some way or other so that you will find in what I say some points that you can perhaps plug into either in your own work or if you wish in the dialogue that we're going to have afterwards. So I have to start with the virus really, I hope you don't mind that because that's what it's all about. A new virus appearing just over four months ago only known about in the international circles on December the 31st and then a very short note saying there's a cluster of atypical pneumonia cases in a hospital in Wuhan China picked up by many others at the same time alarm bells ringing and yes that's the sort of thing that the World Health Organization health emergencies program exists to detect and to pick up and there are many thousands of alarms that come through each year of possible clusters of of a new disease and there's always that anxiety right at the very beginning. Is this really a new disease? Does it have local significance that goes beyond the cases who've already been reported? Does it even have regional global significance? And of course the vast majority of delirts that come through to the gathering intelligence gathering center of the WHO turn out not to be ones that are going to cause a problem but there's always that one or two that becomes a major major threat to the world and so this one as we move through from early January, mid-January to the end of January days that are going to be subject to my new forensic examination in multiple venues in the coming weeks and months. The gradual image came particularly by the middle of January that this was a virus that could be transmitted from human to human that could cause severe disease and that could become one that the world should be worried about. The WHO emergency committee met on the 22nd of January and wasn't quite sure how serious it was because although there was widespread transmission recorded from inside China it wasn't clear how effective that transmission would be outside the country but then eight days later at the request of the director general the emergency committee met against on the 30th of January and said this is a public health emergency of international concern. That's the highest level of alert that the World Health Organization can deliver to the world. It means look out everybody we believe there's a massive problem here and so from that moment onwards WHO went into a very regular rhythm of tracking what was happening with the virus around the world but issuing constant guidance to the world and it was along the following lines. Firstly this is a coronavirus. Coronaviruses are really dangerous. We had one before in 2002 2003 sorry causing SARS in Southeast Asia it was a tough one. We had one causing a Middle East respiratory syndrome or MERS more recently particularly evident in the Middle East. We don't have many other coronaviruses that we know but there's one particularly important the one that causes a common cold but this new coronavirus just appearing the word from the World Health Organization was be careful with this virus we think it's dangerous don't underestimate it don't treat it like flu it's a very different kind of disease from influenza transmitted differently possibly with a different natural history so please don't apply flu models when you're working out what to do about this coronavirus. The message from the World Health Organization from early January onwards was look at what is being done by other countries look at the countries who experienced SARS in 2003 copy them don't work on models that are based on other diseases it might get you into trouble. So by early February WHO was saying one regular message when new outbreaks of this virus develop in different countries make sure you interrupt transmission quickly by identifying people with the disease making sure they're isolated identify those with whom they've been in contact make sure they are isolated as well and protect the particularly vulnerable because at that stage we knew that older people and people with coexisting conditions were particularly likely to get really ill or to die. Now that message of interrupting transmission at the community level through public health services was the heart of the WHO's message constantly since mid to late January and WHO did go to look at what was happening in China with an international team in the middle of February led by Bruce Ellwood and this team included researchers from all over the world they went wherever they were invited to go in China and they came back and said the following very clear findings were emerging from their studies first of all people everywhere have to be fully informed about and involved in the fight against this virus you can't do it without people's full participation because changes in people's behavior particularly with regard to reducing opportunities for the virus to spread are absolutely critical and those changes are going to have to be put in place everywhere where there's a threat of the virus central amongst these is the need for strong personal hygiene and dealing with coughs and respiratory disease but also physical distancing because the virus primarily spreads through droplets and two meters is about the distance you need to be free from getting the droplets from another person who might have it of course there are going to be variations there are going to be questions but right at the moment that two meter rule or six feet rule seems to be right at the heart of our strategies for reducing transmission and keeping people free from the virus we have to hold on to that. The second finding from the WHO team that went to China and it was a finding that was really built up from work in other east Asian countries was there's no substitute from high coverage of public health services knowing who's ill and where they are ill and basically keep an eye not just on those with COVID but those with other conditions in the community because the presence of COVID really upsets health services so you need to be sure that people with other diseases can get treatment and the absolute need to protect health workers so our whole stack of areas were put in place by the Chinese authorities and by authorities in other Asian countries that were experiencing COVID that were all about strengthening the health system but with a particular focus on public health services in the community and being able to maintain surveillance of disease testing people who have symptoms and isolating them plus protecting health workers. The third part of the Chinese experience and the east Asian experience related to being able to ensure that the health services were fully repurposed everywhere so that they could be open for people who had COVID as well as open for people who didn't have COVID. This is a huge task and we've seen how many countries have had to really work hard to repurpose their hospitals and make sure that they are COVID ready and the fourth part of the Chinese and east Asian response was making sure that a whole of government works together without any political friction to deal with the issues as an inter-party and all of society and all of government issue with businesses playing their part and with civil society playing its part. Now of course these days anybody speaking for WHO has to be super careful using Chinese experience but I have no hesitation at all in sharing with you that these were the findings of an international team that went to China and I believe that they do need to be held close and utilized so Singapore used this approach and Singapore has done really well. They've put in place the community public health defences but they did find that there was a chink and that some of their residences for foreign workers were getting infected with COVID so they had to reimpose movement restrictions even though they'd got the defences in place during this month particularly in the early part of this month and isolate people within their facilities for guest workers because they realized that they had a new outbreak coming and this will be the reality for the foreseeable future. We've got to be able to defend ourselves against COVID appearing in any community and we've got to be ready to suppress outbreaks as they occur containing them at their large and stopping transmission if they're small whilst all the time protecting vulnerable people particularly older people from the possibility that they're going to get sick. So my colleague Bruce Aylewood who was part of that original Chinese team has been working in Spain recently and he fed back to me there is a crisis in Spain in residential care particularly with a focus on the elderly how to prevent older people from being infected how to prevent the workers who work for older people from having their own lives massively curtailed because they cannot socialize they cannot meet their friends because of fear that they might bring the COVID into residences for older people. This is a huge challenge and Spain as well as other countries is looking at this and there's a lot of interplay between different European countries thinking through what do we do for the vulnerable older community and for others in residential homes to protect them. Now we are seeing that some countries are able now to deploy a widespread community level defences against COVID and at the same time to build up their rapid response capacity and they're doing that sufficiently well that they're confident that they can start reopening their economies. Like Singapore they're saying we may have to be ready to do movement restrictions again on an urgent basis if a new outbreak emerges but at least we roughly know where the virus is we roughly know what we've got to do. The countries that are finding it possible to do this are those that have been able to ramp up virus testing it helps hugely to do that and we're seeing therefore that new restriction happening in Austria in Germany in the Czech Republic and in Denmark and we know that that's going to be happening in other countries and stuff is beginning to shift even in Italy which has had such a tough struggle. This is very important what's going on it's a simultaneous experiment on how you move from full lockdown to the state where you are COVID ready where you're able to deal with new outbreaks given that the virus is just not going away. I'm seeing really interesting signs now among businesses and among different local authorities as well as among civil society organizations throughout Europe throughout North America and in many other parts of the world as they are beginning to look at other countries experiences and sharing across from what they're seeing how can we together learn quickly how we're going to be able to live and socialize and return to some form of economic growth despite the fact the virus is in our midst. But let me just give you three or four of the lessons that I am experiencing before I stop. First of all don't imagine that you just come out of lockdown and go back to business as usual when you've passed the peak of your epidemic curve whether you are in South Africa or India or Kenya or Brazil or Russia or Ireland or the UK or the US there's one core reality that has to be put in place and that is community level public health defenses that confine people with COVID isolate them trace their contacts isolate them and shield the most vulnerable that core capacity is an absolute must. I was just on the phone with people in Bombay municipality this morning they're telling me proudly how they believe that their use of widespread testing and case finding and contact tracing even in very difficult circumstances in some of the high density settlements in Bombay is helping them to get ahead of the virus and to stop it spreading more widely. I think that's great I'm hearing similar stories coming from groups in South Africa who are talking also about the need to pay attention to people with HIV because they may well be at particular risk and I'm hearing examples of communities in Kenya who are coming together and forming neighborhood health watch groups so that they too can look after each other and also protect their people from food shortages and malnutrition as it crops up. What I'm trying to stress to you is that from where I sit I'm seeing a huge and multifaceted simultaneous learning exercise underway to anticipate the consequences both of the virus itself and of means to control. This is particularly important for poor countries my second point. Poor countries have less room for maneuver when it comes to dealing with this threat. They have less well developed public health services when it comes to responding to this threat they can't easily scale up PCR based that's a particular technique testing for virus and so they're having to work out where the virus is on the basis of rather different indicators. They've got communities who can't cope with lockdowns for very long because they develop hunger and children who are badly in need of nutritional support but because schools are closed they can't get their school meals so the particular challenges in poorer countries are much much greater than they are in industrialized countries or those that have high resources available. It is absolutely essential to pay particular attention to the needs of poor countries for getting COVID ready and to recognize that they've got a much tougher journey to travel than those of us who are quite well endowed. Thirdly when it comes to working for a better world in the future the need for international unity is absolutely essential. This is not an issue that responds well to separate working by different groups either different parts of a nation when you've got kind of split politics as we see in some countries or nations working separately when ideally they need to work with regional solidarity or different parts of the world working separately when this is so obviously the ultimate challenge for global unity because the virus does not know borders at all it will go anywhere and it will exploit our weaknesses. So my third and big focus right now especially because this is the IIA is what is the prospect for getting greater unity within nations between nations and particularly on an international basis given the enormity of the challenges faced here at two or three. First of all the whole damage to food and to food systems and to nutrition will be much much greater if we don't deal with this as an international issue that requires all to work together UN different organizations like and groups perhaps it's time to reinvigorate the Irish hunger task force that was so important in 2008. Secondly international education how a university is going to be able to welcome students from all over the world if there is uncertainty about the extent to which COVID is being contained and looked after in individual countries there will be all sorts of challenges with enabling free flow and there's bound to be a need but in some settings two weeks quarantine for people who want to come into a country to check that they are COVID free are we ready to do that as universities are starting to think about preparing for the next academic year in September this year and then thirdly the return of international travel not just vacation travel not just social travel but travel for business and the travel that will be necessary to keep poorer nations connected with other nations what are the rules going to be who's going to sort out those rules will there be sufficient confidence in the international system from countries who are currently unhappy about it to encourage the emergence of intergovernmental discourse on travel regulations will there be the willingness to bring WHO into those discussions given that it is the part of the world that is most leading on this work it has the best ever head of emergencies that I've ever known Michael Ryan the citizen of Ireland who was showing the kind of solidarity that is needed for this work and has talked about it always but will the political masters of the wild health organization give them the space and the opportunity to start the delicate intergovernmental negotiations that are going to be necessary to establish the conditions for people to move freely between nations well these are big challenges for the future and I'll just repeat them quickly and then I'll stop one all of us learning at the same time what being COVID ready to be able to defend ourselves against new outbreaks emerging and then respond to outbreaks when they come how can we best within communities within nations and between nations just share our experiences and anticipate what the future has in store secondly the particular challenges of poor countries who don't have strong health systems who don't have much reserve to be able to deal with food and other shortages and who are trying very hard to be able to deal with this virus with much much less satisfactory circumstances than for example Ireland or the rest of Western Europe and number three the big challenge of trying to make sure that the world system works well without any particular countries being disadvantaged thank you David thank you very very much for a masterly presentation I mean I think we particularly appreciate the careful description of the development of the virus which you've given us and the implications which it now has internationally and indeed nationally as well we would love to get into questions straight away if that's okay with you and I'll begin with one from Simon Carzwell of the Irish Times which goes as follows the position at the moment is that the Irish government and health authorities here are proposing to carry out 100,000 COVID-19 tests a week for a population of close to five million with an oral rate currently at about 0.5 is this in your view sufficient level of testing to start relaxing lockdown measures can I give them one to use straight away thanks very much indeed the real challenge for everybody as we emerge from lockdown and try to get social and economic activity back to the new normal is trying to answer the question where is the virus and what is it doing where is the virus because the virus only lives inside people so that really means where are people infected and how are they passing on the infection to others and secondly what is the impact of this infection are we seeing any shift in the patterns of those who are getting sick and dying and can we make any projections at all about what the situation is going to be for health services as the lockdowns are released and deep inside all these issues are a series of quite dense ethical questions for society you know we do know that there are there is clear evidence that did certain population groups who are most at risk as a result of this virus and inevitably they're going to people be people who say are the over all sacrifices that all of society has to make so great that they are perhaps out out of context with the actual suffering that occurs and it's right that these ethical debates are occurring because they are so important now if I was in the in the Irish government I would be actually asking the health people to do the kind of level of testing that they think is appropriate to find out how the virus is moving and it has to be done using a combination of studies of people who got symptoms and then wider population based service to find where the virus is you want to get enough of a sample to tell you what's going on and that's usually not a very large number provided the sample is carefully selected and you are rigorous about the sampling plus you also need to have sufficient tests and testing facilities for those who are symptomatic as well as for health workers because of a constant need to make sure you're ensuring that health workers are not inadvertently spreading the disease I'm not going to say whether the number is sufficient I'm just saying that everything I've read about the intention of Irish authorities here at this time is absolutely in line with what I personally believe to be necessary and I absolutely hope that it will be possible for people who are asked to participate particularly in these larger sample surveys that they will do so because this is so important it's like quite likely that we will find that there are people who have the disease who don't have any symptoms of the disease and understanding asymptomatic transmission is a particularly important part of the control strategy thank you David thank you very much for that another question is the current U.S. attitude towards WHO indeed with the number of other countries in a sense jumping on the bandwagon as well do I mean what is your view of these assaults on the WHO at present and do you think that there is any particular WHO case to answer thanks this is a challenge that requires real networking and sharing among public health professionals there are a group about whom we don't hear very often they're the people who say you shouldn't be eating this kind of food or you should be doing more exercise or apps you must stop smoking because they're working for the health of the overall population they don't work in operating theaters very much they don't sit in doctor surgeries instead they look at the health of the community and at a time like this their engagement their sharing of what they know and what they suspect is absolutely invaluable and the fellowship among public health people is a strong one because the values are just very clear the health of every single individual is valuable no one person is more valuable than any other person we work for the health of all the meeting place for public health professionals nationally is usually the national department of public health and there may be a health institution the disease control center internationally it's the world health organization and everybody should remember that this is the place where hundreds of thousands of public health people come together their network together they provide guidance and advice and that is what WHO really is of course there are salaried staff in WHO whose job it is to manage all these networks to garner all the expert advice to try to form judgments they're very very experienced people and as far as I'm concerned there aren't many other of the level of competence that we currently have in WHO right now elsewhere in the world it's a very good strong team and then the third part of WHO is the member states that govern WHO who meet twice a year in the executive committee once a year in a big assembly and they with incredible care and often a lot of give and take hammer out the resolutions that give the mandate to the secretary and to the wider public health community that don't describe how it should work the hammering out of resolutions on how infectious diseases are dealt with and in particular the responsibilities of governments versus the responsibilities of the WHO secretary has always been a delicate process because countries really want to be sure that their individual sovereignty is recognized they've not allowed WHO to be an international health inspectorate instead WHO is asked to work on the information that countries provide to interpret that information and to provide guidance based on that information if countries adopt particular unusual routes for dealing with a problem particularly putting in border restrictions at their borders then under the treaty which was agreed in 2005 of the international health regulations WHO is asked to interrogate countries as to why they've done this always at the beginning of an outbreak there are questions about whether the alert could have been sounded sooner should have been sounded sooner but I ask people when they go back and do their forensic examination look at each day and find out what was available on that day don't look at it just with the retrospective scope because always you'll say things should have been done quicker however yes it's correct to say stuff should have been done quicker stuff should have been done differently because this great big pandemic or public health emergency of international concern should have been stopped better not just by WHO secretariat but also by governments as well and basically the analysis should be applied to everybody we will look at all these dates what was said on the 15th of January at the WHO press briefing what was done on the 22nd of January at the first meeting to look at the emergency committee what was then done after the second meeting on the 30th of January what was the instruction given how strongly was it given and all that kind of stuff that I believe must happen and I would I'm really really keen that it happens but I do wish that the forensic examination that's being done right now was not coming right at a time when the world health organization is super stretched dealing with demands that are massive from every single country every single business every single entity and I particularly wish that one member state had not said we think you're so unsatisfactory that we want to cut your money I find that really really difficult to understand and I'm sure there are clear reasons for it but just at the moment people who work in public health and the secretariat of the world health organization are more needed than any other community and institution in the world at this time so I really do wish that the after action analysis could be put off until we've got through the current emergency and I do wish that we could pull back I know there are reasons why it's impossible I know there are very clear reasons why this particular inquiry is underway but it's not good for world health it's not good for people and I do hope that sound minds will say that out loud. David thank you very much for that that was a question from Michael Collins who's the Director General of the IA. A question now from Dominic McSordy who is the head of concern. Dominic makes the point that the impact of lockdown strategy is going to be very profound in the poorest countries of the world where if you don't work you don't eat and on top of that is the challenge posed by the local situation. Hugo Slim has been suggesting that there is a need in those countries for more flexible so-called flex down approaches that's something that you think should be supported. Well first of all one of the reasons why poorer countries imposed lockdowns quickly when they had few cases was to do everything possible to implement the strongest possible public health case detection and isolation strategy that they could. The lockdowns themselves also froze the virus in the places where it was and if you're going to freeze the virus you have to freeze it properly you really do have to stop movement. I do not personally advocate partial lockdowns when you're trying to reduce the opportunities for transmission. Much better to do a full lockdown quickly get the public health defences in place then release the lockdown also as quickly as possible so that people can get on with their their living. If you do partial lockdown yep you will slow the outbreak but you still will not create those defences in communities that are so necessary. So I tend to be one of those people who says although it's horrible do it quickly do it well and then release it as soon as you possibly can bit by bit because I think then you help people to get back into their economies whilst at the same time you've got the best possible defences in place. Let's see how that one goes. I want to make one last point I agree totally that lockdowns do cause massive increase in poverty for all the people in the informal sector 80% of India's population works in the informal sector the impact on employment is terrible and I think that what we've learned from the present series of lockdowns is the absolute need as Dominic there would I think be the first to agree to make sure that there are strategies for protecting people whose lives are affected by this and perhaps what we need now again because this won't be the only period of lockdown so we'll have to be further lockdowns the absolute need to build into any lockdown strategy very strong very quick and very precise social protection strategies using whatever means are available. David thank you for that a question written in a way which is linked to that discussion is one from Anna Warwick of Irish Aid I mean what advice would you have for a donor country like Ireland which has partner countries in sub-Saharan Africa what advice would you give to a donor considering how it should adapt its development cooperation strategy in light of COVID. Thanks very much indeed I mean the existence of COVID is going to change just about every aspect of our lives everywhere we're all working that out now each one of us both individually in our communities in our organizations and there's no doubt that initially we will feel that things are going to be more dramatic and over time the new behaviors will settle down and we will find different ways of working but those working in development are in a particularly important position right now the great thing about development particularly after the 2030 agenda for sustainable development was agreed is that the growing recognition that many of the challenges we all face are universal that people centered they require an interconnected analysis an integrated response based on partnering what therefore does an aid agency do the first part is to really start from the recognition that we're all in this together this is not a problem that's a developing country problem and not an Irish problem this is an Irish problem a European problem a developing country problem so to adopt that universality is absolutely key all in it together secondly to really focus on the people centeredness of this you know in in responding to this this challenge it's people who have to be at the center it's people lives particularly the lives of poorer people that need to be right in the middle of our of our viewfinder as we're looking at what's got to happen so I would say to be focusing all the time with local organizations on how to make sure that the responses are people centered and particularly focusing on the vulnerable and thirdly I think it's really important that wherever possible we think about public health as being something that's got to be strengthened but it's not necessarily public health by putting more money into health systems and then finding that has to go off into strengthening hospital services yes hospital services have got to be strong particularly health workers got to be protected but it's community based public health using community health workers that you in Irish aid have really promoted for so long that needs to be further enhanced and encouraged just thinking to many of the programs I've seen you do around the world and I'm particularly focusing on one that I watched in Tanzania over the years it's that kind of work that needs to be reinforced and then networked outwards from the projects that you've liked and really are supported and so on to get them to work with others lastly having said it's about universe it's a universe thing having said it's about people focused at the center having said it's public health but public health very broadly public health in terms of well-being and resilience there's one last thing and that's I think something that all of us are realizing and and Tedros keeps saying it which is humility this virus has shown us so many things wrong with the way in which we run our lives everywhere but it's also showing us so many options for how we might move forward but they're not going to come from the people who like me who who are called experts or given titles they're going to come from everywhere and a kind of sense that actually the the new reality is going to be born in communities everywhere and that our job in international development is just to create spaces where these great ideas can circulate that I think is a big part of the future as well. David thank you very much a question from Terence O'Rourke who's an IAEA board member. Terence points out that Sweden has as we know taken a slightly different path what what are the merits and and perhaps demerits of having your own interpretation of WHO advice. So first of all the centerpiece I will repeat very slightly the centerpiece of dealing with this threat is having the capacity in all communities to detect people with disease isolate them find their contacts isolate them and protect the most vulnerable. Now you can build on to this an extra layer of protection by reducing the amount to which people are in contact with each other by restricting movement and then by lockdowns but the lockdowns and movement restrictions will not in themselves deal with the absolute challenge of interrupting chains of transmission. The Swedes felt that they were able to implement across the country strong public health preparedness measures with a whole of society involved and that they were able to reduce movement and the opportunities for people to be in contact with each other without imposing a lockdown instead by doing it through asking people to pay attention to the guidance on risk and to be very respectful of each other within the context of this virus. I think many of us are saying well if a country can believes that it can get the necessary physical distancing without imposing a lockdown but instead by through requesting community participation then so be it they should do that and Sweden isn't the only country that is showing that this is a way to go there are others as well trying to do the same and I think over time we will see a blend of countries achieving physical distancing and an attention to isolation and interruption through the involvement of the public and not necessarily having to go so far with top-down imposed restrictions that that will evolve as the pattern everywhere but it's going to take us time in different countries to do it and it will not necessarily all happen at the same pace but yes WHO guidance is clear on a series of principles but each country will adopt it in their different ways and everybody is looking at the Swedish as I call it experiment because it is a bit of an outlier and seeing whether or not that has lessons for the rest of us. Most important thing now if a really good comparison of experiences across countries is we're all involved in trying to establish the new normal at the same time and that is absolutely critical that is what WHO is doing more and more and I believe we will all depend on it. David thank you for that. Suzanne Keating who's the CEO of Jocas the umbrella group for Irish Development Organisations makes a point that perhaps there are particular countries although if you like the messaging from WHO to donors and others is that we have to take a global approach to the pandemic that there are perhaps particular countries which need very particular effort could you could you say something about that? Yes we we spend so much time in the WHO space dealing with basically a really interesting dichotomy number one as public health professionals we're supposed to provide the optimum guidance for how the reality of this new virus can best be tackled in different societies based on available evidence to date and comparing experiences so there's what I call the gold standard and that is why WHO exists is to establish norms and standards that is at the centre of its constitution but at the same time the organisation is called on all over the world to interpret that guidance and then to work with people as they are implementing that guidance and for many it is really really difficult if you are working in the middle of a major conflict and that conflict has elements of violence to it and that means that it is extremely hard to implement new ways of behaving and get those adopted widespread across a society of course there are masses of challenges with interpreting WHO's guidance so war zones places where there are high concentrations of refugees, places where migrants are collected together trying to move and places where there are simply people in detention or some other kind of place where they are being held in order to try to improve public security be they prisons or be they special detention facilities all of these represent settings where the implementation of the WHO guidance is particularly challenging and that's where one depends hugely on umbrella groups like yours Suzanne and others who can bring together different actors of focusing on these particularly challenging situations and help to build up a consensus of knowledge and understanding and they are really difficult I've been talking with the team at the international crisis group who are trying to establish a place where experience can be shared I also talked to members of the Disasters Emergency Committee in the UK trying to do the same and I was in correspondence over this weekend with the former head of humanitarian response in UNICEF Dan Thool who spent the whole of the last week networking with his colleagues saying can we come up with any kind of sense of what might be best practice in these very difficult circumstances so this is one particular in another area just very quickly and because I know it's so relevant to Ireland is trying to establish ways of working in residential homes for older people all of the findings that I picked up during the last two weeks is that these are very very tricky areas and whether we've got people in the care industry or people I sorry to use that term but there is a private sector there or people working in government or people working in institutions who are actually the the workers the nurses and another staff all of them need to be coming together to work on this there's no substitute for open collective working on this I don't think there is any individual group who necessarily has the right answer we're all having to work through the options and do with trade-offs in our own pace we're all frustrated with a lack of available protective equipment because the markets are all messed up and there's stockpiling of protective equipment going on that's not getting to poorer countries so I just think working together Suzanne on these issues and perhaps the most difficult of all is in settings where there are a lot of people gathered together because they're refugees or migrants and at the same time the older people and the vulnerable people in those communities that's an area where very special attention is needed and again Suzanne I believe that your community can be such an important leader in that group please be connect with me if you think I can be helpful by connecting you with others David many thanks for that I think we've time for one or two more questions if we if we can prevail on your time one would be the rule of the African Union do you think that it is making an effective contribution in terms of coordinating responses to the plazas in sub-Saharan Africa I think that just looking at African countries really they are in a very difficult situation we have seen over the last decade really amazing signs of African nations really turning the corner in their economic progress in trying to deal with a range of governance issues and also in implementing actions in line with the sustainable development agenda it's varied from country to country but really extraordinary success I don't really want to pick out individual countries suddenly along comes covid immediately there is because of the response needed there is a lot of people unemployed the informal sector terribly damaged massive increase in poverty breakdown in food systems breakdown in a lot of other systems as well bankruptcy of small and medium enterprises as well as inflationary pressures on national governments this is terribly difficult I really am so appreciative of the coordination across the African Union by African Union members but supported by very important bodies like the African Union Development Agency and also the African Development Bank and I particularly want to pick out the Economic Commission for Africa led by Vera Songhwe I'd also like to stress that this is really unfortunate for Africa because it's been a hit it hit European countries first and these European countries are already having to use inflationary practices including basically loosening the normal controls on what happens inside finance ministries in order to protect their own smaller medium enterprises their own informal sector workers and in some cases quite large businesses which employ a lot of people who also need to be protected to avoid massive unemployment but it means that the kind of fiscal stimulus in many wealthier countries have gone into their own economies where's the cash that's going to have to go to the IMF for special catastrophe funds special drawing rights and private sector bankruptcy protection in Africa itself I don't really know and so I think the strong work amongst the African Union to really draw attention to the problems and to help African nations work together but then the importance of connecting global institutions with the African Union becomes hugely important just a question from lisha daily of johnson johnson she asks with the number of cases now over three million worldwide does WHO have any sense from epidemiological data of what the final number could conceivably be we're being really careful here the problem is that this is an infection spread by droplets it's not airborne so it doesn't kind of go right through communities and affect everybody if we look what's happening in Mumbai right now there are very discrete outbreaks and they're very clear where they are but they've kind of been frozen in place as a result of the movement restrictions same in South Africa the outbreaks are in particular sections of the population they've not gone everywhere we're at such a delicate point now because of course if free movement starts all over again as far as that is frozen in situ we'll start transmitting again and we will get new and possibly much bigger outbreaks than we've had already if we don't watch it I don't think that's going to happen because I think communities are getting ready but the eventual size of the outbreaks caused by COVID in the interval between now and when there is an in a vaccine that can actually protect all of humanity that size depends on so many variables the most important of which is the efficacy of community level public health responses I do think the number is much greater than the number recorded because the number recorded just just based on testing and we know that particularly in poorer countries there's much more COVID moving around than there is testing available but at some time we also know that there are vast susceptible populations still and so the absolute requirement is all societies everywhere being fully able to defend themselves and the eventual size in terms of the overall scale of COVID in the world depends on the quality and sustainability of our global defensive capabilities at the community level as I say until the vaccine appears and is available and is working and I'm afraid I don't know when that's going to be and and like everybody I'm trying to avoid any over-enthusiastic about a vaccine being ready just in a few months it's not going to be it's going to be much longer but David that last comment I think answers the question which many of us would have would have wished to put a final question comes from Judith Randl who as you probably know is co-founder of Development Initiatives and Judith asked basically are you optimistic for the future and do you think that the values which are embedded in the 2030 agenda and the STGs around international cooperation and solidarity will these values emerge strengthened by the COVID crisis or not? Well I sometimes think this virus was kind of brought to humanity as not as both a test and as an opportunity it's a test to see whether or not we are capable of working together within communities within nations and globally to do with a totally new threat which is still unveiling itself as we come to terms with it and secondly I see it as an opportunity because more and more we're realizing the power of working together the power of being unified and the importance of the underlying values and principles in the 2030 agenda for sustainable development and I'm a stubborn optimist I believe in the inherent qualities in the human race that enable us to work together to do with common threats I've seen that play in play in so many challenges that I've faced whether it is the challenges or other challenges and so I am totally optimistic that we will realize the power of working together my only anxiety is that any delay in reaching that conclusion just makes the problem much much much bigger for the world and so I'm frustrated by the continued willingness of certain leaders to avoid working together because they think somehow that's good for them in the immediate or long term what a terrible mistake and Judith congratulations to all that you do and colleagues in development alternatives and I hope that you will use all all the levers that you have in your power as I'm trying to do as David and others on this call are trying to do to say to every leader everywhere just all this bickering finger pointing name calling another stuff that you're doing only is having one consequence and that is it's making the prospect for dealing with inequities and to getting everybody to work together just more and more difficult so please the sooner you can cope with whatever problems you have between yourselves and put those out the way and get on with the task at hand the better for everybody David on that inspiring note may I thank you for a fantastic presentation I have to say it's covered as much of the ground as we could within the the short time available on behalf of the IIA I'm delighted that you were able to make yourself available for this event we have learned a lot as always your thought provoking with all of your observations and conclusions about this unprecedented crisis thank you very very much I thank also everybody who took part in this event and to put in questions sorry we weren't able to get to all of them but I look forward to future interactions with David Nabarro at the Institute and for the meantime David thank you very very much best of luck with your ongoing work at the WHO and elsewhere and thank you to all attendees from this morning thank you very very much and thank you David thank you Jill thank you the whole team and thanks to the many friends who ask questions I try to reflect my own thinking which is evolving quickly in a set of narratives on a website www.4sd.info I put it in the chat and if you have any views or comments please share them I want the dialogue to go on super good thank you again thank you very very much and for the IIA audience as such the next event will be John Berrigan of the European Commission on this coming Wednesday who will talk about the EU's response to the COVID-19 crisis thank you very much everybody and good day