 We know that 54 low- and middle-income countries during the pandemic could not invest more in global health in their health projects, I mean facing the pandemic, because they had to pay their debt to creditors. We also know that if all the debt of the most indebted countries had been, you know, released in 2020, 40 billion dollars would have been liberated. They would have been 300 billion dollars if also the debt of 2021, we're talking about the two topical, you know, peak years for the pandemic had been released. So you can see the, you know, enormous gap between the 10 billion of the World Bank, which are not faintly achieved yet, and the money that could be liberated through debt cancellation. Hello and welcome to People's Dispatch. As you know, we are covering the Executive Board meeting of the WHO and bringing you stories, reporting, and a lot of perspectives and telling you what's going on really at the EB in Geneva at the WHO headquarters. Today we have with us Nicoleta Dentico. She is the Global Health Lead of Society for International Development, an Italy-based organization, and she also plays a prominent role in G2H2, which is a shot for Geneva Global Health Hub, which is a network of civil society organizations who follow global health governance closely and talk about it and do the real activism to ensure that there is more democracy within the global health governance arena. So, welcome Nicoleta. Thank you very much. And so today we are going to talk about health emergencies and this is one of the major topics which is being discussed at the EB this time, which will also be discussed in the World Health Assembly and in between there will be some meetings. So as we all know that it has become the issue of the day to talk about primarily because of the COVID-19 and the pandemic and what we saw as people of the world, the way things unfolded. So it is recently on 31st of January that marked three years of COVID-19 we declared as a public health emergency of international concern. So, but what we need to see is that are we really responding to the future crisis and the current crisis with those learnings or are we really working as business as usual. So coming to what is happening exactly at the EB, so the Director-General has produced the report which is for Global Architecture of Health Emergencies which will fall under the larger umbrella of Pandemic Treaty, which is being discussed at the WHO. There are 10 proposals that the DG Tedros makes in that. So what would you say what are those proposals and what are the kind of contradictions that the proposals within themselves have? Of course the WHO emergency agenda which has developed over the last two years and which has had a huge boost after the Ebola crisis because we shouldn't forget that this has been a turning point for the emergency, for the emergency agenda of the WHO and also for the restructuring of the WHO and its sense of purpose. So to speak is as we speak the topic of the discussion at the EB as you said is the main chapter of this complex agenda in the 75th year of the of the World Health Organization itself. So there are lots of lots of interesting coincidences as well as the one you mentioned that this is the third year of the declaration of the public health emergency of international concern. A lot of documents, maybe we should also look at the two lines of emergencies. One is the pandemic, post-pandemic kind of structuring of the WHO with all these 10 points and this proposal, 10 proposals that we will look at in in a minute. The other one is the emergencies that the WHO increasingly has to face in an increasingly turbulent world. We should also a little bit separate the kind of a humanitarian emergencies, you know Afghanistan, Yemen, Syria, of course Ukraine and Ethiopia, you name it, the many emergencies that are coming to the fore and that have not been solved from the past and then you have of course the flow of document production, debates that derives from COVID-19. This is the bulky thing. Has WHO, has the international community learned from COVID-19? I have my serious doubts because first of all we should not remember that we should never forget that in fact the WHO has an international community having trusted the two entities of private jurisdiction, foundations, basically the management of COVID-19 and this has consequences in the way in which solutions are now being designed even through the pandemic treaty because we have to recall the fact that the pandemic treaty is something that for example the Bill and Melinda Gates Foundation cherishes very much even the IFPMA, the International Association of Pharmaceutical Producers, they see it as an opportunity to set the rules for the future and there is a big risk that the rules of the future will be tailored according to this multi-stakeholder model meaning that all of society, all of government with various actors no matter where their vested interests are in a totally deregulated scenario. So this is for me from a governance perspective the really least promising arena for the future. The 10 proposals, the 10 proposals are very complex of course setting a pandemic scenario for the future is a complex exercise. What I think is really worrying if words count is that the notion of prevention is literally disappeared from the acronym of the health emergency preparedness and response. Her prevention is no longer there which should be the first lesson of COVID-19 and also that there are many ambiguities and many proposals made with no specification of how they will be implemented such as for example the health council with heads of states to be placed, we don't know where, how many heads of states. The other contradiction we I think is very glaring is how you think of preparing the preparedness and response financially to the pandemic of the future through a World Bank pandemic fund which basically replicates the weaknesses, the frailties and the inconsistencies of donor driven financing which has never really worked well for a single individual infectious disease. Can you imagine for a systemic exercise of even response and preparedness to the future pandemic? So there are many elements that need to be discussed that will have to be you know questioned and investigated further. Great, so I think what you are talking about is also the structural changes which are required and health systems is strengthening also required which we are seeing that many developing countries are talking about even when the rich countries are not really emphasizing much on that but taking off from here you recently worked on a report for G2H2 which talks about debt and the health crisis and health emergencies that how the debt that the developing countries are in has impacted and will continue to impact everything health, wheat emergencies or otherwise. Can you just talk to us and tell us a little more about your findings and the drain of wealth from one side to the other? Of course we don't yet know what the pandemic accord will be, what it will be containing, how it will be framed even if it is going to be a framework convention, a treaty we don't know. So it's a bit anticipatory to now enter into these projections but what certainly will be a pillar of any agreement, binding agreements that the WHO and the international community will strike is the financial part of it. Who is going to finance, who is going to support this enormous engagement commitment for pandemic prevention preparedness and response and even if they take the word prevention away it'll be a major commitment anyway. Well it cannot really be a pandemic fund, it cannot really be something that at the moment imagines a commitment of 10 billion per year and it has only a few hundreds of million actually in the pot at the moment with 1.4 billion pledged and not seen yet. So you know 10 billion per year according to this donor driven logic and this idea which is very colonial to have the countries from the south asking for money from the countries of the north is not going to make any difference in our view. You cannot really treat such an exercise in the ordinary fashion. When you talk about health systems there is a lot of discussions about national public funding for health. How can these countries especially from the global south but even more from the global north too how can countries take the money that is required by the WHO to invest in public health and what should they do with that money? So these are two hordes of the question. We know that 54 low and middle income countries during the pandemic could not invest more in global health in their health projects I mean facing the pandemic because they had to pay their debt to creditors. We also know that if all the debt had been of the most indebted countries had been you know released in 2020 40 billion dollars would have been liberated. They would have been 300 billion dollars if also the debt of 2021 we're talking about the two topical you know peak years for the pandemic had been released. So you can see the you know enormous gap between the 10 billion of the World Bank which are not faintly achieved yet and the money that could be liberated through debt cancellation. Our point in this research and in this report is that actually debt cancellation is a global health issue that you cannot rely on you know postponement of the debt service as the G20 has proposed because these are measures that don't work. Three countries only applied two of which were refused. So it doesn't work COVID is actually urging us to look out for not new solutions. 20 years ago there was a huge campaign on that relief on debt cancellation actually and I think we need to resume that because the situation is getting worse by the day. It is not me saying that we are you know at the eve of a debt crisis of a huge it's a huge time bomb it's a World Bank saying this and even we found during our research that a London School of Economics paper was proposing debt cancellation for households in the UK. So now the situation is really global. The same goes with illicit financial flows you know countries from the south send a lot of money to the north in this uncontrolled unregulated modalities. We needed to change this narrative. We really would like to see governments from the global south take this window of opportunity of this pandemic treaty conversation to really start asking for new rules. In other words now I think it's a golden moment to really decide for the global south countries whether they want to stay being donor dependent or if they want to develop a different track and they should do so because Africa the Africa group at the UN has managed to pass a resolution on a major tax reforms to be discussed at the global level. This is time for new rules. This is time for a new financial justice and we really needed to bring it here and stop all this you know mantra about innovative financing mechanisms a fiscal space and all these all kind of mantric locutions that really don't bring any more funding to the south. I think you also indicated some point that the way money is flowing from the south global south to the global north actually and and how that also impacts and it is not that the global south does not have the money. This is actually related to that we should actually disrupt two narratives that are really interiorized by everyone countries in the north and in the south. The first narrative to be broken debunked and deconstructed and completely dismantled is that it is the global north that gives the money to the global south. This is not true in fact we know that through that through that payment through you know unpaid taxes of multinational corporations in the global south through illicit flows through tax evasions and tax dodging cities actually the global south that is sending the money to the global north. This is the first you know I'm saying it in this way which is a bit sweeping but I can you know we have numbers and figures the report does bring numbers to demonstrate that the Marshall plan goes from the south to the north. The second narrative that we need to break is that the countries in the global south are indebted. Well this is a really odious debt that was created in the past it's actually a very colonial financial trap and if they were indebted countries from the global south have certainly paid that debt in so many ways in so many fashions but the reality today let's face it is that who is really indebted whose debt are we talking about once again if you look at the climate catastrophe the north is the northern countries the industrialized countries the global the north global hemisphere is the one that is indebted towards the global south. Global south countries are paying the price of climate disasters that they have not provoked so I think we really need to you know get rid of all these major narratives and really think with a reality-based approach on how we want to discuss this pandemic treaty negotiations here in Geneva how we which kind of lenses do we want do we want to have to look at reality in this respect the fact that we are only looking at medicines and access to medicine for me is a bit of a missed opportunity we should really widen the glance and look of course at access and look of course at equity but develop a broader perspective that embraces the environmental aspect of the pandemic treaty that is not there yet and the financial measures that we need the two we need to introduce in a in the pandemic treaty negotiation for the future that actually have to put financial justice right at the core of the pandemic treaty negotiation. Yeah thank you so much I think this was really good and one could understand where are is WHO at the moment going wrong and how can we expand the entire perspective and bring more in and and and at one level the whole discussion about finances is important because beat health emergencies beat other agenda items that WHO is discussing there we are facing the problem of money because the governments are not spending on health or they cannot we are facing that WHO itself is facing a different kind of a crisis so probably financial justice is something which is at the root of it all. I really think it is and of course it is also fiscal policies it is also de austerity measures that are being implemented now I mean this is yet another way to leverage privatization of health marketization of health you know the the role of the private sector so there is a very important rather wide spectrum of ways of looking at a financial agenda but what I want to say if you allow me is that after three years of this pandemic three years after the declaration of the pandemic emergency of international concerns now we see health systems even the ones that exist in the north like here in Switzerland or in Belgium or in Italy in France they are devastated after three years of the pandemic all health systems the strongest and the weakest they are coming out of these three years in a they really in a collapsed state from a structural point of view because of the burden of diseases that have not been treated and really have been neglected for three years and also because the huge price that the health workforce has paid for facing and you know the facing the contagion of COVID-19 who are now working in really desperate conditions underpaid insufficient numbers and underemployment in the health structures and those that are employed are also facing an important mental health issue because they have been stressed and have been under you know under stress for three years no stop so the conditions today are not the cozy conditions that we which were not cozy of 2019 they are really desperate conditions the WHO has counted 84 countries in which strikes and you know legal appeals have taken place in the last two years because of the injustices applied through the management of the COVID pandemic on the health workforce you have strikes everywhere in great Britain in France you have in Kenya 10 days you have reported yeah you have so yeah we cannot negotiate a pandemic treaty without looking at this complex reality for which money is not the only solution but certainly investing more in health dedicating more you know commitment to health there would be such a beneficial vision to look at how to reconstruct society after three years absolutely and we also have reported before where in Italy because of austerity measures since 2008 the number of beds to treat pulmonary diseases which is lungs related diseases they had gone down majorly in the in public health sector and when COVID hit that really came to hit the common people really badly and that is when Italy also had a lot of Cuban doctors helping so all of that has happened so of course there is a lot of learning the only unfortunate part is that the the international actors the leaders at the international level are not really behaving as if they have learnt anything and as Nikoleta had pointed out once before to me that the agenda of this year's EB and probably what will guide the WHO in May that looks like a pre-pandemic agenda it does not look like as if we have gone through so much in the last three years in terms of inequity and the number of sheer devastation and death that people have faced but hopefully the discussions will become better sometime and the civil society and activists will keep pushing for more pro-people policies and thank you so much Nikoleta thank you for joining us and yeah we will keep coming back to you for more interviews and insights thank you thank you so much thank you