 Thank you, Philippe, and thank you everyone for joining us today. As my co-chair mentioned, we have a fantastic group of speakers, and we're really looking forward to an engaging session. Feel free to post any questions as they present, and we'll try to get to those at the end of the session. So today we have, first of all, Professor Agnes Villanuejo. She is a Rwandan pediatrician who returned to Rwanda in 1996, two years after the genocide against the Tutsi. Since then, she has provided clinical care in the public sector, served the Rwandan health sector in high-level government positions, first as the executive secretary of Rwanda's National AIDS Control Commission, and then as permanent secretary of the Ministry of Health. She also served five years as Minister of Health in the country, and in addition, she co-founded the University of Global Health Equity, which is an initiative of partners in health that focuses on changing how healthcare is delivered around the world by training global health professionals who strive to deliver more equitable quality health services for everyone. We're very happy to have you today, Agnes. Next we have Dr. Obje for Agnam. He is a visiting research fellow at UNICRIS. Dr. Agnam is researching and writing a book chapter on regional health governance and also developing a capacity-building proposal on African perspectives on global health governance and diplomacy. Prior to this position, he was deputy director and head of governance for global health at the UN University International Institute for Global Health in Kuala Lumpur, Malaysia, where he is now principal visitor fellow. And also get to mention that this is also another UN University Institute that is partnered with UNIWIDER and UNICRIS. He is also an adjunct professor of law and legal studies at Colton University, Canada, and visiting professor at the Institute for Future Initiatives and University of Tokyo. Really great to have you also, Obje. Then finally, we have Dr. Roberta Andragetti. She is a regional advisor for the international health regulations in the WHO region of the Americas. In this capacity, she oversees the application, implementation, and compliance with the international health regulations in the Americas by providing technical support to member states and also ensuring coordination with global health related activities and other international organizations. Prior to this current position, Dr. Andragetti was coordinating alert and response operations and IHR-related activities in the WHO European region, as well as being a medical officer of the global alert and response team at WHO headquarters. She has coordinated and participated in responses to outbreaks related to a broad range of pathogens. And also prior to her assignment at WHO, she worked in the Democratic Republic of Congo, Nicaragua, Spain, Uganda, and the United Kingdom. Also very great to have you, Dr. Andragetti. So we're going to hear from three very well experienced speakers who are going to speak from their regions where they are working and have worked in the past. So we have Asia, Africa, and the Americas represented. And to start off, I think we can start with a broad question to see your views about which lessons can be drawn from the COVID-19 crisis about global health governance. And perhaps we can start with you, Agnes. Thank you, Anna, and thank you for having me. I think there are many lessons that we can learn from this pandemic. I will cite only three that are important in my point of view. First of all, understand the importance of health. Health is not a commodity. And health is at the heart of economic development. Second is the SDGs for health and inequities that is sure we are not on the path to fulfill. And third is the sad lack of solidarity pushing to the reflection of the need of self-reliance. So let's, for the first one, we can see how COVID-19, above the fact that it has caused more than 4.5 million deaths, has disrupted all sectors across the world. And the 2020 SDGs report show us that we have, we had a disruption of immunization that has never seen since the year 70s. School has been disrupted and when girls in some region of the world will be dropped out of school, we'll probably not go back to school easily. Third, our economy has been absolutely disturbed with more than 150 million people that will be pushed into poverty by the end of 2021. The second big is we have the inequities. COVID-19 has created no inequities, has just highlighted inequities. Inequities inside countries and inequities globally. Inside countries, we have seen that the poorest, the vulnerable have been more affected, more infected and died more. It's the case of black and brown people in UK and in the US. It's the case of homeless people, of people living in crowded conditions and the people working in informal sector in Africa. So, the third thing is the fact that COVID-19 has shown to the developing world that we should not rely on multilateral institution or high income countries. Today, we have only 3% of African population that is vaccinated against more than 60% in many high income countries. And just because, and people are vaccinated, people who are not at risk are thinking about a third booster when there is no major evidence, but while people at risk in the developing countries are not vaccinated. We start well with the idea of COVAX based on solidarity, but COVAX was so not supported by the countries who have committed to that. And today, if there is 3% of people vaccinated in Africa only, we have only 1.2% when we put all together the people living in low and mid income countries. And we are amnesic because all what we face with COVID, the world has faced it with the Spanish flu, lying to the population to undermine the situation and for political selfishness, poor people and vulnerable dying more, and the lack of solidarity that has increased the magnitude and the impact of COVID. So those are my three lessons, the important of health. The fact that inequities has been highlighted and we are very far to reach the SDGs for health and for equity. And the fact that the lack of global solidarity has to put each corner of the world to try to be self-reliance. And for this, I mean Africa have to manufacture drugs, vaccine and medical tools to be ready to face the next pandemic. Thank you, Anna. Thank you, Agnes. Really good reflections and a great way to get started our conversation. Obi, what are your views about the lessons that we can draw from the crisis for global health governments? I think you're still muted. You click the microphone button in the bottom of the screen. You should be able to unmute. Obi, can you hear us? Maybe that's a word. It might be good to refresh your browser. That's usually the first troubleshooting option. Well, perhaps while he does that, we can have Roberta answer the question about lessons drawn from the crisis. Thank you for having me and obviously what have we learned? We have learned that here we go again with the same set of gaps, with the same sets of hope and hope of taking corrective actions. And I'm working for the multilateral organization. Then we are basically under the microscope, if not under fire. And once again, yes, we sensed that there was a lot to learn from this pandemic and we embarked in this deja vu of lessons learning. In reality, we are identifying lessons. And as WTO, we have convened three panels to look into the COVID pandemic and, okay, lessons same as with the H1N1, same with the Ebola at another magnitude, and now the set of corrective measures. Here, are we really able to learn any lessons by putting in place, taking corrective measures? And I think the good news is during this pandemic is that countries, despite all the lack of solidarity, inequity that this pandemic has generated, even middle income and low income countries, were able, in some cases unexpectedly, to take the response in their own hands. At least, I think that what there was that learning from the side of the country of really being with the reality check, we cannot rely, if not on ourselves. And at the beginning of the pandemic, we have seen major decisions that were taken by national authority against, thankfully, WTO advice with respect to non-travel restrictions. They shut the border. They put locked people down. For me, and countries even, they showed national authority. They showed that during the first month, they were able to make progress that never happened over years of commitment. And this was the major, was really inspiring. And they should give confidence to the countries. And after all these panels, independent panels, whatever we have put in place at the international level, the good news is that countries, they said, look, basically, we have enough of you WTO telling us what to do. We set up a member state working group to decide what to take forward, what are the corrective actions that we should be taking. And now, as we speak, there is this member state working group on the strengthening, want to see how it goes of WTO in preparedness and response. And they're looking mainly at three areas, governance and leadership. And what does governance mean? And they're looking to governance of WTO itself and they're claiming a more oversight and steering role at WTO governing bodies level. And in terms of leadership, they're even considering some adjustment to the DG position. And they're looking also at the financing set up of WTO and technical tool. And this is a very good news that there was this ownership taken by countries. I really hope that it's taken forward. But at the same time, the same group of countries, like the ones that Agnes was referring to, under other umbrella like the G7, the G20, they're organizing and they're shaping and visualizing a different global architecture for preparedness and response. Then now the challenge is, can we have governance without leadership? Can we have parallel leadership and governance mechanism for public health preparedness and response? And we saw how we ended up this time with inequity, lack of solidarity. And this, I don't know, this is an issue. I don't know maybe something that we should not learn. And this is my contribution. Thank you. Thank you, Robert. So I have really great points about the importance of country ownership, but also how can we stop just learning and learning, but actually implementing change? And I'm sure later on we'll have more of an exchange about also the role of WTO in this when you bring up about parallel leadership and global health. Will be, I don't know if you have, what are your views are in terms of? Can you hear me now? Yes, we can hear you. I'm sorry about that. No problem. Okay. Because we have, the time is quite limited. And I really want to re echo some of the most of the points that Agnes met, but maybe from a different perspective. The future of global health governance in the context of the crisis that we face today, the COVID crisis, reflects, in my view, what most scholars have been writing about in the 90s about the need for a transition from international governance to global governance. There are two different things. When we talk about international governance, it means the centric Westphalia institution, we are nation states, members of the UN and the WHO and all of these intergovernmental processes. But because of the fact that, you know, the concept of the globalization of public health, which in the context of official diseases, disrespects the boundaries of nation states. This is part of what is done to respect national boundaries. They don't respect geopolitical territories. They don't carry national passports. They cross, they grow. And, you know, when this argument is met, I think the world was quite caught on our way because nobody believed that the virus, you know, in this day and age, will be capable of shorting the entire world east, west, north and south. Okay. If you look at, you know, bacteria infections, the emergence of antibiotics, you know, and gave the world, you know, a whole lot of false hope that, you know, groomed beyond, you know, what we're witnessing today, where a virus will emerge and short the entire world. So the point that needs to be strongly emphasized is the fact that because we have such a high level of betrayal of trust, this has led to collapse of global health governance. And in the context of the world that we live in, the world of today, where, as I just mentioned, only a very tiny portion of populations in Africa and under developing, under developing regions have access to available COVID vaccines. What has happened, you know, to the bridges that we need to build, you know, across all of humanity? You know, so that's one question. Can a lightened self-interest drive global health diplomacy? Where we place a premium on every human life. It doesn't matter whether this life is Latin America, in the Caribbean, in South Africa, in Southeast Asia, in Europe. So these are the questions. How do we actually, you know, rebuild, you know, trust in global health governance? And doing this would entail the impact of our mental institutions, international governmental institutions. Collaborating, you know, with non-state actors. There's no way, you know, we can leave this job, you know, for the U.S. system, for instance, actually mentioned. So we need to step outside. And then today we're talking about vaccines. There are serious questions about research and development. Okay. This is, these are goods produced in the, by the private sector. And questions about intellectual property, questions about patents. And once you patent a product, you and I know what is going to happen, you know, the next is profit maximization. Okay. So corporations don't actually, they are primary, you know, primary stakeholders or the shareholders. They want to make sure that, you know, business is good. And there's no charity, really. She mentioned COVAX. COVAX, one of the mistakes you can make in global health governance is to, is to subject the lives of hundreds of millions of people to, to a governance like it is a dispute on charity. Okay. It's pure charity. So we donate, you know, vaccines that you don't need. And in the context of what has happened, you know, again, in response to the COVAX, when we had three major vaccines, you know, in the West, say, in North America, Canada, U.S., most of Europe. And there were safety issues about AstraZeneca, for instance. So most of the countries were, you know, going for Pfizer and for Moderna. Okay. In the U.S., Johnson and Johnson is not yet approved. But what you haven't approved for your citizens, you want to send to, you know, some developing parts of the world, you know, and then because they don't have any option, you know, they take this or they lose it. So, so these are some of the ethical questions that we need to ask. And asking these questions would need to bring, you know, entire government institutions together on the table with non-statutors. And that is when we have to begin to build an effective global health governance mechanism that addresses the needs of the most vulnerable people in developing countries. Okay. So the second point that is related to this is the fact that the COVID crisis, like Agnes mentioned, is not just a health issue. There's now series and series of reports and research that has come out in the past one year that specifically point to the fact that we now face the triple crisis in so many countries. Okay. COVID has, first of all, most of the health crisis. Secondly, it has reversed most of the gains that are made in propagation of extreme poverty, which is the most important SDG. Okay. And the climate crisis in so many countries has also complicated, you know, the rising debt. So we have, you know, a triple crisis now facing most of the underdeveloped and developing countries, the lower middle-income countries. So how do you, how do we actually, you know, reverse this trend? Because it's not only there's a report, there's a research that was done by the Dachamastro Foundation in Osawa, which is very persuasive. I mean, I can send the links, you know, to that, you know, so if you read that, you see where they've done excellent studies in countries in Africa, in Latin America, in the Caribbean, in Southeast Asia, showing how, you know, the impact of COVID on the SDGs, you know, there's now a reversal of some of the goals, some of the gains better on some of those goals. So I want to conclude by saying that one of the lessons we've learned is that, you know, all the stakeholders, national states, international organizations, non-state actors, the global philanthropic community, they have to sit down and think about, you know, how to build bridges, to build back trust in global health governance, to inject the principles of, you know, enlighten self-interest in global health diplomacy. It is lacking at the moment, and we need to revisit that. Thank you very much. I'm looking at my watch also, and I see that time is progressing. I think we have time for a second round of exchanges, but I would suggest that we use this time to do two things at the same time. I think you can use the time that is remaining to react to your colleagues or to comment on what the other panelists were saying, but at the same time, it would also be good if you could address our second question, which is a bit more specific, which was about the role that regional organizations could play, should play, have been playing, have not been playing during this crisis. So it would be good also to have your view on this, the role of that regional level, I mean, the super regional, the super national regional level within the overall architecture. I know that Roberta has some critical views about this. We have been talking about this yesterday, but perhaps we can start with Agnes again first, so that we hear her views on the African regional organizations and their role that they are playing or should be playing, according to Agnes. Thank you, Philippe. I think that the regional organizations are crucial. And I just want to say that Africa should think about which one is good for Africa. And this pandemic has shown us that CDC Africa was our best ally. Even last pandemic when of Ebola, that killed 11,000 people. The first reaction globally came from African Union. So African Union has now a strong CDC, Africa CDC, and us in Africa, we should develop and follow that. It's good for global health security. I no longer count on the Western world to help me. No, they will let me die. I know that I've seen that. So I will be saved by what is there in Africa, having a strong say on the table to say this to do, this is not to do. So global health security can be achieved by no country alone, no region alone, because even now, by blocking Africa to get access to vaccine or other low-income country, we are going to have variant that will respond to no vaccine and the rich country will die again. So not following science, as it has been said now, and even not following WHO advice, we are going to pay that very highly. Second, regional entities like African Union or CDC Africa will help regulate. I want to recall that the first, there was a meeting of African Ministry of Health at the first case in Africa under the leadership of CDC, and the continent has won, decided to go for the good measure. And that's why Africa has not been so much, has behaved well. And it's something that I'm very happy to have seen that Africa can count on itself to pass through a catastrophe like this one. Don't forget that they were expecting 10 million deaths in Africa and the destruction of everything. This was the Western provision. So governance, regulations and support of each country originally, and also will help procure and distribution of medical tools that will save the population in Africa. Without CDC, you know that even when we put money on the table, Western manufacturing was even not considered our orders. And even now, with the vaccine, we have pay AstraZeneca, we have pay Pfizer, 3.4 million doses we pay to Pfizer as a country. And we are still served after Western countries who put their order after us. So ordering, distribution, manufacturing, regulation, governance, yes, regional entities are needed. But the weakness of the WHO is that WHO is not backed by head of state. CDC Africa is directly backed by head of state. WHO should, because ministers of health are there, but let me tell you, I have been a minister of health and my colleagues, most of them doesn't report to the country when they go to Geneva for a meeting. CDC Africa, they report directly to the assembly of head of state. So we should revisit the global architecture of governance to serve better the people. Thank you. Thank you. Shall we continue with Obie? Yes, just again, in the interest of time, I wanted to comment on the Africa CDC, but Agnes has done that most excellently. But just wanting to reiterate the fact that it was just the Africa CDC was a product of the lessons from Ebola, okay? Instead of we know what happened in Sierra Leone, Liberia, Guinea, and the fact that WHO was very slow in responding to those emergencies in those three countries, conflict countries, and didn't declare Ebola a public health emergency of international concern almost eight months after what happened in those countries took place. So the Africa CDC basically is a very good candidate in terms of galvanizing support. In the context of what the WHO DG himself, Dr. Tedros, has called the vaccine apartheid, to I'm just quoting him, that's what he used that term when he was addressing the G20 summit, that we now have vaccine apartheid with respect to limited access to different regions of the world. So in the context of this, vaccine nationalism versus vaccine protectionism, a regional institution like the Africa CDC can actually be strengthened by African governments to address this lacuna, the gap in access to vaccines. You can not just start producing vaccines overnight, okay? This is something that takes time, plans are put in place, the infrastructure. But when the vision is there, and as the political will of the 54 African countries, we can actually begin that journey. And I think in terms of the way that I've read most of the things that the Africa CDC is doing, on the policy plan is off to an excellent start. And I think, again, sometimes we learn from crisis. So maybe this COVID crisis, maybe the lessons from this vaccine apartheid is now galvanizing it to even do more or to put its house in order in terms of looking into the potential, the future, the present and the future global health crisis. What are the things I also want to make, the point I also want to make about the Africa CDC is that we've got this, maybe Roberto will talk about that, that's our area, the international health regulations, which I was fortunate, when I was at WHO in 1999, I was part of the team that drafted the IHR 2005, under the leadership of David Thurman, who was then the head of WHO in facial disease cluster. So the concept of declaring an outright public health emergency of international concern was a novel idea at that time. It was seen as a radical idea. In the 1999 to 2001, we were five weeks, this draft of the new IHR. But it's become since 2005, the major regulatory tool that WHO has. Yes, there's a lot of criticism of the IHR by the independent panels that have been set up since COVID. But rules are rules. If you have treaties or frameworks or regulations, they can provide evidence. So we have to have some form of space within those regulations for the WHO, the DG for instance, to be able to convince his scientific advisors to assess the situation and make a decision whether to declare that particular outbreak, public health emergency of international concern. And this is where the Africa CDC is actually, if you look at the vision, there's a link. So whatever is happening at the international level of WHO, the IHR mechanisms, cannot effectively be linked with the policy framework of the Africa CDC in terms of building surveillance, in terms of building the capacity for health security within the continent. So I see this synergy. And I think it's a very important thing to have the synergy between the vision of the Africa CDC and the WHO's international health regulations. And it's something that I think should be supported in order to enrich the capacity of international institutions to be able to achieve their mandates. Thank you very much. And then, Roberta, it's your turn. Final word in this round. Thank you. Now, regarding the role of regional organizations, I'm now sitting in an office in a region which, praise, is very proud of the Pan Americanisms. But paradoxically, since I've been here, I've seen all these moving parts of sub-regional economic integration mechanisms popping up in the Americas. And I can't even keep track of how many I've seen emerging, disappearing, reshaping. And this because in the different regions of the world, we have a very different level of maturity and governance, which are underpinning these mechanisms. We go from an EU-like situation with all the defects that we know to a situation like the Americas, where every other day we have something new popping up. And when we talk to the countries, the answer is always, ah, we have to have a sub-regional approach, a regional approach. And then I say, but how do you characterize a sub-regional approach in terms of preparedness and response, radio silence? Then we are in this situation where we are dealing the fact of primarily with political entities and these political entities that in terms of crisis, they step into technical ground and as an organization, we are interacting on technical issues with political entities. And we are in the situation of substitutions. We end up in competing for resources. And it's really, really hard to understand where the complementarity between multilateralism and sub-regional entities is, at least in this region of the Americas. In Europe, I can see the role of the EU, the type of the interaction that the EU has in Africa. I can see that there is a unique technical institution like the African CDC under the African Union that has a certain role. But here in this region of the Americas with all this Pan-Americanism, paradoxically, we have all these bits and pieces, these mosaics of changing institutions. And it's really, really hard. And I've been here in this region 10 years, basically. And at the end, I've always been with this wall of radio silence. What does it mean? And having to sort of stepping in. In terms of regional approach, yes, we have all learned the hard way, as Agnes and Obie said. I think a good, we can call it like that, outcome of this crisis is that now countries in the Americas, the Central and South Americas and the Caribbean, they are engaging into a long medium, long-term process to establish the manufacturing capacity for vaccines and other medical supplies. And it's not the first time that there is this attempt of self-sufficiency, establishing self-sufficiency. Let's see how it goes. But at least this seems a solid step forward with solid foundation. I can only keep my fingers crossed. Thank you. Over. Thank you very much. I think indeed that there is, there is on the one hand a good case that can be made indeed for this regional approaches. When the issue is cross-border, is about communicable diseases, is related to the mobility of people. I think there is a good case to be made for regional action. Also, what Agnes also mentioned also at the level of the production of medicines, vaccines in this case, infrastructures and so on. I think there is also a good case to be made from a normative perspective. But I also agree with Roberta, of course, that the reality of regional institutions is very different from one region to the other. And in some cases there is indeed a sort of natural leadership that exists at the level of one relatively or strong regional institution. Whereas in other regions there is, it's not the case. There are overlapping organizations with overlapping mandates, which are, as you say, often in addition, rather political than technical. And so, which of course makes it much more complex. And also then from your perspective and the paho, in your case, I think it must be a challenge indeed also then to engage with these organizations. So no, thank you very much for your insights. I'm watching my clock again. And unfortunately, I think we have come to the end of this session already. It's a pity. I think we could go on for another hour. But I think the final session is immediately following this one. So what we could do and we will talk with Anna about this, what we could do is try to draw some conclusions from this session and perhaps put it in writing also so that people who are not able to attend this session could also, let's say, have an idea of, let's say, the conclusions and then the ideas that were circulated here. I don't know whether Anna, you want to add something at this point? Well, I just want to thank our speakers and the audience as well. I think when we organize this, we suspected we would have a very rich discussion. And as you say, we could have kept going. But my final thoughts are really discussing the complexity of global health governance, the inequities that have been uncovered by COVID-19, and also the differences between regions in terms of how regional organizations, the work takes place and the difficulties of trying these collective actions within regions. I just want to thank everyone again and we will be in touch. I hope we can at least draft the main conclusions from this panel together or organize another and we can continue this discussion. Bye-bye. Thank you very much.