 Thank you so much for joining us today. My name is Jessamy Baganal and I'm an executive editor at The Lancet. I'll be moderating our time together today. It has been 918 days since WHO declared a global pandemic and estimated 17.7 million lives have been lost. Scopus, the abstract incitation database brings up 363,450 document results on COVID-19. There have been several high-level and excellent reports on the pandemic that have come before this commission with tangible and important results. But we face an era of compounding crisis, climate, economic, health, conflict. And behind these cold statistics, individual lives are lost and ruined. And despite the monumental efforts by so many, we still don't fully understand what went wrong and how we can prevent the same mistakes from happening again. Far from diverting our attention away from COVID-19, other crises should make it clear that without a comprehensive understanding of how we dealt with the pandemic, we as a global and interdependent species are vulnerable to any global threat. The moral philosopher, William MacAskill, in his book, What We Ode the Future, suggests that during and after such periods of upheaval, there is a time of plasticity before values and ways that society's approach to problem sets into rigidity. We remain in a period of pandemic plasticity. Things could stay the same. They could get better or they could get worse. But tipping the counter in either direction is easier to do now rather than further down the line. That doesn't mean that the pandemic is over, but that the commission represents the best opportunity to insist that we redefine a global architecture and way of doing things that we surely owe future generations. We've had the very great pleasure of working with this astounding group of experts over the last two and a bit years. We have an esteemed and exciting packed agenda to get through. So with that, it is my great honour to introduce Professor Geoffrey Sacks, chair of the Lancet COVID-19 Commission, world-renowned economist, director of the Center for Sustainable Development at Columbia University and an environmental leader. Geoff, the floor is yours. Geoff, you're on mute. You'd think three years into this, I would not speak on mute, but I was thanking all of the co-commissioners and especially the director general of WHO. It's a great honour to have Dr. Tedros with us today for the launch of this report. I want to give special thanks to Richard Horton, the editor of the Lancet, who is one of the most dynamic and forward-looking global leaders, not only in public health, but in public policy generally. The Lancet has hosted a series of commissions over the years on crucial issues of public health and public policy, and they've been a splendid and extraordinarily important set of contributions. So when Richard Horton invited me to become chair of a new commission on COVID-19, I was greatly honoured and also knew that we had a very high bar to reach because of the excellence of Lancet commissions over the years. But we were able to do that, I believe, because of the outstanding commissioners on this commission and the very hard work that they put into this. Everybody volunteered their time. Everybody served in an individual, not an institutional capacity. In addition to the commission members themselves, we had 10 task forces, each with roughly 10 to 15 members from around the world. And so this is a large group world representative and with expertise across many different parts of society, from politics to public health to fiscal policy and beyond. And it's been an enormous privilege and honour for me personally to be able to play a part in this effort. As Jessamy has just said, we have to regard what has happened, not only as a great tragedy, but also as a failure, because there are 18 million dead so far and still thousands dying every day worldwide of this pandemic. And we really need to understand this. That's a lot of deaths and behind it is, of course, a much, much larger number of infections, obviously, and a lot of long COVID as well and a lot of disruption in the world and a lot of anxiety and a lot of depression and mental health and a lot of people trapped in isolation or other harms from the disease and a lot of increased poverty and hunger. This has been a profound disruption to the world at enormous cost, but we argue it didn't have to be that way. Our main argument is that a pandemic requires cooperation at all scales. We use the term pro-sociality. It means behaving well with others, cooperating with others. It can mean at the most individual and local level not infecting or risking the infection of your family members and your loved ones and your co-workers in an office. It can mean at the political level not treating a pandemic as a partisan issue and a divisive issue politically, but as an issue that requires the best knowledge and best practices to address and cooperation geopolitically, which means the way that nation states their governments in essence, do or do not cooperate with others. The basic point of an infectious disease is that it spreads and therefore individuals create conditions of risk for others unless they take precaution. Wearing a face mask should not be a left-right issue or a divisive issue in society. It should be a prudential issue and a matter of basic decency when the underlying epidemiology calls for it. Cooperation across countries is a sine qua non of a pandemic. A pandemic means a disease that is spreading and transmitting around the world so that it means countries need to cooperate with each other on trade and travel and exchange of information and best practices and sharing tools, whether it's protective equipment or whether it is drugs or oxygen or later on vaccines. That requires cooperation and because we live in a world of enormous inequality where the gaps in income can be a thousand to one. Poor people, vulnerable people need help. A pandemic is not an occasion to leave people to die because they're poor or they don't have access to resources. It is a case for solidarity as well. So cooperation is both about efficiency that is stopping a pandemic at lowest cost and it is about justice and ensuring that vulnerable populations, whether it is older people, people with pre-existing health conditions, poor people, people living in congregate settings, including prisons, for example, or worker hostels, or women trapped in violence in their home situation or people that suffer from mental health conditions that are exacerbated by a pandemic and don't have a strong voice in society are not just thrown by the wayside by a pandemic but we have found in our work in the last two years these conditions of pro-sociality were not carried out by and large. Of course there were heroics on many levels but we have seen a pandemic handled basically nation by nation not with adequate global cooperation. We have seen a pandemic handled often by the whims of particular political leaders or by their election cycle or by what they happen to believe or what they were told by their own advisor or by their own imagination rather than systematic cooperative practice. Now, in all of this has stood a structure that was set up in 1948 that is part of the United Nations multilateral system that we depend on for our lives and survival and that is the World Health Organization and WHO has played an indispensable role and it plays an indispensable role in our world. It is vital for our survival and for our health and I want to pay tribute to Dr. Tedros and his leadership during this period because it has been exemplary but it has faced terrible challenges because WHO got caught up in geopolitics it got caught up in great power competition it faced limits when vaccines went to those who could pay the most not those who needed them the most because the vaccine rollout was organized more along market lines as if this was just another normal commodity rather than along efficient and justice lines to ensure adequate coverage. WHO called for every society to reach at least 70% vaccine coverage but that would require a tremendous level of global cooperation that has not occurred even the vaccine producing countries don't speak to each other properly because the US doesn't speak properly to China or to Russia or to others so we don't even have cooperation among the regions that produce the vaccines much less the cooperation needed to ensure that the vaccines reach those regions that don't produce them and especially the poorest regions our report is divided into our findings which I've summarized at a very high level and a set of specific recommendations let me just conclude these opening remarks with a few more precise statements about our findings and then some statements of the specific recommendations that we make on the findings a starting point which is very important actually is that until today we do not know where SARS-CoV-2 the virus that causes this pandemic came from. Some scientists surmise that it came from a marketplace many scientists are worried that it came out of a laboratory through work that was underway on SARS-like viruses or Sarbacoviruses as they're technically called both hypotheses are viable neither has been disproved there is no decisive dispositive evidence despite what you might have read there's no proof that this came out of a marketplace or out of natural spillover because the laboratory hypothesis is absolutely viable and that is one of the conclusions of this report that we just don't know what I can tell you in two years of looking at this is that there was a lot of dangerous laboratory research underway that was hidden from view and until today some of the responsible agencies like the U.S. National Institutes of Health are not transparent even when the lawsuits demand that they release information the information is redacted so we don't even know what they're releasing they release blank pages rather than actual pages so this is one of our conclusions that till today we do not know where this pathogen came from as I mentioned the rest of the conclusions are we had much too much loss of life because the transmission was not controlled the most effective region at control was what WHO calls the WIPRO region the Western Pacific region or sometimes we call it the Asia Pacific region basically East Asia and Oceania it is in China, Taiwan, Hong Kong, Korea Japan, Australia, New Zealand Vietnam, Cambodia and others where transmission was lower death rates were lower even when we include the estimates of the under reported or unreported cases why is this? I think the best answer is the experience with SARS because that taught a lot of lessons to the region wear face masks physical distancing don't politicize this take it lightly so as soon as this outbreak was known in East Asia they were afraid all over the region whereas in my own country in the United States President Trump said nothing to worry about but in East Asia they had lived through SARS and I think that that historical memory and the institutionalization of preparedness through WHO regional processes was extraordinarily helpful and the WIPRO part of WHO did a wonderful job already 15 years ago in preparing a preparedness strategy because of SARS and then because of other epidemics that arose in the region whereas in the United States and Europe which were at the top of everybody's list of preparedness fell completely short when the epidemic actually arose they didn't know what to do and they didn't have test kits they didn't have PPE they didn't know how to respond and some of the politicians like Trump said just keep everything going pretend it's not there and so we had a lot of terrible outcomes let me turn to the recommendations in short and to conclude my brief overview first we believe that this pandemic continues to demand attention this is not a retrospective we are still in the midst of the pandemic it is coming down in lethality perhaps because of the changes of the variants themselves certainly because of the increased uptake of vaccination and immunization perhaps because of the natural immunity from earlier infections but the threats remain new variants arise there are still major risks so we call for a vaccine plus strategy going forward which means continue the efforts for comprehensive vaccine coverage don't put those aside don't drop them don't forget them but accomplish them and continue with the so-called non-pharmaceutical interventions as appropriate face masks yes that is not a deprivation of liberty that is a simple standard prudential measure of public health so that's the first point we're not out of this and we need this effort second we still need to find out where this virus came from both the natural and the laboratory creation hypotheses are in play both need investigation we call on all governments including the US and China and others to open the books I know that the United States which I follow closely has not opened the books but it was funding dangerous research maybe incidental that has nothing to do with the emergence of the virus but maybe it did and yet we're seeing redactions we are not seeing the real story yet and there's a narrative that we already know it came from a marketplace this narrative is not correct according to our commission not that it's wrong but that it's not proved it is one of two hypotheses and we need to investigate both of them there has been no animal tested positive that proves the market hypothesis there's no explanation for the particular genomic character of this virus technically the presence of a furan cleavage site that explains it's very high transmissibility but the laboratory research was aiming even the insertion of that dangerous part of the genome so we need to know more and we need transparency from NIH and from China from others in order to get to the bottom of this the third point is we need to prepare for two kinds of future pandemics to stop them first we don't want laboratory created pandemics and yet there is a lot of hidden dangerous research underway and it needs to be regulated and supervised and I'm sorry to put even more burden on our dear director general of WHO but we need WHO to oversee the biosafety because we don't have any global oversight of biosafety right now and I can tell you surely whatever the origin of this virus there is a lot of hidden dangerous work underway that is not properly controlled and we need to get it we need to know what's happening and to monitor it and to make sure that it is being safely and properly done and that's not the case right now then we recommend several steps for strengthening WHO WHO is the cornerstone of our global health safety and it was made for a reason back in 1948 it has done around the clock very difficult work including in the most recent hours as I've been hearing in this but we need WHO to have a proper budget a full budget an adequate budget we need it to have the backing of political leaders we need it to have the backing of the global scientific community we need it to have the powers to investigate as necessary we can't let it get caught in geopolitical conflict between the US and China or anyone else it needs strong global backing and I think that this is the main message of our report we want an absolutely strong WHO we have strong leadership but we need to back the strong leadership and finally we need financing to meet the urgent needs of vulnerable populations especially poor people around the world I'm going to finish right now we live in a world of vast inequality as I have emphasized but justice is that everybody has the right to life and the right to health and we've also recognized that since the Universal Declaration of Human Rights and the Constitution of WHO itself so we call for a global health fund based in Geneva working alongside WHO of tens of billions of dollars not a trickle but tens of billions of dollars roughly 0.1 of 1% of the rich world income that's absolutely manageable so that we have the funding to ensure health systems that function everywhere in the world thank you very much thank you again to Richard Horton and to the Lancet for the great honor of chairing this commission I think we're now going to move to the Director General is that correct? that is correct and I think I was supposed to say that I think so Jess that's alright thank you very much so Tedros thank you so much for being with us thank you for your extraordinary work of this whole period I'm sure that when you started at WHO you would not have imagined in that position during the worst global health crisis in more than a century but you are and you've been bold and brave and forthright and I only wish you had all the support at every step of the way that you've needed let me turn it over to you thank you Jeff much gratitude Professor Jeffrey Sacks Dr. Jessamy Begana dear colleagues and friends thank you for the opportunity to share a few reflections on the Lancet COVID-19 Commission's final report I thank Professor Sacks the commissioners the task forces and the commission secretariat at Columbia University for their work I also thank the Lancet Dr. Begana and my friend Richard for initiating this commission almost five years ago to that day I delivered one of my first major speech as Director General at the Columbia University in New York at your invitation Jeff and used to be worried even before the pandemic this pandemic hit my team that day was the threat of pandemics I saved that a century since the 1918 influenza pandemic a devastating epidemic could start in any country at any time and kill millions of people because the world was unprepared and I know Jeff you remember this very well because you were the one who organized the meeting the COVID-19 pandemic has demonstrated just how unprepared we are we thank the commission for its work and we welcome its key recommendations for global coordination to end the pandemic continued work to understand its origins a new pandemic accord and strengthen international health regulations enhanced surveillance more research development and local production of counter measures stronger health systems built on public health and universal health coverage enhanced national pandemic preparedness plans increased financing for pandemic preparedness as you outlined it very clearly Jeff and a stronger and more sustainably financed WHO we appreciate the commission's warning about creating new centers of policy and finance that would compete with or even undermine the central role of WHO Jeff as we discussed last week we do have significant concerns about omissions and factual errors in the commission's report as it relates to WHO's performance we will send as we agreed the commission a written response on these issues but rather than focusing on those issues today I would prefer to focus on the commission's recommendations and how they can help us all to work together for a safer future the commission's recommendations are largely aligned with those of other reviews that have been conducted over the past two years including those commissioned by WHO and we hope we are happy that it's aligned more than 300 recommendations have been funded across those reviews which WHO has collated in an online dashboard building on these reviews and recommendations and at the request of our member states WHO earlier this year published a white paper with 10 key proposals for building a stronger architecture for health emergency preparedness and response the proposals include actions for stronger governance stronger financing stronger systems and tools and a stronger WHO under the umbrella of a new pandemic accord most of these proposals reflect the Lancet commission's recommendations and most are already being acted on WHO member states have been negotiating a new international instrument for several months and are also discussing proposed amendments to the international health regulations just last week a new financial intermediary fund for pandemic prevention, preparedness and response was established at the World Bank to provide catalytic and gap-feeling financing with technical leadership from WHO to enhance global surveillance last year we established the WHO hub for epidemic and pandemic intelligence in Berlin to support enhanced local vaccine production we established the mRNA technology transfer hub in South Africa which is now sharing technology with 15 country recipients to foster increased sharing of biological samples we established the WHO bio hub in Switzerland we established the scientific advisory group for the origins of novel pathogens to establish a framework to study the emergence of new viruses although the progress is as you know slow and to foster enhanced national preparedness and trust between nations we have developed the universal health preparedness review a new peer review mechanism which is now being piloted in four countries we count on the Lancet commission's support for all of these initiatives which are closely aligned with your recommendations in particular we seek your support and advocacy to ensure the successful negotiation of a strong legally binding pandemic accord that truly serves the interests of all countries and all people and the world recovers and rebuilds from COVID-19 we also seek your support to advocate for the centrality of health in development especially for universal health coverage based on strong primary health care there is no dispute that the pandemic has told all of us very painful lessons and very tragic and that the biggest failure would be not to learn those lessons as you say it Jeff WHO will continue to listen to learn and work with our member states and partners to strengthen the world's differences against epidemics and pandemics so that a century from now no one can say the world is unprepared thank you and back to you Jeff thank you so much for your words you can count on us to be part of this debate advocating for a strong agreement and strong financing and we will be with you on that to help to propose and implement the recommendations in this report and most grateful for your presence today and I will turn it back over to you, Jesse thank you so much Jeff and thank you so much to the director general for making time to speak to us today for your reflections and your continued exemplary leadership we'll now have some brief remarks from Miss Gabriela Ramos the director general for social and human sciences at UNESCO and co-chair of the regional task force for Latin America and the Caribbean and a member of the humanitarian relief social protection and vulnerable group task force Miss Ramos over to you thank you so much and thank you Jeff for this fantastic leadership that you exert on all of us every week almost met to discuss the issues thank you again for your leadership as has been said by the people that preceded me this report of course has a lot of insights in terms of what we believe went wrong but that's not the emphasis the emphasis is what we learn from it and what we do with this information and therefore let me just focus on three issues that I believe are really important if we want to be better prepared for the years to come there are many examples of good outcomes in the multilateral system the centrality of the WHO I know that there are these other initiatives that are springing around but we are conscious that there is only one international organization really in charge of health in UNESCO we were proud by the global coalition on education and we were also proud by the recommendation on ethics of artificial intelligence so there are good news in terms of the multilateral system there are also black and whites black and whites as Jeff said in terms of vaccines discovering the vaccine in one year time international collaboration financing, public financing, private engagement one year when we know it takes eight years or more to discover vaccines and deploy them sharing the vaccine access to the vaccine solidarity to the vaccine I think this is the worst case scenario I don't know how we would not activate the waiver of the WTO to allow for countries particularly in the Latin American region where I had the task force that were very capable of producing more vaccines if they were given access to the property rights and I have to say that this was produced with a lot of financing for the public sector we should have had more fairness and justice and the distribution of vaccines the other part is the question of the uneven impact and I think this is really important and I think it is important that we have the resources to counter the legacies of the crisis to be prepared but we still have to deal with the legacies of the crisis and we know that inequalities were high but they just skyrocketed we know that global billionaire wealth increased by more than 50% when we have 100 or more million people falling into poverty so this focus is really important when we go forward in building a more sustainable world and for this investment in health universal health care we have said this many times no time to waste this is an investment we saw it but it's also an investment to have social protection systems the countries that have this protection system to activate were able also to weigh the pandemic from the perspective of the health crisis that from the economic policy and the policymakers from the economic field that are listening to us no more efficiency at the center there is efficiency equity sustainability and there we need to really have these investments and have the governments also with the capacities to do they need to do they are called always when there is a crisis and then they are told you intervene when there is a market failure well this was the market failure of the biggest size ever and I think we need to learn the lesson and the capacities the question of essential workers again women the care economy on paid work all these things are essential and we saw how important they were to keep our economy going but they are not when it gets into the quality of the jobs or the conditions of work in which they exert their issues I think that the recovery needs to have a very strong gender lens because it has a very unique impact with women there is another point that I would like to raise and it might sound self-serving Dr. and Jeff because I'm heading the social and human science sector in UNESCO but the importance of science again investing in science investing in social and human science this is very important and core to the report and again we saw this economy where members were really just looking at science but some leadership were completely neglecting science one step forward and say that we need multidisciplinarity the committees that handled the pandemics probably the epidemiologists and the economies were overrepresented and then we were protecting the health of the body and the consumer and producers but we need to understand humans in the whole interrelationship in the social being in their needs in their aspiration and I feel that social and human sciences would have helped a lot with the investment again in these areas that are so important the report is super rich but I just want to say thank you Mr. Tedros we all saw you every week we all follow you every week and thank you Jeff it has been a fantastic journey to join you in this impressive event thank you to the Lancet commission thank you Gabriella for those fantastic remarks and for all of your help and work on this commission I think we'll now move on to session one about the key impacts and learnings from the first two years of COVID-19 Professor Srinath Reddy president of the public health foundation of India and a key member of the task force on public health measures to suppress the pandemic and regional task force for India will take us through the epidemiology of COVID-19 Srinath the floor is yours thank you very much and greetings of the day whichever time zone people are in in epidemiology we consider the relationship between the agent host and the environment this report too describes the dynamics of their interaction during various stages of the COVID-19 pandemic the agent was a novel virus which was permitted to travel extensively and mutate frequently to become more infected and immunovirus with the whole of humanity being susceptible it could be quite virulent in the initial stages to extract a high toll in terms of severe disease and death the R0 of the reproduction factor the reproduction number varied with human permissiveness to transmission and the biology of the virus and its variants the human dynasty of variants now seems well established but a vigil still needs to be maintained the virus which emerged from the bats in the caves of Wuhan infected humans to pathways that are yet to be fully ascertained it commenced its human to human transmission aided by human behaviors that permitted easy access to many susceptible persons it traveled with people and celebrated with the crowds super spreader events enable surges in infections within countries while unrestricted travel permitted rapid international spread variants emerged with ease when the virus had an opportunity to stay long in the bodies of immunocompromised or immunodeficient persons this was enabled by vaccine iniquity when under vaccinated populations generated new variants which then circled back to vaccine rich countries to initiate fresh waves of infection the host consisted of all humans in terms of susceptibility but elderly persons even younger persons with immunodeficiency or serious comorbidities frontline workers definitively exposed to high doses of the virus like health workers were particularly vulnerable persons living in close confinement were also very vulnerable and failure to provide adequate and timely protection to all of these groups led to many avertable deaths while immunity acquired from vaccines and natural infection was protective against serious illness it did not last long the seductive appeal of herd immunity was a misleading mirage and as has been pointed out by the earlier remarks the behavior of human beings whether individually or in groups played a very important role in the transmission and the level of protection and countries which had the experiential wisdom of handling prior pandemics like for example the western pacific and southeast Asian countries handled it much better based on their experience and we recognize that the transmission which was substantially through aerosols was not initially prevented adequately through advocacy of masks for which there was considerable amount of confusion in messaging and hesitancy in use in different parts of the world and that too escalated the pandemic the environment was viewed through five dimensions the natural environment the built environment the social environment the technical environment and the political environment in terms of the natural environment the ecological barriers which offer natural protection against zoonotic transmission were breached to enable the SARS-CoV-2 virus to emerge and then spread also the built environment we have seen very clearly that lack of adequate emphasis on ventilation and air filtration also cost us much in terms of serious illness and lights which could have been averted if the messaging was appropriate right from the very beginning even the usage of masks for personal protection against aerosol transmission was not adequately emphasized we recognize as far as the social environment is concerned that lack of social solidarity prevented the adoption of much needed pro-social behaviors which are needed to prevent human-to-human viral transmission this of course varied across countries and that was reflected in the figures of infectivity and the height of the surges that happened in terms of the technical environment we have seen data gaps, reluctance to share data, affecting a proper appraisal of the pandemic and also not permitting adequate measures for preventing international transmission we have also seen patent protected proprietary science making a major barrier for access to technologies or affordability of those technologies and that again is an important constraint that we identified in terms of the political environment that revealed policy vacillation as well as permissive attitude to fake news and partisan politics which trumped science no pun intended and indeed I believe it is absolutely important that we recognize that all of these factors play a major role in the initiation and the further escalation of a pandemic if we are to prevent one in the future or respond to it with alacrity and efficiency thank you very much thank you so much Rhea those are some excellent points and a fantastic round up of the last couple of years we'll move on to the financial and economic implications of the pandemic response and I will now address the director of the fiscal affairs department at the international monetary fund and co-chair of the fiscal policy and financial markets task force please take us away thanks so much Jessamy this is a joint work of the task force that I had the honour to co-chair with the Felipe and so I will be talking to you about the pandemic and finance the COVID-19 pandemic took the form of a health and humanitarian crisis in the spring of 2020 severe lockdowns were imposed in many countries and the global economy and finance were suddenly and violently disrupted in 2020 global output in 2020 fell by 5% in the spring it looked like the global economy and markets were falling off of cliff governments and central banks worldwide reacted promptly and forcefully to restore orderly conditions in financial markets and to protect vulnerable households and firms losses were initially larger in those economies that implemented the strictest lockdowns but ultimately were determined by the access to financial buffers and credit and you see that on the slide that looks at advanced economies and emerging and emerging market and developing economies the difference in access to finance is what we call the great financing divide high income countries were able to draw from domestic and international markets to finance increased government outlays at historically low interest rates in the same way that the advanced economies led the contractions they led the recovery and you see the V shaped recovery on the chart on the left hand side in gray below the horizontal axis that is measured in deviations from pre-pandemic projections the advanced economies responses at the desired impact and aggregate demand bounced back strongly however you see in the chart that the same is not true for emerging market and developing economies because these economies could not provide as ample support to lack of sufficient fiscal buffers and less access to credit markets for them recovery prospects are less optimistic and scarring is expected to be significant please look at the charts and note that the gray line stays below the horizontal axis and at the end of the period 2024 there is no convergence in sight but let's look at the poorest countries the low-income developing countries that are expected to remain in terms of their fiscal revenues between 1-2% of GDP below their pre-pandemic levels so despite the fact that there is a reduction in spending levels the primary deficits are still to be above pre-pandemic levels and where are we today the lack of preparation that has been the lack of preparation for pandemic events that has been emphasized by previous speakers led to a very strong economic and financial response which was crucial to prevent a deeper and long lasting global recession but eventually led to inflationary pressures inflation in advanced economies has now reached levels not seen in a generation and you have the chart on the left hand side but the level of inflation in emerging and developing economies is even higher now many governments are using fiscal policy to provide support to households and firms and that is very welcome but such support should in most cases be consistent with the continuation of the process of tightening fiscal policy on the policy recommendations we very much focus the importance of addressing financing financial challenges and debt risks and the importance to have a multilateral cooperative approach to debt problems we emphasize the link between the prevention management of pandemics and the need for action on climate and more generally we make a very important link between the problematic of the pandemic prevention and management with sustainable development but that is something that Thebi Konduri is going to be covering in her own intervention so Jessamy, I stop now Thank you so much Vitor and thank you for that foreshadowing of our next session it's crucial information there as the world grapples with the economic upheavals of the pandemic ok next, Miss Gabriela Cuevas honorary president of the Inter-parliamentary Union and former senator in the Mexican Congress she was the co-chair of the Humanitarian Relief Social Protection Group Task Force and a member of the Global Health Diplomacy and Cooperation Task Force Miss Cuevas will be discussing the socio-economic and other implications for populations experiencing vulnerability Miss Cuevas over to you Thank you, thank you very much Jessamy The COVID-19 pandemic has so far taken an estimated 18 million lives so many of them could have been saved with their right and timely answers and the political will and necessary resources to back them up I would like to recognize Dr. Sack's leadership and the Lancet's commitment to this cause while countries close their borders and refuse to cooperate the Lancet and Jess inspired us to innovate and create a set of recommendations focused on rebuilding a truly inclusive and sustainable world I would like to thank Dr. Tedros for being here with us because we have been talking about health but we need Dr. Cho at the table countries failed at many levels multilateralism didn't have a plan national governments in many cases decided to play national politics irresponsibly private companies maximized their profits and instead of creating vaccines as a public good third-term public funds into wealth for a few hands the pandemic has had a highly unequal impact global and national decisions didn't consider the less vocal voices of our communities the ones who do not vote like immigrants and refugees or who do not have the energy to raise their concerns like our elders people that were too busy taking care of us as the essential health workers and women that were at the frontline fighting the virus without professional equipment communities that never received precise information in their languages including indigenous people not having documents doesn't mean not having human rights vulnerabilities increased the risk and painful consequences of COVID-19 in children women low income people and communities unemployed persons those who live in congregate settings people living with chronic conditions and disability displaced populations and the people without access to quality and affordable health care these people need to be engaged in formal social participation mechanism so that they can be part of future solutions the report gives key recommendations at global regional national community and individual levels and let me add that we created the last force especially dedicated to people under vulnerable circumstances that identified a host of more specific and precise recommendations for urgent action overall we underlined the importance of building social protection systems and to warranty universal health coverage for all but how do we transform these recommendations so that they become reality for all people in our planet especially for the most vulnerable ones multilateralism needs to be transformed in particular, WHO has to be strengthened well funded and imparted with institutional mechanism to give full transparency to member states and the public multilateralism has to set a table for countries to share real information and best practices and to encourage cooperation and communication next year United Nations will host a high level meeting on universal health coverage as a movement where countries have the opportunity to evaluate their progress on this regard we have to keep in mind and in our hearts that health is a human right not a privilege universal health coverage is a key element of the SDGs without health it is less likely that we can achieve other SDGs at the national level on the one side countries should strengthen national health systems on the foundations of public health and universal health coverage grounded in human rights and gender equality but at the same time policies must consider that the pandemic have a tremendous effect in vulnerable populations that require specific policies for example we have to consider the psychological distress that it created in children fatality rates have been at least higher in people older than 65 years than those younger than 40 people with comorbid medical conditions were disproportionately affected national governments are responsible for creating the social protection systems and strengthening health systems in order to warranty that the individual access to money won't decide who lives and who dies the perspective of gender has to be considered in all processes and decisions women make up 70% of the total health care and workforce and it is not enough that we are not properly considered a decision making level such as participation at the World Health Assembly while thousands of women and girls were forced by the pandemic to be trapped in violent homes vulnerabilities were there before the COVID-19 pandemic appeared but this pandemic exacerbated many of them your Exit 2030 always says that implementing universal health coverage is a political choice this report shows that fighting inequality and vulnerabilities is a political decision as well and one that needs to be addressed to be able to ensure that no one truly is left behind so let me conclude these brief remarks by reverting to where I started today we do know what the right answers are what is required is to put them into practice and for that we need political will and they require your resources thank you very much chef thank you very much to the Lancet it has been a wonderful opportunity to work together thank you Gabriella for those great remarks and the laying out how the pandemic did not impact all people equally and it's on a light on many of the weaknesses that were entrenched in our societies and systems already now we'll move on to session two looking at global and national governance for future health threats Miss Maria Fernanda Espinosa is the former president of the UNGA and former minister of foreign affairs and defence in Ecuador she was co-chair of the global health diplomacy and cooperation task force and a member of the regional task force for Latin America Miss Espinosa will be talking about global health governance thank you Miss Espinosa thank you thank you and thank you Jeff for your amazing leadership I think that I don't know what to say because most of the recommendations have a governance edge to them but I have to say that it's so encouraging to hear the good news from Dr. Tedros on what have been the responses to these more than 300 recommendations from different panels and commissions but I think we all agree that many of the shortfalls of the response to the COVID pandemic were governance related in a way where health diplomacy related because and mechanisms were unprepared under funded with lack of clarity in the chain of command both at the national but also at the international level so the example that has been shared over and over again the issue of the vaccine manufacturing in a record level and access and deployment shortages so that's part of the lessons learned of the pandemic so the commission developed a series of recommendations directed to different levels of government and decision makers and we know and we have repeated that endless times that a health emergency requires a strong concerted global action and responses there is sort of a to-do list for local governments, for national governments, for civil society, the scientific community, the private sector every individual has a role to play when facing a health emergency in many places civil society organizations and local governments where the health service providers and therefore should have a key role in this rethinking and redesign of health systems at the national level for the sake of time and considering that WHO should be as we have said the global authority and lead emergency response actor in times of a pandemic I will share perhaps three recommendations again I would like to commend the leadership and efforts of Dr. Tedros in very turbulent waters I would say in very difficult times and number one the authority and power of WHO I think we have said a lot about that the need to boost the authority of WHO the commission has proposed basically three main issues and number one to build up the World Health Assembly with a special segment that brings together ministers of health together with ministers of finance every year to establish a higher layer at WHO Global Health Board composed of the six WHO regions represented by heads of state on a rotating basis this board is called to meet at least once a year the number three is the science part how to strengthen the science council of WHO to become something similar to the IPCC for climate that produces knowledge and analysis on a pandemic prevention preparedness and response every year these annual reports should include findings from the Global Preparedness Monitoring Board for review and adoption by the World Health Assembly the second cluster of recommendations is on the finance of course Jeff and others have mentioned the need for a new global health financial architecture so I think it's clear that the pandemic magnified the financial deficits of the whole UN system in terms of the humanitarian and rapid response funding including let's recall the underfunding of the COVAX facility especially during the first year of its operation there has been however promising developments such as the increase in the WHO core funding from around the million by 50% to 1.5 billion we hope that in times of emergency WHO will have the flexibility to use the resources where they are most needed but as we know these 1.1 billion are still highly insufficient we are very pleased to know that only last week the very fund for pandemic prevention, preparedness and response was established under the during the governing board meeting of the World Bank the commission recommends the creation of a global health fund that would combine and expand the operations of several existing illness specific health funds and add new resources basically for three windows of financing, commodities for disease control, pandemic preparedness and response and the strengthening of the primary health care system especially in low and middle income countries so these funds should have a holistic rather than a fragmented vision illness specific and should place health systems and country ownership at the center let's hope that these specific recommendations contained in the report will be considered in setting up this new intermediary fund the cluster three of the recommendations are regarding coordination and delivering as one within the UN I think that we all agree that UN interagency close cooperation was tested during the pandemic including the new UN resident coordinator structure at the national level so we I think we have discussed this over and over again that in times of a health crisis WHO should have preeminence and articulate the work of the humanitarian pillar the development and the human rights pillar of the organization and they should be connected to a strong role of the global trade and finance multilateral scaffold as well and that includes of course global and regional banks we basically saw learning by doing adaptive working methods and we should draw the lessons from that experience and here I would like to praise an initiative that should bring together more agencies and programs Dr. Tedros it is the partnership using the concept of one health under which UNEP WHO and the world organization for animal health have come together to work on the health models as closely closely linked and interdependent that's a very good model to pursue and we also of course support as a commission the activation of the global emergency platform UN system wide mechanism called by the UN secretary general in his our common agenda report. In closing we strongly support the new international treaty on pandemics that has been developed the concern is that the negotiation will only start in 2024 the question here is a way Dr. Tedros to fast track the process we need to address currently the inadequacies and upgrade the international health regulations we believe and in conclusions in conclusion I think we have all said that we need a strong beneficial multilateral system to respond to health emergencies but more broadly to tackle global crisis. We hope as Gabriella has mentioned that the 2023 twin summits of universal health coverage and pandemics will really make the difference and provide the space for a more ambitious action oriented in greater commitment from governments in all actors that are part of an improved and upgraded global health architecture so we're firmly convinced that efforts to retool the global health governance architecture should be strongly connected to the process the implementation of our common agenda report including of course a new model not only for WHO but for the UN as a whole. Thank you and back to you Jessie. Thank you Maria for highlighting that foundational nature of governance to all aspects of health and how the commission extended it into its recommendations. I was just going to interrupt you there anyway so we could move on but that was perfect timing. Next Dr Phoebe Konduri is Professor of Sustainable Development Economics and Econometrics at the School of Economics Athens University and is the elected president of the European Association of Environmental Neutral Resource Economists. She was the chair of the Green Recovery Task Force and member of the fiscal policy and financial markets task force. Professor Konduri will be talking to us about how we achieve the Sustainable Development Goals and ensure a green and inclusive recovery. Over to you Professor Konduri. Thank you very much. Thank you for the opportunity to be part of this very important report. Thank you Jeff for your leadership and this was an amazing journey for all of us I believe. This Green Recovery Task Force was co-chair by Ismael Dragondin and myself and was supported by a very big number of commissioners and very important scientists in the environmental economics, natural resource economics and sustainability spectrum and what we tried to do is to showcase how we can move away from the multiple crisis that we are facing first and foremost COVID which was the central axis of our work but combining these crises with the recession and inflation as Vitor Gaspar from IMF already explained the climate crisis, the biodiversity collapse and now the war in Ukraine leading to food emergency, energy emergency and of course the overall big issue of inequality across the world. And what we have as a blueprint to simultaneously face all these multiple crisis is our sustainable development goals, 17 goals 169 targets that showcase how we can escape these multiple crisis. So with the agenda 2030 with the sustainable goals, the Paris agreement and then downscaling this global agenda into continental agendas, for example I'm referring to the European Green Deal launched in 2019 and then right after COVID we had the recovery and resilience plans 750 billion in addition to the European multi-financial framework which was focused on the green and digital recovery from COVID and major success in Europe to continue the framework to function within the framework of European Green Deal even after the huge non-linearity of COVID 2021 we had policies like EU taxonomy that streamline capital to sustainable investments and fit for 55 reform of the regulatory and tax framework of Europe in order to become consistent with the climate neutrality target of 2050 of the European Green Deal and 2022 of course all this energy to face the energy crisis and to get independence from Russian fuels. Now what we try to do is to show that within this framework of course and the widespread global failures in the COVID-19 response which were highlighted in many of the presentations and Jeff's presentation of course these failures reverse the progress made towards the UN SDGs and the progress towards the UN SDGs which is our sustainability progress are documented every year in the amazing report of the UN SDSN which calculates every year the progress of each and every country with regards to implementing the SDGs after COVID we have stagnation we don't have progress with regards to the implementation of the SDGs and we know that there is a big funding gap in order to implement the SDGs of about 11 to 14 trillion the report our task force report calculates the funding gap and proposes that of course a global plan to finance the SDGs in need why is green recovery so important well it is important because the climate crisis and agenda 2030 urge for green recovery but also we need to make sure that we don't just need the technological green recovery on board we need the green recovery plans to be equitable and empower marginalized communities and social groups and we need the green recovery to be place-based and inclusive what is also important is that the new partnerships and innovations that emerge due to COVID should be reinforced and supported with further financing what is interesting to know is the sectors that are important for green recovery the energy sector and the need to shift from fuel space to mineral based energy production storage and distribution system culture and food sector needs to be directly linked to the environment and ecosystem the urbanization growth should be managed sustainably we should invest COVID-19 recovery packages in strengthening health systems and research and development for jail engineering should be enhanced to showcase how we analyzed the ability of our current policies to support sustainable development in terms of development that is SDG compatible let me quickly answer three questions with the machine learning approaches that we need I'm going to use the case of Europe but there are information for the other continents does the European Green Deal support the implementation of the SDG well our machine learning exercises show that it does but not holistically it is mostly focused on climate action industry innovation and infrastructure affordable clean energy responsible consumption and production decent work and economic roles and when you look into the six transformations that try to operationalize the implementation of the SDGs and all of these six transformations are important for sustainable development we see that the European Green Deal is more able supports the policies of the European Green Deal support more the transformation that has to do with sustainable production of food use of land water and oceans and supports the transformation on energy decarbonization and sustainable industry but we with regards to the transformations that are relevant to social cohesion education gender inequality health and well-being are not equally supported and this is dangerous because without social cohesion you cannot recover sustainably from COVID without social cohesion you cannot achieve any transformation the transformation is led by the engagement of a society of the stakeholders of the society so it is important to achieve this recovery in a way that is holistic enough to address all the SDGs and let me close my very brief remarks by highlighting one section of these reports that says that it is crucial to integrate in our economics decision and in our investment decisions monetize natural capital we need to understand and convey to everybody the business sector the financial sector the policy sector that any production activity uses produce capital human capital and natural capital natural capital because it's a public good a common good goes and recognize with regards to its value we created a methodology that allows you to identify natural capital across different job biographical regions monetize the willingness to pay per household per country this for the conservation of natural capital and not only that but we have proven that the countries that really have a good performance with regards to SDGs are the countries where the willingness to pay for conserving natural capital using natural capital sustainably is statistically significant it is overall significant so on this happy note saying that health environment and the economy are interlinked and they should be explicitly interlinked in all investment decisions is the way to mobilize and accelerate the implementation of the SDG and achieve a COVID recovery that is really supporting our sustainability the SDGs are an investment program and as such they should be assessed and prioritized in each and every country by taking into account all the market values but also the values that are not in the market but are very important natural capital human capital social capital thank you thank you so much VB that's fantastic we are running slightly behind time probably by about five minutes we'll now move for our final speaker in this session Dr. Miriam Wary is a Kenyan public health advocate and was a member of the public health measures to suppress the pandemic task force Dr. Wary will discuss strengthening national health systems national preparedness plans and universal healthcare Dr. Wary over to you Thank you very much indeed for this opportunity I am sometimes afraid of speaking anymore because I have been doing it for nearly 50 years talking about health challenges in Africa and hoping every decade that things will be different but not much has been different we still have the highest maternal mortality when we have an epidemic we always have a crisis that is human manageable I have come with the understanding that development of primary healthcare in Africa needs to be seen as a global challenge not just as an African challenge I have come to feel that the individuals working and there are many of them working on various issues like I have done for 50 years is not making much of a difference the individual countries doing the same may make a difference but when the new government comes there is no guarantee that that is going to continue so I am appealing to people of good will all over the world to establish Africa Health Fund or Health Africa Health Program some special program for Africa so that we can establish basic facilities for instance mothers still have to in most of our countries mothers are still 10, 15, 20 miles away from the nearest health facility and they have to carry a child of 5 years or 3 years to the facility because most of us still don't have personal transport so I really think that we need to think about the situation in Africa a bit differently from the rest of the world we are in an emergency ongoing emergency and ongoing health emergency and I would like to make the appeal to people of good will that we come together and establish primary health care special program for Africa so that even under international bodies WTO or any other we can ensure the implementation of the establishment of the basic infrastructure the basic health workers even if we just have the basic infrastructure plus the community health worker in every community it would make a difference I have seen in our own communities where the community health worker is present what are different that makes but it is not widespread it is not widespread so I'm afraid I will not be talking about the details but I do want to make an appeal for a focused support to Africa as an emergency region for health development we are in a situation where things are not moving as I say I have been working for 50 years and working very hard and I'm not alone many people have been working we need an emergency approach to deal with that situation because under development has been super important about the health development and so many but I think that once you have a health entrance an entry point in improving health you tend to improve the other things you tend to improve the economics you tend to improve the peace and you tend to improve the overall development so I'm making an appeal for a holistic approach to health development in Africa a special fund, a special program because even with COVID for instance I have gone to my country but also to other countries and people tell you percentages and when you ask them what was the sampling frame for the testing people don't seem to know what is difficult and so on so that is my appeal thank you very much Thank you so much Miriam for that appeal and that sort of heartfelt speech Jess back to you for some final remarks Thank you to all of the commissioners first for your invaluable contributions during this two year process and for your eloquent remarks today by mentioning four topics very quickly first also responding to some of the comments that we've seen in the chat stream on the origins issue the question of the origin of the virus is open the narrative that there is only one answer the natural answer was a narrative created early in February 2020 by a group of scientists around the national institutes of health and it has been the predominant narrative but we know that it was created without the data that we need we know that there are many serious questions that have not been addressed we know that NIH in the United States has held back too much information and redacted too much and not told the public enough so this is basic science which is you investigate viable hypotheses it should not have required a somebody leaking documents from the Department of Defense to understand the dangerous research that was under way but that's how it happened so I want people to know we have not yet been told the facts and we need to get at the facts that's the first point second point on the vaccines the United States government and others but especially the U.S. invested heavily in the vaccines but then turned over all of the profits and the organization to private companies Oxfam estimated last year that nine vaccine billionaires were created in the process for what was essentially a government funded effort now it was valuable to fund this effort but as a public good the vaccines should not be understood as a market phenomenon they should be understood as a public good and we have nine vaccine billionaires but major parts of the world not protected when we have COVAX the official body that was unable to obtain supplies because the vaccine companies were going to those who would pay the bottom dollar we know that we did not organize this process properly the public funding was very much worthwhile but it produced a public good not just a private good but it's been treated as a private good the third point is finance also referring to Merriam Warray's very powerful statement and I've been a follower and a disciple of Merriam Warray for many many years as she has been spreading this message the global health fund that we're calling for is needed because we need to fund basic health systems including community health workers and what the rich countries are doing right now is saying okay we'll put some more money in pandemic preparedness but they're not acknowledging we need more than pandemic preparedness we need funding health systems especially in poor countries we know the rich world finance quite well because I've been watching how selfish the rich world is for decades and been writing about it and been studying about it we need proper finance for universal health coverage and other priorities and that's why we call for a global health fund in Geneva WHO at the disposal of the world and responding to Merriam Warray's powerful call this is not just a pandemic response fund which the rich world may say we need this because we suffered this is universal health coverage that we need to address the final point that I want to close on is that we are facing multiple crises this is apparent this is what Phoebe Kunduri emphasized we have a pandemic that continues we have geopolitical tensions even the risk of war in Asia we have between God forbid the US and China it's a possibility the way that we are going right now because we're not cooperating properly we have so many environmental crises just this year we can't even keep them straight we have massive floods in Pakistan we have massive drought in Europe we have massive drought in China this is disrupting major economies also it's not just the poor and the vulnerable though of course they're the ones that suffer the most we need to get our heads around the idea that war is unaffordable we need to end this war we need to negotiate peace now we need to stop the distractions and stop the belief well if NATO will just pour in more weapons then blah blah blah because we are not facing the reality in this world that we are becoming overwhelmed by multiple crises and we're not addressing any of them properly right now they're all interconnected they can be addressed through the sustainable development perspective exactly as Professor Kunduri emphasized we have a path forward if we choose to take it that is the spirit of the Lancet commission report I want to thank all of the commissioners all of the task force members and all of the people that have participated in today's webinar and especially I want to thank Dr. Tedros for his leadership and he can count on us in the Lancet commission to continue to support him and finally I want to thank the Lancet itself for its continued leadership on crucial issues of public health and public policy thank you very much to everybody I think this wraps it up Jessamy thank you you can close for us you are the emcee today and I turn it back over to you well thanks so much Jeff I think it's the end of this two year journey but only the beginning of much more work to do so thank you to all of our panelists thank you to you Jeff thank you to all of the commissioners and everybody that's participated in today and everybody that's participated in the last two years it's been a monumental undertaking thank you and good