 Good afternoon everybody, it's a pleasure to welcome you to our last talk of the autumn quarter on the COVID-19 issue. We will resume on January 6th with 11 talks during the winter quarter and an additional seven talks during the spring quarter. It's an honor for me to introduce you to Dr. Peter Singer. Dr. Singer is special advisor to the Director General, Dr. Tedros Adenom Gibriasis at the World Health Organization and where Peter serves as the Assistant Director General of the WHO. In this role, Dr. Singer supports the Director General to transform the WHO into an organization sharply focused on impact at the individual country level. Dr. Singer co-chaired the transition team, was the architect of WHO's strategy and its triple billion target and works with colleagues to guide consistent strategy implementation of WHO's program budget. Before joining WHO Peter Singer co-founded two innovative social impact organizations in Canada. From 1996 to 2006 Peter was the Sunlight Financial Chair and Director of the University of Toronto Joint Center for Bioethics which some believe is the largest center for bioethics in North America. He also was Professor of Medicine at the University of Toronto and a senior scientist at the University Health Network. From 2008 to 2018 Peter was Chief Executive Officer of a program called Grand Challenges Canada. During this period Grand Challenges Canada raised $450 million to support a thousand innovations in more than 90 countries which had the potential to save one and a half million lives and to improve the lives of 35 million people. In 2007 Dr. Singer received the Michael Smith Prize as Canada's Health Researcher of the Year. In 2011 Peter Singer was given the highest honor in Canada when he was appointed Officer of the Order of Canada for his contributions to health research and bioethics and for his dedication to improving the health of people in developing countries. Peter is a Fellow of the Royal Society of Canada of the Canadian Academy of Health Sciences where he's Foreign Secretary and of the U.S. National Academy of Medicine. As a researcher Peter has published over 300 articles, has received over $50 million in research grants and mentored hundreds of students. He studied internal medicine at the University of Toronto. He trained as an Ethics Fellow here at the University of Chicago at the McLean Center and then studied for three years with Al Feinstein as a Robert Wood Johnson Clinical Scholar at Yale University. And then he returned to Toronto in 2006, I'm sorry in 1996. It's a huge pleasure to introduce my dear friend and long-term colleague Peter Singer. His talk today is entitled COVID-19, the World Health Organization and the Value of Multilateralism. Peter is going to talk for 15 or 20 minutes and then we'll be open to widespread questioning from the audience who are with us. And we'll go on at least until one o'clock with that. So with that background let me introduce you to Dr. Peter Singer. Peter. Well Mark, thank you so much. It's really so wonderful to be with you, my old friend. Of long, of long, long duration. I was just calculating it's 33 years ago that we were together in in Chicago, but in a sense you're you and the McLean Center program are with me every day. It's a very special year for you I know and let me just start by thanking you and your whole family who've supported you and all your colleagues at the at the McLean Center. It's such a special place and in particular I think there's very few people who can say A, they created a field in your case clinical ethics and B, they populated it and in your case with 500 fellows and it really is a remarkable achievement and you're warm and you're support for everyone you come in contact with and your excellence in medicine is I think just very much appreciated by everybody. So let me just start with that very very special tribute to you my friend and and my respect and appreciation. So thank you for everything that you do that you've done that you'll continue to do and thank you to Anna and the kids and everyone that supported you at the center. Today I want to focus in on what really has been a terrible year 2020 because of COVID-19 but actually my message is one of hope as we end this Annas Horribilis there really is a very very strong signal of better days to come but there's unfortunately going to be a harsh COVID winter before there's a warm COVID spring. As of today WHO's had 67 million cases of COVID-19 reported to it. 1.5 million people have died worldwide and I just want to start this seminar by expressing on behalf of the World Health Organization my condolences to the families of those who've died in Chicago in the United States and around the world and also my respect and appreciation and the respect and appreciation of the World Health Organization of its director general Dr. Tedros for health workers and indeed all essential workers who put themselves in harm's way to benefit their communities. Health workers constitute about three percent of the global population and about 14 percent of cases of COVID so obviously they're burying a disproportionate burden and health workers and all essential workers the groceries clerk the gas station attendant all the folks that work in health facilities really deserve all our respect and appreciation and beyond respect and appreciation whatever tangible support we can provide. I think most people realize this is the worst certainly the worst global public health crisis or acute global public health crisis in a century since the 1918 influenza pandemic and probably the worst global crisis since the since the Second World War. There are better days to come and I just want to kind of emphasize something that's very important and particularly as we're talking in a setting of the university a great university the University of Chicago I want to emphasize the importance over the past year and also over the coming year and I'll come back to this point of young people of students of young people of the importance of what you can do what you do your voice is extremely important and it would be a real privilege for me to stay in touch with you beyond this seminar on Twitter I'm at Peter a singer at Peter a singer and it would be terrific to to stay in touch with you and obviously feel free to tweet anything I say in this open forum at Peter a singer. So with that introduction what I'd like to do is just very briefly sketch sketch one way of thinking about the COVID response and recovery and and I'll talk a little bit about WHO's role in the context of this sketch. If there's one thing I've learned at WHO this year and I came in 2017 with with with Dr. Tedros as Mark mentioned if there's one thing I learned it's the vital vital role of the World Health Organization and indeed of the multilateral system in terms of protecting the world and protecting the most vulnerable people in the world. You know one way to think about the COVID response and recovery is almost like a house and the foundations of the house and I think this is very relevant for an ethics center a talk in an ethics center and in the university actually are some fundamental values. They are the value of trust in fact trust in government is the thing that seems to be very very strongly associated with successful responses in terms of mortality rates leadership which can strengthen or erode that trust solidarity which is so important in terms of people caring for their neighbors caring for people in other countries and I'll come back to this point in relationship to vaccines and probably most of all equity you know in the sustainable development goals we talk about leaving no one behind but the way that COVID has unveiled and revealed and shone a bright light and often very harshly so on the pre-existing social inequities and inequalities in society has I think been unparalleled and I think even unexpected the degree to which that has occurred so trust leadership solidarity equity those are the foundations of the response and recovery and I think it's very telling that these are if you will the soft infrastructure the many of those being ethical values that is really the most important foundation of the response and it's also something Dr. Tedros has emphasized in more than 120 news conferences when he's come to meet the global media during 2020 to discuss COVID it's especially the idea of solidarity and the concept of solidarity and the value of solidarity is something that he's emphasized so that if you will is the is the values foundation of the house that is the COVID response and recovery the the first floor is the essential public health measures and from the beginning of the pandemic WHO has emphasized the essential public health measures with testing at the heart isolating and supporting cases tracing and quarantine in contacts any country that has really been effective at suppressing COVID and several have there's a hundred fold variation for example more than a hundred fold variation in mortality rate across countries which is really stark in any event any country that's been effective suppressing COVID has has really put those public health measures at its heart of testing isolating and caring for cases tracing and quarantine in contacts and of course around that you have the importance of masking and the IHME estimates of lifesaving aspects of masking you have a physical distance you have avoiding poorly ventilated indoor spaces and of course staying at home when you're sick and and and so on so those public health measures and as a last resort the more restrictive measures the so-called lockdowns which are sometimes unfortunately are necessary including now when we have rising cases in many parts of the the world those public health measures are absolutely essential they were essential all through last year they'll be essential through the rollout of the vaccine and they'll be essential after the vaccine is the rolled out so the foundation of the house is these values of trust leadership equity solidarity the first floor is these public health measures the tried and true public health measures including the shoe leather epidemiology the second floor is the new scientific tools and here of course we're talking about diagnostics which have a very very important role drugs and vaccines and I'm going to spend a lot of these opening remarks on vaccines because that's really an area that gives us a lot of hope but don't forget diagnostics and drugs and in fact what you see in COVID is remarkable and unprecedented scientific effort across the board there if you look at January you know in the WHO first was notified on December 31st of 2019 of what was ultimately called COVID and by the second week by the first week WHO was notifying countries and the public etc ringing the alarm bell by the second week it was supporting the release of the genome and by the third week that genomic information had been turned into molecular diagnostics that WHO then started to ship around the world and also the design of the mRNA vaccine and I'll come back to that story but that rapid cycle from genomic information to diagnostic and vaccine mRNA vaccine messenger RNA vaccine is is unprecedented and one that will serve as a platform for as countermeasures for future pandemic preparedness as well so I'll come back to vaccine in a moment but I want to complete the picture of the house the attic the attic is the recovery and I don't want to talk much about the recovery because we're in the midst of the rollout effort for the vaccine but I do want to put it there a so-called building back better which unless we're specific about it can become a mere slogan on the other hand there's great opportunities to make meaningful change in building back better for example through the availability of oxygen by face mask you know pneumonia is one of the leading causes of death of children under the age of five it's estimated that 800,000 children out of the 5 million who die every year 800,000 die of pneumonia it's the largest cause of death after the newborn period and it's estimated that maybe 20 to 40 percent of those children could be saved with a simple measure like oxygen so that's being promoted for COVID so it's come for the COVID stay for the pneumonia and the safe surgery and that's a good example of building back better in the recovery the other thing I want to emphasize in the recovery is the importance of primary health care and resilient health systems the important for not only essential services but also multi-sacral whole government approaches and community empowerment communities have played a central role in addressing the pandemic so I wanted to sketch a quick model if you will or a picture of pandemic response and recovery of a house the foundation being the values trust solidarity the overriding importance of equity the first floor being the tried and true public health measures with the testing at its heart and isolating cases quarantine and contacts the first floor being the new scientific tools and the attic or maybe I should say the second floor being the recovery with primary health care at its center and primary health care of course is very very dedicated to equity as well which is so important in the in the recovery period now where I'd like to focus is that second floor of the house and in particular I'd like to zero down on vaccines because that's what's giving us the signal that there truly are better days ahead I want to start by saying that what we've seen is an unprecedented scientific effort in vaccine development and shortly deployment more than 210 vaccines in the pipeline more than 50 in human trials 12 or 13 in late stage phase three human trials three or four or five of which now have have reported results in one way or the or or the other let's say four have the obviously the the big news came with the Pfizer BioNTech and the Moderna vaccines but AstraZeneca Oxford has recently reported and it's important also to realize that the Russian vaccine has reported as and the Chinese is in the process of being deployed the Chinese vaccine so really vaccines spreading around the world and what's remarkable is the different platforms these are on you know the very very strong efficacy of the messenger RNA vaccines and and and the idea that that's a novel platform and the Pfizer BioNTech for example in the Moderna these would be the first time that such vaccines are licensed messenger RNA vaccines ever and we can go through the different types of vaccines lots of good news in the last two or three weeks more to come some registrations with regulators more to come and even the start of a rollout in the UK yesterday with William Shakespeare of all people being one of the first people who was vaccinated back in May the World Health Assembly which is all the governments in the world their health ministers declared past a resolution that said that immunization is a global public good WHO then developed an allocation framework which offered prioritization to health workers to vulnerable people including the elderly and those with comorbidities some modeling studies that show it's better to vaccinate some people in all countries rather than all people in some countries remarkably that cuts the death rate so simply the way you distribute the vaccine around the world has a significant effect on mortality and then of course the access to COVID tools accelerator led by WHO but in partnership with other groups whose goal is to as it name implies accelerate the development of but also facilitate the deployment of diagnostics drugs vaccines and in its health system connector ensure that health systems around the world are prepared to deploy those new scientific tools and technologies the goal in vaccines is two billion doses by the end of 2021 through the ACT accelerator and you can think about the ACT accelerator both as a lifeline and an insurance policy it's a lifeline for the 92 Gavi eligible countries who otherwise may not be able to afford these vaccines and it's an insurance policy for all countries because it invests in a wide portfolio of vaccines and so offers real vaccine choice for for for every country 189 economies have joined the access to COVID tools accelerator and it's up and running ready to go has had some funding already but at this point the main limitation on the vaccine pillar of the ACT accelerator known as COVAX and partnered with the Gavi and with SEPI alongside WHO is actually funding the immediate funding shortfall is 4.3 billion US dollars and through 2021 an additional 23.9 billion US dollars is needed and that might sound like a lot of money but compared to the costs of the pandemic it's actually not a lot of money there was a recent paper published by Larry Summers that estimated the cost of this pandemic to the United States alone at 16 trillion dollars when you think about the more than 10 trillion dollars in stimulus to date from OECD countries it really puts that into perspective it's actually very very high return on investment and the vaccine needs to be allocated around the world moving from vaccine development the next issue to talk about and let's say the next barrier to focus on is vaccine delivery we're about to embark we already have embarked on the most significant and daunting logistical challenge in countries and around the world probably since the Marshall plan this is a major major logistical effort there are many elements to this but just to name a few the Pfizer vaccine requires an ultra-cooled chain at minus 70 minus 80 degrees the others don't necessarily but that makes it a little bit more difficult obviously to distribute we have issues of vaccine confidence which is much more than just information it also has to do with it also has to do with very much with trust and with the context and the historical injustices to which some marginalized communities have been subject vaccine confidence and then we have a number of necessary digital innovations whether that be the ability to track and trace as either vaccine lots protect the supply chains and their integrity and ensure that we can get people back for their second dose three weeks later in many cases and then of course the return to work return to play return to travel aspects of of the knowing who has been immunized something with which WHO is in the process of grappling if you think about those paper yellow cards for immunization and for yellow fever in particular then you get to start to get a sense of what that electronic task is like I was just going through my mom's stuff and and cleaning it out sadly she died more than 10 years ago I was cleaning out her stuff and came across her WHO immunization certificate from 1957 when she was a refugee from Hungary which really shows you the historical significance of that international standard that's being worked on for covid so that's what I wanted to say about vaccines but this is what is giving us much hope that there are better days to come and in conclusion I do want to conclude with that sense of hope and that sense of optimism there really are better days to come there's a warm spring and summer coming but a very cold and harsh winter between now and then and please please please if there's one practical message I can leave you with don't let up your guard you don't want to be the last person to die of covid-19 as vaccines are being rolled out and you don't want your grandmother to be the last person to die because you gave her covid so please keep up the public health measures that I was talking about now is actually the time to redouble your efforts because spring is around the corner just hunker down and this is obviously related to your local conditions but there's one thing I'd love to emphasize and then in closing what I'd like to say is reach out again to um to the young people listening I want to say that your voice really matters you know the biggest challenge that the world is going to face over the next six months arguably is the uptake of the vaccine the rollout of the vaccine and issues in equity in relationship to the rollout of the vaccine we may well see inequities developing in that rollout between countries within countries and it's so important for everyone including and especially young people to raise your voice against those inequities for reasons of charity but also for reasons of self-interest because until your neighbors are safe until every country is safe none of us are safe and it would be great to stay in touch with you I'm Matt Peter a singer and as Mark said at the outset I really only wanted to talk for 20 minutes or so which is what I've done and leave lots of time I think we now have about half an hour for Q&A because I'm mostly interested in in responding to your questions I want to thank you for your attention I want to thank Mark for everything that he's done and um obviously it shouldn't escape your notice that some of the most fundamental issues in the COVID-19 response and recovery are actually ethical values which shows you again to come back to the importance of of the work that Mark has done that you all the many of the have done with him and that he's pioneered absolutely at the foundation as I say of of COVID response and response and recovery so with that I thank you so much for your attention I really look forward to your comments and questions and really appreciate this this opportunity to be with you it's always great to be home at the University of Chicago in the Clayton Center and appreciate Mark the opportunity that you've provided to to be with you and our colleagues online and look forward to your questions and comments thank you so much well great thank you so much Dr. Singer for for those opening remarks yes I just want to remind everybody to put your questions in the Q&A function of Zoom and we'll try to get to as many of them as as we can for the next 30 minutes or so I want to open up by by asking a question to provide a little more background about what the WHO is and does for those who might not fully understand I think we all know that it exists but can you provide a little bit of background on sort of the purpose and mandate of the WHO and how it goes about doing what it does particular in the context now of the pandemic sure so WHO is 73 years old its vision is the highest attainable standard of health for all peoples its mission which we actually set in the strategy that was developed when Dr. Tedros came and was approved by all governments of the world health ministers in 2018 less than a year after he started this strategic plan so-called general program of work 13 is to promote health keep the world safe and serve the vulnerable in that strategic plan we set a so-called triple billion target and it's an it's a it's an SDG based targets as we basically took the 50 health related sustainable development goals turned them into three targets triple billion and and increased actually before COVID the importance of health emergencies protection one of the three billion and the triple billion target is to a billion more people better protected with universal health coverage which is not only access and service delivery but also financial protection a billion people living healthier lives with better well-being which is all the multi-sectoral things road traffic accidents cigarette smoking etc clean water sanitation and a billion people better protected from health emergencies so triple billion target and then in terms of WHO's functions it really has three functions one is its leadership function and I think you've seen that during COVID its second function is so-called global goods which is its guidance the highest level of which is the international law for example convention the framework convention on tobacco control the international health regulations but also the a few hundred or so guidelines clinical guidelines guidelines public health guidelines that WHO puts out every year and then its function in research I mentioned the accelerator and in data and then finally support to countries WHO has a hundred and a footprint of 150 country offices in six regions about 8 000 people its budget depending on how you depending on how you count it is actually about the size of a large teaching hospital let's say it's three billion a year that's a little bit bigger than its its budget but is it's about three billion a year and so that's what WHO does and as I said at the outset Brian it's what I've learned at WHO is how essential it is to the most vulnerable people in the world and I mentioned some of the things it does and did in COVID as we went along to leadership and meeting the media and really emphasizing the public health functions shipping the diagnostics training millions of health workers online for things like donning and duffing personal protective equipment the normative guidance the the advice it's going to be giving that it is giving on vaccines from which vaccines which populations etc the pre-qualification of vaccines almost the type of quasi regulatory function in the normative sense I'm just listing some some COVID related things and you know more than a hundred surge missions to hotspots whether or not there are country offices there to assist governments and support governments in responding to the pandemic so that's a little bit about WHO and how I think it's been quite essential in the pandemic and and very essential in all kinds of other ways there's very little that you do in health that isn't touched by the World Health Organization so when you go out for a beer at your local bar and there's no smoking when there are bars when there were bars when there will be bars and there's no smoking that is because of the local governments obviously and the national governments but ultimately the international treaty behind that is the framework convention on tobacco control great just as an example great just to sort of get the political question out of the way you know as a large multinational organization in the sort of current geopolitical context where there are sort of large dominant nations or that have may have conflicting views how does the WHO navigate that and gain trust of the international community so WHO has 194 member states and it is so vital to have a place and this is part of its leadership function where every country in the world can come together and one thing you'll see in the interactions with member states is its health ministers but it's also foreign ministers finance ministers heads of government quite frequently interacting with Dr. Tedros and our team the idea that every country in the world can come together and say immunization is a global public good is it extremely extremely important WHO treats its member states equally every member state is important it supports every member state and like the sustainable development goals WHO is relevant to every country in the in the world in terms of trust which was the thrust of your question I think trust is built over time and you see a lot of trust in WHO by many many of those countries and that trust is built actually I think and this gets to the theme of this talk through the importance of the multilateral system and also results based multilateralism that focus on that triple billion target and it's not only a focus on the target we didn't just put the target in the strategy we developed a measurement system to measure that target those targets we then are now regularly doing stock takes we did one today that looks at progress against those targets and then identifies pro thematically geographically what are the bottlenecks to progress identifies ways to overcome them you know to take a concrete example malaria in certain geographical jurisdictions with the tool to overcome it being targeting therapies interventions using data and locating malaria hotspots targeting that's a way to identify an overcome bottlenecks to malaria and a way to reduce numbers of children with malaria think about that across and malaria is part of the service delivery related to universal health coverage and that billion so think about it in that holistic way so that's a little bit about what WHO does a little bit about how it relates to every country in the world a little bit about your point why trust is important ultimately trust is earned through the value of what you do and I think that WHO has proven essential in this pandemic and it's proven essential in the 73 years of its existence maybe Brian just in closing probably its biggest accomplishment has been its role in the eradication of smallpox you know I was floored when I learned that smallpox in the last century killed more people than all the wars combined 300 million people you know how many people smallpox has killed in this century zero you know why because it's been eradicated through the efforts of WHO supporting just one example maybe it's a really good example but one example and that that single act the eradication of smallpox I think justifies every penny that's ever gone into WHO in every word that anybody's ever expended on it and that really is just the beginning of the effect that WHO has so that I think is how to build trust great and since you brought up some of the sort of programs and initiatives that the WHO was working on prior to the pandemic just as we have concerns at the community level about this sort of massive shift in resources time effort towards the pandemic what ends up getting sacrificed and so as all of this effort got shifted to the pandemic what concerns do you have in what sort of areas are you most worried about are going to suffer the most thank you so there was no question that we were behind on those sustainable development goals the world was because remember its countries that committed to them WHO supports countries to achieve these things to which they committed every country in the world so we were behind on the triple billion target on the sustainable development goals before covid we're much further behind now so the regular rate of speed in the recovery is not going to be enough we're going to have to accelerate we're talking a moment about how we accelerate but I think one of the important things is under Dr. Tedros leadership and under the stewardship of our deputy director general Dr. Janayaka WHO has actually kept a focus on all three billions and it's made sure that we're tracking the disruptions that we're responding to the supporting countries on the disruptions on universal health coverage on healthier populations which is the multi-sectoral work and integrating that with the health emergencies protection remember in addition to covid WHO is responding to many many other emergencies at the same time so it's not even the only emergency response the there are some ways that WHO can support countries to accelerate but I've actually already talked about one of them which is identifying the bottlenecks and target resources to overcoming them some others include scaling innovations working better together in the multilateral system more collaboratively and at the end of the day leadership which is what I mentioned in the foundation of the house so accelerating back and to your point which specific almost any service that's been looked at has been disrupted and that will have consequences on mortality rates of women and children's health in HIV malaria and tuberculosis in non-communicable disease I'm sure at the University of Chicago you know people who didn't have coronary bypass surgery who otherwise would have had because of the pandemic and so this affects every country in the world and and as we get into those better days the recovery primary health care getting back on track and accelerating in some of the ways I described is going to be absolutely vital and if there's one thing we've learned in the pandemic is how health is the foundation of economies of prosperity and of national security and as Dr. Federer says without health there is nothing and there's only one way to solve the economic crisis that COVID-19 has wrought and that way is to solve the public health crisis no other way just really shows the centrality of health to almost everything we do and cherish in our society okay Turning to the topic of vaccines there are a number of questions in the Q&A the first is the russian vaccine has largely been dismissed in public discourse does it deserve more credit than we have given it I think let me put it this way WHO is in the midst of evaluating data from vaccine manufacturers and I think that every vaccine deserves fair scrutiny based on the data based on the data provided and WHO will certainly be looking carefully at data from vaccines in wherever they arise and what I can assure you of is WHO will not endorse a vaccine unless we believe that it's safe and effective I can also say that don't think about this as being about a vaccine think about this as being about vaccines for all kinds of reasons different vaccines may have different efficacy in different populations different vaccines have different distribution challenges different vaccines will ultimately have different prices and this is about distributing vaccines to 8 billion people around the world because none of us is safe until all of us is safe all of us are safe actually look this up you can use is or are but so that's again showing some of the value of WHO in terms of evaluating the data of any vaccine regardless of its origin carefully and and also providing guidance as to courses for courses if you will which vaccine or vaccines might be most relevant in which settings in which context and again let me remind you that there's no silver bullet it's not an on off switch it's not going to happen overnight and until during and after the vaccine rollout it's very very important to continue the public health measures that we talked about the next question is could you speak to the ethical principles you rely on when developing the code vaccine initiative how do you determine how when and where to distribute the vaccine to low and middle income countries so the I think probably the most important ethical principle is the principle of solidarity that you do want to do it in first place and interestingly enough I went back and look something like 20 years ago in some journal called International Affairs Sally Benatar of Dalladar and I all mentored by Mark wrote an article about values in global health ethics and I dug into it kind of imply that you know it's a catalog different values equity and and we certainly list solidarity there and almost imply that it's premium enterprise and then some of that work that we picked up later in developing a ethical framework for pandemic preparedness in the context of SARS-1 which hit Canada very hard so solidarity is actually a very very important ethical principle and that's one that Dr. Tedros talks about all the time another very important ethical principle is equity because again if there's anything COVID is revealed it's the pre-existing social inequities in our society and it's shown a very harsh light on that and equity is a very very important principle so from principles like solidarity equity and others you end up you you get to a practical allocation framework that focuses on health workers on and on the vulnerable people who are elderly and people who have comorbidities because as you know the mortality rate of COVID varies drastically depending on your comorbidity and it's not always the ones you'd expect you know maybe it's I don't know maybe I won't get into specifics but it's you know hypertension etc some some really interesting comorbidities as we understand more and more about the physiology and the path of physiology of COVID-19 and I'm not expert in that so I won't delve into it anymore so I don't get myself in in a place that I don't know about great following up on sort of the principle of solidarity the next question is you said it would save more lives to have some people in every country vaccinated this makes sense from the WHO perspective however it seems that individual countries would have an interest in ensuring their own citizens get vaccines as soon as possible even at the expense of other countries so I think we're talking about vaccine nationalism here so how has this played out in reality and is there any mechanism by which any organization government or agency is attempting to influence this in any way so I think that's a very good question Brian a very good point you know let me just start by acknowledging that obviously the first order of business for political leaders is to protect their citizens no question about that that takes you back to political philosophy and but at the same time you know WHO has talked about vaccines as a global good Dr. Tedros has spoken out against what he would say is misguided nationalism and the practical example is you know when we see people who are at very low risk being vaccinated in country X and health workers who are putting themselves in a harm's way in country Y in a COVID ward that maybe is overflowing with patients not being vaccinated I think we're going to have to give give that a very very hard think about what exactly is going on in the world and what kind of world we want to what kind of world we want to have and we are going to see challenges in equity shall we say arise in the next six months and that's why I wanted to start with young people because at a minimum we want to call out those inequities because we all want to measure them we want to see them we want them to be transparent secondly and data is very important here secondly I think we want to call them out and and by we I actually mean you obviously the World Health Organization has done and will do its part to advocate for solidarity for equity in every possible way and that's what we did with that resolution I mentioned on immunization as a global good at the same time I think it's up to citizens and including young people to speak out to raise your voice for equity raise your voice for equity and when you see inequity developing and sadly I think that we may in the coming months related to vaccine rollout speak out about it and then you asked about motivations sure there's an issue in charity here you know and Americans are charitable people in terms of international assistance and so on and and there's also an issue in self-interest because COVID will travel right around the world you won't be able to restart an international trade and travel you won't be able to be safe actually because of international travel because the virus viruses don't carry passports none of us is safe until all of us are safe so this is an issue in charity but it's also an issue in rational self-interest and so Brian I hope that answers your questions not a straightforward or easy question but there's one practical thing that everybody on this video conference can do it's in the next six months in the next year tune into those inequities and raise your voice for equity when when when the need arises because some of the best leaders including at heads of state from heads of state right down to communities are dedicated to issues and equity stand with marginalized communities and and it's very important for everyone especially including I think young people to raise their voice for equity to bend maybe the actions of those who don't towards equity and many many times over the past year I've thought about that fantastic statement from Martin Luther King about the arc of the moral universe is long but it bends towards justice and we can accelerate that arc I think by raising our voice for equity and that's it if there's one task that we should be doing in the coming six months all of us that's it that sort of the solidarity principle seems a pretty challenging you know principle to sort of implement in the sense of there's a lot of heterogeneity I think in terms of social cultural and sort of ethical approaches the next question sort of gets to that in asking do you feel like nations like the US that put so much value on respectful autonomy of patients are more likely to have a harder time emphasize emphasizing principles like solidarity and I think this sort of taps into as well the rise of medical populism can you address that well I'm Canadian so it's not for me to say what the folks in the US should do actually I'm an international public servant so I also have an oath of neutrality related to countries but having said that you know when I was at the University of Chicago yeah we read Mill we read other versions of this in the law school there but but we also read Tocqueville and I think rediscovering some of some of those communitarian philosophical currents that I had the pleasure of learning with Steven Tullman and others I think can can be very very can be very useful I think it becomes quite pragmatic though when you see the image that I described of the overworked tired nurse in a rural African setting who has a very significant chance of death in comparison and I think we have to ask ourselves what we owe that nurse and I think we owe that nurse a lot and and I think we're gonna have to we're gonna have to act accordingly you know the other day Dr. Tedros was asked at the press conference whether he would take the vaccine publicly like like some of your former presidents said that they would and he had a brilliant and beautiful response he said yes I will take it publicly when it's my turn because I'm not displacing someone who otherwise might be ahead of me in line I thought that was a fantastic response that really really emphasized this practical principle of equity by the way while we're on the topic of solidarity and equity one concrete instantiation of that is actually fully funding the COVAX facility of Gavi, CEPI and WHO of the access to COVID tools accelerator that's what's going to help and yes 4.3 billion through the end of this year 23.9 billion for 2021 it might seem like a lot of money but it's not a lot of money when you compare it with economic damage and human suffering that's been wrought by COVID-19 it's probably it's one of the best value for money propositions there is so let's do that and I think that's a message for every country in the world and those countries that really have stepped up to fund that facility really deserve I think the respect and appreciation of all of us and of all countries and of all citizens in the world so all that said what do you see as the greatest threats to equitable vaccine distribution and what suggestions do you have to prevent or respond to those well I mean on the on the plus side the greatest threats are the types of questions you're asking I think the greatest opportunity is for us to reflect on our values on the value of solidarity which has to underpin the value of equity and concretely there's a very very concrete thing that can be done which is funding the covax pillar of the act accelerate I don't want to seem redundant about this but that's really life or death issue for many people and it is an issue of national security for every country in the world the national security the economic prosperity of any country in the world including the United States is not only gained by actions within a particular country it's also gained by actions around the world and in this case very beneficial actions of ensuring vaccines and in particular vaccination and getting vaccination vaccines in the arms of people around the world and I think this is a great time for reflection it's an important time for leadership and of course I mentioned the importance of communities it's a very important time for diverse voices not only to be heard but to be at the decision table making decisions at all from the highest levels of government to community leadership I know we're running close on time I'll try to squeeze in another another question in relation to your comment on trust and on tracking the CDC is asking states to report the identities of individuals who have been vaccinated this is giving rise to considerable privacy concerns do you think this degree of identification is indeed necessary that the WHO has to leave individual decisions to individual jurisdictions and I don't think it's for me to comment specifically on that but I will say one thing the United States is blessed with some of the most fantastic health institutions in the world the CDC which you've mentioned Brian the FDA the NIH these are some of the most respected if you take the historical view over decades most respected institutions in the world and these institutions have worked very closely with the World Health Organization since its inception and have continued to do so through the pandemic and and long may that continue and that's a great benefit USAID it's a great benefit to to the people of the world and I think that's something that Americans should value and cherish the last question sort of coming back to solid solidarity one of the attendees notes that solidarity is an interest is interesting to consider as an ethical principle um can't reasonable people or even countries disagree well I think there's you know I talked about the first uh first uh responsibility if you will of leaders but let's boil solidarity down in very practical terms wear a mask fund covax and uh make sure that the vaccine is just a raise your voice and raise your voice for equity tweet when you see an inequity tweet and while you're at it tag me at peter a singer so um wear a mask uh wear a mask and of course all the other public health measures um wear a mask fund covax and tweet when you see inequity that's the very practical version of uh of the solidarity uh inequity principles well with that I'll bite my tongue with regards to social media and disinformation campaigns but with that I'll give you sort of mark the last word to wrap up this session and again thank you very much dr singer this was this was wonderful and I think we very much appreciate all the work that that you are doing on behalf of the global community thank you and thank you very much for the invitation and and let me just say that disinformation on social media is a problem and WHO has partnered with the largest social media companies to make sure that when you go search google or when you're on facebook or twitter you're more likely to be directed to reputable sources of information locally and the world health organization because of those partnerships and um haven't partnered with but even aligned with the gaming companies because it turns out I didn't know this they reach a log frame of people more tens of billions of people as opposed to billions of people impressions um obviously that individual people uh this is only eight billion in the world uh and so if you're gaming you will see some WHO health messages going down your gaming channels and so that just gives you a sense of how in tune WHO is um with uh with uh doing everything it can do to save lives and that's maybe the place Brian I'll end which is uh that's really what WHO is about it's about saving lives especially the most marginalized but everybody and it's relevant to every country and I'm proud to be associated with it and very happy to be with you today Brian and it's great mark to be with you and again let me end with my respect and appreciation for the incredible work that you've done over the the whole length of your career it's I think remarkable and uh people in Chicago people around the United States and people around the world should appreciate and do appreciate your contribution and thank you so much Mark thank you Peter thank you so much the talk was extraordinary and and the um uh the development and changes in the WHO since 2017 when Dr. Tedros and you joined the program um have had a tremendous international impact and will continue to do so and and your background in in Canada and and part of your training in the States um is is moving to all of us um I just want to thank you so much for for joining us today and um for the work that you're doing especially for developing countries as part of the COVAX program um and um and for those who are most vulnerable not just in the COVAX countries developing countries but also in Canada and the United States and and and European countries it's a great honor to have you here and look forward to seeing you soon in the future thank you so much for all of your great work thank you Mark it's a privilege to be with you and with everyone here thank you so much uh see you on Twitter come on Peter thank you thank you