Helen Clark on Whether the World Is Ready for the Next Pandemic

And why the upcoming UN summit on pandemic prevention could shape how the world responds to the next global health crisis.

The world promised to be better prepared for the next pandemic. But has it followed through?

Former New Zealand Prime Minister Helen Clark, who co-chairs the Independent Panel for Pandemic Preparedness and Response, joins me for a wide-ranging conversation about the intersection of global cooperation, diplomacy, and pandemic preparedness.

We begin by discussing what the current Ebola outbreak in the Democratic Republic of the Congo reveals about the strengths and weaknesses of the global pandemic response system. We then turn to the political and practical significance of a Pandemic Agreement reached at the WHO last year why an upcoming United Nations High-Level Meeting on Pandemic Prevention, Preparedness and Response is a crucial moment in global health diplomacy.

You can watch our conversation below. This episode is also freely available across all podcast listening platforms, including Apple Podcasts and Spotify.

Transcript edited for clarity

Mark Leon Goldberg: Welcome to Global Dispatches. I am your host, Mark Leon Goldberg. Welcome, Helen Clark.

Helen Clark: Thank you.

Mark Leon Goldberg: So you are, of course, the former Prime Minister of New Zealand, former head of the UN Development Program. Though, for the purposes of our conversation today, you are the co-chair of the Independent Panel for Pandemic Preparedness and Response. By way of introduction, can you explain a little bit about what the independent panel is and its work?

Helen Clark: The independent panel was convened in 2020. After the World Health Assembly meeting online in May, as the pandemic was gathering pace, asked the Director General of the World Health Organization to set up a comprehensive, impartial, and independent inquiry into how the international response to COVID-19 had been handled. So, eventually, Dr. Tedros reached out, by around July, to former Liberian President Ellen Johnson Sirleaf, and to me, and asked us if we would co-chair this panel.

And he made it clear to us that the WHO would not seek to influence or shape our work in any way. The mandate was, as per the World Health Assembly resolution, we should get on and pick the panel, and they would resource what we needed to do. So, that was the history. We got going, I think, with the first meeting of the independent panel in around September that year. We had to report by May 2021, and that in itself, I think, carries a story because meeting in May 2020, I suspect the World Health Assembly thought that the pandemic would be done and dusted and we could digest the lessons from handling it.

Sadly, by May 2021, it was still gathering a lot of steam. You had the Delta variant that had come along, which was so deadly. And we were reporting literally in the eye of the storm, which made the report all the more important and I think ensured it got the attention it deserved.

Mark Leon Goldberg: So, it’s because of your participation in that panel that you, I think, are one of the world’s leading experts on how global cooperation can serve pandemic preparedness and response. It really gave you kind of this broad view of the topic. In September, during the UN General Assembly, there is a key meeting at the UN on pandemic preparedness and response, the significance of which I wanted to discuss with you. But maybe to ground our conversation a little bit, I wanted to kick off by discussing the Ebola outbreak raging right now in the DRC, the second largest such outbreak ever.

What does this outbreak reveal to you about the state of pandemic prevention and response today?

Helen Clark: Sadly, it reveals that we are not ready. And let’s then deconstruct what I’m saying here. Look, this is the third Bundibugyo outbreak in this part of the Democratic Republic of Congo.

Mark Leon Goldberg: That’s the variant of the Ebola outbreak that’s raging right now in the DRC, which is unlike the other variants that we had seen more recently, at least.

Helen Clark: This is not the most common variant. It’s only the third time that it’s happened in Democratic Republic of Congo. And of course, there have been many more outbreaks of the other strain of Ebola, which I understand is generally the Zaire strain. But this one was not unknown. Notwithstanding that it was not unknown, we had no what you might describe as field test, a readily deployable field test which could detect that this was happening. And so, the initial tests that were being done were returning negatives because the test wasn’t able to detect this area.

But given that this had occurred before, and we know how in a fragile and conflict-affected setting, a deadly disease can get away, it’s interesting that no effort had gone into a test which could identify this. Secondly, given that it had occurred twice before, it’s interesting that no development of a vaccine was ever prioritized. Of course, we do now have something for the Zaire variant, but Bundibugyo, nothing.

And then, with neither detection capacity at the field level, with no vaccine, needless to say, there’s no specific antiviral either. So, when an outbreak like this occurs, you’re literally unarmed to fight it. Now, this one occurred at a time of tremendous churn and spending reduction in global health. And that meant that some of those who’ve been on the ground, like International Rescue Committee, which David Miliband leads, they’d had to cut their field capacity from five posts to two in that region.

Others were similarly affected. The U.S. Center for Communicable Disease Control is not what it was. And so, into this environment — fragile state, spending cuts — comes this outbreak. It now appears that it has probably been running since January, undetected. In May, when a health worker died in a facility, then eventually the test got sent to Kinshasa and was identified. But by then, this had been running for close to four months. So, it’s not surprising that this has become such a large outbreak with, I understand, many of the cases now presenting not coming from any known chain of transmission.

This means it’s got away. The last Ebola outbreak in DRC took two years to bring under control. But that was not this variant. We are going to have to have quite a long, sustained response, plus the support of some more tools like a vaccine and ideally an antiviral medication which can deal with this as best as possible, and Public Health 101 detection, surveillance, building trust of communities so they will present when family members become ill. This is a cocktail that needs very, very urgent addressing and international solidarity.

Mark Leon Goldberg: Well, so I wanted to ask you about Ebola because this, presumably, is the kind of outbreak that a fully functioning global pandemic preparedness and response, our defenses would have guarded against, should they be fully functioning to like the maximum capacity? And also, just in terms of timing, the outbreak was detected nearly a year to the month after the World Health Organization adopted the pandemic agreement.

Now, my understanding of the agreement is not in full force for reasons we can discuss, but I’m curious to learn from you what that pandemic agreement says and what it does. And if it were fully functioning in the way that you envision, how might it sort of support the response to the Ebola outbreak we’re seeing today?

Helen Clark: I think there’s a couple of layers to those issues. Firstly, the pandemic agreement cannot even come up for signature ratification until the annex to it, which deals with the duty to share pathogens in response for getting some benefit from sharing the pathogens, is negotiated.

Mark Leon Goldberg: Flesh that out a little bit, because I know that this is one of the key kind of issues on the table, this pathogen access and sharing agreement, this idea that countries on the ground, countries where pathogens are likely to occur, would have an obligation to share that information. And then countries that have the capacity to develop remedies to it would have an obligation to share those remedies. This is like a key node that’s yet to be agreed.

Helen Clark: It is yet to be agreed. And had it still been in the first pandemic agreement text, we’d never have got agreement on that because this cuts to the heart of what went wrong with COVID. What went wrong with COVID was that as soon as the vaccines were developed, the capacity that there was to produce them was snaffled up by high-income countries. And when many of us in the West were getting our first or second boosters, there were still health workers, let alone communities and low-income countries who’d never had as much as a single vaccination jab.

So, developing countries were rightly very, very angry about the inequity in the response. And when, for example, the Omicron strain of COVID-19 came along, and South Africa faithfully reported it under the international health regulations, it then started to face some retaliation with people putting up barriers to travel and so on. And people are saying, look, we’re reporting, we’re retaliating against, you know, in the West, you’re developing these vaccines and medications, but we’re not getting the benefit of them.

So, there’s got to be a better deal here. There has to be equity built into these responses. And it’s this issue that remains unresolved years after talks on the pandemic agreement began, which, correct my memory if wrong, but goes back to about the end of 2021. Now, this is not good enough. I sometimes compare the lack of speed with which this issue has been addressed in international negotiations around a convention with what happened after the horrific nuclear accident at Chornobyl.

Within five months of Chornobyl, a specific regional event, you had two new nuclear safety conventions. Well, here we are into the seventh year post the beginning of COVID, and we don’t have a treaty ready to go for signature and ratification. So, there’s something deeply wrong here, and it’s the inequity equity issues which are holding it up. So, happy days that we may get an agreement which could go to the World Health Assembly next year. But then, of course, you have to go through ratification. You have to get enough signatures for that.

And as well, you have to ongoing be supporting the capacity of even the most fragile and conflict-affected countries, like this eastern region of Democratic Republic of Congo, to be able to operate the system. And so, you need both the legal instrument, but also the capacities and the support to make things happen on the ground. At the moment, we don’t have either in this case of Bundibugyo.

Mark Leon Goldberg: I’m wondering, you know, to what extent is this upcoming high-level meeting at the United Nations on pandemic preparedness and response and attempt to overcome the stalled dynamic that you described, particularly around that pathogen access and benefit sharing system. Is that really the intention here with gathering presidents and prime ministers all in one room at the UN to build political momentum to breach the divide that you just described?

Helen Clark: I’ve always been in favor of bringing these issues to New York because, important as the World Health Organization and World Health Assembly are, the reality is that generally heads of state and government don’t go to the World Health Assembly. But they do come to New York. So, you’ve got a chance-

Mark Leon Goldberg: Especially my government.

Helen Clark: Well, this is great…

Mark Leon Goldberg: These days, at least.

Helen Clark: …because it’s left, and the same with Argentina. But they do go to New York. They’re represented there, which doesn’t necessarily make it any easier to get the agreement. But at least everybody is around. So, if you bring it to New York, you get a higher level of attention. You get foreign ministers there. And undoubtedly, a number of health ministers will come for this occasion, too. So, one of the recommendations that our independent panel for pandemic preparedness response made back in May 2021 was that there should be a high-level meeting. And there was one.

It was a bit disappointing, to be honest. It wasn’t concrete enough. The jury was still out on what would happen with the pandemic agreement. I always saw two scenarios for this follow-on high-level meeting, which was in the outcome document of the last high-level meeting in New York. One was that the agreement had been completed in Geneva with this annex around the pathogen access and benefit sharing settled. And then you could have used the high-level meeting as a rallying cry for ratification so that the agreement came into force.

The other scenario, which is the one we’re now in, was that this annex had not been agreed. And this needs to be a wake-up call meeting. And for heaven’s sake, here we are all these years after COVID, a number of other public health emergencies of international concern declared by the WHO since then. We’re still not there. We still don’t have the money. We’re now actually in some difficulty with the prospect of not having a proper monitoring and accountability mechanism. The global body that was set up, the GPMB, which we’ll have to decode, but the body initially co-chaired by Gro Harlem Brundtland, which looked at how prepared we were, that goes out of existence this year. What is going to replace this is a kind of global accountability body.

We don’t have adequate funding for the pandemic fund, which invests in preparedness for countries. We don’t have a surge mechanism for when the worst happens, and a global pandemic materializes. There’s a lot of things that need to be put on the table and spoken frankly about at this high-level meeting.

Mark Leon Goldberg: I wanted to go through a few of those issues that you just described and discussed. The first, though, it really does seem that this outstanding unfinished annex, that’s the pathogen access and benefit sharing system, is what really needs to be agreed upon in order for this agreement to take hold. Could you just lay out for me what you think like an ideal outcome here would be? What would like an equitable and useful pathogen access and benefit sharing system look like?

Helen Clark: So, I would say that that system is essential but insufficient on its own. What is being talked about is that there would be a proportion, generally 20% is talked of, of the products, the innovative products that come from access to the pathogen, whether it’s-

Mark Leon Goldberg: Like vaccines or something or the remedies.

Helen Clark: Vaccines, the commodities, countermeasures, they call them the vaccines and the medications, the therapeutics. That a proportion of that would be set aside for allocation by the WHO, the World Health Organization, to low-income countries. But that won’t entirely do the job. It’s important, and it’s important the agreement’s completed on a fair basis around that issue. What I think is even more important is that there is support for a broader ecosystem for developing and producing these, “countermeasures,” as we call them.

And that means we need more research and development supported in the global south. We need that link to manufacturing capacity in the global south, and we need it then a distribution mechanism backed by international funding for the poorest countries so that everybody can get access. With the best will in the world, Western pharmaceutical companies, and indeed supplemented by whatever India was producing, China was producing, etc., did not satisfy the need.

We need to augment capacity. One of the mechanisms which the Gavi, the Global Vaccine Alliance, which I am now chairing the board of, has done, is set aside over a billion dollars for an African vaccine manufacturing accelerator to support African-based companies coming into this area. We have to have capacity in the regions. And with that capacity, backed by the R&D, and with this terrific R&D in Africa, and then backed by the solidarity financing mechanisms, and by Africa CDC, Africa Centers for Communicable Disease, and the WHO and everyone else, build the capacity to make this whole ecosystem work.

So, while the PABS agreement, the Pathogen Access and Benefit Sharing Agreement, is critical, and we won’t get an agreement to ratification stage without it, we need this other work on building the ecosystem for response as well.

Mark Leon Goldberg: So, at this high-level meeting, It would seem that there are probably some political fault lines that need to be navigated in order for a outcome document. Presumably it would be like a consensus outcome document that all participants in the meeting would need to sign off on. What are some of the key disputes right now about six weeks ahead of this meeting that need to be resolved in order for an outcome document to be both, I suppose, ambitious and adopted by consensus?

Helen Clark: There was a proposed outcome document that was put to member states in very, very recent weeks. And it had a date on it, as I recall, for last week or the last couple of weeks, where it was under a silence procedure. And if nobody objects, then the document goes through. Well, actually, the silence was broken by most member states and for the whole range of regions. And the breadth of the silence breaking indicates that today the facilitators haven’t done their job. The negotiators haven’t done their job.

So, they’re going to have to work through the summer if there’s to be an outcome document before September, which I hope there will be. So, what are they tripping up over? Well, I mean, some is, you know, same old, same old — there’s a reference to sexual and reproductive health and rights, and that triggers an allergic reaction from some member states, so we don’t need to list who they are.

Mark Leon Goldberg: Well, I can list them.

Helen Clark: You can list them.

Mark Leon Goldberg: The United States has typically, in the last several months, objected routinely to references in UN documents that include references to sexual and reproductive health.

Helen Clark: Yes.

Mark Leon Goldberg: I said it so you don’t have to. I’m not a diplomat. I’m not the only one, but yes.

Helen Clark: So then there’s the issue of financing commitments, that developing countries want firmer commitments on preparedness financing, because as I said, the pandemic fund is grossly underfunded. The recommendations, by the way, from both the independent panel and the G20 panel on financing for pandemic preparedness, both recommended in the vicinity of $10 billion to $15 billion a year for solidarity, financing, for preparedness.

Honestly, they’ve had about a fifth of that once, not $15 billion every year. So, they’re doing the best they can with a rather small amount of money. And there’s no such financing mechanism to speak of. But the developing countries are pushing for this. The North is pushing back. Hardship. Anyway, then there’s the issue to be tripped over, which relates to TRIPS, the Trade-Related Aspects of Intellectual Property Agreement under the WTO.

And some countries feel, obviously, that there should be more scope under these waiver provisions for the World Trade Organization, that when a pandemic comes along, all bets are off and you share the intellectual property. But this has long been resisted by high-income countries where the world’s major pharmaceutical companies reside. And this, again, comes back to the heart of the equity-inequity issue. If you can’t get rapid technology and expertise transfer, then in the eye of the storm, even manufacturing capacity in a developing country could be prevented from producing to scale to deal with the outbreak.

Mark Leon Goldberg: So, you know, as you describe it, there are many opportunities for disagreement between countries coming into this meeting. What would a successful outcome to this high-level meeting look like for you, and how will we know it’s successful?

Helen Clark: Firstly, we, from the independent panel and others in the friends group for the high-level meeting, and there’s quite a number of organizations, including The Elders, which I’m also a member of, and others, we would like to see concrete commitments around finance. We would like to see commitments made that are actually measurable, that you can count, not just vague abstractions. We would like to see a clear steer towards having a monitoring and accountability mechanism for people doing what they say they will do around preparedness and response.

And as I said, the mechanism we’ve got, this Global Pandemic Monitoring Board or Global Preparedness Monitoring Board, goes out of existence this year. We would also like to see a reference to a timetabling at a next high-level meeting. You really do need these every three years or so. Otherwise, this topic really will fall off the international agenda. And it must not, because pandemic threats are coming at us at an ever greater rate as we, as human beings, more and more intrude on the wild space and ecosystems and expose ourselves more and more to the spillover diseases from animals, the so-called zoonotic diseases. We are greatly at risk.

Climate change is playing a part in all this, deforestation. We as human beings are rather good at wrecking the ecosystems on which we really rely. So, we can’t think that COVID-19 is going to be the last pandemic that materializes in our lifetimes. The threats are coming at us all the time, and we have to be much better prepared.

Mark Leon Goldberg: Helen Clark, thank you so much for explaining this all to me and for your work on this issue and keeping us all safe. Thank you.

Helen Clark: Thank you.