Recently, in an online dialogue hosted by Huang Shan, deputy editor in chief of Caixin media, Bill Gates, CO chairman of the Gates Foundation, and Dr. Margaret Chan, honorary director general of the World Health Organization and the first Dean of Vanke School of public health and health of Tsinghua University, discussed the prevention and monitoring of pandemics, the impact of Russia Ukraine conflict on the global health agenda and how to cope with common challenges through global cooperation.
"Whether we are preventing a pandemic or dealing with climate change, we need the joint efforts of China and all other countries." In an online dialogue hosted by Caixin in late May, Bill Gates, CO chairman of the bill and melindagates foundation and co-founder of Microsoft, said.
The world has entered the third year of the COVID-19. At the same time, the shadow of monkeypox virus seems to be getting closer and closer. Reviewing the experiences and lessons learned from coping with the new pandemic, what lessons can countries learn from it as they embark on the prevention of the next pandemic? After Europe and the United States took the lead in lifting most of the epidemic prevention measures, Southeast Asia, Japan and South Korea have also successively reopened their doors. What scientific principles should be followed for the deregulation of epidemic prevention and control and the normalization of social and economic activities? After a hundred days of conflict between Russia and Ukraine, how will the Western sanctions against Russia and the global energy and food supply crisis triggered by the war impact the complex and huge global health agenda?
In response to these problems, gates, who is currently in the United States, and Dr. Margaret Chan, honorary director general of the World Health Organization (who) and the first Dean of Vanke School of public health and health of Tsinghua University, who is in Hong Kong, China, elaborated their views in an interview with Huang Shan, deputy editor in chief of Caixin media.
At the age of 74, Margaret Chan served as the seventh director general of the World Health Organization from January 2007 to June 2017. When she was in charge of the World Health Organization, she led the global response to a number of major health crises, including influenza A (H1N1) in 2009, Middle East respiratory syndrome in 2012, Ebola in West Africa in 2014 and Zika epidemic in 2016, and led global health initiatives such as "universal health coverage". Prior to her appointment as director general, Margaret Chan served as director general of the Department of human environmental protection of the World Health Organization and director of the Department of health of the Hong Kong Special Administrative Region of China.
■ Margaret Chan / Caixin, honorary director general of the World Health Organization and the first Dean of Vanke School of public health and health, Tsinghua University
The 66 year old gates devoted himself to philanthropy after he retired from Microsoft. Now he mainly relies on the Gates Foundation, which was jointly founded 22 years ago, to support global development issues such as public health, education equity, gender equality, environmental protection, agricultural innovation and so on. More than half of the resources of the Gates Foundation are used to reduce health challenges such as deaths caused by infectious diseases. It is one of the most important donors of the World Health Organization. In a ted (technology, entertainment and Design) speech in 2015, gates pointed out the risk of a pandemic and called on the world to prepare as soon as possible. Since the outbreak of the COVID-19, the Gates Foundation has made more than US $2billion in commitments to the pandemic to fund the accelerated research and development of vaccines, drugs and diagnostic methods, and help the global epidemic response.
■ Bill Gates / Caixin, CO chairman of bill and melindagates foundation and co-founder of Microsoft
The dialogue took place at the 75th World Health Assembly in Geneva. Although geopolitical tensions such as the conflict between Russia and Ukraine have posed an unprecedented threat to the post-war global multilateral cooperation system, all parties have not forgotten to gather together in the field of public health care, which is a field of progress and retreat. How can the world go out of the new crown and face the next challenge together? Centering on this topic, the following is the actual record of Caixin dialogue between gates and Margaret Chan.
Q
Caixin: Bill, in your new book how to prevent the next pandemic published this year, you proposed that a "global epidemic response and mobilization (GEM) team" should be established to prevent the next pandemic; The epidemic monitoring and response system will be based on national public health systems, and the World Health Organization will lead to better international coordination. What is the biggest challenge in building this "global pandemic response and mobilization team"?
Gates: a lot of global health warnings, including the Ted speech I gave in 2015, failed to make the world devote more resources to the pandemic response. This is unfortunate. At that time, the funds and full-time personnel were still insufficient and did not reach the level required by the world. The COVID-19 has taught us a lot of lessons and triggered a global discussion on how to cope with it, such as what resources the world needs and what kind of innovation it needs? I am a loyal supporter of innovation. Today, the world has some very good diagnostic tools and vaccines, but even so, it has failed to stop the spread of the virus in the world. I wrote the book "how to prevent the next pandemic" in order to attract jade and trigger discussion. I hope that the world can reach a consensus in the next one to two years, so that R & D and global monitoring capabilities can be greatly improved and similar epidemics can be avoided.
Margaret Chan: besides Bill, the World Health Organization and other international organizations have also issued the same reminder, but they have not been paid attention to. Before the end of the COVID-19, bill once again called on global leaders to work together to prevent the occurrence of the next pandemic through this new book, which is exactly what I hope to see.
Q
Caixin: the poor response at the initial stage of the COVID-19 may be related to the slow progress in building the resilience of the global health system in the past. What should be considered a priority in enhancing the resilience of the global health system?
Margaret Chan: it is a fact that the health systems of various countries are not ready for a pandemic. Based on my experience in working with many countries, we do need resilience in health systems, individuals and communities.
What do I mean by resilience? A resilient health system should be able to cope with health crises, such as pandemics; At the same time, other urgent health issues and problems should not be ignored.
Let me illustrate this with statistics. Up to now, about 6million deaths reported to the world health organization or other agencies are directly related to novel coronavirus. However, the latest estimate just released by the World Health Organization shows that nearly 15million people in the world have died directly or indirectly from novel coronavirus. Therefore, it is very important to establish a resilient health system, which not only has the ability to cope with crises such as pandemics or climate change, but also can simultaneously solve childbirth, non communicable diseases such as heart disease, cancer chemotherapy and other health problems.
These are some examples that I would like to highlight. Through partnership and global health cooperation, countries around the world must help those countries that do not have the corresponding capacity to build resilient health systems.
Gates: the encouraging good news is that the global health level has continuously improved in the past 20 years. Many of these occurred during Dr. Chen's leadership of the World Health Organization. We founded the global alliance for vaccines and immunization (GAVI) to fund vaccine procurement, reducing the number of deaths among children under five by half. Although we still have more to do, we should be proud of what we have achieved, both in normal years and during the response to the pandemic.
On the issue of global health, we need to bear in mind that what we have done is not enough, but we should be pleased with the progress made in the past 20 years and build on this.
Q
Caixin: the latest report issued by the independent group for pandemic preparedness and response of the World Health Organization points out that the most important issue at present is to correct the inequality in vaccine distribution. So how can we promote equitable distribution and accessibility of vaccines?
Gates: as for the new crown vaccine, there are both aspects that have made great progress and areas that have disappointed us and need to be improved in the future. The first new crown vaccine was approved one year after the outbreak began, and the progress rate is quite amazing. So far, the World Health Organization has approved a number of new coronal vaccines, and it has been proved that these vaccines are at least very effective in preventing severe illness and death.
At present, the global vaccine production is sufficient, and the vaccine supply is no longer a constraint. The question now is how to distribute vaccines and increase willingness to vaccinate. Of course, this has always been a very complex issue. The only negative situation is that some countries, especially rich countries, have begun to vaccinate young people and other low-risk groups after obtaining vaccines; At the same time, high-risk populations in Africa and South America have not yet started vaccination. It is obvious that the world has not achieved equity in vaccine distribution.
In the future, the world needs to increase vaccine production capacity faster, which will help balance distribution. At present, the discussion on building vaccine production capacity in more parts of the world is also under way. Therefore, more leaders will think about how to achieve fair distribution of vaccines.
Margaret Chan: Although vaccines are very powerful tools, they must be properly applied. For some countries, we need to support their health systems to ensure that everyone can get the vaccine.
For the moment, we need to continue to support the work of the new crown vaccine implementation plan (covax) to ensure that it has sufficient funds and vaccines to deliver to countries with low current vaccine coverage. But in the long run, we should continue to empower and encourage developing countries with the corresponding capacity to produce vaccines. This will not only facilitate the logistics and transportation, but also coordinate the local economic development, so as to serve the people in need nearby. As I said before, I am glad that the World Health Organization is organizing negotiations. I hope that all countries in the world can work together to ensure that we have mechanisms in place to prevent the next pandemic.
Q
Caixin: in the new crown crisis, combating false information has also become an important part of many countries' response to the epidemic. How can we avoid similar false information flooding in the next potential crisis?
Gates: in the field of health, we often encounter such challenges - there are always people who say what can cure diseases, and there are always people who have doubts about vaccines. But during the COVID-19, we saw some crazy claims. For example, vaccines are only a tool for a few people to make money, not really effective. These arguments surprised me. Sadly, this information may confuse some people who could have protected their lives through vaccines and refuse to be vaccinated.
This is a serious problem in the United States. To some extent, Hong Kong, China, may also face similar challenges. In the past, the only way we could overcome this situation was to find people we could trust and let them speak. Therefore, the key to solving the problem lies in who people trust and whether they really listen to their opinions. But there is no doubt that false information and conspiracy theories were indeed rampant during the COVID-19. I look forward to some creative ideas to reduce this in the future.
Margaret Chan: from the historical experience of responding to the epidemic, false information and conspiracy theory are not new. However, the prevalence of false information and conspiracy theories in the COVID-19 is unprecedented, and the situation is extremely bad. False information and conspiracy theories have had a devastating effect. Let's recall that the previous politicized operation of masks and vaccines was groundless, which not only distracted people's attention, but also made people confused and didn't know who to trust. This is not what we want to see. We may not be able to completely get rid of false information and conspiracy theory, but spreading facts, correct and accurate information is the best way to deal with false information.
Q
Caixin: at present, some countries have relaxed most of the epidemic prevention restrictions, such as wearing masks and maintaining social distance. However, some experts warn that the third year of the new crown pandemic may be the worst year in terms of the number of infections and deaths. In the 1918 pandemic, 1920 was the worst year, because people became tired of keeping social distance and other epidemic prevention measures. Is it possible for the COVID-19 to repeat its mistakes?
Margaret Chan: first of all, I would like to point out very clearly that the COVID-19 is not over yet. Novel coronavirus spreads very fast and mutates very quickly. It is important that governments and the public health community be prepared to prevent complacency and remain vigilant. Make the best preparation and strive for the best result. There is no other way.
Of course, I also sympathize with and understand that some people suffer from epidemic prevention fatigue, and they feel exhausted and depressed. I feel it. We are really asked to pay too much, so we must find a balance. We need to encourage ourselves. We need to keep fighting.
In my opinion, China's approach is correct. We need to ensure that the right to life and the right to health are upheld. We need to improve our endurance. When the epidemic eases, we have a chance to relax; But when the epidemic picks up again, we need to redouble our efforts to ensure that people are not harmed.
We also need to make full use of all medical and non-medical means, as well as all other public health measures, such as maintaining social distance, to protect ourselves. It is important for us to realize that the COVID-19 has not yet ended, and it is difficult to predict whether it will become more serious or moderate in the third year. My suggestion is not to make any comparison, especially the 1918 pandemic caused by influenza virus just mentioned. Now we are facing the novel coronavirus. These are two different viruses with different performances. Although there are some similarities between them, and we have predicted some, my advice is not to relax your vigilance.
Gates: the only undisputed thing is that we should do everything possible to improve the vaccination rate, especially for people over the age of 50 or with some basic diseases, and even just two doses of vaccine is not enough. It is already clear, especially for the elderly, that they need a booster every six months. Therefore, regardless of the current situation in each country, it is obviously advantageous to increase the vaccination rate.
As Dr. Chen said, there are many complex situations that need to be weighed, such as children need to go to school and groups with mental depression need to be taken care of. Therefore, different countries adopt different approaches, but all need to improve vaccine coverage. The vaccination rate in the United States is just close to 70%, and many other countries are doing better. The specific proportion should not become a dispute. All countries should try to increase the vaccination rate to close to 100%.
Margaret Chan: looking back at the fifth round of the epidemic in Hong Kong, China, it is precisely because our vaccination rate, especially for the elderly, is very low that we have suffered the most serious impact so far. At present, the HKSAR government is doing its utmost to improve the vaccination rate. Similar efforts are being made in other parts of the world. We should not forget those vulnerable people.
Q
Caixin: coping with climate change is a topic closely related to pandemic prevention. Both of them involve extensional issues such as increasing vulnerability of the ecological environment and reducing biodiversity. How can we understand the intrinsic link between these two global challenges?
Gates: people usually expect the government to take the lead in disaster prevention. For earthquakes, we have building codes. We also have a huge investment in fire prevention. In the United States alone, there are 300000 full-time firefighters and 9million fire hydrants, and everyone has to receive training. As a result, the number of deaths caused by fires has decreased significantly, and the government has performed very well.
I believe that governments clearly need to do more in the areas of climate change and pandemic prevention. The first is pandemic prevention. This problem is very difficult, because pandemic does not often occur, and we can easily forget its danger. That is why I call for the establishment of a permanent "global epidemic response and mobilization team" (GEM) in my book, covering all countries and carrying out training. Just like fire drills or war drills, gem also needs to conduct drills regularly to ensure that it can act very quickly.
Climate change is a more difficult problem to solve. The global monitoring and R & D costs associated with the pandemic will reach tens of billions of dollars, and the cost of improving the public health system will be even greater. But the cost of coping with climate change is higher. It requires more extensive participation and trillions of dollars of investment, because we must change many physical infrastructure of society, such as cars, steel, meat, cement, etc. From now to 2050, we should not only invent cheaper and environmentally friendly ways, but also popularize them at an amazing speed.
As for the pandemic, although its investment is far from reaching this scale, it is more likely to be forgotten. The reason why the issue of climate change gets more attention is that there are often heat waves and floods, such as the recent heat wave in India, which makes people realize that things are getting worse.
Margaret Chan: climate change is the decisive issue in the 21st century, but it has only recently received the attention of global leaders. As Bill pointed out, it is also because of the occurrence of heat waves, the living conditions of polar bears, the deterioration of the polar and oceanic conditions, etc. People need to see this with their own eyes before they can really realize the problems. Therefore, we have not seen more global cooperation until now.
I am glad that the Paris agreement was adopted. In addition, at the 26th conference of the parties to the United Nations Convention on climate change held in the United Kingdom, China and the United States agreed to cooperate with other countries to jointly address our future challenges.
Q
Caixin: the impact of the conflict between Russia and Ukraine has spread all over the world, the energy market is volatile, and the process of climate change may even slow down. Countries in the Middle East and Africa that depend on Russian and Ukrainian grain exports may face a food supply crisis. How will the intensification of global geopolitical conflicts in recent years affect the epidemic response of countries and the broader global health agenda?
Gates: the conflict between Russia and Ukraine is a terrible disaster. It has caused incredible death and suffering. It was a huge setback, and I hope it will end as soon as possible. The disaster is not only on the battlefield, but also affects food costs, food supply and fertilizer costs. I am very worried that not only will Africa suffer from food shortages, but also the resources devoted to Africa's health system may be reduced, because Africa is largely dependent on the generous assistance of European countries. I am trying my best to make this issue get attention, but because of the various losses caused by the conflict, these problems are really difficult to solve.
Dr. Chen and I believe in the power of global cooperation. In the past decade, in terms of global health, China has successfully developed and produced polio vaccine and Japanese encephalitis vaccine, and now has produced cervical cancer vaccine and a variety of new crown vaccines. China has also obtained zero malaria certification and recently celebrated the 50th anniversary of artemisinin. The Gates Foundation has carried out excellent cooperation with outstanding Chinese researchers, and their ability to develop advanced tools is becoming stronger and stronger.
It is unfortunate that conflicts do hinder cooperation in certain areas. Whether it is to prevent a pandemic or to deal with climate change, we need the joint efforts of China and all other countries.
Margaret Chan: like Bill, I am also very concerned about geopolitical situations and conflicts, as well as their impact on global health, especially global health equity. We also need to pay attention to whether the current situation will affect the realization of the 17 sustainable development goals of the United Nations and the overall progress of the global health agenda. These are very important.
You mentioned some important examples of China's contribution to global health, and I agree with you very much. I witnessed China 40 years ago, when China was the world's largest recipient, especially in receiving food aid. But thanks to the hard work of the Chinese people and the efforts of the Chinese government, China has achieved economic growth and improved the health and well-being of its people.
After years of development, China has changed from the biggest beneficiary of global aid to a builder and contributor to global health. I think Bill is right. We need all countries to work together to find solutions, so that people's aspirations for peace, development, health and security can become our dreams.