The Paul Wells Show - Life after COVID: WHO’s Peter A. Singer on the next threat

Episode Date: October 12, 2022

"We may be sick of the virus. It ain’t sick of us.” Dr. Peter A. Singer, Special Advisor to the Director General of the World Health Organization, joins Paul for a conversation about the state of the pandemic, the politicization of public health, and how to get the world back on track.This episode was recorded live at the University of Toronto’s Munk School of Global Affairs and Public Policy. Please take five minutes to complete this podcast survey for a chance at a $100 gift card.

It's a big world out there and sometimes it seems like it's breaking. I'm talking to the people who are trying to fix it. This week, let's do the next COVID better. You know, the enemy is not each other. The enemy is the virus. I'm Paul Wells. Welcome to The Paul Wells Show. the virus. I'm Paul Wells. Welcome to The Paul Wells Show.

Hey, let's talk about COVID. And let's look at the big picture. Not only whether you should keep working from home, but whether a country like Canada is really defending itself if it's only defending Canadians. About whether the panicky health protectionism that saw a bunch of countries hoarding protective equipment and then vaccines was the right way to go, and whether there's any hope of doing things another way when the next health crisis hits. Because now we know that sooner or later, it will. It's hard to talk about any of this without talking about the World Health Organization, the agency of the United Nations that spends all of its time handling the big global threats to health and well-being. The WHO has come in for a lot of criticism during COVID, so that needs to be part of the conversation too. Fortunately, there's someone there who can explain a lot of these

things to us. He's Canadian. He's a top advisor to the Director General of the WHO. His name is Peter Singer. Throughout the pandemic, Dr. Singer has been very outspoken about how rich countries can't just concentrate on containing the virus domestically, because very soon everyone pays the price for that. Here's a tweet he wrote last year. How do you double down on inequity and injustice, he wrote. Deny countries vaccines so they generate variants, and then when they do, impose travel restrictions. That's a pattern he's still seeing.

As special advisor to the director General of the World Health Organization, he was the architect of the WHO strategy and its triple billion target, aiming to improve health outcomes for 3 billion people. So he's thinking in big terms. And he has an impressive resume going far back before he joined the WHO. He was previously the CEO of Grand Challenges Canada, a non-profit that funds innovation in healthcare around the world. It was launched under the Harper government, and that's where I first met him about a decade ago. And before that, he ran the

University of Toronto's Joint Centre for Bioethics. So when I wanted to check in on the state of this historic global catastrophe that isn't over yet, I thought of sitting down with Peter Singer. And we did just that in front of an audience at the Munk School at the University of Toronto a couple of weeks ago. We talked about where the world goes next and what lessons we should learn from this mess. I pressed him a bit about whether the WHO is fit for purpose. I asked him whether Canada has always lived up to its ideals during the pandemic. And we road tested a few popular theories about the WHO's influence and governance. So we covered a lot of ground, which is a good thing because there's a lot of ground to cover. After the break, my conversation with Peter Singer, thanks for joining us.

Thank you, Paul. It's great to be here with you. Let's go back maybe to the beginning of this story. Almost every one of us had a moment in March 2020 where we realized that whatever we thought we were going to be working on, we were now going to be working on dealing with this pandemic. When was that moment for you? It was in early January of 2020 because the first notification came on New Year's Eve, actually, in 2019. And then even into the first week or two of 2020, WHO was gearing up, warning people, and providing advice by early to mid-January to governments. And by the end of the month, January 30th, 2020, Dr. Tedros declared a public health emergency of international concern, which is the highest level of alert under international law. And he did that at a time when there were fewer than 100 cases and no deaths outside of China. So sometimes people say March, I say January, it was certainly the

case for me, and arguably should have been the case for every government in the world. and arguably should have been the case for every government in the world. The tempo of events in January was extraordinary. The question was, is this virus spreading outside of China? Is it airborne? Is there human-to-human transmission? And there were tentative answers followed by contradictions on every step of that path. Was there a period during that time when you thought, you know, we might be able to dodge this bullet? It might be a fairly limited outbreak, or did you know from the beginning that this was the big one?

It was pretty clear pretty quickly that this was a very, very significant problem. And WHO was warning, Dr. Tedros was warning right through January. Just to put it in context, this is the biggest public health crisis probably in 100 years. If you look at estimated mortality, probably upwards of 20 million people have died. Maybe another 20 million deaths have been actually averted by vaccine. So that puts it in the ballpark of the 1918 pandemic where 50 million people died. So hugely significant public health event, and I think a hugely significant global crisis, because one of the lessons of the pandemic

is this isn't just about development, because it affected every country in the world, obviously. It's not just about health. It brought the world economy to its knees, and it raised questions of national security. So it shows how health is very central to development, but not only development, economic prosperity, and also national security. So it shows how health is very central to development, but not only development, economic prosperity, and also national security. And of course, it did turn out to be a very, very

significant, not only global public health crisis, but global crisis that revealed a lot about who we are. It was kind of an x-ray of our soul. So we talk about the moment when you realized that you're not going to be doing what you were going to be doing. What was that? What had you gone to the World Health Organization to achieve? Yeah, I mean, I'd had the huge privilege of working with Tedros, who's a very inspirational principal leader in the run-up to the election in 2017, because actually the WHO election now is very much like a Security Council election. It's one country, one vote. And so I'd been doing that. And then he asked me to come with him

at that time, and I did. And I like to say I went to Geneva for two weeks, five or six years ago. And what I was focused on was supporting his vision of WHO really supporting countries to have measurable impact in countries. And so we were developing a strategy around health promotion, around universal health coverage, around health protection. Some of those things in health protection, and actually also in those other two billions, really presaged a lot of what ultimately would transpire. And now we're at the point where progress on health goals in the world is about one quarter the pace that countries agreed to in 2015, the targets they want to reach by 2030.

So the question becomes, OK, well, how do you accelerate that? Because obviously so much has been disrupted and COVID has changed so much in terms of health, in terms of health delivery. And now it's a matter of actually getting back on track and accelerating. Okay. Dr. Tedros Ghebreyesus, who is the former foreign minister of Ethiopia, first director of the WHO to be elected by a vote of the full membership. And it was a contested election. It was a hotly contested election. The other candidate had the backing of the United Kingdom and Canada,

and he didn't. Were you involved in that campaign at all? Yeah. And, you know, I supported Tedros, A, because of the type of principled leader he was, which really came under test, shall we say, in COVID. Also, when you look at these global institutions, it is important that they be led with people with firsthand experience of the problems. You know, he was the first African, actually, interestingly enough, the first health minister to be director general of WHO,

the first non-phys director general of WHO, the first non-physician. So there were a lot of firsts there. And his experience with diplomacy as a foreign minister really did come in handy, shall we say. What was the aftermath of that election? Was it harder to rally around the new director after a process that was new for everybody? I'd say it was almost the opposite, you know, because it brought a type of democratic legitimacy to the whole situation. He really won with a majority. I mean, it was a contested election. Elections should be contested. But he really won with a majority of the countries of the world, a strong majority. And he had a very strong and legitimate mandate to lead.

And that he has done. And recently, as you know, he was reelected for a second five-year term with an even stronger majority. So that type of legitimacy, I think, puts him in the principled position of being the world's top health diplomat. And I went there to support him, and in particular, to support his vision of measurable impact in countries. Because the multilateral system ain't perfect, and WHO's the central player in health in

the multilateral system, along with its sister agencies, UNICEF and others. But the multilateral system ain't perfect. But a world without multilateralism is a very, very scary world indeed in terms of cooperation and in terms of solving the global challenges we face, be it the pandemic, be it climate change, be it economic inequality, and so on. It's almost surprising to arrive to the role with a proposed mandate for measurable impact on the ground 60 years after the organization came into being. What was it doing before then? It was doing a lot. I mean, the premier accomplishment obviously was the

eradication of smallpox, but it had done so much more also historically. For example, if you walk into a bar here or a restaurant, there's no smoking, front of pack labeling, a lot of that comes from the framework convention for tobacco control. WHO has a lot of comparative advantages including 152 country offices so it works very strongly supporting governments but measuring that measurable progress which was the idea behind the sustainable development goals as well, is also really important to bring into multilateral organizations, which have this additional important role of global diplomacy. You know, another bit of comparative advantage is it's the only place that 194 health ministers of

the world get together as they did during COVID to exchange good practices. So it was doing a lot of measurable impact, but doing that systematically and taking, let's say, the 50 out of 170 something targets that the countries of the world had agreed to and clustering those into three things. The three things I mentioned, healthier populations, universal health coverage, health protection, really helps you to execute a strategy to it, and to show that you're improving. And that's not something that happens overnight, but it's something that I think has lessons for other agencies in the multilateral system as well. So there was a lot of measurable impact that was happening, but one way to improve an organization is really to do that very systematically and very strategically. And that's where he went. And it was also his experience as a health minister of Ethiopia and the things that he had accomplished there. And where did pandemics

fit into the plan while it was still a hypothetical? Top of mind. I mean, I remember walking with him around the time of a UN General Assembly through Central Park. And a reporter was interviewing him and asked that great question, what keeps you up at night? And he said, what keeps him up at night was a pandemic. And that was some months before COVID. So it's not that people hadn't thought about that. It's not that Tedros hadn't thought about that. It's not that WHO hadn't thought about that. But the world was in a cycle of panic and neglect. So if you go back to 2015 and Ebola, once that was kind of done, there was a cycle of panic. And then countries in the world put forward plans and asked for financing to prepare better for the next one. And then those things weren't financed. And we got into the

neglect part of the cycle. So part of the issue, Paul, going forward is to make sure we don't repeat the cycle of panic and neglect on pandemics, which is why Tedros and WHO are kind of leading, and the countries of the world are leading in terms of negotiating a pandemic accord, a financial innovation, a financial facility, WHO World Bank, and other things. But one of the points I'd like to make, and we can go into this in more depth, is there's a lot of technical fixes here, and we should pursue them, local production of vaccines. But the real issue here is that the foundations of the house have a crack in it. You know, the moment that you're thinking of renovating your house and you discover the foundation has a crack in it, that foundation

is cracked. And what I mean by that is equity, because the top three lessons of the pandemic are equity, equity, and equity. Leadership, which is the most effective vaccine. trust, trust in government, trust in ourselves. Those are the things that correlate with pandemic outcomes the best. And this disturbing COVID hangover of polarization, you know, a recent ECOS poll in Canada showed that one in four Canadians support the freedom movement, which means they're against pandemic restrictions. And that creates a very polarized environment within countries and also between countries to move forward. So yes, we have to deal with the technical things, local production of vaccines, countermeasures, early warning, etc. But what I want to highlight is there's also some foundational cracks here that need repair.

Inequity, issues in trust, issues in leadership, issues in polarization that will significantly impair the way that we tackle any global challenge if those things aren't repaired. So issues in leadership. On March 11th, I believe, Dr. Tedros announced that they were designating COVID as a pandemic. During the five weeks between the public health emergency and the pandemic, he said that what struck him and what caused him to take this extra step was astonishing inaction. What were the symptoms of that?

How did that inaction play out on the ground in Europe, in North America? Yeah, you know, announced is a pretty strong word. One of the points I want to make is that the only international agreement, formal agreement on early warning is the international health regulations and the declaration of a public health emergency of international concern. And that happened on January 30th, 2020. So it tells you something if you want to date the thing from March, because people should have been acting in January. There was an independent panel that looked at this and made the point that governments just didn't really gear up to what was coming during, let's say, a sleepy month of February. And it goes to the point that, or many governments, and the ones that did tended to do better.

And it goes to the point that solving these global problems really relies on domestic governmental action of 194 countries in the world. And think about transposing that with our development model, which is kind of based on charity. So one of the key lessons here, and I'm building on your question of what happened in February, is to strike a better balance between, let's say, charity in international development and self-reliance on the part of governments, which is really the only sustainable solution to the inequities in the world. But what happened was not much. Basically, WHO had sounded the alarm, the red lights were flashing, the alarms were

blaring on January 30th and building up to January 30th and through February. But in some parts of the world, not much was gearing up in terms of the public health response on the ground, the various precautions and so on. To finish your sort of three horsemen of the apocalypse, there's equity, there's leadership, and then there's polarization. WHO plays a big role in that as a sort of designated villain in the piece. From the very beginning, people were saying WHO is a puppet of China. It helped China cover up the early stages of this. The president of the United States, the previous one, President Trump, announced that the United States would withdraw funding from the World Health Organization. First of all, how do you respond to that sort of nest of allegations? And secondly, how much did that affect the work that you were trying to do?

Well, I mean, just to point out that in this, let's say, bipolar world, WHO has 194 member states. But in this bipolar world, WHO has been under severe pressure, both from the heads of government of the United States and the head of government of China at various times. And so the way I would respond is Dr. Tedros has been an extremely principled leader. He's treated 194 governments the same. He's worked issue by issue. And when you do that, and when you do the right thing, and that's, I think, what helps them sleep at night and what helps us all sleep at night, that's how you withstand pressure. And again, I think his upbringing in the face of conflict, in the face of other types of more immediate pressure, shall we say, helped them to develop

this very calm, principled approach. So how I respond to it is when you do the right thing, from time to time, you'll come under pressure, even from very powerful players. And then you don't buckle if you're confident that you're doing the right thing. And that's exactly what happened here. We'll come back to my conversation with Dr. Peter Singer in a minute. Thanks to everyone who makes this show possible. Our partners at the University of Toronto's Munk School of Global Affairs and Public Policy, where that conversation with Peter Singer was recorded, and at the National Arts Centre in Ottawa. Our founding sponsor is TELUS,

and our title sponsor is Compass Rose. Our publishing partners are the Toronto Star and iPolitics. World Health Organization has no mandate, no ability to make national governments work against their will. It's essentially an organization for herding cats. In a moment of crisis, how keenly do you feel that limit on the organization's abilities? The World Health Organization is there to find the overlapping consensus among governments and then to help to implement it. And that's an extremely essential function because these threats are transnational,

be it pandemics, be it climate. I don't want to devalue that function. That consensus finding and implementation itself is an extremely important function. And in fact, that's a comparative advantage to 194 health ministers. And practically speaking, meeting on a weekly basis, exchanging ideas, developing a pandemic accord. But it is true that WHO has no authority to undermine the sovereignty of any country. And that is true,

and the countries of the world should decide together in the context of this accord, how they want to manage that. And the practical issue, of course, becomes entry into a country, assessment of threats, stuff like that. So the way I respond to it is, even with that, shall we say, limitation, it's an extraordinarily important function to have a place where people can find, governments, not cats, but governments, can find that consensus. And that saves lives. We should be proud of that. And then what governments collectively want to do, governments collectively will do. So consensus itself is hugely important, even if it doesn't have, let's say, the police powers of an IAEA of entry into countries. While all this was going on, did you get COVID?

while all this was going on did you get COVID yeah I got COVID very early in March of 2020 my wife and I both did that it did have some lingering effects and then I got it again I got it again last spring but I got I just had an asymptomatic case so I got it a couple of times but. But I think almost everybody has had COVID. Not everybody, but almost all of us. So there's nothing special about that. What I did do was- How many people here have had COVID? Yeah, almost everybody.

So kind of half the room? Yeah, yeah. I mean, the real thing I was struggling with actually was vaccination early on. And the reason I was struggling with that was obviously I really wanted vaccination because I knew how life-saving it was. You know, vaccination plus boosting has about a 96% decrease in mortality rate. I mean, it's really very, very significant. And as I mentioned, probably 20 million lives averted and inequitably distributed. But I didn't feel right getting vaccinated myself while so many health workers who were on the

front line, for example, in Africa weren't. So the first time it came up for me in the Swiss system, I deferred it and then I got it later. So you can't defer COVID and you shouldn't defer vaccination, but you were asking about a struggle. That's the issue that I struggled with, is the morality of that. And that's a very personal issue about the morality of vaccine inequity. So when you're flying on a plane, it says, if people need oxygen masks, you should always make sure that yours is on properly before helping the person next to you. Did that principle enter into your calculations? At least I'll be taken care of and then we can worry about distributional effects later? You know, what underlies inequity is solidarity. And what underlies solidarity is love. The real question here, and I think this is the question

that COVID raised, is are we really our brother and sister's keeper? Do we really love our neighbor like we love ourselves? Those are the questions underlying it. And then it depends, of course, who you think your neighbor is and who you think your brother and sister is. So yes, you could argue about the airplane metaphor and the masks, et cetera. But most fundamentally, and this I think applies very much going forward, what we have to find is a world where we value a life, even a distant life, in a rural community in Africa, as much as we value our own life. And if that was the case, then we wouldn't see those inequities. We would have saved many more lives. I mean,

there's a bound of reality here, which is why you need vaccine distribution and vaccine production in low and middle income countries. But the point I'm trying to make, Paul, is there's also a fundamental ethical issue to grapple with. And the reason I brought out that vaccine example for myself is that's not an issue for me. It's an issue for every single person in this room and for every single person listening.

Because this ain't the last time we're going to face this choice. Either there will be another variant, hope not, or there will be another pandemic, hopefully not as severe, and we'll grapple with exactly the same issues. And what was really remarkable to me through this whole thing is that, yeah, there's a lot of technical issues, but it's the foundational things in human values, in equity, in trust, in leadership, in love, if you let me say that, that really were revealed. And that's why I say it was an x-ray of our soul. And I just gave you one little personal example. But I think that's something that everyone could reflect on in respect to many of the

global challenges that we face. So when the government of Canada drew vaccine supply from a global stockpile that was designed to ensure that vaccines got to developing countries, what did that X-ray reveal? You know, governments are elected to protect their people, right? So there's an understandability in it. And the fact of the matter is that Canada has the second lowest mortality in the G7, probably because of those vaccine things. But governments do what their people direct them to do at the end of the day, to a greater or lesser extent the end of the day, maybe it's more productive.

And I think it's extremely important to do this going forward is to do a very serious self-reflection about whether each of us wants to live in that kind of world where there's hundreds of thousands of deaths as a result of that inequity. You asked what it felt like. It felt sad. It felt sad to know that people were dying who didn't need to die, including health workers who were putting themselves, if you will, in the line of fire to help others. It felt sad. And so your point about governments, I think let's turn the mirror on

ourselves. Let's turn the mirror on citizens. And that applies to how we approach inequity in the future. And it applies to how we approach these issues of polarization in the future. Another thing I heard from a staffer working for the federal government a year and a half ago was, look, when we get these vaccines to some of these developing countries, the level of vaccine skepticism and hesitancy is such that people don't even want to take them. Do you buy that? Not really. I mean, you can't dissect out demand and supply. If you don't have access to vaccines, you may not demand vaccines. They're so intricately related. So you need to do both. And a good test is we did both here

in Canada. We had both supply and we dealt with distribution, even calling in the army at times, and that led to demand. That's the beneficial cycle that you need. And you have to do that early at a particular time. It's that scale up phase early on that's really super hard. And that's why the domestic vaccine production is important. But I want to raise another point about equity, is it's not just international among countries, it's also the domestic vaccine production is important. But I want to raise another point about equity. Is this not just international among countries? It's also a domestic issue. So a great case example of this is the black community in Toronto. The community organized.

It pushed the municipal government to disaggregate data by race. Then they could identify that the attack rate was several fold higher in the black community. They could identify that the attack rate was several fold higher in the black community. Then community leaders could become screeners, ultimately vaccinators, building trust, because a lot of this is about information, but it's also about trust. And then they could bring down the differential rate of COVID deaths, of COVID attack rate, et cetera. So when we talk about equity, it's easy to think about it as an international thing, but even more so,

we have to think about it as a domestic thing. And what COVID revealed, it didn't cause the structural inequities that are in our societies, be it essential workers who have to go to work, et cetera. It didn't cause those inequities, but it certainly revealed them. And I think that's a really important thing to keep in mind

as we want to move forward to tackle health challenges. And again, I would say any of these challenges that we face. There are people who say, how much can we trust public health expertise at all in any circumstance, given that in the early days of this pandemic, public health authorities are saying, above all, don't go around wearing masks.

You're just taking masks from where they really are needed. That there is historical evidence of compounds that were seen to be very beneficial, like DDT, that turned out to have just absolutely nefarious health impacts. Obviously, these kinds of analyses are now restricted to a very small part of the population, but they believe profoundly that people who say, I'm from the government, I'm here to help you, are often not telling the whole story or not even aware of the whole story. How do you combat that strain in public opinion? Yeah.

I mean, firstly, the fact of the matter is that I think science evolves. Right from the beginning, WHO was talking about opening windows, talking about ventilation, talking about masks, et cetera. But science does evolve, and we do learn things. So the information does change, and that ought to be the norm, and that ought to be expected. And getting that message out, I think, is important. Having said that, it's not principally an issue. It is an issue in information, and there's this term infodemic, but it's certainly not only an issue in information. It's more primarily an issue in trust.

And so that's where things need to be rebuilt. And I think, really, you asked a very practical question, how do you rebuild trust? I think the way you rebuild trust is through leadership and in communities. Pandemics start and end in communities. And so when we talk about leadership, I'm talking about not only the leadership of heads of international organizations, like Tedros, I'm talking not only about the leadership of heads of state and heads of government, I'm also talking about community leadership, which at the end of the day might be the most important of all. And the way to rebuild trust is actually for community leaders to really

internalize the information to lead because people trust their own communities. You know, if you take, for example, the African American community in the United States, or indigenous communities in Canada, very good reason to distrust somebody, you know, coming at a white lab coat with a needle. And I think that building up that trust has to come within communities. And I'll add one more thing. I don't want to be too much of a downer. There's a lot of hope here. And where the hope lies is in young people. So take one concrete example in Canada of Vaccine Hunters Canada. They did a terrific job. A bunch of young people, self-organized, did a terrific job matching people to vaccines. And my advice to young people, and that's where my hope for the

future lies, by the way, my advice to young people is find a problem and solve it. They found a problem and they solved it. And so, you know, yes, we're highlighting the cracks in the foundation, but those cracks can be repaired. They can be repaired within communities in Canada, and they can be repaired by young people, which I think is where a lot of the hope lies, as demonstrated in the pandemic. So I'm going to keep throwing hard questions at you. You keep throwing me hope if you like.

I'm just trying to help your outlook, Paul. Tonight when I get home, I'll be like, oh, you know he was right. But in the meantime, there's an awful lot of fatigue. You're right that we're not sure that there isn't going to be a really pernicious new variant that's going to come at us in the next few weeks. And yet people have been staying home from work, keeping their kids home from school, wearing masks, trying to stay up with vaccines for now, you know, more than two years. Is it getting harder and harder to implement these restrictions as needed?

Yes. And, you know, thank goodness this was the worst public health crisis in 100 years. And it did disrupt things terribly. But at the moment, at least, the end is in sight. So last week, 8,900 people were reported to WHO to have died of COVID around the world. That's one-tenth of the peak of January 2021. That's 8,900 too many, right? But it's still one-tenth of the peak. So the end is in sight. I think we all need to continue to take reasonable measures. But at the same time, people are tired. They are damn sick of this. And so am I. And so are you. And it's in that context that we have to navigate. So I think that's extremely important to recognize, to understand, and to be commensurate

in one's response. But we may be sick of the virus. It ain't sick of us. That's the key issue. Hopefully, we'll be through this soon if there's not another variant. But I can guarantee you there'll be another pandemic. And hopefully, it won't be at this scope and scale. And hopefully we'll be better prepared if we fix some of the foundations and do some of the technical things that have been unveiled. But that pandemic fatigue is a real thing. It's important. And if anything, it should cause us to redouble our efforts to come together against a common enemy. You know, the enemy is not each other. The enemy is the virus. And even though we're tired of it, we should try to join to defeat it. Dr. Singh, the first time I met you,

some mutual friends got us together. We spent a couple of hours at a pub in Ottawa talking about all of these issues. And I'm left with the same feeling I had then, which is that I wish we had a few more hours to hash this stuff out. But we'll just have to make a date for another pub or another conference room down the road. Thanks so much for taking the time today to help us figure all this stuff out.

And thanks for the work that you're doing. Thank you. Thank you very much for the work you do. Not to mention the fact that podcasts are probably the only reason some of us go to the gym. And so, so you're also improving people's fitness at the same time. So thank you very much, Paul. And it's a real, it's a real privilege. It's a real privilege to be with you. To be continued. Thanks everyone for coming out. Thanks for listening to The Paul Wells Show. Remember, try to cough into your elbow. The Paul Wells Show is produced by Antica in partnership with the National Arts Centre

and the University of Toronto's Munk School of Global Affairs and Public Policy. It's published by the Toronto Star and iPolitics. Thanks to our founding sponsor, TELUS, and our title sponsor, Compass Rose. Our senior producer is Kevin Sexton. Our associate producers, Haley Choi. Our executive producers are Lisa Gabriel and Laura Reguerre. Stuart Cox is the president of Antica. The fantastic music was written and composed by Kevin Bray. If you're enjoying this show, spread the word. Thank you.