Health Committee on June 23rd, 2020

[Lawrence Gostin]

Well, frankly—

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

We have our own—

[The Chair, Liberal, Ron McKinnon]

Mrs. Jansen, please let the witness answer.

[Lawrence Gostin]

You know, frankly, there are countries—mostly the United States, but less so Canada—that didn't take it seriously enough in the sense of really using their public health capacities. Many of the countries that had experienced SARs did do very, very well, as you said. Singapore would be another example of that.

I think the tenor of your conversation is what I don't accept. Deflecting the blame to an institution like the World Health Organization is not the answer. I—

[Tamara Jansen, Conservative, Cloverdale—Langley City, BC]

I think I have to challenge that suggestion—

[The Chair, Liberal, Ron McKinnon]

Thank you, Mrs. Jansen. Your time is up.

Dr. Powlowski, please go ahead for six minutes.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Thank you, fantastic witnesses. I am glad to see that you both have a connection with Hamilton. You're affirming MP Bob Bratina's assertion that the world actually revolves around Hamilton.

One would hope that the world would come together after the COVID crisis. After all, it doesn't matter where we are in the world—other than maybe some places in the South Pacific—because we're all experiencing the same things. We're all forced to socially distance and wear masks in public. People are staying at home worried about the health of their elderly relatives, worried about when their income is going to start to come in. This should bring humanity together, but in fact, there are suggestions that this is undermining globalism, undermining our common sense of humanity.

Borders are closing. We're trying to make sure that supply chains are domestic rather than dependent on foreign countries. We're seeing diseases as coming from other places and affecting us.

Certainly, globalism has done a lot to make the world a better place. There are so many people who lived in abject poverty before globalization. There are countries like Mexico, China and India where there was a lot of abject poverty and now it's quite rare as a result of globalization.

Similarly, the world has been a fairly harmonious place with not a lot of international conflict since the formation of the United Nations in 1945. I'm a little worried post-COVID-19 that we're becoming a little more fractionated, a little less together in terms of humanity. This is pulling us apart, rather than together.

My first question to the panellists is this: Do you think this is the case? Are we going to come out of this more united globally or less united?

Second, what can we, as Canada, do to ensure the former, that we come out of this more united and strong, that our international institutions are stronger, not weaker, and that we're not going back to the kind of world we were prior to 1945?

[Lawrence Gostin]

Jeremy, did you want to answer that or shall I?

[Jeremy Konyndyk]

I'm happy to take an initial attempt at it.

I think that is a real risk. One of the things that has been really striking so far about this crisis, in contrast to, say, the 2014-15 Ebola outbreak, is just the lack of a sense of a common global effort. I put some of that, frankly, to my own country. I think there's been a lot of insularity in the way the U.S. government has handled this. Usually, you'd look to the U.S. government to be trying to lead and convene those kinds of global efforts and we haven't seen that. That's reflective of some broader trends in the world, but it's really unfortunate and, as you said, very rare.

We're all facing a common enemy here, so we do need a more common approach. We're not going to be able to defeat this or be truly safe from this anywhere until it is controlled everywhere.

I think it ties back to the previous question on a travel ban. One of the concerns about travel bans is that, as all of the literature on travel bans suggests, at best they buy you two to four weeks of time to prep. They do not buy you enduring protection. They will delay, potentially, the arrival of an outbreak in a country, but they do not prevent it. Unless you're New Zealand or Fiji, they're not going to prevent it.

The utility of a travel ban, if there is such, is to slightly delay the arrival of the outbreak so that you can prepare, but it still will arrive. I think we're at a point now where this is in every country in the world. For a country like Canada or the U.S., or any country, we're not going to be able to rely on travel controls to keep us safe. We need to suppress it at home and we need to simultaneously work on suppressing it overseas because as long as those...

Every country is going to have a lot of dry kindling until we get a vaccine. As long as there are sparks flying from anywhere in the world, there's a chance that that dry kindling will get hit again. That's what South Korea and China have experienced as well. The greatest threat—maybe not the greatest threat but a significant threat—for them since they got it back under control has been the reintroduction of travel.

I think we're right. If we want to be able to get the economy back on track, we have to be able to get global travel back on track. About 10% of global GDP depends on travel or tourism. That's a big hit. That's a really big hit if we have to sustain two to three years before there's a vaccine widely available, with huge damage to global travel. The best way to do that is to suppress it everywhere and that has to be a global effort. That's not something that countries can just do individually.

[Lawrence Gostin]

I agree with Jeremy on everything he said in terms of the current COVID response and the need for unity. I think it's absolutely essential.

Marcus asked about the post-COVID world. That really interests me a lot, because one day this is going to be over. What will the world look like, and what will Canada's role be in that world? This is really important. Will it be a world that's more splintered? Will it weaken or undermine international institutions or international treaties? Will it weaken human rights? Will we see the first flare-up lead to large-scale lockdowns, mass quarantines, and travel and trade restrictions?

We've been down that road before. We really have, and it doesn't work. I appeal to Canada, because I've seen from your southern border the country that, frankly, I sometimes wish we were in the United States: one that engages globally, one that leads, that talks about human rights, that talks about trade, travel, globalism and the rule of law. That's what I want to see, and we have a choice as a world. We can go down one path and close everything and become nationalistic and thump our chests the way many of the strong leaders do, or we can co-operate.

Truly, if COVID teaches us anything, it's that we're all in this together and that we need to work together. That's going to be even more important as we try to get vaccines and therapeutics.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Gostin.

Mr. Thériault, you have six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Mr. Gostin and Mr. Konyndyk, I'm very pleased to have the opportunity to speak with you today. Given everything that you told us earlier, I'd like to speak with you for six hours. Unfortunately, I have only six minutes. I would encourage you to provide documents that relate to your thoughts regarding the questions that we'll be asking you. Your testimony is very valuable to us as we look for solutions.

I'd like both of you to answer the first question. When mainland China was facing a massive contagion, very few people thought that the United States of America would become the largest source of infection on the planet.

Given your extensive experience with global pandemics and your knowledge of health care systems and plans, did you anticipate the magnitude of the pandemic affecting our neighbours in the United States, with whom we share a very large border?

What do you think are the main reasons for this?

[Lawrence Gostin]

Jeremy, do you want to go first, or shall I? I'm happy either way.

[Jeremy Konyndyk]

I'm happy to say an initial few words on that, Larry.

It's a really great question. One of the things that we have seen from many countries is an underestimation of the risk this disease poses.

I wrote an opinion piece in The Washington Post that was published on February 4 in which I called for a “no regrets” approach. I urged the United States government, and really the world, to look at what was happening in Wuhan, China, at that point, and ask themselves whether it could happen here. This is because, in my view, as soon as we saw hospitals being overwhelmed in a wealthy metropolis like Wuhan, a city of 11 million people with a very modern health care system in a fairly wealthy upper-middle-income country, there was very little reason to think that any developed country—whether that was in North America, western Europe, east Asia or anywhere—would be immune.

I think that at a minimum, every country should have been preparing from that moment for the possibility that the conditions in Wuhan could happen in their own country. There was no good reason to think that would not happen. Every country should have been asking itself two simple questions on January 23, when Wuhan began shutting down: One, could that happen here? The answer in every country was clearly yes—if it could happen in Wuhan, it could happen anywhere. Two, are we ready for that to happen? Are we prepared if that does happen? That's the idea of a “no regrets” approach.

That was not the approach that the United States took. It was not the approach that most countries took. I think there was a certain magical thinking that somehow what happened in China would stay in China, but I don't think there was ever a scientific basis for believing that would be the case.

Therefore, yes, I did expect that this could happen in the United States. I was calling for preparedness and was disappointed to see that it didn't happen.

[Lawrence Gostin]

I thought that was a terrific question as well. Thank you very much for asking it in such a gracious way, I might say.

The global health security index—Jeremy and I are both involved in that—had the United States top of the list in terms of health capacities, and the International Health Regulations require all countries to develop core health system capacities to be able to rapidly detect and respond to novel outbreaks.

A very valid question is, why were high-income countries in North America, Europe and Asia hit so hard? I think the answer is that health systems are not enough. We need to prepare and plan, and we need leadership to act. As the Prime Minister of New Zealand says, “Act hard and act early.” We didn't do that. Certainly the United States and Europe and many other countries didn't do that.

I would come back to what Jeremy said in his opening statement. I was quite impressed—but I'm always impressed with what Jeremy says—about the idea, and I have said this, that trust is Public Health 101. You need to get the public's trust.

I note that there is something else we haven't discussed, which is the populist undermining of science and experts. One sees this in the attacks on WHO, one sees it in the undermining and sidelining of the U.S. CDC, and now even the White House coronavirus task force, and you see it in Brazil and other places.

Leadership matters, so we need two things. We need a strong health system, but we also need to take these things seriously and get the public on board with a consistent message of solidarity.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We will go now to Mr. Davies.

Mr. Davies, please go ahead for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair, and thank you to both witnesses for being here.

Professor Gostin, could I start with you?

You've written recently that “The WHO has achieved so much, even with paltry funding. Out of the COVID-19 pandemic, the WHO could be reimagined as a stronger, more responsive international agency.” Given the lessons learned from COVID-19, what reforms do you believe are necessary to strengthen the WHO?

[Lawrence Gostin]

I thought you'd never ask. Thank you.

There are a number of them. I'll start with sustainable funding. The World Health Organization now has a funding level that's less than one large U.S. hospital, one-quarter of the amount of the U.S. CDC, and it has a global mandate.

Even worse, of the paltry funds that it has, it only has control of about 25% to 30% of its budget. All the rest is directed to pet projects. No organization can succeed when it's funded at such a low level and when it isn't given discretion over focusing its resources on global priorities.

The second change I would make is just a basic one. The world has the WHO it deserves because it doesn't politically back the WHO. It puts the WHO in the middle of politics and in political fights. I'm working now closely with the WHO, and they're distracted just at the wrong time, so political backing would be the second change.

The third would be to strengthen compliance under the International Health Regulations to give the WHO tools for independent verification to the extent that we can, with state and official reports, partner with countries on the ground to get more clarity and compliance in terms of public health recommendations. I realize that those recommendations themselves have been in dispute.

Then there's the process for declaring a public health emergency of international concern.

I've said earlier that the WHO is not a perfect organization. Sometimes that can be so frustrating, but they are working really hard, and we need to make them the best global health organization we can, rather than tear them down.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks.

If I could drill down a little bit on the funding, in a Vanity Fair article you were quoted as noting that the Trump administration's plan to withdraw from the WHO would “probably be the most ruinous presidential decision in modern history”.

You also said in a recent article that if the U.S. were to withdraw, that would leave the prospect of the Bill & Melinda Gates Foundation becoming the WHO's top donor. You pointed out that if that were the case—leaving a private foundation to be the highest donor—it would be transformational.

I'm going to ask you two questions in one. Can you explain why, in your opinion, the U.S. decision to withdraw would be so ruinous, and what the implications of the top donor being a private foundation would be?

[Lawrence Gostin]

I think we may hear more imminently from the President of the United States on this issue, and I'm not at liberty to disclose exactly....

I now have over 1,000 signatures from leading public health people in the United States, urging Congress to block the withdrawal. I do believe it would be the most ruinous decision of a president in modern history to simply turn our back on the World Health Organization. I never thought I would see that in my country. I think it would weaken the global order. It would weaken public health, and I think it would put the United States itself at a higher security risk.

To your second question—they're both fantastic questions—the WHO is an intergovernmental organization. It's often been called the world's health democracy, because it's one country, one vote at the World Health Assembly. To think that a private donor.... As much as I do admire Bill and Melinda Gates—and they do have their hearts in the right place and they're a wonderful foundation and wonderful human beings—we nonetheless can't let a private foundation that's unaccountable and non-transparent and has its own preferences to make decisions that could affect global health priorities. We do need countries to step up—

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Chair, do I have time for one more quick question?

[The Chair, Liberal, Ron McKinnon]

You have 20 seconds.

[Don Davies, NDP, Vancouver Kingsway, BC]

Last, Mr. Gostin, you mentioned the accessibility of vaccines. How can the international community ensure equitable worldwide distribution of any COVID-19 vaccine or therapeutic that might result in the months and year ahead?

[Lawrence Gostin]

Thank you very much for that question. I'll send you a JAMA article that I co-authored on that very subject.

The idea is that we need to plan for it now. I would like to see that planning under the auspices of the World Health Organization, whereby all countries pledge to not have a price on intellectual property competition and to equitably share the vaccine, but it could be under the auspices of the G7, the G20 or the United Nations.

I think what we need is a coalition, and I can think of Canada as being one of the leaders of this coalition and trying to push countries. We need to plan for equity now, before anybody knows that they're going to win the race. Now everybody has an incentive to co-operate, so we need to plan for that equitable distribution very early on.

Thank you so much for those questions. I do appreciate them.