SSU Forum/GraSPP Research Seminar: The Future of International Health Cooperation after the COVID-19 Crisis

OPENING REMARKS: Kiichi Fujiwara, Director, Institute for Future Initiatives, UTokyo
The forum opened with remarks from Director Fujiwara, explaining the purpose of the event. There are already over 15 million people worldwide infected by COVID-19. Though there is a continuous attempt to suppress the further spreading of the virus, the weaknesses of the international health cooperation have now become visible. This has led to a series of questions to rise: What are the structural problems that hinder the function of international cooperation coordinated by the World Health Organization (WHO)? Compared to previous cases of pandemics including Ebola, SARS, and MERS, what are the issues that the COVID-19 pandemic exacerbated? What is the cue to strengthen the system in order to prepare for future pandemics?
With these questions in mind, two panels were prepared for this forum. The focus of the first panel would be structural problems of the international cooperation that has surfaced while combating the COVID-19 crisis, followed by a discussion of future prospects. The second panel would analyze socio-political issues from the perspective of “Human Security” and Sustainable Development Goals (SDGs).

PANEL 1: STRUCTURAL PROBLEMS OF INTERNATIONAL HEALTH COOPERATION IN THE COVID-19 CRISIS

“A crisis of global health systems in the midst of the COVID-19 pandemic”
Kenji Shibuya, Professor, King’s College London
While the COVID-19 infection is spreading worldwide, government and market failure in the global health is becoming quite noticeable, and this pandemic has become by far the most politicized compared to previous ones. Under this situation, criticism towards WHO is growing. For example, WHO has been accused for being late in responding to the crisis. Yet, WHO did declare the then novel coronavirus outbreak a Public Health Emergency of International Concern (PHEIC) just after four weeks the first confirmed case in China was reported. Considering that the organization is under many restrictions such as limited agency so as not to override sovereignty of state, or additional difficulties due to the fierce tension between the United States and China, Professor Shibuya defended WHO and pointed out that the criticism may be out of proportion.
Instead, as major causes of the hindered function of international cooperation, the Professor referred to domestic political issues within the member states and unstable international relations between the states. Figures show that earlier lockdowns in the United States or the United Kingdom in accordance with WHO’s alert, putting aside domestic political issues, could have prevented massive casualties. As for Japan, the Professor did concur with the government’s decision to postpone the 2020 Olympic and Paralympic Games, but raised issues on the maintenance of scientific independency, accuracy, and credibility, a simultaneous situation also found in other countries as well. The need for new evidence and information on the novel virus has led to the proliferation of scientific papers without peer reviews, causing the erosion of trust in science itself. He especially saw problematic that some scientists are acting as government spokespersons when they should be devoted advisors analyzing the situation and presenting options so that policy makers can make sound decisions based on scientific evidence.
Although there are many issues, Professor Shibuya shared a few hopeful prospects. COVID-19 vaccine candidates are being developed under international alliances such as GAVI, and China is collaborating with scientists from other countries so as to advance the research on the new virus. Global efforts continue in the midst of the crisis.

“Global Health and Security – Historical Context and COVID-19”
Ayako Takemi, Project Member, Institute for Future Initiatives, UTokyo
By reexamining the historical background of the evolution of international health management, Ms. Takemi analyzed how effective information gathering to respond to outbreaks and national security have become significantly overlapping domains. The agreement process of International Sanitary Convention in 1892 was a political effort to overcome disagreements in scientific facts, and LNHO and WHO were established as a neutral organization that dealt with health issues apart from political-security dimensions. But in recent years, Global Outbreak Alert and Response Network (GOARN), a “network of networks” that includes networks from military organizations, has been implemented to attain effective and timely information collection. This network approach has led to the revision of the International Health Regulations, expanding its scope from three limited infectious diseases to all public health hazards regardless of its cause. As deliberate incidents such as terrorism attacks would also fall under the scope of IHR, Ms. Takemi pointed out that this transition had some degree of influence on the securitization of health issues.
Ms. Takemi also commented on other issues that surfaced due to the COVID-19 pandemic, such as the failure of information sharing within one country, namely the situation seen in the United States, restricting the export of supplies useful in preventing the spread of the infection, a decision made by Russia and Ukraine, and the spreading of the virus by military personnels sent to conflict zones. In order to tackle these issues, possible policy interventions, Ms. Takemi suggested, would be strengthening cross-domain intelligence networks while setting up the proper framework to designate the scope of information sharing, and setting and securing appropriate procedures for political decision-making.

“The Issues and Future of Global Health Governance”
Hideaki Shiroyama, Professor, Graduate Schools for Law and Politics and Graduate School of Public Policy / Vice Director of Institute for Future Initiatives, UTokyo
Professor Shiroyama focused on the role of WHO and emerging issues that were brought to light due to the spreading of COVID-19. Global health governance has always been fragmented, and attempts to reform WHO has been made since the 1980s including those aimed at fighting antimicrobial resistance or supporting the implementation of universal health coverage in collaboration with the UN, G7, and G20. When the Ebola Epidemic occurred in Africa in 2014, health, humanitarian, social, political, and economic risks combined and prevented the developing countries from containing the infection on their own. The countries’ decisions to close borders, the late involvement of WHO, the slow progress of research and development of medication for emerging diseases were other factors that worsened the situation. WHO has responded by reforming itself to urge collaboration with other organizations such as the UN and initiating CEPI (Coalition for Epidemic Preparedness Innovation) to promote the development of new drugs for emerging diseases.
Nevertheless, although many reformations have been made to strengthen the global health governance, Professor Shiroyama pointed out that new issues have been revealed by the COVID-19 pandemic. The necessity of broader coordination across sectors including security and economy was recognized, and the lack of cooperation between countries, not only the developing countries but also the developed countries, especially the United States who has announced its withdrawal from the WHO, was highlighted. While these issues need to be addressed, Professor Shiroyama shared his analysis that the decision of the United States to withdraw from WHO is not necessarily based on the assessment of the effectiveness of WHO but on geopolitical factors, and emphasized that whether this decision will lead to a meaningful reformation of WHO should be examined closely.

Panel 1: Q&A
After the three presentations, the panelists took questions from the audience.
As to whether WHO was able to accurately predict the outbreak of an infectious disease such as COVID-19 in developed countries, Professor Shibuya responded by first commenting that the Ebola epidemic was a significant risk not only for the African countries but also for developed countries, and placed importance on the governments’ willingness to listen to alerts raised by other countries and initiate preventive measures without pause. Concerning the support for developing a more inexpensive method to diagnose infections compared to the current PCR test kit, he mentioned the cooperation between WHO and NIH to prepare a new method that has the capacity to test 6 million cases per day. He reassured the audience that the world is moving in the right direction in this field.
Ms. Takemi was asked about the influence of nationalism on the distribution of vaccines, and answered that it will definitely have an affect, and pointed out that operational procurement and risk communication will be the two pillars in addressing the situation.
Another question raised was the effectiveness of GOARN. Was it as effective with COVID-19 as it was with SARS in 2003? Professor Shiroyama argued that GOARN and the cooperation within the scientific community both play a significant role in the fight against COVID-19, but that higher expectation due to the success with SARS may cause disappointment, and shared his view that the lack of coordination across sectors instead eventually led to the failure of international health cooperation. WHO has always been criticized for its responses against health risks and the former UN Secretary General Kofi Annan has sarcastically joked that the “SG” for Secretary General actually stands for “scapegoat.” Professor Shiroyama agreed that WHO has been an easy target, but defended the organization by commenting that its response to COVID-19 was quite appropriate, learning lessons from the previous SARS experience. Following the discussion, Director Fujiwara analyzed that the international health regime’s delicate balance is in some ways disrupted by the President of the United States’ actions, noting that the global superpower should accept its role and responsibility within the global community and be conscious of the influence of its decisions.

PANEL 2: SOCIOPOLITICAL PROBLEMS CAUSED BY COVID-19

“How the UN System responded to COVID-19 outbreak: Challenges and Prospects for Future Pandemic”
Yukio Takasu, Special Advisor to the Secretary-General of the United Nations on Human Security / Former Permanent Representative of Japan to the United Nations / Chairman of the NPO “Human Security” Forum / Visiting Professor at Ritsumeikan University
Ambassador Takasu reflected on the United Nation’s recent responses to the spreading of COVID-19. On March 30, a report called “Shared Responsibility, Global Solidarity: Responding to the Socio-Economic Impacts of COVID-19” was released. In the report, three principles that the UN responses would be based on were included: to mount the most robust health response to meet urgent medical needs; to do everything possible to mitigate the effects on millions of people’s lives, their livelihoods and the real economy; to learn from this crisis and build back better, and to seize the opportunity to strengthen our commitment to implement the SDGs and the Paris Agreement. Also, the UN system organizations have played a role in responding to the crisis, basing their overall response strategy on a human security approach, promoting resource mobilization, and providing medical and material support. In order to help the most vulnerable people including the disabled, the elderly, women, refugees, and IDP, who will be impacted the most by the spreading of COVID-19, the UN Security General has called for a global ceasefire during the pandemic.
Through these responses from the UN organizations, several challenges have become visible. The division among key players, the need to strengthen their authority and capacity, effective fundraising, and the implementation of a new system to deal with new pandemics are a few of those challenges. Ambassador Takasu also pointed out that a multilateral consultive mechanism, along with a multilateral cooperation frameworks such as those like the Global Fund or CEPI where countries can join public and private partnerships, should be built. The COVID-19 Technology Access Pool (C-TAP), aimed at enabling newly developed vaccine technologies to be treated as international common goods, is also one of the initiatives inaugurated because of such concerns. The Ambassador concluded by emphasizing the importance of a continuous effort to strengthen the authority, capacity, and resource of multilateral institutions, to build a networked multilateralism, and to realize a more effective multilateralism.

“Living in COVID-19 Risk Societies: The challenges of Risk Assessment and Management in European and Southeast Asian Countries”
Yee-Kuang Heng, Professor, Graduate School of Public Policy, UTokyo
Professor Heng looked into different countries’ COVID-19 responses in detail. He first shared England’s case where scientists from few research institutions were chosen as advisors for the government. What happened was that the option of lockdown was excluded due to “groupthink.” It has been pointed out that scientific advisers or civil servants who drew up the strategy against influenza may have a “cognitive bias” when responding to the current COVID-19 crisis. As these few scientists’ opinions influence the government’s strategy against COVID-19 significantly, a dozen scientists have created another “unofficial” independent panel to counterbalance the “official” opinions. In Germany, a second example the professor shared, risk management was quite successful and the government was able to avoid the worst case scenario. But then a paradox occurred; the public accused the government for overreacting to a nonlethal virus, with numerous protests being held against the “excessive” preventive measures.
Singapore was one of the countries that declared lockdown. Then huge outbreaks happened in “blind spots” such as crowded dorms where the foreign migrant workers stayed. COVID-19 has revealed previously obscured inequality and disparities within the society. In Sweden and England, deaths caused by the new virus accumulated in care homes, and middle class families fleeing from urban centers or the elites feeling entitled to special treatment breaking lockdown rules were also seen as problematic.
Countries chose different risk communication strategies. England adopted the slogan “STAY HOME,” while Sweden avoided using the term lockdown, bracing the country for a long battle ahead. The German Chancellor Merkel was praised for making an unscheduled appearance on television to talk directly to her people. Vietnam made use of inexpensive text messaging or user-friendly apps in their “proactive communication strategy” to prevent the spreading of the infection. Also, in Singapore, the government provided support for migrant workers who are unable to work from home and called the program “Circuit Breaker,” aimed at breaking the vicious cycle of outbreaks reoccurring in poor crowded regions.
Professor Heng concluded by stressing the importance of studying these examples both successful and unsuccessful to improve future risk assessment and management.

“Social Impact of COVID-19 on Conflict-Affected Areas in Africa”
Kazuyo Hanai, Assistant Professor, Institute for Future Initiatives, UTokyo
Assistant Professor Hanai introduced the COVID-19 situation in Democratic Republic of Congo, one of the poorest countries in Africa that is also conflict-affected. As of July 15, there are over 600 thousand confirmed cases of COVID-19 in Africa. Although the number may not seem so troubling, Africa does have some unique issues that complicates the problem. DR Congo, in particular, is a conflict-ridden country, with the fight over conflict minerals causing violence against civilians. In addition to such conditions, the country has only one laboratory in the capital Kinshasa testing all cases of suspected infections within the entire country. With water and sewerage systems insufficient, poor sanitation is also another issue. The country decided to close borders and declared lockdown in the cities in order to prevent the spreading of the virus, but because mobility was strained, the “informal trade” that supported the local economy was significantly impacted. People lost a large portion of their income. Those without face masks or food were packed inside small homes without ventilation, and the fear of starving to death rather than being killed by the virus became a real threat for the people.
Other infectious diseases such as Ebola and malaria have been tormenting the country. With widespread corruption within the government, some became convinced that Ebola outbreaks were part of the government’s conspiracy and attacked the treatment facilities. The United Nations has called for a global ceasefire to prevent the further spreading of COVID-19, but the armed groups in DR Congo that have lost their stable income from illegal taxing of minerals are now attacking and looting local people. Assistant Professor Hanai questioned whether the COVID-19 prevention policies in DR Congo align with the “Siracusa Principles” adopted by the WHO, a guideline that seeks to ensure that any restriction on civil or political rights are inevitable for the greater good. She insisted that there should not be any region or country left behind when preventive measures of COVID-19 are implemented.

Panel 2: Q&A
Following the three presentations, participants answered several questions from the audience. As discussed in the Q&A section of panel 1, the current situation in which international institutions become easy targets of criticism or scapegoats was mentioned again, and Ambassador Takasu commented that in the case of the UN, the best way is to continue to cultivate trust with the major member states so that it can resolve global issues. When asked about the role of local governments in emergencies such as the fight against COVID-19, he gave the example of SDGs implementation where local governments are frontline responders. The UN does in fact count on not only central governments but also local governments, and SDGs implementation will also be a good entry point of international cooperation between multiple countries including China. The progress made in achieving SDGs have been wiped out because of the COVID-19 crisis, so the Ambassador insisted that public funds should be used effectively to move forward once again.
On the relationship between central and local governments, Professor Heng shared his observation that the division between the two are becoming more apparent even in Japan, similar to the situation in England. He advised that the local governments at the frontline responding to the crises could build up their capacities by making use of the expertise of universities in the region. Also, in order to maintain science’s independence from politics, whether it is England where the two are becoming closer or Japan where it seems that the government is ignoring scientific facts, the Professor said transparency is the key, such as publishing new evidence online so that anyone interested could find the information easily, or revealing which scientists are on public committees.
Asked about the current status of the Peace Keeping Operations of the UN in conflict-affected areas in DR Congo, Assistant Professor Hanai said that it needs to be taken into consideration that there are over a hundred armed groups scattered throughout the region making it difficult to settle the situation in the first place. Under the current COVID-19 situation, of the personnels sent to the region, over forty were infected with COVID-19, so managing the operation itself is becoming more challenging. Another question from the audience asked why South Africa has much more cases of COVID-19 than any other country in Africa. Assistant Professor Hanai described the country as an economic giant in the region with active domestic traffic, and it tends to become crowded where there are a lot of people, increasing the risk of infection. She also suggested that perhaps more cases are tested compared to other countries in the continent, leading to the difference in the number of cases confirmed.

CLOSING REMARKS: Kiichi Fujiwara, Director, Institute for Future Initiatives, UTokyo
At the end of the forum, Director Fujiwara acknowledged that countries have taken preventive measures against COVID-19, but questioned their attitude of ignoring the voices of the academic community or international organizations. The rescue packages prepared by each of the countries were merely insufficient or with little if any coordination, and the Director was alarmed that COVID-19 crisis had chopped up all the connections necessary to bring out the common good, including the connection between countries, or between the central and local governments. Another pandemic may occur in the near future, and even the annual World Economic Forum held in Davos will discuss issues related to the pandemic at its next meeting. Because an outbreak requires immediate responses, global climate change, a potentially more serious challenge is left unaddressed, and whatever progress that was made for a better world may be annulled as a result. In order to fight global issues, Director Fujiwara stated that conversations discussing how to rebuild a framework for international cooperation, such as those conducted in this forum, are imperative more than ever.

We have a video recording of this forum on UTokyo TV website. If you are interested, please click the button as well.

※This forum was organized in connection with the MOFA subsidy projects granted to SSU of IFI.