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The future of global health security

Public health attorney Lawrence Gostin on global vaccine inequities and combating misinformation and distrust

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The COVID-19 pandemic revealed how unprepared the world was for such a global health crisis, as even the most sophisticated public health systems failed to cope. As SARS-CoV-2, the virus that causes COVID-19, continues to evolve, Berkeley Public Health invited internationally recognized public health security expert Dr. Lawrence Gostin to participate in a live discussion held March 17, 2022, on the Future of Global Health Security as part of a panel that also included Berkeley Public Health Epidemiology  Division Director Dr. Arthur Reingold and alumna Dr. Sue Desmond-Hellmann, former CEO of the Bill & Melinda Gates Foundation.

Berkeley Public Health Dean Michael C. Lu moderated.

The group started off discussing the COVID-19 pandemic, future possible variants, and global vaccine inequalities.

“I think delivery is a big issue [in global vaccine effectiveness], not just hesitancy,” said Gostin. “To me, the most important thing is to enable countries to make vaccines and treatments themselves and not rely on donations. In my view, the idea of charitable donations from rich to less rich countries, which has been the prevailing and dominant way that we’ve done equity, is outdated.”

“Even before the pandemic, global health equity was the prevailing narrative of our time,” he continued. “But it was really accelerated and became amplified during COVID-19. And I think there are ways to change that paradigm in the future, if only we have the will to do it.”

“People in my line of work say it’s not vaccines that keep us safe,” said Reingold. “So you can have all the vaccines produced anywhere you want, and all the storage facilities you want, and if we can’t get them into people’s arms, they accomplish nothing. So this issue of delivery is obviously critically important.”

“Hesitancy, it really doesn’t describe the scope of the problem that we now have, particularly with regard to disinformation on the web and other places. The virulence of anti-vaccination sentiments…to me is a serious problem that we somehow need to address,” Reingold continued. “And so, making vaccines locally is great. Giving people the wherewithal to deliver vaccines within a country is critically important. We need to find a better way to convince people that vaccines are a good thing. And historically, we did a pretty good job with measles vaccine and polio vaccine and convincing people to take them or to give them to their children. But I think the landscape is different now. And I’m really puzzled about how to fix that.”

Here in the U.S., public health institutions struggled to coordinate and communicate with the public, exacerbating an already significant lack of trust in experts and government.

“COVID-19 certainly has been an epic failure for public health here in the United States,” said Lu. “At a moment when the American public really needed public health, our public health system really failed to protect the health and safety of the American people. So this is a question for all of you. What went wrong?”

“I think you have to start with public trust,” Gostin said. “You can give all the advice you want. But if people don’t listen to your advice and if there is a cacophony of different messages from political leaders and governors and presidents and the CDC, it becomes deafening and maddening. And it’s very sad. … Public trust in CDC, and even state and local health agencies, has gone down. The public health workforce has been dispirited. Some are fired, some have left. When they should have been heroes, they’ve been castigated.”

“We don’t trust government in the United States,” he continued. “It’s all about, What are my rights? What’s my autonomy? What’s my liberty? And we’ve stopped saying, What do I owe my family, my neighbors, my community, my country, my world?”

“So this neighborliness,” said Desmond-Hellmann. “Boy, do I want to endorse that! But a couple things that really strike me. First of all, one of the things that we shouldn’t forget is that COVID-19’s actually really hard. SARS-CoV-2 is hard. It is a virus that’s respiratory-borne and you can transmit it when you have no symptoms. That’s hard. Being able to be somebody who passes along a virus when you’re not sick, I mean, think about that. That’s a really powerful, important thing.

“So I think that that was very, very challenging for people, just getting your head around it. But the number one thing that I feel like didn’t work in the U.S., we don’t have a working public health system tied into CDC with data that you can link to our medical care system, which is also very troubling,” Desmon-Hellmann continued. “And so thinking through a health system, including a public health system, and data that are reliable and can inform decision making and inform the citizenry. We’re all citizens. We deserve to understand what’s happening in our country.”

Gostin and his fellow experts also discussed how important health systems are to health security.

“What is global health security and what must the world do to better prepare for the next pandemic or the next global health security threat?” asked Lu.

“You start with strong health systems,” said Gostin. “And then, it’s well beyond COVID because there are lots of things that are really, really important now, like antimicrobial resistance. So basically, it’s health systems. It’s data systems. It’s having good international institutions, like the World Health Organization. We really know what to do. We’re just not doing it and we’re not funding it.”

For more of the conversation, including a discussion of the challenges a federalist system imposes on public health management, watch the full event on Berkeley Public Health’s YouTube channel.

Lawrence Gostin, JD, LL.D., is a university professor, faculty director of the O’Neill Institute for National and Global Health Law, and professor of medicine at Georgetown University. He is also a professor of public health at Johns Hopkins University and the director of the World Health Organization Collaborating Center on National and Global Health Law. Dr. Gostin’s proposal for a Framework Convention on Global Health—an international treaty ensuring the right to health—is now part of a global campaign, endorsed by the UN Secretary-General and Director of UNAIDS.