The council who have tuned in not only to today but for your strong support to the council in the past and especially in this critical time. A special welcome to everyone joining the council for the first time. Our main topic today is about the leadership challenges facing people around the globe with covid19. Both currently and in the future. We are absolutely thrilled to have with us today dr. David navarro to talk about these matters. The doctor was the special unveiled envoy for the u. N. He was also the special coordinator for the u. N. For the avian flu, the bird flew, pandemic, epidemic. He is currently special envoy for the World Health Organization for this covid19 response. History inng Infectious Diseases and Public Health. David, thank you. We are thrilled you could be with us today. Its great to be with you all. Delighted to be part of this webinar. Thank you. Lets start with giving us an update. Before we get into leadership issues, give us an update on where we are in the world with covid19, and what you see for its future and our future in the country. Thanks indeed. We are all very aware of this virus, covid, and the terrible distress and destruction it is causing, but we sometimes forget that, four months ago, the Public HealthCommunity Around the world did not know about it at all. Really, the first thing that was heard was message received at the end of december. In the World Health Organization. If we count between the end of december and now, really is four months. In these four months, what an extraordinary transformation since the start of the beginning. A rathers causes unpleasant infection that starts in the chest, and if we are unlucky, it will affect the whole body. As far as we can tell, out of every 100 people who are infected by the virus, only about 20 become really ill. Ofortunately, only about 2 and fortunately, only about 2 of those are likely to die. The trouble is, because this is a new virus, we are having to learn about it all the time. In the beginning, many thought it was like influenza. Influenza is a disease, caused again by a virus, but it is a virus we know quite well. We have had pandemics of influenza around the years. Some of them have been very serious, 1918. Some less so, 2009. This is not an influenza pandemic. Washe beginning, it identified as an outbreak of a ,ypical pneumonia as we call it and was quite rapidly discovered that it was caused by a coronavirus. There are not many coronavirus theyown to humanity, but are also, at the same time, frequently encountered because the virus is the common cold. One of them is a coronavirus. There is another coronavirus that emerged in 2003 that caused an outbreak of a disease in east asia. Discovered as a coronavirus in china earlier in january, and the structure of the virus was quickly discovered and made available internationally. The World Health Organizations initial reaction was the following, this is a potentially very serious disease. It has the ability to spread quickly, and it will cause a great deal of suffering, particularly among older people. When i say spread quickly, this virus spreads alarmingly rapidly. It causes outbreaks of disease a double in size every two to 2. 5 days if left unchecked. That means it is easy for an outbreak of the disease to build up fast. It is transmitted only really through respiratory droplets. These are the small droplets that come out of our mouths when we talk, when we sneeze, and when we cough. Usually, these droplets dont go further than over three feet or one meter. So, if we can stay apart from each other, two meters, then it is hard for this virus to be transmitted from one person to another. The way in which the transmission occurs is that, basically, people infect each other through this close contact. An outbreako stop building up in any location, the easiest way to do it is to interrupt transmission by finding people with the disease and isolating them quickly. They haveng those who been in contact recently and isolating them as well. In that well, as soon the outbreak starts, it is interrupted. Quicklynable to do that when we are unable to do that quickly, the outbreak can increase 1000 times in size in the span of a month. When we have these big increases , then, a different tactic has to be added. As well as encouraging the interruption of transmission wherever it is happening. He also introduced physical distancing on a large scale, so people have to keep more than six feet apart from each other. The best way to do that, countries has discovered, is to do stayathome orders or shelterinplace orders, or in some countries, it is referred to as a lockdown. The lockdown itself does not stop transmission. It slows the spread of the disease, so the painstaking work to find people with the disease and isolate them can go on so as to interrupt transmission and deflate the outbreaks so we end up without the disease. Because the disease is spreading so fast, and because many countries found it hard to initiate this interruption of transmission quickly, more than half the world now is living under conditions of lockdown, and the big challenge for every government everywhere is, how do we get out of lockdown and get ,ur economies functioning again and getting society to return to a point where everyone is happy . Even though the virus itself is not going to go away. That is why more and more countries are looking to examples, particularly from east asia but also in europe now of cotrees of countries that have worked out how fast, coupled with the fact that the virus is still here, is not going to go away for the foreseeable future, and at the same time, we cannot go on living in lockdown because of its damage to peoples lives, livelihoods, business, and indeed to everything involved in people moving around and getting along with their business. So what is it countries are doing to enable them to deal with this threat . Ofs look at the example south korea. They had the experience of sars in 2003. They knew as soon as you get outbreaks of a virus like this, coronavirus remember, not a flu virus, as soon as you get outbreaks of this new coronavirus, the most important thing to do is stop it fast, i lead the ideally to confirm people have the disease with testing, and do everything you can to interrupt transmission by isolating people when they have signs of the disease, immediately and finding the people with whom they have been in contact and icing leaching them as well isolating them as well. South korea was able to get a measure of control quickly but not before they had struggled with a series of outbreaks in data as a result of the number of gatherings that occurred. South korea could do it. Obviously other countries have done it. Singapore did it as well, but they have had a resurgence about breaks because people coming back into the country, so they have had to Institute Limited lockdowns, but they have really boosted their capacity, finding people with the disease and interrupting transmission. Another country doing successfully on this is germany. They prioritize the business of finding people with the disease. They have the capacity to test widely. Their technique, which was important, was that they reinforced the Health Community ,ervices, and with new staff thousands of them, so they could be ready to find people who are sick and make sure they were isolated. The other thing with germany and south korea and singapore has done is that they recognize older people were particularly a threat, so they put special protection in place for older people as well. Toherine, i know, wants me talk about what life will be like in the coming weeks and months with this virus in our midst, with the threat of big outbreaks, the possibility with when outbreaks come, when outbreaks come, they overload our services. Most importantly, and i have to keep repeating it, is this capacity to find people with the disease, isolate them, trace contacts, isolate them, protect the elderly, and make sure hospitals are equipped so they can respond if there is a big increase in the number of people with the disease. Super challenging, given at the moment the levels of protective equipment for Health Care Workers are in short supply, and testing to find people, whether they have the virus, is not easily done. There are many parts of the world where testing is not available. All of us that are working for Public Health, what we are saying is focus on Public Health capacity. To get that in place, make sure it is strong, and learn from what countries of east asia have done to ensure all people know about the disease and what they are going to do. Publicre we expand our Health Capacity across the community. So that if there is an upsurge of cases, hospitals can respond without being overloaded, going on to make sure they can provide other forms of health care. Because, from time to time, you will get outbreaks, that is the pattern of the future, make sure you can protect poor people that suffer as a result of lockdowns, and ensure they can get cash, food, and make sure their children can continue to be educated so that you prevent the effects of containment measures from themselves causing a lot of distress. You cant restart your economy unless you have this faith it basic Health Capacity in place, and that is what countries all over the world are doing, particularly i want to say in the poorer countries who realize they cannot afford to lockdown for too long. So, they are rushing to put Public Health services in place, and try to get that right because they will need that for the foreseeable future. I call it the covid ready state, and that is what we all have to time have that have. Thanks, david. Lets talk about this issue about who decides what, when. Nonpandemic environment, we as Public Health professionals of the cdc and the u. S. , the World Health Organization, internationally, every nation has some sort of an entity who gives advice about how to avoid disease, cope with disease, and who follows whether or not they are following anything dramatic that might come our way. But at some point, when it becomes more of a disaster or problem, or more of a potential problem, the leadership shifts from the Public Health professionals to the elected officials or the political politically chosen officials, whether that be on the national, state, or community level. Knowindicators should we about what habits for when that shift occurs, because somehow, it occurs when it moves from just a health issue to being an issue that impacts society. Thank you, catherine. You know i work quite a lot on other outbreaks and pandemics. The main at the beginning was influenza. The thing about influenza pandemics, there is always a point where you realize the virus is just going to spread everywhere, and your strategy shifts from one of trying to contain the virus and stop its spread to one of trying to limit its consequences for people, and that shift is often quite described as the shift from containment mitigation. My colleagues in the World Health Organization said, even in january, they said be careful. This is not the flu. This is a coronavirus, and it causes small outbreaks that grow big. They dont grow everywhere all over the country in the same way influenza does. You dont end up with a lot of people infected and some people having heard immunity built up. With this one, you have to keep the Public Health functions at the center, and have them strong and in place, even when you have the most intense pandemic developing. That is one of the reasons they delayed calling it a pandemic. They wanted to keep the focus on outbreaks and detecting outbreaks quickly. ,n this particular situation there has not been, in many of the countries in which im involved, a dramatic switch from the Public Health people being in leadership position to heads of government. Instead, what is happening in every country i have been foring, the Prime Minister president s, with their cabinets, are constantly seeking guidance from the Public Health community, asking the question, how can we emerge from our lockdowns whilst, at the same time, making sure we are not going to get flooded with lots of new cases of new people with covid at the same time . Unlike anything ive seen before, the Public Health people and the heads of government are isking hand in glove, which an easy relationship because it is quite often presented by others in government as being a tussle between the economy and Public Health. The Public Health people are having to say the same point over and over again, it will be virtually impossible, they say, to restart the economy if the Public Health defenses are not properly in place. If there is inadequate testing to find people with the disease, hospitals have to be reinforced so that when outbreaks come, they can be dealt with. That is because this is a completely novel virus and a novel form of pandemic, due to droplet transferred coronavirus, and that is a threat that will be with us forever. The Public Health people have to stay involved. However, there have been instances where heads of government say to the Public Health people, hang on, what you are asking us to do to introduce these defenses to be ready to do lockdowns from time to time, these are all just two demanding on our too demanding on our economies. People,call in other Infectious Disease modelers, who try to model the different scenarios. Then, they call in the people responsible for essential services and requirements, like people in food and agriculture sectors, or people working in residentials residents, or people working in prisons. What they are asking the Public Health people to do is to ask is to help work out exactly how essential functions like food and food markets, official functions like prisons and other services, or functions like Residential Care for people with special needs, how things continue to occur the way the added precautions are in place are the Public Health imperatives to be held there. I have to stress, in every government im working right now, this is a difficult time. The publichealth people are giving the best advice they can, based on what we know about this new virus, what we know about the immunity that develops when you are infected, about the prospects of a vaccine coming, or the possibilities of different treatments, and they are trying to sift through this information in realtime time, but the heads of government are getting frustrated, constituents are saying we want to get working again, want to get onto airplanes again, so there is a constant dialogue between the two. I think both sides are finding it quite difficult, because they see the tradeoff, very starkly, and they are nervous about what might happen if they go either way, saying forget about the virus and get on with life. That could leave with lots of older people, particularly in residential homes, or we will put maximum emphasis on trying to be super segregated for the virus, and they worry you they worry you end up with an awful lot of people unemployed and not able to get employment. That is what you have now. I think there is a constant dialect of going on in every dialect going on in every country trying to figure out the best way into the new covid ready state that lies ahead. Thanks, david. You wrote a paper for Harvard Kennedy school last year i think, where you talked with a couple other authors about collaborative leadership. U. S. , leadership at all Different Levels. We hope that, between the levels of community, county, state, and federal governments that there is a lot of collaborative leadership. It seems there sometimes is or sometimes isnt. This crisis shows, in every nation, collaborative leadership becomes important on health. How do you collaborate and delete at the same time . Oh yes. First of all, i would like to colleagues work of of mine, who together with me wrote a paper on the systems leadership. We were focusing on the leadership needed in any major challenge that requires people to Work Together and find Optimal Solutions that are greater then the sum of their individual contributions. Leadership kind of that is absolutely essential now. The next one i see practiced in more and more locations as we come to understand exactly how dangerous this virus can be, especially if we do not work well together. It let me use three words. The first word is consistent. In countries that have varied governance at Different Levels, sometimes even with different Political Parties dominating governance, say at the prevention level or local level compared to the national level, there are real challenges with maintaining consistency of guidance and its implementation in a way that everyone knows what they are supposed to be doing. Many of us have seen how beennance has decentralized from Central Government to the provincial administration or state administration. Then, to the county administrations or commune administrations. We now have extremely well ofumented cases and examples how inconsistent leadership between Different Levels of government in a country can be a major problem in having a concern it conservative and principal approach to dealing with this virus. As ican sometimes be, said, enhanced at various political levels. And, if there is a Political Party involved of a provincial administration, it is different m the Political Party this has been reinforced by the United Nations secretary as well as lead by the World Health Organization director general, that in dealing with covid, we need to do everything we possibly can to avoid decisions being politically contested. They need to be consensus decisions if at all possible. Im talking with leaders of some countries who have been explaining how they are able to bring Political Parties in order to get consistency within countries. The second one relates to collaborative leadership, bringing together of Different Actors from all of the different parts of the Public Health community to Work Together. They need to have a common identity that they are working for Public Health, working for the good of all people without any regard to sex, race, wealth, or geographical origin. That they are just putting peoples wellbeing at the center of their activities. Secondly, you need to relate to each other in an environment where they respect and trust each other. There is an and normas network publichealth actors around the world coming together regularly with deepest respect for each other, as each are trying to do with their physical issues. Able to send information confidentially, not being scared it will be used against them, so they can express their anxieties and concerns, as well as their ambitions. This networking of collaborative leadership is now very last four in the months. It is keeping the Public HealthCommunity Together and linking them with others responsible for key essential services. The third and last part is coordination. If one country is approaching their covid using one series of techniques, and the next country with which there is a long land order is approaching things differently, and theres a lot of things held up because of this mistrust between the two countries that essential services, food, or other requirements cannot go across the border. Thats a really unsatisfactory situation. Especially real the four worded leadership is greater than any other time ive been involved in global issues, and that is 45 years. Many of us are looking to the leaders and saying it is time for coordination and it is time for coordination for the sake of poor countries and or people. The consistency and degree of collective miss and coordination are hallmarks of the leadership leading now to help us through the Current Crisis and into the new covid state. Thank you. Mentioned many times as your h. O. , butole for the w. We must talk about some of the strengths and weaknesses. The guardian had an article recently which explained some of s and weaknesses and we have heard from the president of the United States and concerns about the who. Tell the w. H. O. Tell us how you feel about this. Some have said they didnt act soon enough. But also about what the role is and isnt. People dont understand the possible fort is the World Health Organization to do. The first thing i want to say is working in the midst of an outbreak because i have done it a few times. The most important thing to say is when youre watching an outbreak will up, at the beginning you are never sure if this is going to be a serious or major outbreak that will cause a huge amount of misery and that is the exception or is this like what we normally see, a small outbreak that limits itself and goes away . Hundreds hundreds and of outbreak alerts throughout the world all of the time. The challenge is to sit through the ones that are serious and what will be judged as to whether or not they are a National Concern and making that judgment is the kind of thing the technical teams the World Health Organization starved by specialists out over the world are Huge Networks that go into Public Institutions throughout the world and involving the United States as a very important contributor. Using that network and losing the intelligence that w. H. O. Picks up, always trying to make a judgment, what is it we are seeing . Afterwards, you can always find different decisions should have been made. Those of us who work in Public Health thrive on what we call after action reviews, because through that we modify and change. For example, after the Ebola Outbreak in west africa, there were many studies that identify points where action could have been taken mark rapidly and done differently and people could have been more forthright, all things that would have led to a much lower death rate and much so afternsequences action reviews are key. But when youre making decisions day by day, you do sometimes make tough calls. The review helps us to be better. That is number one. Looking forward to the after action reviews. We hope they are undertaken perhaps after we get through the we need tobecause look through the things necessary. Inquiries are difficult. Now about the World Health Organization. This is part of we call the multilateral system. It is one of about 22 specialized agencies. They are not directly reporting to the secretarygeneral of the u. N. They have into vending governance. It is made up of 194 different Member States. Those Member States meet every year in the World Health Assembly and twice a year in smaller executive boards that meet in january and towards the middle of the year. In these meetings, the Member States hammer out the rules under which the who in which the w. H. O. Is going to work. Thes made up the of director general. The team is not very large of thenical agencies and teams in six other locations around the world and regional offices in more than 130 countries report into this headquarters. It is an organization within overall budget of 2 billion and supplemented by other funds. That budget is one third of the budget that the u. S. Centers for Disease Control, yet this is the equivalent of the centers for Disease Control of the world. They operate within the rules set by the Member States. In 2003, sars outbreak the basic rule for how the w. H. O. Gives with Infectious Disease was subject to revision. Came out was something called the internet for new health the International Health regulations of 2005. It is the responsibilities of government when they have Infectious Diseases and what they should tell w. H. O. And what they should allow who to do and it also indicates that if they composed travel restrictions they should improve the who. That is basically to make sure any information that comes to w. H. O. Is broadcast simultaneously with no hiding. So when you are sitting at the headquarters and you get news of something going on sent by a member state, you rely on the information sent by that never state. W. H. O. Is not expectorant. It has never been given the license to do that. The rule say the secretary works on the basis of official information even to it by the Member States. The Member States have also geted that w. H. O. Can publicly accessed areas to get information and w. H. O. Can receive emails in from people around the world providing information. W. H. O. Works on what it is given. Write upical experts the information and provide feedback to the public everywhere. Whether it is an Infectious Disease, whether it is localized transmission, is it an Infectious Disease that affects wider Public Health . As the information reached w. H. O. In january, everybody was involved. The World Health Organization had to reach judgments on what was happening and that has been recorded and been spoken about. I will not go into the details about what judgments were made at what time. The important thing is around the 22nd of january, the director general said i am going Committee Emergency made up of specialists around the world and i will ask them to advise me if this is a Public Health emergency of National Concern. That is the highest alert the w. H. O. Can give. Calling it a pandemic is not something official in the say the, but the rules interNational Concern declaration is the major serious emergency declaration. Cannot reach a unanimous conclusion. And they said they would reconvene in 10 days time because at that time there was very little transmission of the disease outside of the chinese mainland. The director general asked them to reconvene and they reconvened again, i think it was towards the 30th of january and then there was the unanimous opinion of the committee that this was seriously and that director said they would come back and he thought they should declare as a National Concern. That is when w. H. O. Gives strong advice to all governments. Treated with in normas respect and close down outbreaks as soon you get the staffing. The problems will be very severe. That guidance has remained clear ever since. I realize i might be overdoing it. Some questions of was this done quickly enough. Really important thing to say is within therates rulebook that has been given to it and if the rulebook needs to be changed, then im sure it will be changed. Then the technical experts will work in a different way. Right now, it is working within rules that have been set the worlds governments in 2005. Thank you, david paid i know we have had several questions and i hope your discussion has answered some of those questions. There are a few followups that and we willtting get into that as will much of the world afterwards and evaluate how not only they responded but the u. N. Responded and governments at every level in every country. There are other questions about followups and sports. The bigance, there was though, totally virtual but for related causes and covid19. We also saw that the u. N. Just appealed today another 2 billion, including money for logistics and transportation. U. S. Is we now that the going to withhold some of its own funding. Can you just give us a short about the needs of financials. Outbreak toof this people and National Economies in thatorld are just so huge i cant put a number on it right now. The urgent needs are also huge forgetting protective equipment to Health Workers and ensuring Collaborative Research on finding better tests and also discovering a vaccine as quickly as possible. Request for money coming through are really about getting essential goods and support to people in poorer countries, peoples people whose Health Services run a thousand times last per person than the Health Services in the u. S. Or europe. Any of these appeals may prompt big figures. They are going to contribute a small fraction of the total amount in poor countries. The is why there is all emphasis. It is the poor people and poor countries that are most at risk and most at need. Is like tryingo. To remove the right hand of a surgeon removing money from w. H. O. Is like trying to remove the right hand of a surgeon trying to perform surgery. I want say anymore about that. On itwas once said leadership, you see what someone is really like when theyre in the midst of a crisis. Given that, as perhaps a closing comment, what advice would you give the leaders at every level if you were to give one piece of advice about what they should be paying attention to, what would that be . People. On the all of the people. Not just those who are here now but the generations to come. Make sure they have as much opportunity as they should do to be healthy, be safe, to be informed, and to themselves lead , because the actions we take now will have impacts for a very long time. The decisions we make now will be judged over time. If we prioritize the needs of all people, we will be fair and just to respect human rights. We found in our decisionmaking to put the needs of people in front of every choice we make. Thank you. And about the future, the role of young people young people maybe, maybeome, not understanding this crisis better than older generations are. But it will be their future and what advice would you give to young people around the world about how they might lead in the future and learn from this crisis . We have managed to find the virus has found a way to make it to the devices we have in society that keep us healthy in the face of threats to our health. We had another virus that did this 25 years ago, the virus was hiv. The way in which societies learned to live with as far as this threat was by changing the havey are by changing behavior and by doing it in a way that has enabled us to have loved and joy despite the threats that it posed and the people who laid that work actually were not people like myself, doctors or other health professionals, it was the people , everybody, particularly young people. They said, ok, we will find ways to live in love with hiv. Trickiers is a bit than hiv, because it is transmitted so easily through close contact between someone who has the disease and someone does not. I would like to encourage old, whoeverung or they are or wherever they are, to be thinking really hard right now how can we go on with fair and is full and going to give us the best possible chance for the future while at the same time keeping ourselves, our communities, our older people, are people with special needs safe from having their own existences put into question as a result of this virus . It is going to require ingenuity from all of us, learning how to behave when we have symptoms of the disease, whether school or university or work or the gym jim or the club. For the club. Or the club. How are we going to think about health in the future . Investment in health in many countries has been dropping compared with investment in so many other areas. Businesses will not be able to function without some Health Services and nobody will be able to go to the hospital and expect Decent Health care unless they can be confident that Health Workers are properly protected. There are so many hospitals where Health Workers are having to struggle to protect themselves and this is putting their own health at risk and health of other patients at risk. We need to be thinking very hard , what is the role of health theers in the society, nurses and doctors in those who keep the hospitals running. People. R older how are we going to find ways to respect the people who we will defend on in the future to keep us healthy . Time, are young and have please let your mind flow. Mingle your sense of humanity and the common good and love and joy and the wish to live and think of yourselves as how can we Work Together to be part of the covid Ready Society that will be the society for the foreseeable future . Hearte i cannot and on my till we have a vaccine that will keep everybody commune in one year, two years, three years. There are things we dont know is how easy it will be to develop a vaccine. It is up to all of you to use your ingenuity, your connections , your opportunity to dialogue and debate. Think hard how to have a covid Ready Society with nobody stigmatized, nominations left behind, no community under great stress, even if they are refugees in a refugee shelter or people and i person are all people in a Residential Care staff lookinghe after them. How can we Work Together to get this right . It is the biggest challenge that probablyhas faced probablythat since it was discovered in 1854 that dirty water carried diseases. Now we have to do a massive shift and we have to do it fast. Thank you for being so informative and think you for your leadership. We can call the participant to join us today. You revolutionized the World Food Program and have done bryant things on leadership, and donere so modest brilliant things on leadership and you are so modest. I am honored have worked with theand i am grateful to council for letting us have this exchange. Globalk you chicago Affairs Council and thank you for all who participated today. Cspan has roundtheclock coverage of the federal response to the coronavirus pandemic and it is all available on demand at cspan. Org coronavirus. Watch white house briefings, updates from governors and state officials, track the spread throughout the u. S. And the world with interactive maps. Watch ondemand, anytime, unfiltered at cspan. Org coronavirus. House Speaker Nancy Pelosi holds a News Conference this morning following passage yesterday of the fourth coronavirus a package. We will have live coverage at 11 30 a. M. Eastern here on cspan, online or listen with the free radio app. President trump leaves the White House Coronavirus test was briefing this afternoon, scheduled to start at five clock eastern. , online,atch it here or on the free app. This oped from senator john thune staying connected while we are staying apart, he is joining us from his ho i