The u. N. His bio is Available Online so let me be very brief in introducing him. Mark has more than 30 years of experience in both humanitarian and development context. Most of it spent with the u. K. s department for international development, which he eventually led as permanent secretary. He had led their humanitarian responses to such context as iraq, syria, nepal, several cases in africa, and haiti. He was also their directorgeneral for policy and corporate performance and finance. An extraordinary wealth of experience both in the context working where operations occur and on the infrastructure that helps to manage them. So were delighted to have sir mark with us today. Mark, there are innumerable humanitarian crises under way right now and at large scale. I know you Just Launched the u. N. s consolidated humanitarian appeal for the funding to support that effort. But today we want to focus on covid. And what the pandemic has meant for the crises that you helped to manage and for the system as a whole. With that, mark, welcome to brookings. Mr. Lowcock bruce, thank you very much indeed. Thank you particularly to you and your colleagues for giving us a chance at this conversation. Let me thank my team as well for helping me prepare for it. Im not going to speak to the full text. Ill talk around the issues, picking out the questions youd like me to address. Bruce terrific. Lets start here. I want you to bring us into the room. Youre dealing with crease all over the world crises all over the world. But when was it that covid was brought to your attention as part of your portfolio for response . Mr. Lowcock on the 6th of january, just after the holidays, there was a meeting called of a few senior colleagues, including the direct general of the world health organization, and me, with a discussion on pandemics. There had been a new report that had just flagged the worlds potential vulnerability to a dirty new airborne disease or, if the jargon, if you like, a respiratory pathogen, with a potential for large scale loss of life and huge consequences for the world economy. And this report, like others, said the world wasnt [indiscernible] so we had the meeting and we agreed on a series of measures to take, including advancing the u. N. s own readiness, conducting simulation exercises and so on. At the end of the meeting, mike ryan, the experienced, energetic irish doctor, who is the head of emergencies at w. H. O. , and who ive worked with very closefully recent years, including on [indiscernible] he said his team were currently gathering information about a new virus in china. They didnt know much about it yet but it looked as though it could potentially be significant. So that was my introduction to the year of covid. Bruce quite striking when you think back on it and how much has changed since and what we know now. Its not the first pandemic youve dealt with or at least not the first epidemic youve dealt with, certainly not the first Infectious Disease youve dealt with. From your experience and your teams work, how much do you think we could learn from past experiences of Infectious Disease spread . Mr. Lowcock let me say a few things about this. The first thing i think its important to say is were in the middle of it and i offer thoughts today in all humility. Covid has been the biggest problem the world has faced in more than 50 years. A deadly airborne pandemic caused by a new virus is intrinsically different to cope with. At the beginning the most Important Information is just unknowable. You dont know how the virus is transmitted, the systems it causes, how long it takes those symptoms to appear or disappear, who is most vulnerable, who will recover and what most. And most importantly, you dont know how to tackle it. So the virus has a head start and the respond nesktabley has mistakes while theyre playing catchup. In some ways the most surprising thing about the experience so far is not how bad the response has been but how good. Not least in the development of Speedy Development of vaccines. Were in the middle of the crisis. In some ways were in the darkest bit of the tunnel in most countries now. We can see a glimpse of light in some places. But im a bit wary of coming across like that surgen who wakes his patient up halfway through the operation and asks her how she thinks its going. Because theres lots we still dont know and we dont know what were going to get to. What is clear is that mistakes have been made in the response. And lots of important decisions are going to be taken before were at the end of the experience. So it does make sense to think now about what we need to do over the next period. We do learn some things from previous pandemics. Pandemics have been around more than 5,000 years, since the dawn of agriculture basically. The one taking the most human lives was the bubonic plague which first came to europe 1500 years ago, when they were forced to import large quantities of grain from egypt and unfortunately they imported plaguecarrying rats in the process. Then of course in the middle of the middle ages, 700 years ago, the black death took bubonic plague Something Like 1 3 or 2 3 of the entire population of europe. That was when i think people realized things like quarantine could help you. More of these events happened. You know, we have cholera in the middle of the 19th century. That was the moment when countries first started to collaborate. The First International conference took place in paris in 1851. Of course then we had the spanish flu and it was after health ish flu that the organization, the league of nations, was created. Because because there was a recognition that these could be global, not just local problems. So pandemics have always been part of the human experience. But it does look like the risks have grown recently. In the last 40 years weve Senior Citizen sars and h1n1 and zika and ebola. The diversity of new disease outbreaks is increasing. Why is that . Well, the global population is bigger. Maybe approaching five times the size of 100 years ago. We have an older population, a more urban population, a more mobile population. I think ports and Border Crossing counted 1. 5 billion International Arrivals last year and i have to admit, a disturbing number of those were me. [laughter] weve had human encroachment into animal habitats which is leading to more transmission of infections and from animals to people and once you get this new infection, the nature of todays societies makes it difficult and expensive to prevent the spread. Especially as the case with this virus. For those infectious viruses, some of whose carriers either develop symptoms slowly or maybe dont develop symptoms at all. Bruce i want to come later to the question that you sort of raised of the quantity of travel that you and your team normally do and of course youre impeded from that now. I want to come to what the impact of this is in terms of your work and your teams work. But before we go there, you talked about the report that came out in january looking at the risk of a new pandemic and assessing preparations. What is your sense of how well prepared Different Countries were or werent and how have Different Countries responded to this and what do you see in terms of patterns and that in that response . Mr. Lowcock right. This obviously is going to be the suvet a huge amount of work and discussion once we get to the other side of the pandemic. And it should be by the way. Because as bill gates put it, what weve got now is pandemic 1. We ought to ask ourselves the question, how do we prepare better for pandemic 2 . There wasnt a shortage of experts and reports warning of the risk. He simulations were conduct thed and a lot of the reports that were written were quite prescient about the scale of the potential risk. The report i mentioned that we discussed on 6 january, to report the global preparedness monitoring board, had flagged the risk as basically reduction of 5 in the size of the world economy. Which turned out to be quite prescient. One of the problems, though, i think with a lot of the expert analysis is too many of the preparedness initiatives werent well enough vested in the reality of how different societies actually work and how human beings actually behave. Obviously the standard mix of measures for dealing with diseases spread through human contact. All aimed to reduce interaction. Thats why you have the focus on hand washing and physical distancing, masks, reducing socializing, testing and tracing to identify who might be carrying the virus. Quarantines and isolations and so on. But there are practical legal, institutional and social constraints to implementing all these measures, even if we consider the huge economic costs they apply. The constraints vary considerably between countries and levels of preparation and levels of past experience. Experience vary as well. Obviously by the end of march, the virus got to every place in the planet. Everyone was having to deal with it. What that meant is there were lots of different responses and analysts have observed a variety of different response models over the last eight months or so. So theres a first category which, if you like those countries with recent experience of sars and m 1 n 1 nd measures, mers, m 1 n h1n1 and mers, they had governments which enjoyed levels of trust which facilitated broad compliance with severe restrictions. Or in some cases they had authoritarian systems to which compliance could be ensured. Those countries tended to act quite quickly and relatively effectively. Then there was a second group of countries, including many in europe and north america, they typically had relatively large and effective medical systems, as distinct from Public Health relevant exposure. In some cases like the u. K. , where as you know im from, they disinvested in Public Health institutions as part of the austerity measures following the 20082009 financial crash. Some of these countries tended to overestimate their capacity, underestimate the risk, in some cases they had leaders high in confidence but limited in relevant experience. Typically this category of countries acted slower, later and more weakly. Then a third group, those at the forefront, for example, of the h. I. V. Crisis, including a number of african countries, they knew their capacity to act was weak but at least they had relevant recent experience. So they acted early earlier and decisively, taking the limits measures that were feasible for them. They may also have been benefiting from younger populations who were a bit less threatened by the virus and because some of those countries are less urbanized, many people are living in conditions which were less conducive to the spread of the virus. Then theres a fourth category. And that includes those with limited relevant capabilities and basically no relevant experience, there are some middle Income Countries in that group, including in latin america, but this category includes most of the worlds poorest and conflictaffected and fragile chris and they often had significant refugee and displaced populations and thats why back in march, many people thought that this group of countries, would be the ones worst hit of all. And that has turned out to be true. But not as some people expected through the direct impact of the virus and the disease itself, but as a result of the conomic carnage its wrought. Overall what i would say is countries facing a large premium on individual freedoms with limited relevant recent experience, with less strong Public Health systems than their overall level of Development Might have implied, where trusting government has been fall and maybe you have leaders who are a bit less well personally equipped for such a crisis, those countries did tend to underperform. But some of these countries had two huge advantages. The first was they could cope better with the economic crax and the second was they had the scientific and industrial capability to develop vaccines and treatments faster than anyone else could. So those are, if you like, the kind of different models weve seen in response. Bruce im very struck, well come to the impact on the humanitarian conflicts but im struck in your categorization that there are sort of two factors that really stand out that havent been much discussed. You see a lot of discussion of regime teep, of democracies [indiscernible] etc. I think the evidence for that is pretty weak. What you point to is two things. Trust in institutions or governments or social trust writ large, and recent experience in dealing with a pandemic or an Infectious Disease outbreak. Thats very striking. You feel strongly that those two features are pretty important as to how and whats driven the response, is that right . Mr. Lowcock yeah. I mean, this is going to be very heavily scrutinized and examined but i do suspect a lot of the relevant lessons will be in those areas. One of the really remarkable things that again people are going to observe is, you know, in the marchapril period, governments and businesses, but also many families and individuals, took decisions in the light of very high levels of fear and anxiety. The effects of which were temporarily essentially to close down substantial parts of the worlds economy. And the goal of course was slowing the spread and the impact of the virus and buying time to find solutions. And that is a really remarkable approach to handling the problem. Its never been previously adopted. It was feasible only because countries were rich enough to be able to protect their citizens from the worst effects of the economic lockdown. Those countries essentially threw out the fiscal and Monetary Policy rulebook saying [indiscernible] vast array of Business Loans and social payments and tax holidays and [indiscernible] central banks, subsidies and so on. Those measures werent formally coordinated across the Major Economies as they were in the 20082009 financial crisis, but all those economies did the same sorts of things in a synchronized way. The cost of that obviously ran into tens of trillions of dollars. Dizzying levels of expenditure. And before long, thats going to need to be addressed. But it was possible to do that for the first time really in history. Because in those societies where rich enough, i guess well come on to what was different in the poorest societies, but its quite striking that that was a choice available to the richest countries. Bruce lets go to the poorest societies and the places where you would be traveling if covid restrictions werent stopping you. Talk more about what the impact has been and what youve seen in the context and some of the poorer context, what has been the effect . What do we know . Are there gaps in our knowledge about whats going on in some of these context and the overall responses . Mr. Lowcock ok. So theres very important set of questions there. Let me just start by just continuing the economic theme a bit. From what i said just now. Because really my most criticism of how the crisis has been handled so far is the betteroff countries failed to offer an adequate helping hand to the poorest countries who faced the same economic crunch but lacked the resources and institutions or access to markets to take the measures that betteroff countries could do. Those poorest countries have had a collapse in earnings, tourism revenues, as well as the impact of the global shutdown, and while the betteroff countries drew more than 20 of their National Income to protect their own citizens, the poorest countries could only access 2 of their much smaller incomes. Now, the fact that this happened is surprising because what needed to be done actually was pretty clear from the experience of the 20082009 financial crisis which was much smaller obviously. Global g. D. P. Fell by. 1 compared with 4 or 5 this year. But the obvious measures that were taken in 2008 and 2009 support the most vulnerable countries, including [indiscernible] the recapitalization of Development Banks [indiscernible] they havent been taken this time. And also theres been a failure basically so far adequately to address the debt burden in the poorest countries. I think this is the fact that these things havent happened is its obviously a commontary on the state of geopolitics but it also represents a governance failure in leading countries who have in the past acted collaboratively for the wider benefit and in their own selfinterest and this is having huge consequences to go on to the next bit of your question. Because in countries where humanitarian agencies work, the impact is much worse than it needed to be, had International Action been better. So were going to see an increase in extreme poverty for the First Time Since the 19 0s, by the 1990s, by the end of next year, probably 150 million more people will be back in the category of [indiscernible] the world bank extreme poverty measure. Thats going to go from a bit less than 600 million before covid to 750 million, almost roughly speaking by the end of next year. Weve seen very heavy compromising of Health Services in the poorest countries. That will lead to a reduction in life expectancy. The annual debt toll from h. I. V. And t. B. And malaria could double. The number of people facing starvation might double as well. Women and girls by the way will suffer most in all of this. Theres also been a lot of commentary recently on the reduction of Mental Wellbeing and psycho social stress which the effects of the pandemic go beyond peoples physical health. D the former head of the British Royal service has drawn attention to huge impact on wellbeing. Larry somers recent paper noted that if you if you start to put a value on all this Mental Health suffering and its impact on producttificity, which is a real thing, then that dramatically increases the overall cost of the pandemic. These same things are also featured in other country, theres a plague of violence against women and girls that really demands attention. Unfortunately, the stress and anxiety and fear the pandemic triggered, a lot of people have been cooped up in cramped conditions for long periods of lockdown, they dont know where to get income to put food on the table, thats taken a toll on the behavior especially of men. In some countries where we were calls to hotlines have increased 70 , theyre a bit overwhelmed. And by the way, alongside this, were starting to receive disturbing reports of Sexual Exploitation and abuse which were acting on now and in other countries. One of the things im keen to draw attention to is while everyone has suffered through the pandemic its really the poorest countries where it looks as though its going to be, you know, the biggest potentially what amounts to a grand reversal. Bill and Melinda Gates in their report in september said the last 25 weeks threatened to unravel 25 years of progress in some Key Development activities around immunization. At the beginning, bruce, you know ive been doing this work a long timing its worth remembering, many of these countries were 25 years ago, i s working in a country where children on their most children never went to school, many died by 18 and women died in childbirth. Us. This is coming back to the grievances, the hopelessness and despair, the conflict and instability and migration an refugees and so on. So you know, i think, an this is something we said in the report last week, read the serious risk as whats essentially a grand reversal of the substantial progress made over the last 40 or 50 years in improving average Life Experience for the median person on the planet, living longer, ability to read, going to school, redeucing hunger. Hose things are at risk now. Mr. Jones one of the questions that came in from the audience beforehand has to had to do with this knocking us off the pathway, do you think thats something that can be undone relatively quickly . Or is is this the kind of shock to the system that takes us down a layer and it will take a very, very long time to recover from . Mr. Lowcock it depends on what we do. Theres a fivepoint plan id like to lay out in conversation which can reduce the danger of what you described. But you know, the things ive just run through, increasing poverty, increasing hunger, declining life expectancy, those s. B. G. s andre the those things are going backwards. Humanitarian action states that to some degree. Whether its lost far short time or permanent is something that depends on what we do next. Mr. Jones why dont i give you an opportunity to lay out your fivepoint plan . That sounds well worth it, why dont you do that. Mr. Lowcock do you mind if i say a little bit first on what humanitarian aid has done . Mr. Jones yeah. Mr. Lowcock i think its important to say a little bit about what we have been able to do. And i wont go into the nor mouse detail but theres quite a bit in the text were releasing about it. One thing i do want to say is, we had a big focus on public information. While the main problems in the modern world is that too many people believe things that are not true and they dont believe things that are true. And thats obviously exatser baited by exacerbated by one of the worlds biggest growth industries, fake news and misinformation. In the highly charged atmosphere you get in the early stages of a pandemic where fear, anxiety and fifths abound and correct information is quite limbed, we recognized there was there was an Important Role for us to play in this area, because one of our assets is that people trust nformation we provide. Which you know gathers information on who trusts information from what sources. So one of the things we tried to do early on is ensure that every person on the planet at least knew a few basic facts about the virus and what they could do to protect themselves. Our campaign for that which is being facilitated, by the way, by more than 110,000 volunteer other countries who have been identifying if you like, plain, and weve reached more than a billion people many multiple languages, i think that was a , od thing to do we launched with problems i described a couple of weeks after they declared covid a pandemic, we raised a billion dollars in the first few weeks, now raised 3. 8 billion, weve given help to 33 llion refugees, sanitation improvements for 70 Million People, health care for 75 million. Lots of things we have done including some innovative things like when commercial airlines disappeared, and we had a question of how to get humanitarian aid workers in and out to the frontline, the World Food Program created a new service which in the middle months of the year transported 25,000 humanitarian ta workers from 400 organizations, n. G. O. s, to and from the frontlines. And i also want to say that humanitarian workers have stayed and delivered through this. In the u. N. We have 50,000 colleagues who work on the front line. The n. G. O. s and others have more. Theres been a lot of, you know, courage and commitment and individuals being willing to take personal risk in conditions which are really tough. But the problem is, all all of this has basically just taken the edge off the worst of the problem. Things i mean its true things would have been much worse in the absence of what we did but that isnt exactly a ringing endorsement. It would have been good to have had more money to do more. Anyway, we are where we are. Should i run through my sort of five points i think we need to Pay Attention to next . Is that the next thing to do . Mr. Jones yeah. But let me ask one thing first. The scale of the response, building the air service while flying it, dealing with the scale of the response, has it forced you to pay less attention to other issues you would have been dealing with in a number of these contexts . Can you say a word about that . Mr. Lowcock yeah, well, i think theres been a little bit of substitution. Verall, for 2020, for the appeals we coordinate, which is 2 3 of humanitarian action, we probably raised more than 20 billion this year, another record. Last year we raised 18 billion. So most of whats happened on covid has been additional. And so, the preexisting programs have largely been protected. But there have been a little bit of substitution, particularly in the health area. People are focused a bit more on covid related things, a bit less on routine immunization. I think this is really a problem, its one of the things i want to flag for the future. And of course delivering anything has got much more difficult because of lockdowns and in some countries there have been an opportunity taken to make it harder for humanitarian agencies to get access to some communities that maybe are not the priority of some of the people who control who can go where. But largely so far, whats happened on covid has been in addition to ongoing support. Has been a little bit but not a vast amount of substitution. Mr. Jones thats in terms of money and access but what about simply sort of political band width, your time, the secgens time, the time of other leaders, surely to some extent, at least, covid has pulled people away from issues they might others has been spending time on. Mr. Lowcock what we tried to do is the classic thing of making opportunity out of a crisis. One thing, for example, we really pushed really hard this year is cease fires. We tried to move forward some political processes using the argument that, you know, this is not a good time to be having a fight about something which is much less important than the exiss ten rble threat to your community. Some places, you know, that has worked. Weve been able to make a bit of progress on some issues. Im afraid overall there hasnt been enough uptick and response for that. Again, thats largely a tissue largely on the state of global geopolitics. Mr. Jones maybe well come back to. This im curious to understand humanitarian access, blockages and to what extent the powers that be have been behind you in terms of pushing thru for access. I want to end by asking you the wider consequences of all this and the geopolitical context were in, but lets go to your fivepoint plan. Mr. Lowcock ok, well. I mean the first thing, this is how i think we need to do it over the next six to 12 months. We have tohing is sustain humanitarian programs in the 56 countries dealing with a bigger crisis. Last year we published a report of more than 35 Million People will need assistance to survive next year, a 40 increase on what weve been dealing with coming into 2020. Its almost entirely due to covid. D we set out plans to, if we get financed, to do that. One of the most critical things is, you know, we have to stave off multiple imminent famines, including yemen, south sudan and elsewhere. And i studied famines as a graduate student my first job was dealing with a famine that cost a Million People their live ethiopia in the 1980s. Its one of the most remarkable achievement history that we can almost find this extreme example of human failure, theres been a history, famines used to be ubiquitous, they didnt have to be, and they are now back. Its not because of a shortage of food. Theres never been as much food available per person around the world as there is now. Its because of the crisis, especially in places afingted by climate change. It will be a horrible stain on humanity for decades to come if we become the generation to oversee the return of such a terrible scourge. We have to make that a priority. The second thing then is, finally, to do the obvious cheap and effective things to put pressure on the most fragile countries. I think their shareholders must take the necessary decisions to allow the i. F. I. To step up. Firstly, the substantial shombs s. D. R. s and allow countries that dont need to access them to be recycled straight away. To top off the allocations for the most Vulnerable Companies that need them. We need to populate the debt treatment framework. For rescheduling and writedowns. That has to cover the major creditors. That means both official and private creditors an also, by the way, those who are trying to ghost their responsibilities by hovering somewhere in between the official and private grouping. We need to ask to be more aggressive in using their Balance Sheet in supporting abroad, recognizing the Balance Sheets may need strengthening later on. We need to agree on how to provide support especially through the world banks most important vehicle poorest countries. The third thing is about vaccine deployment. For several reasons. The new vaccines will be rolled out first in countries whose scientists and pharmaceutical companies developed them. But i think quickly theyll be able vablee for others too. How that getsing mored will matter a lot. Nobody will have more vaccines beyond the first three. Pfizer, biontech and the astrazeneca collaboration. Some might be cheaper and easier to deploy in the most fragile countries. Covax facility, they have an Important Role to play in working out the best approach and theyre going to need to be well financed so that they can have support in the poorest countries. I want to mention two particular challenges on this that need to be welling mored. First, ensuring the Covid Vaccines dent get financed for the poorest countries at the expense of other activities which might save other live those countries. So just to expand on what i mean, it would be perverse and probably in fact would increase less of life to pay for the Covid Vaccine by cutting funding for things like Food Security or routine immunization. The second challenge then relates to limitations of the vaccine Delivery System in fragile and covidaffected countries. There have been unhappy previous experiences with those chopping and changing priorities. I remember a 10year period in Northern Nigeria, for example, where there were successive bursts of enthusiasm for polio eradication and Malaria Control and we found that they were being done at the expense of routine immunization. Its going to be a challenge to deliver the Covid Vaccine to the todo list of weak Health Systems without running this unf unintended intentionally hurting other objectives. The fourth relates to plans about the need for needs of women and girls. The most stomach churning periences i have in this job in every location of every humanitarian horror story on the planet is listening to women and girl december scribe the brutality and abuses or sometimes just the ignorance or ka louseness they experience mostly at the hands of men. To really implore people put their money where their mouths are, to finance more work which many humanitarian agencies are keen to do to deal with this problem now. The fifth thing is, look, i ink theres going to be some show with regard to cry sess. They recently had more than 1,000 organizations which found that most of them had already lost funding and cut programs. In the u. K. , another survey found that barely half of n. G. O. s think theyll be operating two years from now. I think the funders would be welladvised to do what they can to enable the best organizations and those with the greatest potential to play an Important Role in the future to survive because, you know, good institutions are central to progress. Theyre hard to build, actually, and theyre easily lost. So that is the five things i hope well get good focus on. Mr. Jones thats extremely important and well come back to some of them. I want to ask you something that came from the audience and maybe adds to the focus on women and girls which was the particular vulnerability of refugees and migrants and whether theres a specific element we need to be worried about there. Mr. Lowcock when we launched on the 25th of march our Global Response plan, we had three objectives. Basically, one, to do with containing the spread and impact of the disease, one to do with containing the economic consequences and the third to do with vulnerable groups. We were very, very focused on refugee, nigh mie grants and displaced people. Actually, what you see in all those groups, most are women and girls and a lot are people with disabilities. And the humanitarian agencies have not done a good enough job historically in understanding that those are the most Vulnerable People and we still thats still an area for improvement. Mr. Jones another question from the audience, you touched on this earlier but maybe amplify a bit, around information sharing and information management. Have you seen significant channels in getting information, are there adequate Monitoring Systems . What are critical gap information in all of this . Mr. Lowcock so i talked a bit about information about what the pandemic is and how it can be kind of handled. So beyond that, i guess the question is driving at what about information for responders . That is one of the biggest things that my office sort of is responsible for. And thats one of the reasons why we kept, basically kept everybody on the frontlines. So we could gather information and were able to design effective responses for the most Vulnerable People. Obviously the loss of transport systems and restrictions on movement have had a big effect on that. D were mostly through the worst on that now but you know theres a lot of places where we dont have as much information as would be desirable. In some places, the people who are in charge, whether theyre National Authorities or very often extremist groups, actually, one person in 100 on the planet now live a place where the people in charge are not government but are from some kind of nonstate group. You know. Whether its some criminal group or too often an extremist group. These people are a high proportion of our people were trying to reach through crises and information in those places is a premium. This is a key area. R. Jones i want to talk about the wider implications for the humanitarian system. I have a couple of questions about that but i wonder if you have thoughts about the wider cons dwhovense pandemic writ large . Mr. Lowcock i mean, let me say a few things about this which go beyond just the humanitarian system. So stretching my mandate a little bit, i think its too early to be clear what things will look like in three or five years but it wouldnt surprise me if they re if the recovery in better off countries is brisk, though obviously the economic chickens will come home to roost. In the poorer countries, on the other hand, where, you know, i and my colleagues would be working, i think the covid hangover is likely to be long an harsh. Especially if theres no improvement in interNational Health. Especially the first two points i set out in my five points. I suspect that the biggest economic and social effects of the pandemic, when its measured globally over the long term, may turn out to be that arriving from the disruption to the education of hundreds of millions of children. Actually the effect of that might not be very visible. It will never live in a world where those kids didnt have their education interrupted. But those effects will be there and theyll be very real. I think that countries that can afford to are going to invest more in Public Health as well as scientific and Technological Research to prepare for pandemic 2. I think therell probably be some permanent realization of sensitive supply chains. I think theres sharp expansion weve seen in digitization of all sorts including by the way digital medicine. Thats going to be locked in and amplified and actually, largely expansion is mostly positive in my opinion across the planet. And then, you know, obviously theres bound to be another soul searching about the future role of shared multilateral institutions. Everyone i know in the leadership of institutions is keen to learn lessons and work out what we can do. But in future, logically, obviously, collaboration against shared threats which hurt everybody easing everybody in but whether logic will in fact prevail in the current geopolitical context remains to be seen. Mr. Jones theres been a certain absence of that logic in response to some leading powers, you may not want to name them but i will. Both china and the United States it seems to me have responded to this crisis, lets say this, they have not been kind of a it has not been a glorious exercise of international leadership. Certainly by the United States but china. On the other hand, i think its been pretty important to see a number of european countries, a number of asian and middle Eastern Countries stepping up. A central question about this is, the following. You sit at the frontline of a very elaborated international system. Has has drawn us which grown in the postcold war period. It was much more targeted in the cold war period. That grew up in a context of unilateral, there was no real opposition no geopolitical opposition to constrain that system. We are now entering a period where geopolitical tension is a real, vibrant fact of international life. How worried are you about geopolitical tension and constraints, geopolitical tensions constraining the system in which you sit at the heart . Mr. Lowcock the first thing i would say and i said this publicly before is that in my, you know, experience which now extends for a period, whenever the world has dealt with with a crisis in the past, its because theres been good u. S. Leadership. Especially convening others. That was true in the hivaids crisis. It was true in the response to financial crisis in 2008 and 2009. And the world is different now and i think in future, what is going to be true is the world will tend to respond better to crises, those crises affecting the whole planet where china and the u. S. Are able to Reach Agreement on how on some things everybody should do. If we, you know, if we stay in a world which is largely bilateral , so china runs its responses and the u. S. And western countries run another set of responses, thats going to make the going to make for suboptimal responses. Weve actually actually suboptimal for both china and the u. S. As well. I saw know, had xinping inened to xi 2016, maybe we were on the cusp of a stronger Chinese Investment n multilateral institutions. I dont think weve seen that. What weve seen is largely an expansion of bilateral activity. Some of the things that need to be done, particularly on the debt relief side, i think are not going to happen unless everybody is at the table. And i mean fundamentally the creditors all have the same interest they want their debters is vised, they want markets operating which are viable. So there are winwin to use a phrase lots of people dislike, there are outcomes that everybody benefits from, but whether they can be found or not emains to be seen. Mr. Jones in discussions about global issues, of course people will realize the larger interest of coordinated response because it blows back on you if you dont respond to it. So the fact that we havent seen the scale of coordination or leadership, now were in a very particular american moment. Were in a kind of, you know, moment of evolution in china, maybe this is a passing moment, but it worried me to see the degree to which the Worlds Largest powers did not respond to this crisis with an instinct to drive coordinated or nabble responses. Mr. Lowcock theres an even bigger, slower burner, but burning brighter, example, climate change. Mr. Jones i want to push you a little bit on this i know theres probably limits to what ument to say publicly, but i was in the office in 20042005 and we had been dealing with sars. One of the responses then, the u. S. And chinese battled it out in the International Assembly and agreed on Health Regulations which were pretty farreaching. Global Infectious Disease monitoring were built up in the w. H. O. , there was quite a lot of investment of that over about a 10year period. But that did not seem to help us as much as we thought it should in the face of this. Ultimately of course youre dealing with sovereignty of states and if they choose not to comply with International Regulation they can do that we do that all the time. The chinese are starting to have the freedom to do that. Maybe reflect a little bit on the consequences of that. Lowcock i feel sure therell be a revisiting of the i. H. R. W. H. O. s members are decided on a process for that but i dont think thats been the biggest explanation of mixed quality responses. To the pandemic. I think the bigger explanation is in the discussion we had earlier about the feasible choices available in different sorts of societies to deal with his kind of problem. I think in some countries theres even a debate about what level of effort there should be to strengthen the Public Health system. The u. K. Made frankly a bad decision to disinvest in our Public Health system. We actually, you can have a fantastic National Health service, which by the wahab in absolutely the frontline in developing an testing out treatments and in the vaccine thing. But one of the reasons theres been fast process, we found out more things that dont work than do work so far. But a lot of that is because of whats happened in the National Health service in the u. K. The u. K. Basically in the wake of austerity disinvested from the Public Health system. But other big countries also have surprisingly weak Public Health systems. An of course the differences are displaced different ways from individual free dooms versus the collective good this isnt a political point so much as a societal difference. Its in the about democracy, its about the forms of government. Ts a broader issue. So theres a lot you can do on preparedness. We dont get you into those issues. But some of the fundamental things are constrained by those sorts of issues. Mr. Jones again, the theme of sort of logic swaying international affairs, i was struck in the aftermath of sars and ebola and everything, theres always a yin and yang in the Global Health debate about disease management or Public Health systems. It seems covid is the absolute definitive answer is, both. You cannotting more these kinds of things without coinvestment in those two sides of the equation. Im going to pull you out a little bit further on vaccine distribution. You talked about some of the challenges were going to confront. There are also differences in the kinds of vaccines. Some require two shots, some that require cold storage. All of that is going to be immeasurably harder if youre in Northern Nigeria or northwestern yemen or a number of contexts where your people are serving on the frontlines. Maybe say a word about that issue, how you think about that challenge. Mr. Lowcock most of what we need to know, we dont know yet on that. We dont know the number of vaccines, when theyll be available, in what volume, and so on. The cold chain issue, its important not to jump to too any conclusions. Another vaccine requires a cold chain and its been deplied in three major Operation West africa, and recently in western d. L. C. Of course its different when youre doing it in a concentrated place. The cold chains have been easier toing more there when youre doing it to everywhere thats harder. But i think the cost issue is a significant issue. Particularly because of the substitution risk. You know, theres one of two financiers who frankly already have made decisions which is to effectively just take money away from other lifesaving activities an put it into Covid Vaccines. O you know, thinking about the trying to maximize the vaccines assuming levels of effectiveness are comparable and assuming you can produce enough of everything, thats clearly going to be a relevant discussion. Realistically, i would be surprised if theres very much deployment of vaccines before quite late next year in the poorest countries. They might be big but if theres a lot in the kind of countries where my colleagues and i do most of our work, id be a bit surprised. And if that buys time to get it replacing Food Security or measles vaccines with an expensive Covid Vaccine im not sure thats a terrible tradeoff. Mr. Jones presumably theres Public Health logic that would say you want to vaccinate first populations that are highly mobile in terms of preventing recurrence. So leave aside ethical considerations for a minute which we shouldnt for more than a minute but leave that aside for a minute, you dont want singapore unvaccinated when singaporians are flying all over the place, out of singapore and new york, you want hubs of global interconnection to be vaccinated early. But ethical considerings might push you in a different direction so maybe just reflect on that. Mr. Lowcock if youre saying people like me who spend our lives in airplanes need to be at the start of the queue, dent let me stop you. I dont know about that there are various things that need to be talked through. What ive observed is the initial phase seems to be focused on older people, people with preexisting conditions, health workers. And probably for the next few months, you know, there isnt much discussion to be had beyond those groups. It wont be real chisses to be made before, you know, i dont know when maybe february or march. But im with you on the point that thinking about the right order from a global Public Health perspective is a smart thing to do. And i dont think the smart thing to do will be complete vaccination in a small number of countries for everybody including those not at risk, as opposed to trying earlier on to minimize risks for the planet as a whole by reaching other populations in other parts of the world. Mr. Jones in about 2 1 2 minutes the lords of zoom will close off this session. I want to say one final thought before that. Let me ask if theres one final thought with which you want to leave our audience. Mr. Lowcock the main thing really is when youre in the middle of the tunnel and its very dark, you still have to think about whats happening next. And what policymakers, decisionmakers decide to do over the next few months will have a big impact on the effect of this crisis in the very poorest countries through 2021 and thosesques will be felt everywhere on the planet, not just in those countries themselves. Mr. Jones perfect, mark, i want thank you and through you i want to thank the large number of humanitarian workers both for the u. N. And national and international n. G. O. s on the frontlines. We spend a lot of time in this country and the british countries talking about frontline workers in our societies but there are frontline workers in other countries as well and you are trying to help them. So through you to them an enormous thanks, an huge thanks for you being here. Mr. Lowcock thank you. Its been an interesting conversation, thank you very much. Tonight on the communicators, chief policy picoff. 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