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 an