Thread by @kakape

The most comprehensive review of how the world responded to #covid19 and how to prevent the next pandemic was published today.
It will likely be the basis of discussions in coming months and years and so I read it for you.

Story here, thread to come:
sciencemag.org/news/2021/05/t…

Who wrote the report?
This is the Independent Panel for Pandemic Preparedness and Response (IPPPR), established last year in response to a resolution of the World Health Assembly.
It consists of 13 members led by @HelenClarkNZ and @MaEllenSirleaf.

@HelenClarkNZ @MaEllenSirleaf (To be completely transparent:
I was actually interviewed by this panel in February but only about the communication aspects of the pandemic. I have no other involvement with this report or the panel.)

@HelenClarkNZ @MaEllenSirleaf There are a ton of important points and quotes in the report, but this may be the key one:

“Pandemics pose potential existential threats to humanity and must be elevated to the highest level.”

@HelenClarkNZ @MaEllenSirleaf Let’s look at the panel's analysis of what went wrong first:

@HelenClarkNZ @MaEllenSirleaf 1. We were warned. Again and again and again. We didn’t listen.
“Despite the consistent messages that significant change was needed to ensure global protection against pandemic threats, the majority of recommendations were never implemented."

@HelenClarkNZ @MaEllenSirleaf 2. Countries did not give this the needed money and attention.
“Too many national governments lacked solid preparedness plans, core public health capacities and organised multi sectoral coordination with clear commitment from the highest national leadership."

@HelenClarkNZ @MaEllenSirleaf 3. WHO was late in declaring the outbreak a PHEIC.
"The Panel’s view is that the outbreak in Wuhan is likely to have met the criteria to be declared a PHEIC by the time of the first meeting of the Emergency Committee on 22 January 2020."

@HelenClarkNZ @MaEllenSirleaf 4. WHO could have warned of h2h transmission earlier.
"While WHO advised
of the possibility of human-to-human transmission ... Panel’s view is that it could also have told countries that they should take the precaution of assuming that human-to-human transmission was occurring."

@HelenClarkNZ @MaEllenSirleaf 5. The International Health Regulations (IHR) which govern what WHO can do slowed down the response.
"the legally binding IHR (2005) are a conservative instrument as currently constructed and serve to constrain rather than facilitate rapid action"

@HelenClarkNZ @MaEllenSirleaf 6. Even when PHEIC was declared, countries did not respond.
“in the absence of certainty about how serious the consequences of this new pathogen would be, “wait and see” seemed a less costly and less consequential choice than concerted public health action”.

@HelenClarkNZ @MaEllenSirleaf I felt this one in my bones:
“It is glaringly obvious to the Panel that February 2020 was a lost month, when steps could and should have been taken to curtail the epidemic and forestall the pandemic."

@HelenClarkNZ @MaEllenSirleaf 7. When countries responded some did not do it based on evidence.
"Countries that devalued science failed to build trust in their response and pursued inconsistent strategies that left them lagging behind the epidemic and with high infection and death rates."

@HelenClarkNZ @MaEllenSirleaf 8. Health systems were underfunded and ill-prepared.
"Health systems and health workers were not prepared for a prolonged crisis. ...The health systems which had been under-resourced and fragmented over a long period prior to the pandemic were the least resilient."

@HelenClarkNZ @MaEllenSirleaf 9. Existing inequities made things much worse.
“The Panel notes that COVID-19 has been a pandemic of inequalities and inequities … Inequality has been the determining factor explaining why the COVID-19 pandemic has had such differential impacts on peoples’ lives and livelihoods"

@HelenClarkNZ @MaEllenSirleaf The upshot of all this?

"For the Panel it is clear that the combination of poor strategic choices, unwillingness to tackle inequalities, and an uncoordinated system created a toxic cocktail which allowed the pandemic to turn into a catastrophic human crisis."

@HelenClarkNZ @MaEllenSirleaf Before I tackle the panel’s recommendations (maybe in a separate thread), let me add some thoughts from myself and some experts I spoke to about these points that the panel identified as contributing to the pandemic:

@HelenClarkNZ @MaEllenSirleaf Most people I spoke to agree that a PHEIC should have been issued a week earlier (several told me so at the time).
But they also agree it’s beside the point. As @angie_rasmussen told me: “In my opinion that wouldn't have changed anything about the pandemic.”

@HelenClarkNZ @MaEllenSirleaf @angie_rasmussen What this does highlight is the structural problem of how WHO has to operate under the International Health Regulations.
As the panel notes, the IHR place “greater emphasis on action that should not bet taken, rather than on action that should"

@HelenClarkNZ @MaEllenSirleaf @angie_rasmussen The panel fails to call out bad actors, like China for its early handling of the outbreak, @LawrenceGostin told me:
“The independent panel had the opportunity to give WHO political cover to name names, to identify fault, honestly, where it occurs. And they didn't do that.”

@HelenClarkNZ @MaEllenSirleaf @angie_rasmussen @LawrenceGostin And while you can talk a lot about international organizations, as @JeremyFarrar told me, the decisions ultimately rest with national governments: “Look at Europe: the tightest region of countries linked together in the world and they effectively all acted individually."

@HelenClarkNZ @MaEllenSirleaf @angie_rasmussen @LawrenceGostin @JeremyFarrar I’ll stop here and write about the core of the report, its recommendations in a separate thread later.
Or you just read my story: sciencemag.org/news/2021/05/t…

@HelenClarkNZ @MaEllenSirleaf @angie_rasmussen @LawrenceGostin @JeremyFarrar And here is the report itself:
theindependentpanel.org/wp-content/upl…