From my experience of thinking about major globally relevant health challenges, I am in no doubt that significant global co-operation in health is a pre-requisite for any serious effort to deal with future health risks — both known and unknown.
Even before the current global covid-19 pandemic, I had some awareness of the need for such international cooperation, partly because of my background as a trained international macro economist, but also , related to this, because of my experience of having led an independent review for the UK government on the threat of global antimicrobial resistance (otherwise known as ‘AMR’).
Probably the main reason why I was asked to lead the AMR Review, is because - back in 2001 - I dreamt up the concept of the “BRIC” countries, Brazil, Russia, India and China, and demonstrated that their likely economic growth would transform many aspects of global economic and related life. This prediction became quite well known, because we suggested that, by the late 2030’s, the economies of these countries could collectively become larger than those of the G7 group of countries from the industrialised West — and that, critically, before 2030, the Chinese economy could on its own become bigger than the economy of the US. The idea that these changes were likely to occur appeared to have an impact on the strategy of many international business people and, after some years, also on the policymakers of the BRIC countries themselves. By 2010, along with South Africa, the leaders had set up their own BRICS club. Of course, by that time, all five had become active members of the G20, which had become an important (and more representative) body than the G7 for tackling key aspects of global economic governance after the 2008 financial crisis.
Due to the traction of the BRIC idea, many other so-called emerging economies would often try to persuade me that they also deserved to be part of the group, including many from Asia, both north and south, as well as other parts of the world.
As I often tried to emphasise, the exercise that demonstrated the potential future for the BRIC - and other - economies, was purely an exercise in the art of the possible. Indeed, it was based around the simple premise of long term drivers of economic growth, and countries achieving their potential. There are two crucial ingredients: a country’s labour force including its age distribution and growth, and also its productivity. Any factors that suppress or boost either will affect a country’s actual growth performance.
In 2014, when i was asked to lead the global, independent AMR review, having spent many years thinking of the BRICS projections, one of the first things i asked my AMR team to do, was to re-create the scenarios of the future as done in the original BRIC analysis — but this time, also to “ shock “ the modelling by considering various paths for the rise of anti microbial resistance if we were unable to stop that risk from occurring. By undertaking this path analysis, we were able to derive two different sets of the future: one, the perfect world where every country reached its potential; the other, where the fulfilment of potential was constrained by the end of effective antibiotics and other microbials.
At the time of our review, it appeared as though around 700,000 people around the world were already dying as a result of some form of antimicrobial resistance. Importantly, a significant number of these deaths were related to drug resistant TB, something that all five BRICS countries share as a threat. Our scenario-gazing showed that if AMR wasn’t dealt with now, then there could be around 10 million people a year dying globally of drug resistant diseases by 2050, and that (staggeringly), due to reduced productivity in much of the world, an accumulated $100 trillion worth of potential nominal GDP would be lost. Much of this lost potential and sadly, deaths would occur in Africa and the East, but (as i became fond of saying), AMR is a threat that doesn’t distinguish between colour or creed. East, West, male, female, black, white, sunni or shi-ite , it doesn’t distinguish. Along with climate change, it is a truly global threat.
While we were cautious about pursuing in depth detailed analysis of individual countries, it was quite clear from our research that as many as 1 million lives a year could be lost regularly in each of India and China; and it was very unlikely that their economies would be able to fulfill their potential.
Some people have occasionally thought those kind of predictions might be simply scaremongering. But the outbreak of covid-19, and the colossal loss of lives and economic activity has changed people’s mindsets. Increasingly, people are coming to realise that these things do happen, and that they may happen again.
At the time of writing, there is great hope in the most developed parts of the world for a large economic recovery. But even if this optimistic outcome were to occur, many nations will have little chance of returning to their pre-pandemic levels of GDP until 2022 at the earliest; and of course, some are in the grips of the pandemic still. And very sadly, there has been horrific loss of life.
The case for a much better global policy framework for serious health threats is now clear, and we need urgent efforts. This will require huge global co-operation. The West and the East will need to be at the centre of that cooperation for it to be successful.
This is for obvious reasons, but let me make some of them clear. To achieve the true benefits of global cooperation, as we witnessed in 2008 , you need key countries, including the biggest and most influential to be at the heart of the global effort. The US and China, in particular, played critical roles in 2008. Both directly, and through established multilateral bodies, they need to play such roles again.
A less well discussed, but to me equally obvious lesson of this pandemic that the East ( at least Northern Asia) can teach the rest of us, is the need for modern technology to be at the centre of global health surveillance. I often reflect that, back in February 2020, many UK commentators repeatedly opined that the pandemic in the UK was two weeks behind Italy. This was very frustrating, because the UK was also two, perhaps even three weeks behind South Korea. We didn’t have to mimic Italy; but sadly, we did, indeed - at least during the first phase - more than surpassing their troubling loss of life. South Korea meanwhile, along with many other Asian nations, treated the outbreak with much greater seriousness, using modern technology to stamp out concentrated areas of outbreak at great speed. Others, as distinct as Vietnam and Taiwan seemingly did the same. By contrast, at the time of writing, many Western countries, despite having vast stocks of vaccines to deploy, still struggle with aspects of covid-19 surveillance; and of course, in the emerging world, the challenge of detection is mammoth.
So here is what is necessary, and where specific East-West cooperation is crucial.
Firstly, we need to stop health challenges, especially ones that can turn into global diseases and pandemics being only the concern of health institutions. While the knowledge and strengths of the WHO need to be preserved, if we are to be better placed to deal with future acute threats such as. Covid-19 and slow creeping threats such as AMR, we need the world’s leading financial institutions to be directed to take some leadership on these challenges.
Specifically, and this requires board consensus, the IMF needs to start monitoring and opining on health preparedness as part of their highly influential annual Article iv survey of member countries. It is not good enough for the WHO to be the sole body responsible for this, not least as it has little power to enforce compliance. Instead of shouldering the whole burden, the WHO should be sharing its expertise with the IMF — and, because this is macro specific, the IMF needs to recognise its duty to try to prevent anything like a repeat of 2020 happening. For this to happen, will require the support of the IMF’s two biggest shareholders, the US and China.
Beyond this, and directly learning from the 2008 crisis, the existence of the financial stability board, the FSB, needs to be used as the basis for a new global health board, the GHB, also to exist under the G20, reporting to G20 heads of government or finance ministers. This would ensure regular monitoring of global health threats, and allow for the flow of necessary finances, in advance of health risks becoming pandemics. Part of this responsibility would be to preside over a much stronger global surveillance system to monitor emerging threats and to take steps to diminish their likely adverse influence before they came real. This idea of a Global Health Board originated in the Monti Commission, established by the European region of the WHO to propose ideas to help the world to be a better place. So it is certainly not a threat to existing health bodies, and indeed will bolster their likely affectiveness, including that of the WHO.
But any effective measures to establish a Global Health Board will have to be agreed by the G20, of which the leading nations from the East and West (and, in particular, the US and China) are key members.
It may well be that the existing array of global health bodies could be streamlined, and if not, certainly strengthened. Another idea from the Monti Commission that has been discussed would be the extremely ambitious proposal to merge the WHO, FAO and OIE all into one single body. The simple rationale is that, as we have seen with covid-19, and is clearly the case with AMR, we are all connected — humans, animals and the environment. Maintaining separate global bodies for each area probably makes it harder for any one of them to take responsibility for the collective health threat. One Health is the modern reality: so why not have the WHO become, in time, the WOHO, the world one health organisation? Even if this is too ambitious in the near future (and not yet being pushed by the Monti Commission), it is eventually, surely, a must. But this, too, would require East-West cooperation.
And then of course, there is the need for bilateral and collective cooperation on research and development.
One of the interesting facts that has emerged from the vaccine development process for both Ebola and Covid-19, has been not only the speed with which effective vaccines were developed and introduced, but the amazing scale of cross border cooperation, including amongst private sector agents. This remarkable international cooperation in vaccination clearly needs to become a permanent feature of normal life, and not just something that occurs during a crisis.
In addition to cooperation amongst policymakers themselves, it is vital that policymakers create a set of so-called push and pull incentives. This is the only way to make sure, in the event surveillance doesn’t stop threats breaking through, that we have the right set of tools to respond even more quickly than during Covid-19. On the push side, direct financial support for university and early stage biotech research, and collaberation amongst researchers is particularly attractive from a sustainable finance perpective. Alongside this, another push-type incentive should be to encourage shared clinical trials, as proposed by the UK in its role as 2021 G7 hosts, whereby individual entities cease to just go through trials alone, and instead use a shared global platform so that economies of scale can benefit all of them, and almost definitely on a more cost effective basis. On the pull side, as I have argued for many years , we need a set of rewards or prizes to change the economics of antimicrobials production and to remedy the current lack of a market incentive. In this regard, we need precisely the same for vaccine availaility to the lower income world. As this pandemic has shown, once the volume-incentive is there, the big pharmaceutical firms will come. But all of these push factors and pull factors depend on East-West cooperation — and, as ever, in particular on cooperation between China and the US.
Lord Jim O'Neill worked for Goldman Sachs from 1995 until April 2013, spending most of his time there as Chief Economist. He chaired the Cities Growth Commission in the UK until October 2014 when it provided its final recommendations. Jim is currently chairing a formal Review into AMR (anti-microbial resistance), which will make recommendations on how to solve this global challenge in spring 2016.
Jim is Honorary Chair of Economics at Manchester University. He is also a Visiting Research Fellow at the international economic think tank, Bruegel, and on the economic advisory board to the IFC, the investing arm of the World Bank. He is one of the founding trustees of the UK educational charity, SHINE and serves on the board of ‘Teach for All’ and a number of other charities specialising in education. In September 2013 he became a Non-Executive Director of the Department of Education.