COVID-19 Global Action Plan Letter

RE: COVID-19 Global Action Plan

October 1, 2020

To: Prime Minister Abiy Ahmed, Ethiopia

President Nana Akufo-Addo, Ghana

Prime Minister Jacinda Ardern, New Zealand

President Khaltmaagiin Battulga, Mongolia

President Moon Jae-in, South Korea

Prime Minister Katrín Jakobsdóttir, Iceland

Prime Minister Pravind Jugnauth, Mauritius

President Luis Lacalle Pou, Uruguay

President Ursula von der Leyen, European Commission

Prime Minister Sanna Marin, Finland

President Mokgweetsi Masisi, Botswana

Chancellor Angela Merkel, Germany

Prime Minister, Mia Amor Mottley, Barbados

President Cyril Ramaphosa, South Africa

Prime Minister Pedro Sánchez Pérez-Castejón, Spain

Prime Minister Justin Trudeau, Canada

The Elders

Former Foreign Minister of Algeria, conflict mediator, and UN diplomat Lakhdar Brahimi

Former Prime Minister of Norway and WHO Director-General Gro Harlem Brundtland

Human rights champion Hina Jilani

Former UN Secretary-General Ban Ki-moon

Former UN Commissioner of Human Right Zeid Ra’ad Al-Hussein

Former President of Chile Ricardo Lagos

Former Minister of Education of Mozambique Graça Machel

Former President of Ireland Mary Robinson

Former President of Colombia and Nobel Peace Laureate Juan Manuel Santos

Former President of Liberia and Nobel Peace Laureate Ellen Johnson Sirleaf

Former President of Mexico Ernesto Zedillo

Champions for an AIDS-Free Generation

Former President of South Africa Kgalema Motlanthe, Chair of the Champions

Former Chair of the Kenyan AIDS Control Council and Former Chair of AMREF Miriam Were, Deputy Chair of the Champions

Former President of Malawi Joyce Banda

Former Justice of the South African Constitutional Court Edwin Cameron

Former President of Mozambique Joaquim A. Chissano

Former President of Zambia Kenneth D. Kaunda

Former President of Mali Alpha Oumar Konaré

Former President of Botswana Festus Mogae

Former President of Nigeria Olusegun Obasanjo

Former President of Namibia Hifikepunye Pohamba

Prince Seeiso Bereng Seeiso of Lesotho

Archbishop Emeritus and Nobel Peace Laureate Desmond Tutu

Former Vice President of Uganda Speciosa Wandira-Kasibwe

CC: UN Secretary-General Antonio Guterres

CC: WHO Director-General Tedros Adhanom Ghebreyesus

Dear Presidents, Prime Ministers, Elders and Champions,

We write to you as global health scholars, advocates, and practitioners who are deeply troubled by the lack of global leadership in our shared struggle against COVID-19. We write to you as concerned citizens of the world, all too aware of the immense and growing human toll that COVID-19 and its economic and social ramifications are taking in countries that have the fewest financial and health resources to respond. And we write to you with a keen awareness of your leadership – within your countries and globally, including how those of you who now have the responsibility of guiding your countries through COVID-19 are following science and making your best efforts to protect the health and well-being of your populations. In light of this, we request that you spearhead a global COVID-19 response and recovery action plan.

The toll in countries with fewer health and economic resources to respond to the pandemic continues to mount, with new COVID-19 cases and deaths increasing in some countries even as they have fallen in others. New waves of COVID-19 remain all too possible. Many tens of millions of people are being driven into poverty and facing hunger, hundreds of millions of children have been unable to access remote learning during school closures, and fears grow of a massive toll in lives lost from COVID-19-related health care disruptions. Yet well over seven months since WHO declared COVID-19 a public health emergency of international concern, there is no global strategy.

Outside specific funding appeals for their vital work – for the United Nations and World Health Organization, the Coalition for Epidemic Prepared Innovations (CEPI) and Gavi, the Vaccine Alliance, for instance – funding lacks necessary coordination and remains insufficient. National interest and wealth has driven the distribution of testing kits and other needed supplies and equipment, producing grave inequities, if now mitigated by the UN/WHO COVID-19 Supply Portal. The Access to COVID-19 Tools (ACT) Accelerator partners are committed to equitable distribution, with the COVID-19 Vaccine Global Access (COVAX) Facility and Gavi COVAX Advanced Market Commitment (AMC) the heart of the global effort on equitable distribution of vaccines – but well over 100 vaccine candidates – and other medical technologies – are outside this partnership. The COVID-19 Technology Access Pool will share knowledge and intellectual property, facilitating but not ensuring access, but many countries are not participating.

Accordingly, we respectfully ask that you use your platform as a head of state who has been successfully leading your nation through COVID-19 with a minimal loss of life, or who has already assumed a role in global COVID-19 leadership, or who has had a long career of global leadership, to initiate global action to develop, and advocate for and monitor adherence to, a global COVID-19 response and recovery action plan.

Given the central role of WHO and the United Nations in a coordinated global response, we encourage you to fully involve both organizations. For example, you might propose to UN Secretary-General Antonio Guterres and WHO Director-General Tedros Adhanom Ghebreyesus that they immediately launch a joint UN-WHO high-level commission to spearhead the proposed global action plan. It could be comprised of yourselves and others as may be warranted and advisable, including civil society and with input from UN and WHO member states to help secure political buy-in. In the interest of time, such a commission may wish to release action plan components as they are developed. The commission could work closely with the UN and WHO, including WHO’s Independent Panel on Pandemic Preparedness and Response and a proposed Global Health Equity Task Force, which would be housed within WHO to support it in establishing an equity-focused response to COVID-19, or other WHO initiatives on equity in the context of COVID-19.

We outline in the attached document (and copied below our signatures) possible elements of such an action plan. It could cover funding targets and mobilization, equity-based principles, and targets, monitoring, and evaluation, along with strategies in key areas, like equitable distribution of medical supplies and equipment and of tests, therapies, and vaccines.

Many thanks for your kind consideration, and we look forward to your response and continued leadership. Please let us know if we can support your efforts in any way or would like to discuss this further by contacting Professor Lawrence Gostin at the Georgetown University Law Center (gostin@georgetown.edu).

Sincerely,

Chelsea Clinton
Vice Chair, Clinton Foundation
Board Member, Clinton Health Access Initiative
Board Member, Alliance for a Healthier Generation
United States

Lawrence O. Gostin
Professor and Faculty Director, O’Neill Institute for National and Global Health Law
Georgetown University Law Center
Director, World Health Organization Collaborating Center on National & Global Health United States
United States

Michele Barry
Senior Associate Dean for Global Health and Professor
Director, Center for Innovation in Global Health
Stanford University School of Medicine
Chair of Board, Consortium of Universities for Global Health
Founder, WomenLift Health
United States

Mariëlle Bemelmans
Director, Wemos
Netherlands

Mushtaque Chowdhury
Formerly Vice Chair, BRAC
Founding Dean of the BRAC James P. Grant School of Public Health
Bangladesh

James W. Curran
Dean and Professor
Rollins School of Public Health, Emory University
Co-Director, Emory Center for AIDS Research, Emory University
United States

Lola Dare
President, CHESTRAD Global
Nigeria/United Kingdom

Patricia Davidson
Dean and Professor
School of Nursing, Johns Hopkins University
United States

Mark Dybul
Professor and Co-Director, Center for Global Health Practice and Impact, Georgetown University Medical Center
Fellow, Joep Lange Institute
Former Executive Director, Global Fund to Fight AIDS, Tuberculosis and Malaria
Former U.S. Global AIDS Coordinator
United States

Victor J. Dzau President, U.S. National Academy of Medicine
Vice Chair, U.S. National Research Council
Professor, Duke University School of Medicine
United States

Richard Elliot
Executive Director
Canadian HIV/AIDS Legal Network | Réseau juridique canadien VIH/sida
Canada

Paul Farmer
Chief strategist and Co-Founder, Partners In Health
Kolokotrones University Professor and Chair of the Department of Global Health and Social Medicine, Harvard Medical School
Chief of the Division of Global Health Equity, Brigham and Women’s Hospital in Boston
United States

Walter Flores
Principal Advisor, Centro de Estudios para la Equidad y Gobernanza en los Sistemas de Salud (Center for the Study of Equity and Governance in Health Systems)
Guatemala

Eric A. Friedman
Global Health Justice Scholar, O’Neill Institute for National and Global Health Law
Georgetown University Law Center
United States

Luiz Galvao
Former Head of Sustainable Development, Environmental Health and Health Equity, PAHO/WHO
Researcher at the Center for Global Health, FIOCRUZ, Brazil
Adjunct Professor, Georgetown University, United States
Brazil

Perry N. Halkitis
Dean and Professor
Director, Center for Health, Identity, Behavior & Prevention Studies
Rutgers School of Public Health
United States

Margaret (Peggy) Hamburg
Former Commissioner, U.S. Food and Drug Administration
Immediate past chair/President, American Association for the Advancement of Science (AAAS)<
Former Foreign Secretary, U.S. National Academy of Medicine
United States

Martin Hevia
Dean and Associate Professor
School of Law, Universidad Torcuato Di Tella
Argentina

Oraibi Imabibo
Convenor, Global Health South
Nigeria

Christian Locka
President, Action for Humane Hospitals
Cameroon

Franciscka Lucien
Executive Director, Institute for Justice & Democracy in Haiti
United States

Réginald Moreels
Humanitarian surgeon
Former Minister, International Cooperation Belgium
Belgium

Moses Mulumba
Executive Director, Center for Health, Human Rights and Development
Uganda

Dainius Pūras
Professor, Vilnius University, Lithuania
Former UN Special Rapporteur on the right to health
Lithuania

Srinath Reddy
President, Public Health Foundation of India
Former President of the World Heart Federation
India

Walter Ricciardi
President, World Federation of Public Health Associations
Professor, Catholic University of the Sacred Heart
Italy

Mirta Roses Periago
Member, National Academy of Sciences of Buenos Aires
Argentina

Umunyana Rugege
Executive Director, SECTION27
South Africa

Sasha Stevenson
Head of Health Rights Programme, SECTION27
South Africa

Oyewale Tomori
Former President, Nigerian Academy of Science
Professor of Virology and former Vice Chancellor, Redeemer’s University
Nigeria

Sten Vermund
Professor and Dean, Yale School of Public Health
Professor, Yale School of Medicine
United States

Debrework Zewdie
Distinguished Scholar at the CUNY School of Public Health and Public Policy (United States)
Former Director, Global AIDS Program, World Bank
Former Deputy Executive Director and Deputy General Manager, Global Fund to Fight AIDS, Tuberculosis and Malaria
United States/Ethiopia

Plan elements

1. Principles guiding global action plan and to guide national action: Principles would include human rights, national and global equity, non-discrimination and protection of marginalized and vulnerable populations, and global solidarity.
2. Funding: The plan would include global funding targets that encompass the universe of international funding needed to support low- and middle-income countries, including funding for health systems for the immediate response and longer-term recovery and strengthening, food security and other social safety net programs, bridging the digital divide and enabling schools to reopen safely, and sustaining employment, as well as longer-term social and economic recovery. Funding should also encompass UN agencies and international and national civil society organizations. And funding must include and reach grassroots and community-based organizations. This is vital for reaching the most vulnerable populations, for building trust and ensuring that people have accurate information – facilitating acceptance of treatments and vaccines as they become available – and for empowering members of the public to follow measures necessary to control COVID-19, while having the food, income, and other support required to do so.

These targets could be periodically updated with new information and as needs change. Along with overall funding needs, which could be categorized and differentiate between grants and loans needed, targets could include specific appeals, such as for the United Nations, WHO, CEPI, and the World Food Programme.

The plan should also address specific mechanisms and strategies for raising resources and limiting further economic fallout, from significantly expanded debt relief – as urgently needed – to the required funding from wealthier governments and international financial institutions, to creative possibilities, like IMF special drawing rights.

3. Equitable distribution: The global action plan would provide a strategy for creating the manufacturing base required for rapidly and maximally scaling up production of successful vaccine candidates and therapies, wherever and whichever companies, organizations, or partnerships may develop them. It would build on COVAX and the Gavi COVAX AMC, the principles of the People’s Vaccine, and the COVID-19 Technology Access Pool. It would contain principles to guide global distribution based on equity, need, and universal access. Further, the plan would need to ensure a mechanism to coordinate global access so that vaccine distribution follows these principles, with COVAX emerging as the core of such a mechanism. This part of the global action plan should be developed in close coordination with the co-leaders of COVAX: WHO, CEPI, and Gavi, the Vaccine Alliance.

The plan would also include policies that all countries should adopt to promote and encourage equitable distribution of vaccines and therapies. These could encompass ensuring that relevant laws and policies on intellectual property are consistent with global equitable distribution, and that national licensing laws and regulations will enable vaccines and therapies that WHO recognizes as safe and effective to be rapidly introduced. Policies and actions for countries to avoid could be included as well, such as export controls and deals with manufacturers that provide them privileged access.

Further, if the current approach of donations and country requests through the UN/WHO online COVID-19 Supply Portal is insufficient, the plan could provide for supplemental, or different, approaches for equitably sharing the limited supply of personal protective equipment, ventilators, and other medical supplies and equipment needed for the COVID-19 response. Distribution must not be driven by factors like the manufacturer’s location and countries’ ability to pay. The plan could also include measures to increase supply.

4. Additional actions: The plan would also encompass other global actions, forms of global cooperation and coordination, and national actions affecting the capacity of other countries to respond to and recover from COVID-19 and its consequences. These would include a WHO-led open access online platform for sharing and accessing lessons on responding to all dimensions of the COVID-19 pandemic; measures to protect internally displaced persons, refugees, asylum seekers, stateless people, and migrants; strategies to protect and meet the needs of vulnerable and marginalized populations and prevent COVID-19 from exacerbating income, educational, and other inequalities, and; the necessity for countries to avoid food export restrictions that could disrupt global food supply chains, limiting limit food availability and increasing prices, thus increasing global hunger.
5. Monitoring and evaluation: Lastly, to ensure accountability, the plan would encompass monitoring and evaluation, with countries and international organizations regularly reporting on their actions with respect to the plan’s funding targets and actions. This transparency and constant monitoring and assessing progress will be necessary to motivate action and to identify areas requiring advocacy as well as new approaches, partnerships, or other measures. At the same time, to enable timely collection and use of information and to minimize reporting burdens, targets and metrics should be straightforward and easily measurable.