The COVID-19 pandemic calls for urgent reform of health care, surveillance and governance in the WHO European Region and beyond

Copenhagen and Moscow, 10 September 2021

Pan-European Commission on Health and Sustainable Development makes recommendations for 53 countries in the WHO European Region

• Adopt a One Health policy recognizing the interconnectedness of human, animal and environmental health.
• Address the deep-seated health, social, economic and gender inequalities exposed by the pandemic.
• Invest in innovation, data collection and sharing, and strong national health systems.
• Improve regional and global health governance, learning lessons from COVID-19.

Calling for action at all levels of society

Despite repeated warnings of a global pandemic from the scientific community, the world was not prepared when SARS-CoV-2 first emerged in late 2019.

Divergent and erroneous policy responses meant the impacts of COVID-19 have been and continue to be catastrophic, with over 1.2 million deaths in the WHO European Region alone (over 4 million globally), and an unprecedented economic downturn that dwarfs the 2008 global financial crisis. It is vital that we learn from our mistakes, for we cannot afford to make them again.

Dr Hans Henri P. Kluge, WHO Regional Director for Europe, said:

“We can’t allow another pandemic to bring the world to its knees and must do everything in our power to prevent a catastrophe on the same scale from happening again. That’s why I have convened the Pan-European Commission on Health and Sustainable Development, led by former Italian Prime Minister Professor Mario Monti and made up of subject-matter experts from across the European Region, to reflect on what has and more often hasn’t worked in our response to COVID-19.

“We are calling for action at all levels of society – on fixing fractured societies, on safeguarding planetary health, on innovation and investment in health systems, and on better European and global governance. Our main challenge has not been identifying strategies for success – we know what we need to do – but our collective inability to implement them effectively. A significant obstacle has been reluctance on the part of governments to share decision-making powers or to agree shared governance arrangements for the benefit of all. It’s time to learn some important lessons so we don’t make the same mistakes again.”

Professor Mario Monti, Chair of the Pan-European Commission on Health and Sustainable Development, said:

“The Pan-European Commission on Health and Sustainable Development calls on national governments, regional and global organizations, and stakeholders of health- and social-care systems to engage in far-reaching reforms, investment programmes and improvements in governance, drawing light from the pandemic.

“In addition to increasing prevention, preparedness and response to pandemics, our recommendations design a new strategy for health and sustainable development. This requires awareness of the interconnections between human, animal and plant health and their impact on emerging zoonotic diseases; of the links between climate change, biodiversity and human health; and of the need to reinvigorate and extend our national health services.

“Last, but not least, it is necessary to enhance the position of health policy in overall policy-making by governments and international organizations by setting up a Global Health and Finance Board at the G20, recognizing that health is a global public good. New generations deserve a better world – one where progress does not come at the expense of their health and the health of the planet.”

Many countries’ first knee-jerk reaction to the pandemic was to close geographic and economic borders, implement isolated national responses, and ignore cross-country considerations. However, COVID-19 showed us that single-country solutions are not enough when it comes to the spread of communicable diseases in a hyper-connected, globalized world. Such crises can only be tackled effectively through joint international action.

One Health

The concept of One Health recognizes the interconnection between people, animals, plants and their shared environment. When one part is at risk, the others are also in danger. Human activities like deforestation, trade and consumption of wildlife, and international travel are thought to have led to the emergence of SARS-CoV-2 and facilitated its global spread. We, and our descendants, now face a precarious future unless we all take urgent action to correct course.

• The Commission recommends countries establish cross-government One Health strategies, based on the concept of “health in all policies”, to safeguard future generations from existential threats.

Inequality

For years, policies have contributed to high levels of wealth and income inequality, underinvestment in social protection, unequal opportunities, job insecurity, precarious housing, racism, and other forms of discrimination. We must close the equality gaps now to increase the declining levels of trust in public bodies and to decrease polarization in society.

• The Commission recommends countries identify and target those who lead precarious or impoverished lives and tackle societal distrust to improve social cohesion, including by setting quotas for female representation in public bodies tasked with drafting and implementing health policies.
• The Commission recommends countries gather data on the various levels of health within populations and develop systems to monitor health inequality and access to health and social care.

Innovation

The pandemic has clearly demonstrated that the existing model of innovation in health – where most of the risk is borne by the public sector and most of the returns flow to private companies – is flawed and not fit for purpose. The scale of the pandemic has meant that huge amounts of resources have been available for vaccine research and development; this is not the case for products with a small market, such as medicines to treat rare diseases.

• The Commission recommends that governments harness innovation to improve One Health based on partnership between the public and private sectors, where both risks and returns are shared.

Investment

The pandemic delivered an unprecedented shock to national health systems. There were shortages of almost everything: beds, health workers, protective equipment, even oxygen. At the same time, outside our hospitals, frail and older people in long-term care facilities were not sufficiently protected, causing many avoidable deaths. In many countries, routine activities such as primary care and mental health services effectively ceased. Suspension of some activities, like cancer screening, is likely to have a profound impact in the years to come.

• The Commission calls on countries to address long-standing funding gaps in primary health care, mental health care and social care, while investing in and protecting the health workforce.
• The Commission calls on governments to proactively prioritize the prevention of communicable and noncommunicable diseases, rather than reacting to health-care issues as they arise.

Surveillance and monitoring

Pandemic prevention and management cannot be left to private markets nor to individual countries. The country or countries unable to contain the virus become a source of new infection and variants. Surveillance and data collection are therefore essential to controlling the pandemic, but they require a global effort built on trust and information-sharing.

Capturing health expenditure data can also inform evidence-based decision-making and encourage innovation.

• The Commission calls on countries to invest in measures to reduce health threats, provide early warning systems, and strengthen surveillance and data collection while safeguarding individual privacy.

Global governance

COVID-19 demonstrated how some governance structures failed to protect our societies from the worst impacts of the pandemic, with some countries resorting to responses informed by politics rather than science. At present, there is no global taxation system, nor any way to sanction countries that do not contribute to global public health. To safeguard future generations and be ready for the next pandemic, we must improve global health governance.

• The Commission calls for the establishment of a Global Health Board under the auspices of the G20, and the development of a Global Pandemic Treaty and a Global Pandemic Vaccine Policy.

Regional governance

The WHO European Region stretches from the western edge of the continent in the Atlantic Ocean (Greenland) to the far east of the Russian Federation on the Pacific Ocean. It is an extremely diverse region, with variations in wealth, population size, demographics, health-care access, education levels and (digital) interconnectedness. This poses a series of coordination and policy problems.

• The Commission calls for the establishment of a Pan-European Network for Disease Control and a Pan-European Health Threats Council, while investing in data-sharing and data-interoperability platforms across the Region.

What next?

There is real work to be done to ensure the hard lessons learned in the Region over the past 20 months are translated into action. Concerted commitments by governments to change, and to change together, are essential if the Region and the world are to become truly resilient and address the inequalities and failures that perpetuate the experience of crisis.

Final report: Drawing light from the pandemic: A new strategy for health and sustainable development
Evidence Review: Drawing light from the pandemic: a new strategy for health and sustainable development
Pan-European Commission on Health and Sustainable Development
Statement ­– A bold new strategy for health and sustainable development in the light of pandemics
10 September 2021, Statement to the press by Professor Mario Monti, Chair of the Pan-European Commission on Health and Sustainable Development