Hans Kluge, WHO Regional Director for Europe, in an interview on why Europe and the world were not prepared for a pandemic despite repeated warnings, and what we can learn from this for the future.
Infectiologists, epidemiologists and other health experts have been warning for years and decades about the possibility that a new infectious disease could spread worldwide, thus becoming a pandemic. How well were the European Union and its Member States prepared for the COVID-19 pandemic?
Hans Kluge: Europe – and the wider world – were not prepared for COVID-19, despite repeated warnings from the scientific community that a global pandemic would strike sooner or later. We had the opportunity to learn some important lessons during the 2003 SARS outbreak, but sadly as a region we didn’t put in place the right surveillance, tracking and testing tools that are so vital in the early stages of a viral outbreak. There is huge diversity and disparity in Europe when it comes to national health systems. The COVID-19 pandemic illustrated gaps in the preparedness and response investments of many countries. This underlines the need to rethink and plan how to make health systems more resilient to emergencies going forward. COVID-19 has clearly demonstrated that a coherent, whole-of-government and whole-of-society response is vital for effective response management, which ensures that policymaking is coordinated, consistent, inclusive and reflects the evolving needs of all population groups.
This isn’t the first global pandemic, and it certainly won’t be the last. One day – hopefully soon – the pandemic will be behind us, but we will still face the same vulnerabilities that allowed a small outbreak to spread across the globe. That’s why I believe we need to reform the International Health Regulations and develop a global treaty on pandemic preparedness and response. Such a treaty would strengthen the World Health Organization (WHO) and foster improved sharing, trust and accountability, and require generational commitments from Member States to outlive budgetary, election and media cycles.
The outbreak of the infectious disease COVID-19 was officially confirmed in China at the end of December 2019, and the WHO Director-General already declared the outbreak of COVID-19 a “public health emergency of international concern” at the end of January 2020. Did the European Union and the Member States react too slowly?
Hans Kluge: Every country responded to the pandemic in the best way known to it. The overriding goal in those early days was to save as many lives as possible. In hindsight, however, there are many lessons we could and should learn, so we are better prepared for future health emergencies. COVID-19 is a new virus, and nearly two years into this pandemic we are still learning more about it every day and using this developing knowledge to respond in the best way possible. There is something to learn from every country as no country got the response to COVID-19 right all of the time and we have seen there was no “one size fits all” solution. A challenge that all countries faced was around “handbrake” lockdowns. We learned that locking-down and opening-up rapidly is not the strategy we should pursue. The gradual introduction and lifting of measures based on epidemiological and behavioural criteria remains our best option. We also learned that measures to restrict movements of people and goods should not be our first line of defence, but the last resort to slow down transmission and buy time if needed to increase capacities for testing suspected cases, isolating and treating confirmed cases, and tracing and quarantining contacts.
Did the COVID-19 pandemic boost nationalism as well as multilateralism?
Hans Kluge: Never before in human history have we been able to develop so many effective vaccines to combat a new pathogen as quickly as we have with the SARS-CoV-2 virus. This is testament not just to great technological advancements in gene sequencing and vaccine development, but also to the global community of scientists who willingly shared information and knowledge, in real time, sometimes at great personal risk. These cross-border partnerships have saved millions of lives and counting.
On the flip side, many countries’ knee-jerk reaction to the pandemic was to put up economic and geographical borders, even when the science didn’t support this. European politicians were in many cases forced to act based solely on national public opinion, with little regard for what happened outside national boundaries. But the virus knows no borders. A regional and global response is the only way we will end this pandemic. That said, WHO stands by Member States in their efforts to provide desperately needed vaccines for their populations.
What should be done in the European Union and its Member States to be better prepared for a pandemic next time?
Hans Kluge: Right now, countries in the WHO European Region need to continue using COVID-19 data and surveillance to gain rapid and continuous action from the community right up to national level. This includes smart use of genetic typing and sequencing but also the more low-tech but essential need to hunt the virus down and suppress its transmission. More broadly, European countries need to improve the integration of various health information datasets. COVID-19 has revealed to us that siloed information hurts rather than helps the response, and countries need to expand access to critical health information on a real-time basis during emergencies of any kind, so they can make evidence-based decisions rather than relying solely on intuition and political agendas.
To what extent is it possible to prepare perfectly for a natural event such as a pandemic at all?
Hans Kluge: If we could have predicted COVID-19, we could have saved millions of lives and even more livelihoods. Alas, we don’t have a crystal ball. But we do have science and technology at our fingertips, and it is up to us to harness the power of both to help prepare and respond to future pandemics and other health emergencies. We also need to rethink how we invest in our national health systems, our health workforce and the research & development of new medicines, protecting both people and the planet along the way. This is why I have convened the Pan-European Commission on Health and Sustainable Development, chaired by former Italian prime minister Professor Mario Monti, which lays out a series of recommendations for European governments to strengthen their health systems, harness the power of big data and artificial intelligence, empower their citizens to make healthy life choices, and be prepared for the next pandemic. There is real work to be done to ensure the hard lessons learned in the European Region over the past 20 months are translated into action.
Hans Henri P. Kluge has been WHO Regional Director for Europe since February 2020. He has 25 years of experience in medical practice and public health in numerous settings around the world. He began his career as a family doctor in Belgium and worked for Médecins Sans Frontières (MSF) Belgium from 1995 in Liberia, Somalia and Russia. In 1999 Hans Kluge joined the World Health Organization (WHO) as Tuberculosis (TB) and TB-HIV Project Manager for the WHO Country Office in Moscow.