Honourable Chair, Excellencies, distinguished participants, esteemed partners,
A year has passed since we last met in this forum.
It has been a momentous year. An exhausting year. For many people a year of fear and tragic loss. For all of us, a year that has seen achievements and disappointments. Another year in which one health issue – and its economic and social consequences – has dominated our lives.
So how does the COVID-19 balance sheet look?
Eighteen months into a global pandemic we have seen over four and a half million people die – a figure we all know drastically underestimates the real total.
WHO itself has lost several staff in our Region, and I take this opportunity to express my sincere condolences to the bereaved families and friends.
We have seen how the Delta variant has been a game-changer, fuelling new waves in countries across our Region and beyond.
To those that did not survive infection we must add the millions more whose lives and livelihoods have been disrupted. Years of progress in reducing extreme poverty are being slowly eroded.
But on the other side of the ledger, the fight back is underway.
Community leaders keeping friends, family, and fellow citizens safe. Health workers toiling day and night to deliver life-saving care, battling fatigue, infection, and burnout.
We, with our partners, delivering tons of medical supplies: oxygen, respirators, PPE – even entire field hospitals.
Hundreds of hours of virtual and in-person health worker training, with technical guidance on a vast range of pressing needs.
Scientists and the regional research community contributing to the global effort to produce diagnostics, therapeutics, and vaccines.
A year ago, we hoped for vaccines. Today safe and effective vaccines are a reality.
Immunization workers and volunteers across our Region have administered more than 750 million COVID-19 vaccine doses.
But progress is unequal – in this region, as in others. Globally, a vastly disproportionate share of vaccine has been purchased and administered by a relatively small number of the wealthiest countries.
With the combination of effective vaccines and tried and tested public health interventions we have at our disposal all the tools to end the pandemic.
At the same time, case numbers and deaths are still rising. The risk of new variants is ever present.
So, an honest review of the balance sheet tells us that the virus still has the upper hand.
We acknowledge the seriousness of the challenges we face. However, I want to convey a message of hope and not despair.
Without solidarity and collaboration, without good judgement and leadership and without the principles of good public health, the virus will keep its thumb firmly on the scale.
In my earlier remarks today, I spoke about the challenges of returning to normal, I spoke about fighting on many fronts.
Our prime focus right now is the pandemic itself and increasing vaccine coverage. Vaccinating the whole eligible population in any country is a task of enormous complexity. More so when resources are scarce.
More vaccines are now available but, with growing reliance on donations, they come with different cold-chain requirements, dosing schedules, different levels of efficacy and potential side-effects.
Distinguishing disinformation, misinformation, and product preference from genuine fears about immunization takes patience and skill. Supply and staffing constraints are easily confused with vaccine hesitancy and require different remedies.
And of course, reaching levels of coverage commensurate with herd immunity becomes harder the closer we get to the target.
Our health systems have been hard hit, not just by COVID-19 itself, but by the additional demands the pandemic has created.
We see this in mental health, in non-communicable diseases, and the multiple health impacts of lockdown.
But even more we see it in terms of widening inequity.
Not least between those with the good fortune and financial means to shelter, digitally connected to friends and family, and supported by essential workers who may not have all these securities.
They are not so much left behind, but left exposed.
In these circumstances universal health coverage (UHC) becomes ever more vital.
The Declaration on the Collective Response to COVID-19 reaffirms the importance of achieving UHC, of maintaining essential health services and public health programmes now and in the future.
I am proud to say that the country and flagship chapters in the Annual Report demonstrate how our work over the last year has continued on UHC and on many other fronts.
Thirty-five million children vaccinated against measles and rubella; increased taxation on tobacco products; the launch of a new patient safety action plan; increases in health worker recruitment – to highlight just a few achievements.
Excellencies, friends and colleagues,
The challenge is not just about restarting health systems that have been disrupted. We have to regain lost ground in health outcomes; rebuild capacity; and restore trust where it has been lost.
Despite the pandemic, we cannot focus on one set of tasks to the exclusion of all others. At the same time, when bandwidth is limited and resources are scarce, neither can we just continue with business as usual.
Our priority has to be maintaining the integrity of basic frontline services – no matter who provides them.
This means focusing less on the needs of every individual health programme and more on making sure that the vulnerable are not abandoned. A mindset and perspective that is even more relevant for countries in conflict or those facing crises in governance.
Excellencies,
We need to start thinking now about making health a key component of post-pandemic recovery.
After the damage inflicted by the pandemic, nobody can deny the link between health and the economy.
The only way business, trade and every other aspect of life is going to return to any kind of normality is through controlling the spread of COVID-19 worldwide.
We may believe that increasing health spending is a good in its own right and that investment in health should be at the centre of strategies for post-pandemic recovery. But persuading others may not be as easy as we imagine.
In the face of one of the most serious economic downturns in decades there is no guarantee that ministries of finance will agree that increasing health investment offers a sure and certain route to economic recovery. We have to make the most compelling case possible.
Health investment strategies will also need to show how non-health sector spending (in areas such as education, employment, and social security) can make a contribution to health outcomes. Restoring health must be our watchword.
This is not a time for thinking in silos.
Our friends and colleagues in the World Bank have been looking at the potential impact of the pandemic on health spending.
Their conclusions help us understand the challenges we will face in sustaining progress toward UHC.
It is likely that overall government spending per capita is likely to fall in all countries this year and next. This in turn will impact health spending for some years to come.
Different scenarios are possible but the most likely is that health spending will fall and that it could take until 2024 or 2025 to reach pre-pandemic levels again.
The message is crystal clear: Unless ministries of finance are prepared to increase the share of government spending on health, ministries of health are going to be faced with significantly reduced budgets.
In addition, out of pocket payments are likely to decline as incomes fall and treatment is deferred. Support from external development assistance is, at best, uncertain, and in all likelihood may well decrease.
Our task therefore is urgent.
Two things are required: convincing advocacy to make the case for an increased share of government revenues and strategic advice on investment priorities, designed to limit the health impact of reductions in spending.
Let me say a few words on priority setting.
We do not yet have a complete audit of the effects of the pandemic on health. Each country is different.
For some it has been the absence of any kind of social safety net leading to a sudden loss of income for those affected. For others the risks of forced migration. In others again the effects of hunger and malnutrition. Lockdown measures have had an impact on mental health, domestic violence, alcohol, and drug abuse.
Understanding who has been harmed and how can help in setting priorities and in understanding how spending in other sectors can contribute to health.
When the fundamental problem is falling state revenues, strategies that raise resources and positively impact health seem like an obvious step to take.
Pro-health taxes are not new in this Region and, as you will see in the Report, new initiatives are being actively considered in several Member States.
The usual targets are well-known: tobacco, alcohol, and sugar-sweetened drinks.
To prepare the case for health we need convincing estimates, not just of health gains but realistic projections in terms of revenue generation.
The Decade of Strengthening Human Resources for Health has sought to address shortfalls in the number of health care workers, particularly nurses.
Post-COVID-19 recovery presents opportunities and challenges.
Increasing recruitment at the primary care level benefits health service provision and UHC. It can have a positive effect on the overall labour market – as an economic stabilizer, on poverty reduction, on the position and employment of women and on income redistribution.
But more spending on salaries can crowd out non-salary costs and create shortages of essential commodities. Caps on recruitment can result in even existing staff being unable to find a job.
A coherent position on health worker recruitment – consistent with each country’s circumstances – will be a key element of post-pandemic strategic planning.
And finally, some of the changes that have happened by necessity during the pandemic have potentially positive effects on equity and efficiency.
They include task shifting, delinking health insurance from employment, greater use of telemedicine and information platforms, and more imaginative use of public-private partnerships.
Taking stock in each country should highlight positive changes but must also look out for changes that pose risks. When relaxation of spending rules compromises financial accountability or when scarce tax revenues are used to subsidize care for the better off.
Excellencies,
As I said earlier, we still have a mountain to climb.
But we have learned a great deal in the last 18 months that stands us in good stead for the task ahead.
We have to be ready for more surprises – expecting the unexpected. But we have learned that preparedness is not only about technical systems, supplies and logistics. It is about leadership, imagination, and solidarity.
We have learned too that health security is not only about protecting people from disease. Health also has a stake in protecting livelihoods. COVID-19 has shown us the intimate and fragile links between health and social care. It has cast an unforgiving light in some places on how we protect the health of the elderly.
Disruption to trade and supply systems has prompted renewed debate about national and regional self-sufficiency in medicines, vaccines and health technology. Given what we have learned, how should we approach this long-term strategic issue in ways that benefit all countries in the Region?
And lastly, to conclude, the standout lesson from the pandemic is that the problem is not a lack of knowledge or technical tools.
Ending the pandemic is in our hands. We have the means.
What is needed is the leadership required to overcome divisions within and between countries.
Divisions that erode the solidarity and collaboration needed to finish the job in relation to the pandemic.
The pandemic has shown that governments can take radical and unprecedented action to protect peoples’ lives. We have seen – through sharing resources and mutual support between countries in this Region, how solidarity and collaboration can make a difference.
The greatest risk when it is over is that the pleasure of returning to normal life blunts the important debates about our common future that the pandemic has provoked.
For the health community across the Region and beyond, our challenge is to keep these debates alive, seeking ways toward more sustainable, equitable and healthy lives for all.
Excellencies, Chair, colleagues,
I thank you for your attention and your unwavering support.