1 00:00:00,160 --> 00:00:04,560 Speaker 1: Seven into the Clements Manila Show. Let's walk, let's talk 2 00:00:04,880 --> 00:00:08,000 Speaker 1: twenty five minutes before eleven outlock. All right, let's get 3 00:00:08,000 --> 00:00:12,280 Speaker 1: into that conversation about the World Health Organization. I've already 4 00:00:12,320 --> 00:00:17,160 Speaker 1: explained a little bit about when it became quite prominent, 5 00:00:17,600 --> 00:00:20,760 Speaker 1: but I think we need to get deeper into this 6 00:00:21,040 --> 00:00:26,239 Speaker 1: global health authority which has got so much power. Right, 7 00:00:26,400 --> 00:00:30,520 Speaker 1: it's more than probably in just an advisory body, but 8 00:00:30,600 --> 00:00:33,160 Speaker 1: it makes decisions, and we need to understand who funds 9 00:00:33,159 --> 00:00:35,880 Speaker 1: it and how much influence do politics have on its work, 10 00:00:35,880 --> 00:00:39,879 Speaker 1: and importantly, how do the World Health organizations policies and 11 00:00:39,920 --> 00:00:45,800 Speaker 1: recommendations filter down into our own healthcare systems, from how 12 00:00:45,880 --> 00:00:49,519 Speaker 1: diseases are managed to how vaccines are rolled out. You know, 13 00:00:49,600 --> 00:00:54,000 Speaker 1: in a world where health threads are increasingly global, whether 14 00:00:54,040 --> 00:00:58,120 Speaker 1: it's pandemics or climate related illnesses, or ongoing battles with 15 00:00:58,280 --> 00:01:02,680 Speaker 1: diseases like TB and HIV, the understanding institutions like the 16 00:01:02,680 --> 00:01:06,600 Speaker 1: World Health Organizations actually becomes even more important. Professor Alex 17 00:01:06,720 --> 00:01:10,840 Speaker 1: Vandinhew is the chair of the Social Security Systems, Administration 18 00:01:10,920 --> 00:01:15,479 Speaker 1: and Management Studies at vats University School of Governance. Joining 19 00:01:15,520 --> 00:01:17,800 Speaker 1: us on the line. Thank you so much for making time. 20 00:01:17,840 --> 00:01:20,760 Speaker 1: Thank you for coming through to guide this conversation. Good morning, 21 00:01:21,200 --> 00:01:25,280 Speaker 1: Good morning. So let's just start with the basics of 22 00:01:25,400 --> 00:01:30,039 Speaker 1: understanding the World Health Organization. How would you describe it 23 00:01:31,160 --> 00:01:34,679 Speaker 1: to a lay person? And when exactly was it formed? 24 00:01:36,480 --> 00:01:38,720 Speaker 2: Sorry I don't have the start date of it, but 25 00:01:38,800 --> 00:01:42,880 Speaker 2: it's certainly over the last It's existed in the post 26 00:01:42,920 --> 00:01:45,600 Speaker 2: war period and form parts of a sort of a 27 00:01:46,640 --> 00:01:51,320 Speaker 2: collection of United Nations organizations that have been set up 28 00:01:51,400 --> 00:01:57,720 Speaker 2: essentially to deal with multilateral issues. Who was formed as 29 00:01:58,080 --> 00:02:02,840 Speaker 2: its members or governments of countries and that can impact 30 00:02:02,840 --> 00:02:05,720 Speaker 2: on its nature, but in essence it becomes a global 31 00:02:05,760 --> 00:02:12,760 Speaker 2: standards organization. It's set standards, It provides information on health systems, 32 00:02:13,280 --> 00:02:17,720 Speaker 2: It tries to coordinate action internationally. I would say that 33 00:02:18,000 --> 00:02:23,440 Speaker 2: rather than it having any institutional power, it largely has 34 00:02:24,120 --> 00:02:28,359 Speaker 2: a sort of an advisory role to play, and it 35 00:02:28,400 --> 00:02:34,400 Speaker 2: has influence rather than power. But it's in a possession 36 00:02:34,440 --> 00:02:38,560 Speaker 2: to deal with global health issues that might be poorly 37 00:02:38,639 --> 00:02:41,720 Speaker 2: managed just at a country level where you need to 38 00:02:41,800 --> 00:02:44,400 Speaker 2: kind of look at a sort of more of a 39 00:02:44,480 --> 00:02:45,600 Speaker 2: multilateral approach. 40 00:02:46,600 --> 00:02:50,280 Speaker 1: It's been around for what seventy seven years now? How 41 00:02:50,320 --> 00:02:53,000 Speaker 1: has it evolved? Over the years, and I mean the 42 00:02:53,040 --> 00:02:56,320 Speaker 1: world must have felt like it needed a single global 43 00:02:56,360 --> 00:02:59,480 Speaker 1: health body like this after World War Two? But is 44 00:02:59,520 --> 00:03:03,200 Speaker 1: that a reason still relevant today? How have we seen 45 00:03:03,360 --> 00:03:05,520 Speaker 1: this organization evolve over time? 46 00:03:06,639 --> 00:03:11,520 Speaker 2: Well, it remains quite relevant in getting collective action at 47 00:03:11,560 --> 00:03:14,680 Speaker 2: the government level. I'd say it's weaknesses that it only 48 00:03:14,720 --> 00:03:20,519 Speaker 2: operates through governments, So it actually makes what who can 49 00:03:20,600 --> 00:03:24,359 Speaker 2: do somewhat difficult because if it can't go in and 50 00:03:24,960 --> 00:03:29,280 Speaker 2: attack a government and what it's doing, so it's very tentatives. 51 00:03:29,320 --> 00:03:33,320 Speaker 2: Like if it was engaged in South African health reformal policies, etc. 52 00:03:34,160 --> 00:03:37,080 Speaker 2: It would largely have to be very careful of weary 53 00:03:37,280 --> 00:03:41,200 Speaker 2: of making sure that it doesn't undermine the government. So 54 00:03:41,680 --> 00:03:45,600 Speaker 2: as a body that works through governments, it's going to 55 00:03:46,040 --> 00:03:49,680 Speaker 2: it's going to be very let's say, it's not going 56 00:03:49,760 --> 00:03:52,680 Speaker 2: to be hypercritical. But what it does do is is 57 00:03:52,720 --> 00:03:56,160 Speaker 2: it provides a considerable amount of information and data which 58 00:03:56,200 --> 00:04:00,000 Speaker 2: allows countries to compare themselves and their performance across country. 59 00:04:00,400 --> 00:04:05,200 Speaker 2: They can set standards, they can identify issues through setting 60 00:04:05,240 --> 00:04:08,200 Speaker 2: up expert committees which can discuss though so there's quite 61 00:04:08,200 --> 00:04:12,560 Speaker 2: a lot of experts from South Africa who participates in 62 00:04:13,240 --> 00:04:18,880 Speaker 2: who committees and from those committees. Even though it's into government, 63 00:04:18,880 --> 00:04:22,560 Speaker 2: which which tends to reduce you know, it can be 64 00:04:22,800 --> 00:04:27,400 Speaker 2: sort of lowest common denominator issues. If there's huge conflict 65 00:04:27,440 --> 00:04:30,480 Speaker 2: with one country, it's going to contradict their values or 66 00:04:32,480 --> 00:04:34,960 Speaker 2: what basie is important. People are going to be very 67 00:04:35,000 --> 00:04:38,720 Speaker 2: careful about the language of any kind of international agreement. 68 00:04:38,760 --> 00:04:41,800 Speaker 2: It's going to kind of gravitate towards the position where 69 00:04:41,800 --> 00:04:44,960 Speaker 2: everybody can agree and where every government can agree. You 70 00:04:45,040 --> 00:04:47,240 Speaker 2: realize that something you know, quite a lot can be 71 00:04:47,360 --> 00:04:51,320 Speaker 2: left out. So it does have to be careful and diplomatic. 72 00:04:51,960 --> 00:04:57,000 Speaker 2: And there's a lot of institutional politics that operates around 73 00:04:57,000 --> 00:05:00,960 Speaker 2: how it functions. But I would say that it's it's 74 00:05:01,800 --> 00:05:05,120 Speaker 2: and those are always kind of negatives. But the WHI 75 00:05:05,200 --> 00:05:10,559 Speaker 2: does serve a very important purpose collaborating in a complex area. 76 00:05:10,680 --> 00:05:14,599 Speaker 1: So how are those institutional politics settled? Though? Because we're 77 00:05:14,640 --> 00:05:17,760 Speaker 1: looking at what one hundred and ninety four member countries here, 78 00:05:17,880 --> 00:05:20,280 Speaker 1: and I'm sure some listeners are wondering, how does an 79 00:05:20,320 --> 00:05:25,720 Speaker 1: organization that big actually make decisions? Who is really in 80 00:05:25,839 --> 00:05:30,360 Speaker 1: charge here? We understand in fact that there are some 81 00:05:31,080 --> 00:05:34,520 Speaker 1: you know, donors who help put in money in the 82 00:05:34,560 --> 00:05:38,839 Speaker 1: World Health Organization, and one wonders how far their influence 83 00:05:38,920 --> 00:05:41,880 Speaker 1: goes in the decisions that this global body takes. 84 00:05:42,600 --> 00:05:46,000 Speaker 2: Yeah, so it can be sort of, you know, one 85 00:05:46,080 --> 00:05:49,160 Speaker 2: can speculate. It's not easy to get evidence of what 86 00:05:49,200 --> 00:05:53,159 Speaker 2: the dynamics are, but quite clearly funders play are going 87 00:05:53,160 --> 00:05:56,599 Speaker 2: to be very important in determining agendas, and that includes 88 00:05:56,640 --> 00:06:00,599 Speaker 2: both countries who are the largest donors and the and 89 00:06:00,720 --> 00:06:04,320 Speaker 2: if there are private donors that are very crucial as well. 90 00:06:04,400 --> 00:06:08,840 Speaker 2: Their voice is going to be given a degree of respect. 91 00:06:09,440 --> 00:06:13,960 Speaker 2: But as an organization itself, if it completely undermines the 92 00:06:14,000 --> 00:06:18,960 Speaker 2: trust of smaller countries and smaller you who are donating less, 93 00:06:19,720 --> 00:06:22,560 Speaker 2: they are going to withdraw from such an organization. So 94 00:06:22,640 --> 00:06:25,400 Speaker 2: they do have to be very careful in pursuing the 95 00:06:25,480 --> 00:06:28,960 Speaker 2: agendas of kind of the larger countries. So countries like 96 00:06:29,040 --> 00:06:32,719 Speaker 2: China will clearly have a say. The US would have 97 00:06:32,760 --> 00:06:35,920 Speaker 2: had a say if it's stayed in that the United States' 98 00:06:36,080 --> 00:06:40,119 Speaker 2: position is not necessarily consistent with the United States through time. 99 00:06:41,680 --> 00:06:45,240 Speaker 2: When Biden came in, he reinstated membership of the WHO. 100 00:06:45,360 --> 00:06:48,760 Speaker 2: So there is very much a Trump position to withdraw 101 00:06:48,800 --> 00:06:54,039 Speaker 2: from the WHO, which is very likely to be overturned 102 00:06:54,040 --> 00:06:57,680 Speaker 2: again the moment Trump is either removed or ceases to 103 00:06:57,720 --> 00:07:00,920 Speaker 2: be in office. So I think it's that's part of 104 00:07:00,960 --> 00:07:04,000 Speaker 2: a position which is isolationist. In the United States, I 105 00:07:04,000 --> 00:07:08,799 Speaker 2: think it's very maverick. But globally, I think most countries 106 00:07:08,880 --> 00:07:11,239 Speaker 2: do respect the body with its imperfections. 107 00:07:12,520 --> 00:07:15,239 Speaker 1: And what is it still? What about less than twenty 108 00:07:15,240 --> 00:07:19,960 Speaker 1: percent of the World Health Organization budget coming from member states? 109 00:07:20,320 --> 00:07:24,600 Speaker 1: Are these Monday three contributions coming from member states and 110 00:07:24,680 --> 00:07:26,920 Speaker 1: other options? I don't know if you're aware their options were. 111 00:07:27,080 --> 00:07:30,080 Speaker 1: Maybe as a country we're feeling if we're a bit broke, 112 00:07:30,200 --> 00:07:33,400 Speaker 1: so we aren't able to meet those obligations and what 113 00:07:33,480 --> 00:07:34,560 Speaker 1: the options then become. 114 00:07:35,680 --> 00:07:38,920 Speaker 2: So obviously the size of a country will determine its 115 00:07:38,960 --> 00:07:44,800 Speaker 2: its ability to contribute, and there will be sort of 116 00:07:44,880 --> 00:07:49,560 Speaker 2: variations there. But the problem of leaving out countries that 117 00:07:49,680 --> 00:07:54,560 Speaker 2: can't contribute enough. It's problematic for an organization like WHO 118 00:07:54,720 --> 00:07:57,560 Speaker 2: because diseases might emanate from those countries that they have 119 00:07:57,680 --> 00:08:02,640 Speaker 2: to manage the idea areas actually to you know, there's 120 00:08:02,680 --> 00:08:05,920 Speaker 2: a degree across subsidy in that organization. But part of 121 00:08:06,200 --> 00:08:08,920 Speaker 2: you know, the issue with how it's funded is that 122 00:08:09,000 --> 00:08:13,720 Speaker 2: it might disproportionately influence who's in the administrations, who becomes 123 00:08:13,720 --> 00:08:17,760 Speaker 2: the director general, who are you know, the and its location. 124 00:08:18,200 --> 00:08:22,880 Speaker 2: Its location in Geneva, which is very very far away 125 00:08:22,880 --> 00:08:27,520 Speaker 2: from the countries that face sort of very significant burdens 126 00:08:27,520 --> 00:08:31,160 Speaker 2: of disease. It's very cushy, let's put it that way. 127 00:08:31,480 --> 00:08:34,280 Speaker 2: That might be kind of convenient, But Geneva is a 128 00:08:34,320 --> 00:08:39,280 Speaker 2: neutral country. It's a country that doesn't have global sway, 129 00:08:39,440 --> 00:08:43,239 Speaker 2: so to speak. So although it's a fairly cushy destination, 130 00:08:43,400 --> 00:08:47,360 Speaker 2: it's it's actually not the it's not the United States 131 00:08:47,400 --> 00:08:52,480 Speaker 2: or France or Germany that might have an interest in 132 00:08:53,400 --> 00:08:57,599 Speaker 2: what who recommends in the standards they set I see. 133 00:08:58,120 --> 00:09:01,600 Speaker 1: I wonder then don't we have the I mean on 134 00:09:01,640 --> 00:09:05,679 Speaker 1: the continent that was it, the Africa Centers for Disease 135 00:09:05,760 --> 00:09:09,120 Speaker 1: Control and Prevention. I think it's called CDC and and 136 00:09:09,160 --> 00:09:13,880 Speaker 1: I wonder if there's tension then or overlap between the 137 00:09:13,480 --> 00:09:16,880 Speaker 1: the CDC on the continent and the World Health Organization 138 00:09:17,000 --> 00:09:20,560 Speaker 1: or do you get a sense that they complement each other. 139 00:09:22,000 --> 00:09:26,680 Speaker 2: Yeah, they're not. There is overlap, but the role of 140 00:09:26,720 --> 00:09:30,120 Speaker 2: the Africa CDC is more more specific, it's more focused 141 00:09:30,160 --> 00:09:35,120 Speaker 2: on you know, infectious disease surveillance, and that's quite important 142 00:09:36,559 --> 00:09:41,920 Speaker 2: because they would need to operationalize interventions who is dealing 143 00:09:41,920 --> 00:09:45,760 Speaker 2: with health systems more generally, So it's very likely that 144 00:09:45,840 --> 00:09:51,720 Speaker 2: there's that there's there's no it's a contradiction in the overlap. 145 00:09:52,120 --> 00:09:57,720 Speaker 2: They're more likely to coordinate and act in partnership. I 146 00:09:57,760 --> 00:10:01,560 Speaker 2: can't see that, and there's certainly in my experience there's 147 00:10:01,600 --> 00:10:06,520 Speaker 2: no antagonism between the two. They both have a role 148 00:10:07,240 --> 00:10:10,080 Speaker 2: and they have to kind of they have to work together. 149 00:10:11,480 --> 00:10:14,680 Speaker 2: So CDC is very important because it's it's actually going 150 00:10:14,679 --> 00:10:18,000 Speaker 2: to try and identify diseases as fast as possible and react. 151 00:10:18,440 --> 00:10:21,160 Speaker 2: W h O might be a little bit more distant, 152 00:10:23,240 --> 00:10:27,800 Speaker 2: and and you know South Africa has been very active 153 00:10:28,000 --> 00:10:33,200 Speaker 2: in surveillance and very you know, it's it's ability to 154 00:10:33,200 --> 00:10:38,240 Speaker 2: to do a genomic analyses and to identify disease very 155 00:10:38,280 --> 00:10:44,240 Speaker 2: fast and also to provide a potential treatment regime for 156 00:10:44,559 --> 00:10:47,240 Speaker 2: for anybody in Africa if needs be. In the case 157 00:10:47,280 --> 00:10:51,679 Speaker 2: of an infectious disease is important. So you need to 158 00:10:51,679 --> 00:10:55,680 Speaker 2: coordinate on highly contagious infectious diseases, you have to react 159 00:10:55,760 --> 00:11:01,400 Speaker 2: fast and obviously in COVID it would have been very important, 160 00:11:01,920 --> 00:11:04,120 Speaker 2: but that overwhelmed everybody. 161 00:11:04,880 --> 00:11:06,959 Speaker 1: In the past, I know, the World of Organization has 162 00:11:07,000 --> 00:11:11,920 Speaker 1: supported US as South Africa and hosting a COVID vaccine 163 00:11:12,040 --> 00:11:16,840 Speaker 1: Technology Transfer Hub just right after COVID nineteen. How significant 164 00:11:16,960 --> 00:11:21,560 Speaker 1: was that because there's always been debates about health equity 165 00:11:21,679 --> 00:11:24,320 Speaker 1: and who gets medicines first when we are in times 166 00:11:24,320 --> 00:11:25,440 Speaker 1: of crisis. 167 00:11:26,400 --> 00:11:30,400 Speaker 2: Well, that's important and the issue rarely is not about 168 00:11:30,559 --> 00:11:34,839 Speaker 2: who support because there was also support from France and 169 00:11:35,520 --> 00:11:39,160 Speaker 2: various developed countries who are happy to in the US 170 00:11:39,480 --> 00:11:42,840 Speaker 2: to have the technology housed in South Africa for the 171 00:11:42,840 --> 00:11:47,240 Speaker 2: purpose of production. Both South Africa can develop and test vaccines. 172 00:11:47,280 --> 00:11:52,440 Speaker 2: It does a lot of clinical trials for multinationals, including 173 00:11:52,520 --> 00:11:55,280 Speaker 2: vaccine trials. It was doing trials for all the vaccines, 174 00:11:55,600 --> 00:11:58,800 Speaker 2: sorry for most of the vaccines that were being designed 175 00:11:58,840 --> 00:12:02,679 Speaker 2: for COVID. The problem is actually more of an industrial 176 00:12:02,720 --> 00:12:05,560 Speaker 2: policy problem and that the unit cost of production are 177 00:12:05,600 --> 00:12:08,199 Speaker 2: the biggest risk. They were looking at m RNA because 178 00:12:08,600 --> 00:12:11,880 Speaker 2: the unit costs are much lower than the other platforms. 179 00:12:12,320 --> 00:12:15,360 Speaker 2: But still, if you you know, in a pandemic like 180 00:12:15,440 --> 00:12:19,680 Speaker 2: COVID suddenly generates a massive demand for a vaccine and 181 00:12:19,720 --> 00:12:23,400 Speaker 2: then it drops off to nothing, and so you don't 182 00:12:23,440 --> 00:12:27,520 Speaker 2: have enough kind of off take to be sustainable necessarily 183 00:12:27,600 --> 00:12:30,360 Speaker 2: at the lower levels of demand, so there has to 184 00:12:30,400 --> 00:12:34,040 Speaker 2: be a regional strategy. The difficulty is if you look 185 00:12:34,080 --> 00:12:38,000 Speaker 2: at a country like India, for instance, they developed a 186 00:12:38,040 --> 00:12:42,000 Speaker 2: production capability which wasn't targeted at the region. It was 187 00:12:42,040 --> 00:12:45,319 Speaker 2: an industrial policy strategy, it wasn't even a public ol strategy, 188 00:12:45,800 --> 00:12:49,400 Speaker 2: and they targeted the global markets in order to be sustainable. 189 00:12:49,440 --> 00:12:52,240 Speaker 2: So they produce very low cost of production, you know, 190 00:12:52,360 --> 00:12:56,760 Speaker 2: medicines and vaccines. But we have to be able to 191 00:12:56,800 --> 00:12:59,920 Speaker 2: export globally to be to have these low costs of production. 192 00:13:00,840 --> 00:13:05,679 Speaker 2: So that's the real issue to overcome. The technology is, 193 00:13:07,000 --> 00:13:11,680 Speaker 2: you know, it's very South Africa is able to manage 194 00:13:11,679 --> 00:13:15,080 Speaker 2: that technology, but it can't necessarily manage the unit costs yet. 195 00:13:15,960 --> 00:13:19,000 Speaker 2: But it's got to have in terms of an agreement 196 00:13:19,040 --> 00:13:23,560 Speaker 2: in Africa. If demand were confirmed at Africa level, that 197 00:13:23,679 --> 00:13:26,840 Speaker 2: might help a bit. But in fact most of the 198 00:13:26,880 --> 00:13:30,880 Speaker 2: demand for medicines and vaccines comes from South Africa and Africa, 199 00:13:31,320 --> 00:13:36,200 Speaker 2: which is which is not a big enough market. But 200 00:13:36,320 --> 00:13:38,760 Speaker 2: you do need to have regional production. You do need 201 00:13:38,800 --> 00:13:45,719 Speaker 2: to have a public health strategy that is potentially reasonably 202 00:13:45,760 --> 00:13:51,440 Speaker 2: sustainable given the industrial policy negatives, in other words, that 203 00:13:51,480 --> 00:13:54,120 Speaker 2: you can't produce it at scale all the time. You've 204 00:13:54,160 --> 00:13:56,160 Speaker 2: got to have that in the case of disasters. 205 00:13:56,640 --> 00:14:00,360 Speaker 1: Yeah, absolutely, and I mean with that instances where the 206 00:14:00,400 --> 00:14:03,600 Speaker 1: World Health Organization also faced criticism for its so slow 207 00:14:03,679 --> 00:14:07,360 Speaker 1: response to, for instance, the Ebola outbreak back in twenty 208 00:14:07,360 --> 00:14:10,839 Speaker 1: twenty four. So that these become important, I'm going to 209 00:14:10,880 --> 00:14:13,920 Speaker 1: take a quick out break. We've got some questions coming 210 00:14:13,920 --> 00:14:16,720 Speaker 1: from some of our listeners. Oh seven two seven oh 211 00:14:16,760 --> 00:14:18,480 Speaker 1: two one seven oh two. What questions do you have 212 00:14:18,520 --> 00:14:22,280 Speaker 1: about the World Health Organization or inputs? By the way, 213 00:14:22,360 --> 00:14:24,520 Speaker 1: you can join the conversation by calling us as well 214 00:14:24,560 --> 00:14:27,280 Speaker 1: ONH one one eight eight three oh seven two top 215 00:14:27,320 --> 00:14:28,160 Speaker 1: minutes before eleven. 216 00:14:28,320 --> 00:14:32,440 Speaker 2: You're with Clement seven O two. Let's walk for talk. 217 00:14:32,360 --> 00:14:34,960 Speaker 1: Ten minutes before eleven out block all right, I want 218 00:14:34,960 --> 00:14:36,720 Speaker 1: to bring in your questions now on OH one one 219 00:14:36,880 --> 00:14:38,720 Speaker 1: eight eight three oh seven O two if you want 220 00:14:38,720 --> 00:14:40,480 Speaker 1: to send a what's up? Oh seven two seven O 221 00:14:40,600 --> 00:14:44,400 Speaker 1: two one seven O two in conversation with Professor Alex Vandenhew, 222 00:14:45,080 --> 00:14:49,080 Speaker 1: and we're talking about the World Health Organization. I think 223 00:14:49,120 --> 00:14:51,920 Speaker 1: we need to pay more and more attention to these 224 00:14:52,000 --> 00:14:57,680 Speaker 1: multilateral institutions, especially now in this changing geopolitical world. I 225 00:14:57,760 --> 00:15:01,200 Speaker 1: think that will give us a sense of where things 226 00:15:01,280 --> 00:15:06,720 Speaker 1: are likely to go, what decisions may be influenced by 227 00:15:06,760 --> 00:15:12,160 Speaker 1: these institutions. Oh, you know, what decisions may influence these 228 00:15:12,320 --> 00:15:16,480 Speaker 1: kind of institutions. So I've got a question here about 229 00:15:16,960 --> 00:15:19,520 Speaker 1: from Lee and Alberton, who says, Hei Clement, please can 230 00:15:19,560 --> 00:15:22,600 Speaker 1: you ask the prof there about the sway that Big 231 00:15:22,640 --> 00:15:29,600 Speaker 1: Farmer has seeing seeing that they make grants to universities 232 00:15:29,920 --> 00:15:34,680 Speaker 1: making them obliged to accommodate certain medicines and exclude odds. 233 00:15:34,680 --> 00:15:37,360 Speaker 1: So how much influence then does Big Farmer have on 234 00:15:37,440 --> 00:15:40,400 Speaker 1: an organization of this magnitude. 235 00:15:40,880 --> 00:15:44,720 Speaker 2: Well, I think that the impact of Big Farmer on 236 00:15:45,920 --> 00:15:49,080 Speaker 2: countries is more significant than it is on the WHR 237 00:15:49,240 --> 00:15:53,720 Speaker 2: necessarily because thee w HR doesn't necessarily influence those decisions, 238 00:15:54,040 --> 00:15:57,560 Speaker 2: although it can in a lot of cases. The development 239 00:15:57,600 --> 00:16:04,960 Speaker 2: of essential medicine lists, etc. Are an important sort of 240 00:16:05,320 --> 00:16:08,760 Speaker 2: function that can that other people can use for references. 241 00:16:09,200 --> 00:16:11,920 Speaker 2: But those appear to be certainly in my experience and 242 00:16:11,960 --> 00:16:16,200 Speaker 2: discussions where people who are working with a WHO and 243 00:16:16,320 --> 00:16:20,920 Speaker 2: other multinational organizations, they were highly critical of Big farmers, 244 00:16:21,080 --> 00:16:26,320 Speaker 2: manipulation of markets for instance. They all large companies that 245 00:16:26,400 --> 00:16:29,720 Speaker 2: have a lot of influence need to be you know, 246 00:16:29,760 --> 00:16:32,920 Speaker 2: the rent seeking activity has to be examined very carefully. 247 00:16:33,200 --> 00:16:36,560 Speaker 2: But it goes much wider than who and who is 248 00:16:36,600 --> 00:16:40,160 Speaker 2: not necessarily somebody who makes all the decisions for countries. Again, 249 00:16:40,200 --> 00:16:43,160 Speaker 2: it's an advisory structure, it's not one that determines what 250 00:16:43,280 --> 00:16:48,200 Speaker 2: countries do and the actual countries themselves and their own 251 00:16:48,280 --> 00:16:51,360 Speaker 2: policies of what regulates their relationship with a big farmer. 252 00:16:52,320 --> 00:16:55,440 Speaker 1: And I saw that Global Health Aid is being cut sharply. 253 00:16:55,480 --> 00:16:57,880 Speaker 1: I mean some estimates put the drop it between thirty 254 00:16:57,920 --> 00:17:02,080 Speaker 1: and forty percent this year. How does that affect what 255 00:17:02,160 --> 00:17:05,280 Speaker 1: the World Health Organization can do? And what does it 256 00:17:05,359 --> 00:17:08,160 Speaker 1: mean for us here in South Africa who also rely 257 00:17:08,320 --> 00:17:10,119 Speaker 1: on public health services? 258 00:17:11,080 --> 00:17:14,040 Speaker 2: Yea. So it's difficult to fully assess the impact because 259 00:17:14,040 --> 00:17:16,240 Speaker 2: what it does do is it kind of devolves certain 260 00:17:17,160 --> 00:17:21,160 Speaker 2: issues to countries themselves, and if their capability is low, 261 00:17:21,240 --> 00:17:24,800 Speaker 2: they're going to be disproportionately affected. So in the case 262 00:17:25,119 --> 00:17:29,479 Speaker 2: of that reduction in support, South Africa has been and 263 00:17:29,560 --> 00:17:33,600 Speaker 2: other countries have been affected more by the USAID cuts, 264 00:17:34,200 --> 00:17:41,360 Speaker 2: which we're supporting HIV and AIDS treatment and that has 265 00:17:41,359 --> 00:17:44,359 Speaker 2: had and research that has had a big impact, and 266 00:17:44,400 --> 00:17:49,000 Speaker 2: of course they're rapidly structuring. The other problem has been, 267 00:17:49,080 --> 00:17:54,040 Speaker 2: although there can what's sort of some shifting to Europe, 268 00:17:54,359 --> 00:17:57,720 Speaker 2: the wars and the threats from Russia have meant that 269 00:17:57,760 --> 00:18:01,280 Speaker 2: people have kind of put more budgets into defense expenditure, 270 00:18:01,800 --> 00:18:04,400 Speaker 2: which has also taken away you know, the first thing 271 00:18:04,480 --> 00:18:08,880 Speaker 2: you cut in those budgets, your your sort of softest 272 00:18:08,920 --> 00:18:13,000 Speaker 2: option is your your international aid. And so the world, 273 00:18:13,600 --> 00:18:16,040 Speaker 2: you know, developing countries have been affected by that to 274 00:18:16,480 --> 00:18:20,080 Speaker 2: some degree. In South Africa there is a shift. There's 275 00:18:20,119 --> 00:18:22,080 Speaker 2: a question, you know, a lot of people have questioned 276 00:18:22,080 --> 00:18:25,119 Speaker 2: whether or not South Africa should have been so dependent 277 00:18:25,359 --> 00:18:29,760 Speaker 2: or so you know, acquiescent to donor support, and whether 278 00:18:29,840 --> 00:18:33,280 Speaker 2: or not it should have been building this funding and 279 00:18:33,800 --> 00:18:37,960 Speaker 2: the support and research funding into the domestic budget. South 280 00:18:37,960 --> 00:18:40,960 Speaker 2: Africa is not you know, it's it's understrained, but it's 281 00:18:40,960 --> 00:18:44,520 Speaker 2: not poor and it has the capacity to do more. 282 00:18:45,240 --> 00:18:48,399 Speaker 2: Uh and so the and so there is an issue 283 00:18:48,440 --> 00:18:51,000 Speaker 2: about at least South Africa that it should be doing 284 00:18:51,040 --> 00:18:53,080 Speaker 2: a lot more, and there's been a lot of discussion 285 00:18:53,119 --> 00:18:56,240 Speaker 2: about shifting that into the country, and it has successfully 286 00:18:56,320 --> 00:19:03,480 Speaker 2: moved some programs, you know, into domestic funding, and that's 287 00:19:03,600 --> 00:19:07,280 Speaker 2: likely to continue, but other countries are not in that possession. 288 00:19:08,800 --> 00:19:12,320 Speaker 1: Have there been any lessons from how the COVID nineteen 289 00:19:12,320 --> 00:19:16,160 Speaker 1: pandemic was handled, because I mean, at some point there 290 00:19:16,359 --> 00:19:19,480 Speaker 1: was you know, there were questions being asked about the 291 00:19:19,520 --> 00:19:24,560 Speaker 1: relationship between the World Health Organization and China during that 292 00:19:24,680 --> 00:19:27,840 Speaker 1: pandemic and how it could have been handled. What's your 293 00:19:27,920 --> 00:19:30,399 Speaker 1: sense from your observation, are the lessons that have been 294 00:19:30,480 --> 00:19:35,200 Speaker 1: learned are the ways that will likely not be repeated 295 00:19:35,240 --> 00:19:38,160 Speaker 1: because there's an acknowledgement that this could have been done better. 296 00:19:39,240 --> 00:19:42,520 Speaker 2: Yeah, so I think that I nice to look at 297 00:19:42,520 --> 00:19:47,679 Speaker 2: the whole COVID response, both nationally and internationally. It was 298 00:19:48,000 --> 00:19:51,879 Speaker 2: poorly handled because it was too novel. You know, the 299 00:19:51,960 --> 00:19:55,199 Speaker 2: last time an equivalent pandemic happened was just after the 300 00:19:55,200 --> 00:19:59,040 Speaker 2: First World War, and there's a hundred year gap, and 301 00:19:59,320 --> 00:20:02,760 Speaker 2: that wasn't hand very well then. But it's an incredibly 302 00:20:02,840 --> 00:20:10,040 Speaker 2: difficult disease to manage. It wasn't necessarily who calling the shots. 303 00:20:10,520 --> 00:20:12,720 Speaker 2: They could have been regarded as a bit slow declaring 304 00:20:12,720 --> 00:20:17,200 Speaker 2: an emergency, but in fact the information coming from China 305 00:20:17,359 --> 00:20:22,800 Speaker 2: was actually more important for the actions that countries were taking, 306 00:20:23,480 --> 00:20:26,040 Speaker 2: and a lot of people looked at what China was 307 00:20:26,080 --> 00:20:29,800 Speaker 2: doing in Wuhan and then copied it. And that's probably 308 00:20:29,800 --> 00:20:33,960 Speaker 2: where the problem came, rather than from WHO. I'd have 309 00:20:34,000 --> 00:20:37,439 Speaker 2: said that WHO was quite slow in acknowledging that this 310 00:20:37,600 --> 00:20:41,560 Speaker 2: was an airborne pandemic, you know, in other words, it 311 00:20:41,640 --> 00:20:44,840 Speaker 2: wasn't communicated through doplets falling on surfaces and then your 312 00:20:44,880 --> 00:20:47,399 Speaker 2: hands touching it and your food getting it. It was 313 00:20:47,440 --> 00:20:51,919 Speaker 2: airborne and that's a much faster transmission mechanism than droplets, 314 00:20:52,400 --> 00:20:56,080 Speaker 2: and that was very evident from upfront, so that Africa 315 00:20:56,280 --> 00:21:01,120 Speaker 2: actually adopted the WHO position for quite a while, largely 316 00:21:01,160 --> 00:21:05,520 Speaker 2: because it wanted to preserve ppe for healthcare workers. But 317 00:21:05,560 --> 00:21:12,000 Speaker 2: the problem is that people then were less cautious about 318 00:21:12,560 --> 00:21:15,920 Speaker 2: situations where everyone transmission is actually going to be very 319 00:21:16,480 --> 00:21:21,360 Speaker 2: going to be facilitated. But it overwhelmed everybody, overwhelmed WHA, 320 00:21:21,520 --> 00:21:26,080 Speaker 2: overwhelmed China and overwhelmed South Africa, and South Africa's response 321 00:21:26,240 --> 00:21:30,200 Speaker 2: was also poor. So was the United States, and so 322 00:21:30,359 --> 00:21:35,040 Speaker 2: are many industrialized countries. What it did reveal was, first 323 00:21:35,040 --> 00:21:39,320 Speaker 2: of all, how multilateral agreements broke down so easily because 324 00:21:39,440 --> 00:21:41,680 Speaker 2: when it came to treatment at the end of the 325 00:21:41,760 --> 00:21:46,400 Speaker 2: day or vaccination, people looked at their own very very 326 00:21:46,440 --> 00:21:53,840 Speaker 2: quickly and rather than to the broader globally, and so 327 00:21:53,960 --> 00:21:57,639 Speaker 2: that kind of unfairness global sort of lack of justice 328 00:21:57,640 --> 00:22:03,240 Speaker 2: and fairness was problematic vaccines in South Africa we were 329 00:22:03,280 --> 00:22:06,359 Speaker 2: also terrible in the case of vaccines. I mean, we 330 00:22:06,440 --> 00:22:08,920 Speaker 2: had a facility that was going to do final fill 331 00:22:09,000 --> 00:22:17,040 Speaker 2: and and exports of three hundred million doses of Johnson 332 00:22:17,080 --> 00:22:23,439 Speaker 2: and Johnson's vaccine in twenty twenty one, but all of 333 00:22:23,440 --> 00:22:27,840 Speaker 2: that was indicator was going to be directed to the 334 00:22:27,960 --> 00:22:30,919 Speaker 2: United States first, in Europe second, and in twenty twenty 335 00:22:30,920 --> 00:22:33,840 Speaker 2: two we would have got access to that facility's output, 336 00:22:34,040 --> 00:22:39,720 Speaker 2: which was very bizarre, not necessarily because that facility to 337 00:22:39,760 --> 00:22:42,520 Speaker 2: control it because they were working on contracts. But you 338 00:22:42,600 --> 00:22:44,760 Speaker 2: have to ask where was government. We're sitting with this 339 00:22:44,840 --> 00:22:46,960 Speaker 2: facility in South Africa and we were going to be 340 00:22:47,000 --> 00:22:49,879 Speaker 2: a back of the queue. So you know, that just 341 00:22:49,920 --> 00:22:52,639 Speaker 2: shows you how much can be produced for three hundred 342 00:22:52,680 --> 00:22:57,320 Speaker 2: million doses was more than enough for South Africa in 343 00:22:57,359 --> 00:23:01,520 Speaker 2: many other countries, So I was strategy was so far 344 00:23:01,640 --> 00:23:04,360 Speaker 2: behind where it should have been and that's not anything 345 00:23:04,400 --> 00:23:07,600 Speaker 2: to do with WHO. That's entirely due to government's own 346 00:23:07,640 --> 00:23:10,879 Speaker 2: weaknesses in developing a vaccine strategy and implementing it and 347 00:23:10,960 --> 00:23:16,000 Speaker 2: running it out, and in the case of many other areas, 348 00:23:16,040 --> 00:23:18,240 Speaker 2: I mean, you have to look at domestic policy first. 349 00:23:18,320 --> 00:23:21,440 Speaker 2: You don't wait for WHO to tell you what to do. 350 00:23:21,560 --> 00:23:24,240 Speaker 2: You have to do it locally. We've got enough public 351 00:23:24,240 --> 00:23:28,280 Speaker 2: health experts in South Africa to advise on coherent responses. 352 00:23:28,560 --> 00:23:32,159 Speaker 2: You really don't need WHO for that. You need WHO 353 00:23:32,359 --> 00:23:37,000 Speaker 2: for multilateral cooperation, coordination and standard setting. 354 00:23:38,760 --> 00:23:40,719 Speaker 1: Absolutely, thank you so much for making time for us. 355 00:23:40,720 --> 00:23:45,160 Speaker 1: Professor Alex Brander Hev the Chair of the Social Security Systems, 356 00:23:45,200 --> 00:23:49,280 Speaker 1: Administration and Management Studies at the Vitz School of Governance.