COVID-19 Narratives by Dr David Nabarro

On 21 February 2020, Dr David Nabarro, Co-Director of the Imperial College Institute of Global Health Innovation at the Imperial College London and Strategic Director of 4SD, was appointed as one of six Special Envoys to the World Health Organization (WHO) Director-General on COVID-19. In this role, David provides strategic advice and high-level political advocacy and engagement in different parts of the world to help WHO coordinate the global response to the pandemic.

Please visit the World Health Organization website for official guidance.

The following Narratives are being written by David and peers to share with those who want more information about the situation and to help raise the awareness and readiness of all actors. Click here to sign up to the 4SD Newsletter for regular updates.

25 January 2021: An article by John Atkinson and David Nabarro. Originally published in the MJ on 25 January 2021.

4 December 2020: An Insight by Richard Edelman. Originally published at

11 November 2020: A working paper by Dr David Nabarro, Katherine DeLand and Florence Lasbennes.

16 November 2020: By Dr David Nabarro and John Atkinson, originally published by the Guardian on 15 November 2020.

14 October 2020: By Dr David Nabarro. Take it seriously. The virus that causes COVID-19 is dangerous and easy to underestimate.  It will be an ever-present threat in many communities for the foreseeable future. My WHO colleagues and I are encouraging everyone to work out how they can go about their lives – continuing to work and earn, be educated, socialize and more – while holding the virus at bay.

25 September 2020: By Dr David Nabarro. There are new COVID challenges everywhere. Tricky times for all leaders. The virus has not changed and still has the potential to do lots of damage. There is plenty of advice available, much of it is conflicting.

20 September 2020: By John Atkinson and David Nabarro, originally published online by The MJ on 14 September 2020 and published in print on 17 September 2020.

11 September 2020: By Ben Ramalingam , David Nabarro , Arkebe Oqubuy , Dame Ruth Carnall and Leni Wild. Originally published by Harvard Business Review as one of a number of free articles related to COVID for all readers.

23 August 2020: By Dr David Nabarro and Katherine DeLand. Educational continuity is essential to long term social cohesion and economic success. That is why in the context of COVID-19, we must better understand what it might mean to reopen schools so students can continue their education, whilst staying ahead of the virus.

20 August 2020: OECD Forum Network article by Dr David Nabarro and John Atkinson. The article forms part of a series in which OECD experts and thought leaders — from around the world and all parts of society — address the COVID-19 crisis, discussing and developing solutions now and for the future.

11 August 2020: Enormous efforts are underway everywhere to contain the spread of the virus and limit its impact: intensified action is needed among poorer people and nations yet there are marked shortages of resources in multiple settings. 

24 July 2020: When the COVID-19 virus spread from Wuhan (China) across the world through Europe, the Americas and beyond in the space of a few weeks, it gave us proof, if one was ever needed, of how tightly interconnected we all are. Not only are our globalized economies interdependent, but also we ourselves are one with the environment around us, and with one another.

15 July 2020, Lancet Comment by Dale Fisher, Yik Ying Teo and David Nabarro: Before the advent of the COVID-19 pandemic, several countries had their preparedness for pandemics assessed via the Global Health Security Index (GHSI).1 The USA and the UK were identified as two countries most prepared. Experiences with COVID-19 have shown that in-depth assessments of outbreak preparedness need to go beyond publicised plans…
Read the full text as the Lancet Comment article PDF (49kb)

14 July 2020, A synthesis of the Open Online Briefing of 9 July 2020, extracted by and first published by Thinking the Unthinkable.

3 July 2020, British Medical Journal Blog by David Nabarro and John Atkinson: We anticipate that the SARS-CoV-2 virus and the resulting disease covid-19 will remain an ever-present threat to the world for the foreseeable future. It makes sense that until now many countries have treated the outbreak of covid-19 as an emergency and tackled it using crisis response approaches…

19 June 2020: The numbers of new cases are (in general) reducing in Western European countries this time: it is likely that they will start to grow again as the movement of people increases. The current experience of Beijing, China is an indicator of what can happen even when authorities and people are on high alert…
Download as PDF English (274kb)

10 June 2020: One hundred days ago on 2 March, 90 percent of the 88.9k reported cases of the novel-coronavirus were within China, 4.7 percent in South Korea, and the death toll was 3,043. COVID-19 had been declared by the World Health Organization (WHO) as a Public Health Emergency of International Concern weeks earlier and I was quickly shifting gear into my role as one of the WHO Director-General’s Special Envoys on COVID-19 Preparedness and Response.
Download as PDF English (221kb)

2 June 2020: To tackle global challenges, we need multiple systems to work. That is a lesson I hope leaders at all levels take home from the COVID-19 crisis. This way, our new world might be a better one. For what COVID-19 is showing so clearly is that if we are to really treat, manage and prevent global health – or, indeed, any health condition, anywhere – whether in ‘normal’ or ‘crisis’ times, health, food, economic, environmental, social and political systems all need play their respective roles…

25 May 2020: In the face of uncertainty, complexity means fragility. Because uncertainty cannot be controlled, the only option we have is to manage complexity.
Download as PDF English (158kb)

20 May 2020: My Darling Son, When you were born, I never could have imagined that five years later we would be living such a historical and unprecedented crisis like COVID-19. As I watch you play alone in our living room, distanced from your friends and family, (other than your mother and I), I feel the need to write to you this letter so that, as you grow, you remember these seven universal laws that will help you live a happy, healthy and peaceful life.

19 May 2020: A Narrative by Dr David Nabarro and Joe Colombano, originally published by the Inter Press Service News Agency.
When the COVID-19 virus travelled from Wuhan, China halfway across the world through Europe, the Americas and beyond in the space of a few weeks, it gave us proof, if one was ever needed, of how tightly interconnected we all are. Not only are our globalized economies interdepended, but also we ourselves are one with the environment around us, and with one another…

18 May 2020: Across the world, the nations that are getting ahead of the virus know that economies and societies can thrive if they implement comprehensive action to keep it at bay. Yet, not all the nations represented at the Assembly are implementing the COVID-19 containment policies that have been continuously advocated by the World Health Organization (WHO) since late January 2020. – Dr David Nabarro
Download as PDF English (184kb) Français

13 May 2020: These ten learning points come at a time when many complex decisions are being made by leaders at global, national and community level. Each decision hmust balance social and economic consequences whilst putting public health first.
Download Narrative as PDF English (168kb) Français

5 May 2020: “I am really delighted to host this guest blog in our narratives from Professor Corinna Hawkes, Director of the Centre for Food Policy at City, University of London. In it, Corinna explores a theme that I find powerful: that health is an outcome of multiple systems and interacting processes. Leaders need to appreciate the value of seeing the global challenges that COVID-19 presents in terms of multiple interconnected systems, all inter-dependent. Seeing the world in this way is a critical element of our thinking at 4SD. I hope you get as much from Corinna’s blog as I did.” – Dr David Nabarro.

1 May 2020: An opinion piece by Dr David Nabarro in his role of Special Envoy to the World Health Organization (WHO) on COVID-19 and Founder and Principal of 4SD, and Peter Bakker representing the global business leadership voice as WBCSD’s President and CEO. 

28 April 2020: “There is an enormous amount of learning underway but it may take months to resolve some of the unknowns about the pattern of spread and effectiveness of alternative suppression strategies.  And we should not assume that the virus will go on behaving as it does now.” – Dr David Nabarro
Download as PDF English (218kb)

21 April 2020: Narrative Twenty stresses that now is the time to prepare for COVID-ready workplaces – workplaces will be ahead if they are already consider how to adapt and recognise issues like physical distancing and managing leave for those who feel ill.
Download Narrative Twenty as PDF English (89kb) Français

20 April 2020: My emphasis in this message is for the need for all communities quickly to become alert and ready for COVID.  This is because the virus is going to remain in our midst for the foreseeable future.  I do not think it will disappear any time soon.  – Dr David Nabarro
Download Narrative Nineteen as PDF English (49kb)

10 April 2020: Narrative Eighteen dives further into “COVID-readiness” by looking at key aspects of the economy including the need to protect the lowest-paid people, valuing and rewarding women especially for the roles they play in essential health care, food systems and social care and the deployment of bold measures to lessen the economic and social impact of the restrictions on activities and movement.
Download Narrative Eighteen as PDF English (131kb) Français

9 April 2020: Narrative Seventeen poses seven potential questions to help understand the sequence needed to ease away from a lockdown.  Decision-makers will be considering multiple factors when deciding how best to do this. 
Download Narrative Seventeen as PDF English (136kb) / Français (140kb)

4 April 2020: Narrative Sixteen considers the fundamental challenges of a new normal, the leadership required (that leaves no-one behind) and the need to establish a Pandemic Emergency Coordination Council now.
Download Narrative Sixteen as PDF English (96kb) / Français (105kb)

3 April 2020: Narrative Fifteen delves into what reaching a COVID-19 ready state means and the challenges that are inherent in doing so.
Download Narrative Fifteen as PDF English (54kb) / Français (94kb)

2 April 2020: Narrative Fourteen analyses the introduction of lockdowns in areas where transmission is occurring.  A lockdown means restrictions on movement and association, with priority given to essential services like food and healthcare whilst dramatically reducing the nature and number of person-to-person interactions.
Download Narrative Fourteen as PDF English (89kb) / Français (97kb)

2 April 2020: Narrative Thirteen details three important elements needed for a collective response – Public Health, Fiscal, and Community Resilience – and recognises the role of women’s leadership in the response.
Download Narrative Twelve as PDF English (104kb) / Français (116kb)

27 March 2020: Narrative Twelve dives into the reality of struggles faced by local authorities in a small french village where decisions are made and evolve quickly, whilst citizens search for immediate reasons and answers.
Download Narrative Twelve as PDF (119kb) English/ Français

25 March 2020: Narrative Eleven takes a step back from the emergency as a threat to our health and considers the economic shocks, impact on businesses, poverty and social consequences of the crisis. It concludes with a useful approach for policymakers to tackle such a complex problem.
Download Narrative Eleven as PDF (94kb) English / Français

24 March 2020: Narrative Ten takes a sincere look at the position leaders’ are in – their decisions are changing by the day, not necessarily because they are making mistakes, but simply because the situation is rapidly evolving.
Download Narrative Ten as PDF (88kb) English / Français

24 March 2020: Narrative Nine builds on Narrative Three by detailing how big business, small business and the self-employed are affected, ways to contribute to the response, and most importantly, the need to act quickly and decisively.
Download Narrative Nine as PDF (95kb) / English / Français

22 March 2020: “It will take the world much longer to suppress this pandemic if nations continue to work independently and are inconsistent in their application of WHO guidance” – This narrative collates Dr David Nabarro’s thoughts as G20 leaders prepare for the “Extraordinary Leaders’ Summit” early this week.
Download Narrative Eight as PDF (88kb) English / Français
Download Narrative Eight Presentation as PDF (5mb) English

19 March 2020: As countries all around the world enter the most restrictive peacetime measures they may have experienced, people everywhere will experience a range of moods and emotions that will impact on their lives.  The overall message for now is: ‘Be Fast, No Blame, No Regrets’.
Download Narrative Seven as PDF (124kb) English / Français

15 March 2020: Narrative Six is a call for Solidarity responses to COVID-19 outbreaks.
We must unleash local capacity, activate networks, coordinate efforts and use WHO guidance.
Download Narrative Six as PDF Presentation (382kb) English / Français / Español / Deutsch

15 March 2020: Narrative Five highlights the urgent need for rapid coordinated effort with multiple actions simultaneously and continuous learning.
Download Narrative Five as PDF (62kb) English / Français

14 March 2020: Narrative Four focuses on the power of people-centred systems leadership to end the COVID-19 pandemic including the need for resolute action by all and systems leadership.
Download Narrative Four as PDF (403kb)

5 March 2020: Narrative Three discusses the important role of business and the contribution that business leaders can make. All sectors – businesses, civil society and government – have vital roles to play in keeping life going despite the virus.
Download Narrative Three as PDF (336kb)

3 March 2020: Narrative Two details readiness planning and the key components of integrated management: engagement of people, organization of public health services, planning provision of clinical care, and preventing societal disruption.
Download Narrative Two as PDF (207kb)

26 February 2020: Narrative One provides insights into China’s effort, the importance of readiness, key public health functions and the urgency for systems leadership to be established so a massive synchronized multi-actor effort can be mobilised.
Download Narrative One as PDF (170kb) English / Français

  1. Multisectoral coordination is a challenging issue for Bangladesh, even coordination within health system is difficult. There is a need to generate evidence for quick response. Is there any tools or guideline for establishing multisectoral coordination for responding COVID-19. Is there any global initiative to guide and monitor the progress of local and global actions? I am here to get your assistance and initiate advocacy for political and economical assistance in Bangladesh.

  2. on Institutional and Political Leadership in coordination of a multi-sectoral approach to the management of new and emergency diseases

    A key area of what is happening involves challenges in managing movement of biological organisms including pathogens, institutional frameworks, risk profiling, analysis, management responses, contingency planning and emergency actions. Several UN Agencies have mandates on Biosecurity and Biosafety but unfortunately lack coordinated approaches to develop operational tools, guidance and partnership to manage future recurrences such as is happening. Issues on Environmental Biosecurity measures and Safeguards are seemingly looking at mainly policy and regulatory frameworks without strengthened technical capacity to “chase” and address issues using all the scientific advances available. Some of the key pathways of movement cover areas including Transport, Tourism, Zoonotics, Biological safety and management (Plant safety, Animal Health, Microbial Safety), Border control, Trade, Bioterrorism and so on. Will be grateful for your thoughts on what you think should be a Systems wide approach in handling such unfortunate incidents including broadening the WHO One Health Program to include an Environmental Agenda and raising the profile of practice on biocontainment measures on gene and material movements, monitoring and enforcement, Early warning, Testing and related emergency procedures.

  3. Thank you for lending your experience and skills at this challenging time. I remember well your calm and informative briefings at the UN during the Ebola crisis. Totally trust your guidance!

  4. Dear Dr Navarro,
    Happy to see you are professionally active and profound in your thoughts and clear in the direction of your response. Glad to see $SD and also that you are one of the six global envoys appointed by WHODG.
    I am now in Egypt. Happy to help.

    • Dear Dr. Nabarro,
      When the world around us is in turmoil we look to our regional, national and international leaders for vision and clarity. Thank you for having this though all the challenge!

  5. I believe that I have COVID-19 (day 16 now). I believe that meats and dairy make the virus flare. COVID-19 is transported into the cells via the ACE2 receptor with the help of the TMPRSS2 protease.
    What I can find easily in PubMed is that TMPRSS2 is implicated in prostate cancers. Men who consume a lot of meat and dairy are at higher risks for ultimately developing TMPRSS2+ prostate cancers. Those that consume a lot of tomato paste have lower risks. While this concerns lifelong dietary patterns, I can’t help but wonder: Could the expression of TMPRSS2 be immediately responsive to the foods that we eat? Each time that I cheat in my diet – thinking that I am well enough to use up that milk before it spoils, I get hit with another viral flare. Please, if you catch this and cannot clear it easily, watch to see which foods help and which hurt. If we can reduce the severity of this merely by adjusting diet, then let’s do so!

    • Dear Lisa, we believe healthy, nutritious diets are essential for strong immune systems. We are learning more about this virus everyday. There is not yet any conclusive information from the World Health Organization about the link between diets and COVID-19. If you are interested on hearing more about how the situation is evolving, please join the Open Online Briefings this week: Best, 4SD


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