14 March 2020, COVID-19 Narrative Four

By Dr David Nabarro, Strategic Director of 4SD, Special Envoy to the World Health Organization Director-General on COVID-19 and Co-Director of the Imperial College Institute of Global Health Innovation at the Imperial College London


The World Health Organization maintains that the epidemic of disease caused by the three-month-old coronavirus (COVID-19) can be contained and controlled through decisive action by the governments and people of all nations working together. There is evidence from many countries that have been able to prevent individuals with the disease from triggering outbreaks.   There is evidence from China, South Korea and Singapore that major outbreaks can be contained and controlled with the right actions done quickly and well.

The WHO has now described COVID-19 as a pandemic.  Why?  First: The spread of disease is alarming and rapid.  Second: It threatens all the people in our world, will paralyse health services and could contribute to the deaths of many thousands of people.  Third: it is essential that all governments are robust and rigorous in their responses.

The WHO believes that the actions we all take now can limit its scale and impact and wonders why so many leaders have approached it in ways that are half-hearted and nonchalant.  Is it because the disease is so new, fast changing in unexpected ways?  Are governments torn between focusing on social and economic issues and doing what is right for people’s health?  Are they finding it difficult because it is a multi-country issue and they tackle it from a national perspective?  Are they concerned that their actions will play out in the political sphere and affect their chances of re-election? 

The pandemic declaration signals that we are in an epic struggle for the health of all.  The context changes rapidly.  But let us be clear, half measures are more dangerous than doing nothing.  They create the illusion of action when leave open doors for the virus to wreak havoc.  The need for accountability and audacity is NOW, not in a few days or weeks. 

That is why we focus, now, on leadership.  Many of our current leaders do not find it easy to work with the interconnected realities of people’s lives, to connect diverse groups together, encouraging ambition in ways that are audacious and authentic.  Perhaps it is because people-centred systems leaders do not push themselves forward: they recognize that results happen through enabling everyone to contribute, to be accountable to each other and to claim credit for success together.  People centred leadership inspires people’s trust and confidence but is missing at the national level. 

We have seen success clearly in China, South Korea and Singapore – in countries that put their people first and accepted the bitter medicine of getting things under control.  We marvel at it.  We wonder whether it can happen in Europe and North America.  Yes, but it means the right mindset from the start, with leaders acknowledging that they have to earn the trust and respect of everyone (including those with whom they do not agree) if they are to success in the face of an extraordinary threat.  Let us explore this in more detail. 

Systems leadership to end the COVID-19 pandemic starts with the big picture: that helps us all agree on where we are headed.  Here is mine: the COVID-19 pandemic has the potential to cause enormous harm to people, societies and economies: there is little point in trying to project how much harm because we just do not know.  If we work together and are smart we can dampen, delay, blunt, limit, contain and stop the pandemic, and limit the harm it causes.  It is up to us to get organized to do this: no-one else will do it for us.  It must be a priority for us all in the coming weeks: we must factor it in to all planning and all decisions. 

Systems leadership to end the COVID-19 pandemic means understanding the many perspectives on the pandemic in different societies, accepting that all of them are valid (and not belittling those that do not fit any one worldview).  It does mean prioritizing people’s health and well-being, working together to ensure that as many people as possible are not disadvantaged by the pandemic or by control measures.  Systems leadership does not lead us to artificial choices – such as the demands of public health and the needs of the national economy.  Systems leaders appreciate that life is complex: inevitably that leads to uncertainty and vulnerability.  After all, there is no one right answer.  Systems leaders are authentic: they do not create smokescreens (like “proportionate responses”) because they recognize that people understand that decisions are tough. 

The WHO gets this, of course.  Health is an outcome of multiple systems and interacting processes.  But the pandemic is a bit special. It is a threat to all and it does not wait till uncertain leaders have finished their dithering.  This pandemic thrives on hesitation and it is advancing explosively where leaders are distracted.  Complacency in one part of the world leads to dangers for others.  WHO knows – and has shown – that the pandemic can be tamed through resolute action now.  But it needs resolute action by all, not leaders in one part of the world blaming others and refusing to cooperate.  That is shameful, dangerous and irresponsible – and its consequences will be reflected in lives lost.  Systems leaders step up and act forcefully despite anxieties, uncertainties and doubts.

Systems leadership to end the COVID-19 pandemic needs people with experience.  WHO’s Emergencies Programme has assembled the world’s experts and created space for hyper-fast learning and reflecting on the best ways to go.  They tell us that COVID-19 threat is different from influenza.  COVID-19 is challenging – just ask the hard-pressed doctors making life-or-death choices in Milan right now.  COVID-19 damages life and livelihoods, society and economies.  COVID-19 challenges all stakeholders to work together, to be responsible, to be assertive, robust and accountable. 

It also needs people who are authentic and open.   All of us have readjusted our views of the threat over time.  The general view now is that it is serious and needs our collective undivided attention with a focus on everyone everywhere.  Not the people of one community, one state, one country and one region.  We should be honest in admitting that there is much we do not know.  If we pretend that we have the answers we will be likely make some serious mistakes.  And they could be deadly as people’s lives are on the line. 

It needs people who will take responsibility for the good of all.  Massive outbreaks in Europe and the US will seed outbreaks elsewhere.  Some will be in poorer countries which are less able to cope.  The wealthier nations must do all in their power to contain coronavirus now.  No delay.  Every person must take action to lessen risks of infection and transmission.  This will dampen the pandemic.  If not, the world will face a massive tragedy that could, in WHO’s words, be contained.  We will demonstrate that humanity is unable to act for the common good even in a crisis.  Surely we can do better.

Systems leadership to end the COVID-19 pandemic means being ready to apply lessons learnt. WHO’s Director General told us today what needs to be done. China, Singapore, South Korea, Japan, Iran, Italy and other nations are sharing their experiences.  We have much to learn and if leaders apply the learning now the scale of the suffering throughout our world CAN be limited. 

Here are some elements for systems leadership to end the COVID-19 pandemic.  We will need to identify and engage those who are ready to step up and lead this epic struggle.

No regrets strategies that put people first and leave no-one behind.  Accessible testing readily available.  Highly organized public health action involving people and government working together.  Everyone focusing on ways to reduce exposure and support those who are infected.  No blaming individuals who are infected themselves or infect others. 

Supporting each other through these tough times, especially those whose livelihoods are undermined as a result of control efforts.  Sharing and debating our anxieties and concerns in an open and supportive way.  Recognizing that even if cases are not being reported from a location or community there may still be transmission underway.  COVID-19 is amongst us all, it is not somewhere far away.  But we can make a difference to the scale, intensity and impact of the pandemic. 

Being strong: this work will last for the next six months at least.  It will be a dominant feature of all our lives.  We must carry each other through it.  Hospitals will become our most precious resource to be nurtured and used with care.  Comprehensive, well-organized and collective efforts, backed by adequate finance, are essential.  Health workers are key and must receive all our support. 

Caring for everyone.  What will happen to small businesses that do less well if people prefer to stay at home and not venture out?  What are the prospects for those who work in hospitality, retail, caring and service sectors which require contact with people?   Life will be hard especially if they have no insurance.  The custodial sector will face challenges too.  Low-paid people will face economic hardship because of contraction in labour markets.  Economies will be stressed: the poorest will face massive challenges as employment tightens.  We must be inventive and leave no-one behind. 

Being challenged again and again.  It is not a simple choice between “fear and panic versus business as usual”.  The best leaders will be able to combine their attention on people’s health, wellbeing and livelihoods, and chart a path that has meaning for all.  Now is the time for them all to stand up: they will help us all navigate into the future. 

Prioritizing together working for the public good.  No political point scoring, no falsehoods, no undermining.  Fragmentation means more people hurt, more societal damage.  Leaders are accountable and the virus will show if they are failing us.  The damage caused by this pandemic will be minimised through communication, inclusion, organisation, cooperation, coordination, innovation, openness, transparency and more.  The pandemic will be exacerbated if there is name-calling, suspicion, fear, exploitation and obstruction. 

Drawing on the strengths of all people and make the best use of all the assets at their collective disposal.  Prioritize those most in need.  Prevent market manipulation and hoarding.  Explain what they do, share their data and encourage others to grow.  

Keep learning.  The world has never faced an infectious respiratory disease like COVID-19 before.  It has only been with us for three months and we are all learning about it quickly.  We know it differs from influenza or Ebola virus disease. We see it hurting people, disrupting societies and damaging economies.  We have also seen that outbreaks can be contained, limited and stopped.   We are helped by generous sharing of experience by countries as well as widespread debate about what to expect in different media.  We see a multi-centred research effort underway though it will be some months before safe and effective vaccines or therapies are widely available.  Most importantly, we see that people are ready to contribute to the response and want to do so in ways that have the greatest benefit – for them and for society. 

Anticipate: think “How will the pandemic evolve?  How are we to get ready for what is around the corner?   How will we implement the right measures rigorously when they are needed? 

Keep checking the things that matter, relentlessly.  How to prepare people so they know what to do to be safe?  How to organize and test community health services?  How to ensure that those in need get the health care they require?  How to sustain livelihoods for those whose economies are collapsing?  The faster and more robust the action taken, the greater chance of halting the pandemic quickly.

Be international – this virus does the not respect national boundaries.  All people of all nations must be involved irrespective of the extent to which their people are touched by this epidemic.  Concerted efforts by the leaders of each nation are vital if we are to avert months – even years – of disruption to lives and livelihoods. 

Bring people on board and connect with them throughout the pandemic.  Tune into people’s hopes and anxieties, regularly and without being defensive.  Meet people where they are and sense their rhythm.  Seek to understand their perspectives and worldview.  Foster trust build confidence and defuse anxiety.  Use their voices to unite all sections of society so they act together to contain the pandemic. 

Find resources everywhere: from subnational authorities, religious groups, societal organizations, professional bodies, media, sports, entertainment, schools, universities and more.   Help them appreciate the importance of hand hygiene, cough etiquette and distancing.  Work together in identifying why society-wide measures – such as reducing gatherings or curtailing movement – may need to be introduced.  Do it together so that it is our collective effort that halts the pandemic.  

Encourage seamless action and reaction: coordinated and robust responses that are implemented seamlessly with a view to maximum impact from the start.Err on the side of caution: the pandemic will win if we are complacent or half-hearted.  Ensure thatemergency protocols are activated and working.  Check that all involved know what is expected of them and are ready to implement.  Set up coordination systems that work.  Match response to challenge, repurposing people and money, re-assigning roles and responsibilities. 

Encourage all to innovate, take risks and use initiative, not to be scared and risk averse.  Treasure front-line responders – especially public health and hospital workers – as they are key to responding.  Review progress regularly – together – so that all see the needs and adapt.  Encourage – and do not penalize – those who must make difficult judgements using incomplete information even if subsequently they seem to have erred. 

Maintain a regular rhythm of information, so that the people are with you.  Set up hotlines that work and virtual forums that all can access to share information and reinforce public health services.  Ensure people can access COVID-19 diagnostic testing and treatment, as well as treatment for other health conditions.  Value health workers who are especially exposed both to the virus and to people’s anxieties. 

The COVID-19 pandemic is a massive existential challenge for humanity.  The actions of leaders will determine how it goes: will it damage the fabric of our society or demonstrating the power of our solidarity?  To stop it quickly, robust, resolute and rapid actions are needed now.  This calls for ambitious, audacious, authentic and accountable leadership everywhere.

On 21 February 2020, Dr David Nabarro, Strategic Director of 4SD, and Co-Director of the Imperial College Institute of Global Health Innovation at the Imperial College London, was appointed as a World Health Organization (WHO) Director-General Special Envoy on COVID-19. In this role, David and five other special envoys are providing strategic advice and high-level political advocacy and engagement in different parts of the world to help WHO coordinate the global response to the epidemic. David joins special envoys Professor Dr Maha El Rabbat, former Minister of Health of Egypt; Dr John Nkengasong, Director of the African Centres for Disease Control and Prevention; Dr Mirta Roses, former Director of the WHO Region of the Americas; Dr Shin Young-soo, former Regional Director of the WHO Region of the Western Pacific and Professor Samba Sow, Director-General of the Center for Vaccine Development in Mali in this collective effort.

Please visit: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 for official guidance from the World Health Organisation on the virus. These Narratives are being written and shared by David for those who want more information and to help raise awareness and readiness of all actors.

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