Victor Dzau,President, US National Academy of Medicine, spoke at the launching ceremony of Institute for Global Health and Development, Peking University (PKU-iGHD) and the Beijing Forum 2020: COVID-19 Shocks to Global Health and Development:

Thank you very much indeed, I want to begin by thanking Gordon Liu, for inviting me to this forum and importantly for launching the PKU Institute for Global Health and Development, I have enormous respect for PKU, having collaborated with PKU when I was a chancellor in DUKE. In fact, I attended and spoke at your 100th anniversary of Peking University Health Science Center (PKUHSC). I'm American, but I was born in China, Shanghai. It is a great honor for me to speak to you.

It's also a great pleasure to follow Larry Summers, my good friend as in his lecture, I think he laid out the issues extremely well. And so I'm just going to mainly review for us the COVID 19 global response preparedness, emphasizing two things.

One is the report from the Global Preparedness Monitoring Board GPMB, and secondly are the countermeasures vaccine, and how indeed we are trying to meet the global needs and achieve global solidarity.

In 2018, the WHO, and the World Bank co-convened a new monitoring board called the Global Preparedness Monitoring Board (GPMB). This is in response to the UN secretary-general’s commission that recommended after Ebola the need for such a monitoring board. I was very fortunate to serve on the board in fact with Dr. George Gao, Director of CDC in China. And in 2019, GPMB released its first report called ‘A World At Risk: Annual Report on Global Preparedness for Health Emergencies’. Importantly, it says that one of the very real threats of rapidly spreading pandemic due to lethal respiratory pathogens. And because we all know this is very profound and precedent because although we thought about this risk, nobody thought it would ever happen. And of course, it's happening in 2019 to 2020. In this report we asked for seven urgent actions. For the heads of governments, countries and financing mechanism all to work in coordination and collaboration. And of course, not much happened in response.

We now know because of the pandemic of COVID 19 has caused devastation across the world. If you look at the latest numbers, based on data I showed two days ago, they are now 77 million confirmed cases globally, but 1.7 million deaths. US unfortunately leads the world in the number of cases with 17.8 million cases and over 300,000 deaths.

It has been said by Dr. Summers that this is not just a health threat. In fact, it is an economic crisis. It is an educational crisis. It is a suicidal crisis. It is a world crisis. In the SDG goals, 90% of healthcare system is disrupted during this phase, 1.6 billion children are out of school. Less than 30 percent investment，reduction 30 percent in clear energy, and over 135 million people have been pushed into poverty.

What are the lessons learned? We learned that COVID 19 has revealed a collective failure to take pandemic prevention and preparedness and response seriously and prioritize accordingly. As Dr. Summers said, we live in an interconnected world. And infection anywhere is a catastrophe everywhere.

I think the important issue we learn is human dimension. The importance of leadership and citizenship. The need for leaders to lead based on science and make decisive and strategic decisions and citizens to participate in protecting themselves and each other.

I think what we also learn is the current measurements of preparedness are not predictive. Using the global health security Index, US ranks number one. But as you know, we are not fare so well altogether.

Health emergency preparedness requires effective agile systems, as has been said pandemic preparedness is common good. You have to invest and return on investment is immense. No one is safe until all are safe. Global preparedness is not simply the sum of national preparedness, and the world of preparedness is already complex. It needs consolidation and not fragmentation.

The GPMB 2020 report is very relevant to what's going on released on September. We called it a world in disorder. I recommended five, actually six different actions. Leadership, citizenship, robust governments of preparedness, strong agile system with health security, sustained investment, and important cooperative research and development.

I'm going to go through quickly some of the recommendations. As I mentioned already, I think what distinguished the countries as successful from those who haven't done so well is actually leadership. Leadership is that makes decisive early decision based on science and not criticization. Leadership is that creates national strategy, and also involves everyone one of us as responsible citizens to be responsible for the public good, to protect ourselves but importantly, protect each other.

Number three recommendation is global governments of preparedness. We have to amend the international heath regulation to the World Health Assembly. We have to develop mechanisms for assessing multilateral preparedness, and there must be international framework of governance that's clear, and not complicated.

We also have to develop strong agile systems for every country. Heads of states must strengthen national systems by having an all of society approach. Not just health. Not just economics, not this forced dichotomy of health vs. economics. It's all of society approach with one health approach, buildings sufficient public health capacity workforce, strengthening health systems and importantly, putting systems of social protection to safeguard the vulnerable. And importantly, heads of government must strengthen WHO as an impartial international organization for directing and coordinating pandemic, response and preparedness, and renewed commitment to multilateral system.

The two key areas I want to talk about. First is sustain investment. It's really important that global leaders along with UN, WHO, and international finance institutions recognize that preparedness as a global common good, and is not at the mercy of political and economic cycles. Nations must make sure that every nation has insured adequate finances for domestic investment in addition to global investment. And there has to be a mechanism for sustainable financing of global health security which mobilizes resources scale, in time and not rely on development assistance. On the research sector, governments, WHO, international organizations and the private sector has to be coordinated effect end to end from research development, health emergencies, a sustainable mechanism to ensure rapid and equated access to vaccines, therapeutics, diagnostics, and non-pharmaceutical interventions.

This is very relevant. As Dr. Summers said, countries which have resources have active mobilized domestic resources to be prepared, and to respond. In the areas of vaccines, diagnostics, therapeutics, US has invested heavily into this coordinate response called Active and Operation Warp Speed. Thus far have spent up to $18 billion to acquire vaccines and therapeutics, and diagnostics. China has done well also in the creation of vaccine and has invested as well as Russia. I'll come back to this later.

What happened at the beginning of the pandemic is the lack of a coordinated system for the rest of the word or all over the world for that matter to come together to say how do we respond together and how do we invest together to allow us to have sufficient tools, if you will respond to COVID.

March 10th, 2020 the GPMB particularly led by Jeremy Fry and myself called for an injection of $8 billion US dollars of new funding globally for the development of vaccines, drugs and diagnostics. The good news is the European Commission led by President Von Der Leyen my good friend, hosted a global pledge which raised $18 billion US dollars in a mere seven weeks. Out of that, in parallel to this is the creation of a coordination and coalition known as Access to COVID-19 Tools Accelerator or ACT-A which was formed for speed and rapidly increasing accelerating the tools and also achieving global equity.

What I think is unique in ACT-Accelerator is coming together of multiple agencies and entities globally which are working in silos but for the first time came together to work together in a coordinated and voluntary fashion. This includes WHO, GAVI-- the Global Alliance for Vaccine Immunization, CEPI -- the Coalition for Epidemic Preparedness Innovations, organizations that do vaccine R&D, Welcome Trust, Unitaid，World Bank, the Global Fund, FIND, and all the others. For the first time, response to this threat, these individual entities have come together to work together in a coordinated and voluntary fashion.

ACT-Accelerator is overseen by a global council of the WHO, the G20 countries plus the European Commission and a number of partners, if you will. It's overseen by a coordination hub, and ACT-Accelerator Principles on which I serve. It's organized into three pillars: vaccine partnership, therapeutics partnership, diagnostics partnership, and a cross-cutting whole system connector. I want to emphasize the creation this brings together the end to end from R&D to manufacturing to procurement to deployment. Together for the first time, people working together not only looking at what vaccines to invest but how to actually support risk manufacturing to procurement to all the way to distribution. And for example, in vaccine partnership called COVAX, CEPI, WHO and GAVI is working together and this is a pillar I'm particularly active in.

So what has ACT-Accelerator done today. For vaccines, the goal is to have 2 billion doses by the end of 2021. If you follow what Dr. Summers said that we should have everybody vaccinated by 2022, we have a long way to go. Yet, this is an ambitious goal by having people come together to achieve this. For therapeutics, 245 million courses by mid-2021. For Diagnostics, 500 million tests by mid-2021. In the mere, since April, eight months its done huge amount. Not only securing vaccine candidates but also supporting trials, and securing some of the vaccines. Its followed 1700 clinical trials with about 200 trials which is in fact is closely involved with and is the first life-saving therapy dexamethasone given out to low and middle income countries. And diagnostics, the first antigen replica diagnostic test has been established and approved as ready for effective implementation.

We have a long way to go. But let's take vaccine. As you know the news is good. Pfizer and Biontech received approval from the UK and mercy authorization in the US in December, and following that by Moderna, and AstraZeneca is not far behind.

The China vaccine, developed by Sinopharm and CNPG has actually been out there approved since July. And the Russian Vaccine Sputnik V has improved in August level. As Dr. Summers said it's quite amazing. The rapid speed from the sequencing of the virus in January to actually creating the vaccine that is now at authority by phase 3 trials, and now coming into usage in a mere ten months. And of course much celebrations towards technology and science including RNA technology, DNA technology, viral vector, and many others. We are certainly encouraged with this.

However, many countries, particularly low-income countries are not able to secure these vaccines despite the use of GAVI. But more importantly, middle-income countries and even high-income countries which are small and do not have the resources of China, Russia, the United States, have to work together in order to find ways to hedge their bets and to purchase large amounts of vaccine in the pool mechanism. So ACT-Accelerator vaccine COVAX pillar has been successful in bringing together 190 economies in total with low income countries to GAVI and high and middle income countries together to create a pool of purchase vaccines, and today we have 1 billion doses all together secured globally.

There's a long way to go. Because financing and getting up to 2 billion still has a major gap of $28 billion dollars to achieve the goals of ACT-Accelerator, which the vaccine will require another $7 to $8 billion dollars. So you can imagine the importance of having sustainable financing, particularly in the future. Not only to secure vaccine now, but in the future in preparation for other pandemics.

As been said, multilateralism is truly important, and we see that happening and also give credit to China. I'm aware it's now ready to ship 400 million doses to other countries in helping other countries as well. We need the coordination of rolling out vaccines, an equitable distribution so that everybody gets access to it whether they can pay or not. in rich or poor countries, ensuring public trust in vaccines, and of course as I said a sustainable coordinating framework and financing mechanism for the future.

With the availability of vaccin, that raises many questions certainly in our country and others. Is it safe? Because it is authorized so rapidly, and come to market so rapidly with only two months of follow up. Will people take the vaccine? If we have limited doses certainly and initially, like we have now, who do you allocate to first? Who do you give it to second? How do you distribute the vaccine and how do you ensure global equal access?

WHO fair location vaccine says that it'll go to first healthcare workers, elderly, and those at high risk, so that is in fact accounts for 20 percent of the initial population of all countries. COVAX aspiration is to make sure every country has 20% of vaccines immediately available for next year. But the distribution becomes a problem, while it is possible to distribute it from the WHO, and elsewhere to each country. It's very challenging in GAVI eligible countries to low-income countries. Experience shows that there are two separates, not connected supply chains: one that moves vaccine from supplies to country, and second that moves vaccines from country to national local storage distribution. We are facing this in our own country. How do you get from the central government to the state to local jurisdiction? And how to get it to individuals? Importantly storage of mRNA vaccine has to be -70 degrees for Pfizer, -20 degrees for Moderna. And supply chain. WHO estimates that more than 50 percent of vaccine may be wasted globally every year because of temperature control and logistic and shipment-related issues. And there is not enough workforce to do this mass vaccination.

So we have a lot of work to do. In terms of vaccine hesitancy in the United States, 50 percent of population said they will get vaccinated. 30 percent said they will not. And about 20 to 30 percent are unsure. We have people who are hesitating. In the global survey, it shows that 70 percent are very or somewhat likely to take the vaccine. The news is good in China, almost 90 percent in China, but about 50 percent in Russia. The reasons of anti-vax are just hesitancy in general. We have population in the United States that have felt exploited over the years, communities of color who don't trust the government. So a solution is a concerted effort to address hesitancy through campaign, public education, and important trust, and transparency and honesty about side effects and ensuring vaccine safety system that patients are being followed after they get vaccinated. And we are nationally conducting that work for the CDC.

I think we've learned a lot about this issue from COVID-19. That's absolutely important as has been said to have 1) Globally coordinated end to end R&D Preparedness and Response Ecosystem for vaccines, therapeutics, and diagnostics; 2) Strategy and coordination in public health intervention (detection, testing, contact tracing, data reporting and analysis), and digital innovations at national and global levels. 3) Multilateralism to engage all countries to work together for global coordination and equitable access; 4) Sustainable financing: long-term predictable, reliable financing for global common good for pandemic prevention, preparedness and response.

In summary, COVID is demonstrating the importance of four critical interconnected dimensions in pandemic response and preparedness. First responsible leadership. Second, engaged citizenship. These human dimensions, I can't speak enough how important they are. Agile system and sustained investment. As has been said by Dr. Summers, we all have to work together. Multilateralism is the essential linkage at the center, ensuring all function coherently and effectively at all levels -- local, national, regional, and global levels. Solidarity is what we must achieve so that equity can achieve for all.

I too am optimistic with where we are today. With the new US administration coming in and hopefully, I too echo Dr. Summers comment that we hope China and US work together for the gear good of humanity. Thank you very much.