‘Where’s the leadership?’ A Q&A with WHO special envoy David Nabarro…

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Coins2Day spoke with David Nabarro, a special envoy to the World Health Organization (WHO) on COVID-19, late into his day on Thursday. The infectious disease expert, who previously worked on SARS, Ebola, cholera, and influenza outbreaks, was troubled by the world’s fragmented response to the recently declared pandemic, but hopeful that a coordinated international response to the novel coronavirus quickly spreading around the world could prevail.

This interview has been edited for clarity and length.

The WHO declared COVID-19 has become a pandemic on Wednesday. How do you see this playing out?

Nabarro: This is something that is actually capable of being tamed and overcome by humanity quite quickly if we want and if we can organize ourselves to do it. The question is whether it’s beyond the capacity of the current generation of Western leaders to rise to the challenge.

I’ve been working with the WHO on this for about six weeks, and I’ve also worked previously on Ebola in West Africa, on the influenza pandemic, H1N1 in 2009-2010, and on bird flu in 2005-2006, and I was in the WHO when we had the SARS outbreak in 2002. This is infinitely more serious than all of those in terms of its potential impact.

It’s also potentially soluble, I think, even more soluble than some of the others. If people make relatively modest changes to their behavior, if public health systems throughout the world can function as they’re designed to function, if hospitals can be organized to deal properly with the workload of people with coronavirus, and if business and governments can come together and approach this as a massive challenge that we’re going to respond to collectively, then it can be done.

How are things going so far?

Although we’ve seen success in some countries that is quite remarkable, there is a group of leaders, particularly in Europe and North America who are just not getting with the issue properly and the consequences of that could be very serious.

We saw in China—after some initial missteps that probably pile into insignificance compared with some of the missteps being made now—a really extraordinary response of society and government. Not just in Hubei province, where they were able to bring a massive tragedy into some kind of order and under control—it’s not there yet, but it’s coming.

But more importantly, we saw that the whole thing did not spread out and overwhelm the rest of China, and that through quite a deal of discipline and organization, the spread of the disease into other provinces has been contained. We saw in Singapore, as the result of really effective public health work, good hospital work, and a really fantastic collection of people, the virus being contained. We’ve seen in South Korea after problems at the beginning, they’ve also managed to get it under control, and it’s been a real team effort. And in Japan, there are still a few challenges but it’s getting better. Southeast Asia has shown us that it can be done. Are the lessons of Southeast Asia being followed elsewhere? I don’t know.

We see in Northern Italy something went very badly wrong. We’ve got reports from what’s happening in some parts of Northern Italy. They’re really disturbing. I think they’ll get it sorted, but it will be at a huge cost, not just in terms of death, but at huge costs to the fabric of society and to the economy.

What are we seeing in the rest of Europe? Half-hearted, slightly lackadaisical, dismissive responses in one country and the effort to try to handle things and not get too much disturbance because there are elections coming up in another country this weekend. Real uncertainty in another country as to the best way to handle things. Altogether fragmented leadership. The wonderful instruments that exist in the European Union are not being used. So I’m really concerned about what’s happening in Europe. I hope it won’t happen, but I anticipate that during the next two or three weeks we will see more explosive outbreaks in Europe.

Look at North America—really peculiar leadership. The wrong things being prioritized, inconsistency across the states, and the likelihood of major, explosive outbreaks in at least three locations in the coming weeks. Businesses are contacting me and my colleagues, saying, “What’s going wrong? What can we do to make this as time-limited as possible?”

But leaders are making remarks like, “This is being imported from somewhere else,” and they don’t talk about sorting out their own countries. They make remarks like, “We’ll wait til the time is right. We don’t want people to get bored.” So. The prospect is that there will be intense outbreaks of coronavirus coming up in the next two months in different parts of Europe because there is transmission going on but it’s not being detected.

Let’s say it goes on as it is at the moment. The collective of the pandemic is doubling in size in terms of cases every five to six days. We currently have a cumulative number of 115,000 cases. If we go along at the present rate, the collective total will be a million by the beginning of next month and a billion sometime in June.

And if we’re unlucky and it doesn’t calm down in the hot weather in the North, it will go on spreading into Africa and different parts of Asia. It won’t be detected through testing. Suddenly there will be large numbers of people, very sick, turning up at ill-equipped hospitals and there will be a much higher death rate than in parts of the world that have reasonably good healthcare.

The world collectively has a choice right now. Everybody, everywhere, in every nation, especially those with transmission underway, should be focusing entirely on what they’re going to do to deal with this extraordinary existential threat.

It has the potential to kill many people and completely destroy economies, undermine the painstaking gains that we’ve made over the last 10-15 years and create possibly the most extraordinary recession we’ll have known in our lifetimes. Tedros [Adhanom Ghebreyesus, director general of the WHO], is thinking—as are others in the international system—where’s the leadership? I’ve never felt so profoundly depressed in my professional life.

What went so wrong in Italy?

The virus was circulating and not noticed for three weeks probably— and then suddenly explosive transmission. It doubles every few days. What we learned with Ebola is our institutions tend to be designed to increase efforts in a linear way.

When you’ve got an exponential problem going like that it actually feels as though you’re standing still because the exponential is so fast. It feels like you’re never in front of the curve.

The only way you can get ahead of an exponential curve is through big shifts or resets, and in a way that was what Tedros was trying to do by calling this a pandemic. He was to trying to get every leader in the world to realize that the way in which they were doing it was just not good enough.

What should we be doing?

People say to me, “Shouldn’t we cancel big events? Should we be doing this or that?”

Nobody should be doing big events. None. We shouldn’t be having football games. Major companies should be not just sending people home; they should be stopping. We should be putting every single bit of human energy that we can into this giant jump we need to make in capacity to get on top of these outbreaks.

So the whole of the population knows what they’ve got to do to reduce risk to themselves and to others. And so the public health services work beautifully like they’ve done in these countries that have succeeded. So you track people, you find the chains of transmission, you follow up the contacts. Hospital services—you build new hospitals. Quick, quick, quick, quick, quick, out of containers or empty sports stadiums. Even if they’re not being used, you have them there ready. You need the capacity so if the thing goes on exponentially increasing, you can get it right.

At the moment, hospital capacity in the U.S. And Europe is full. I’ve got reports from anesthesiologists and others in Lombardy [in Italy] saying the kind of decisions they’re having to make about who can survive and who can’t survive right now in overfull intensive care units with a shortage of ventilators are absolutely barbaric in a modern country, a G7 country. So everyone should be focused on this, and it should be organized.

What I would say to leaders in the West is please study what China had to do and please study what Korea had to do and study what Singapore is doing. Please study the difficulties that Iran has faced. Please study what has happened in Italy, and form your own conclusions.

The WHO advised against restricting travel and trade early in the outbreak. It has since praised China’s success, which came from a lock down approach. What is the role for travel and trade in this pandemic? Is locking things down the right approach? Should it have been done earlier?

This is a really tricky one. Creating a barrier between myself and the problem would work if the barriers are going to be watertight. But you can’t create watertight barriers. It’s very hard to block borders of any nation unless they happen to be a sort of island that’s pretty well-fortified. If you’ve got land borders people will come through. Second, people can have disease but not show it. And if you’re saying geography, in most cases you’ll be out of date fast because this thing is popping up in so many different places. So it’s crude but not stupid. You can slow things down.

Where everything goes wrong is when one country feels that they’re is somehow being blamed or punished for the fact that people of their country are traveling. And then you get resentment and damage to what we need most of all, which is international cooperation. Without international cooperation, these kinds of things are so hard to deal with.

So there’s times when restricting movement inside countries and restricting movement between countries is a logical thing to do. But I’m really wishing that it can be done through collective effort. Helping Lombardy to have a restriction on movement, yes, but [Lombardy] also comes up and abuts against a France here and Switzerland there, so we need to draw the curves not so much that it’s designed around one particular country but around a number of countries. It shouldn’t be some national game.

How’s international cooperation going right now?

Despite the fact that they’ve got this sort of huge wiring system right across the world—the UN system—national priorities are making harmonious behavior super difficult. Suspicions, blaming, and all that. Perhaps it’s just the environment in which we have to work, and we should stop being starry-eyed in thinking that collaboration will come back.

But I am starry-eyed, and I remain of the opinion that getting on top of or ahead of this outbreak is only going to be possible through a common narrative, a shared strategy, a willingness to look at those who need the most help and to reserve this precious equipment and reagents and treatments for those most in need and avoiding all this stigmatizing and stuff.

I’m still hopeful. I still think that in the end we’ll come around. I think businesses will sooner or later through their CEOs come up against the state and government and say, “You’ve going to do better.” Tedros declared a pandemic because he was frustrated by the failure of governments to take this seriously. And I think businesses will come next, and, frankly, I think the people will be the next phase. I think there will be a growing number of people who say, “Come on. This is so important. It’s the future of our world, and we just have to work on it together.”

What do you tell business leaders when they turn to you?

Businesses are amazing because their CEOs have realized that not only are their business models in real difficulty, they also realize that they connect with billions of people through their brands. They’ve got huge supply chains; they got big shareholding networks. They want to survive. They don’t want the markets to be completely damaged. So they see it in their interest as being part of the response.

Klaus Schawb, founder and chairman of the World Economic Forum (WEF) said, “I want to give all the assets the WEF has to deal with this outbreak. It’s the most important thing going on that has happened in my time as chairman. I’ll stop everything.”

He’s got everybody working from home. He’s got all these industry groups completely focused on how each sector group can be helpful in relation to the pandemic. He’s got CEOs coming together each week on a platform, several hundreds of them thinking how they can connect, carry messages, empower people, make them feel strong, give them leadership. So businesses are just there and engaged and brilliant. They say, “We’ll do what’s needed.” And so the real challenge for me is governments somehow either saying “You public health people are exaggerating,” or saying this is the fault of x, y, or z country for bringing the virus into countries when in fact the virus is already there.

In the U.S., we have an issue with many people not having paid sick leave. Especially in the service industry—they can’t afford not to go to work.

I think this is the most important point of all. No health insurance, no nice employer is going to continue paying them when they’re working from home because their work involves contact with people.

People in the construction industry, people in the hospitality sector, people who work in restaurant kitchens, people who work in utilities—some of them will be able to work, but an awful lot of them won’t. And then their kids are going to be sent home from school.

Who’s going to look after the kids? The whole thing is going to hit poor people like nothing we’ve ever known before in advanced economies. And that really worries us. In Italy at the moment, there’s a huge underclass of poor people who are wondering, how in the hell are we going to survive?

Is this something businesses are ready to address?

I don’t know. This is a point we’re starting to explore with them. Perhaps we’ll get alacrity with them when we point out that this will be a bit of a dollars and cents issue.

This has been a process of continuous discovery, and as people start to come to terms with what this really means, there’s been a huge mindset shift among many people in the private sector over the last two weeks. The WHO can’t be responsible for some of this. So I expect this will be something that really would need to be an initiative from business leaders.

Anything else you would add?

In the U.S., you have a lovely thing where you give special attention to serving members of the military, where they get to go to the front of security lines at airports and have special lounges at stations and so on. They’re treated with real respect and people say thank you for your service.

We need to do that with health workers—not just the doctors and professors but also the nurses, the auxiliaries, the people who are going to be keeping the hospitals going, who are going to be gowned up in PPE—hot, sweaty, because it’s going to get hot—people who we’re going to depend on carry us through this.

Anything we can do to really help increase the respect that society gives to health professionals—because we depend on them more than ever for this—is great. In Europe, the real value of their income has been dropping, dropping, dropping, dropping over the years. Typically, the [female] health workers, they’ll be the ones who save a bunch of lives, and they’ll be the ones who face the greatest dangers. It’d be really nice if we can get real authentic support for them.