An Insider’s Analysis Of The WHO’s $31 Billion Dollar Pandemic Plan

“Global health governance is not fit for purpose, and it doesn’t represent a vast majority of global needs and wants and desires, and people on the ground and what’s going to affect them. It gets captured.”

Today I sit down with Garrett Brown, professor of global health policy at the University of Leeds. Brown has been working on strengthening health systems in the African context for decades.

“You can talk about rights and freedoms, but none of those matter if you don’t have good health. You can’t exercise any of those things,” he says. “It’s a fundamental part of what it means to be human and have any minimally decent life.”

Brown and his research team were recently hired by the World Health Organization to determine whether its $31.1 billion plan for pandemic preparedness and response was justifiable, or even feasible.

“The worry is that if you’re asking nations to pony up roughly $26 billion, where are they going to find that money? They’re going to find it from existing programs,” says Brown. “Indonesia has just basically suspended their polio program and moved those human resources into vaccines.”

Brown is troubled by the high cost of the WHO’s pandemic plan, which would require resources for basic health to decrease by 34 percent, and basic nutrition by 10 percent.

“We saw this with malaria, tuberculosis, HIV, AIDS, reproductive health—that resources were being shifted from certain national budget lines into pandemic preparedness,” says Brown.

Interview trailer:

Watch the full interview: https://www.theepochtimes.com/an-insiders-analysis-of-the-world-health-organizations-31-billion-pandemic-plan-garrett-brown_5196306.html

FULL TRANSCRIPT

Jan Jekielek: Garrett Brown, such a pleasure to have you on American Thought Leaders.

Garrett Brown: Thank you for having me.

Mr. Jekielek: Garrett, you run a research group at the University of Leeds that provides quite a bit of information to the WHO.

Mr. Brown: Yes.

Mr. Jekielek: In your unique role, you have a view into how this very opaque system operates. Here we are, and we’re going to take a look. But for starters, how did you end up being someone that provides this profound pandemic research information to a group like the WHO?

Mr. Brown: In the early days of the pandemic, I wrote a piece for the BMJ, which is the British Medical Journal, suggesting that we have five paradigm failures in the way we’re thinking about the pandemic. That was read by the head of evidence and analytics at the WHO. He said, “My unit is trying to think of a different way of approaching these things. Would you look over some stuff for me?” I said, “We need to evidence this better.”

He invited me to do that and we provided 343 pieces of evidence for this new framework that was coming out. Then, I just started getting more and more involved in different committees. The more recent work we’ve been doing for them is thinking about financing these massive costs for pandemic preparedness that people are talking about, and the feasibility of actually financing these numbers.

Mr. Jekielek: $31 billion a year was the number that’s been floated, unbelievable in scale. We’re going to definitely talk about this. Before we jump into that, what were these paradigm problems that you saw at the beginning?

Mr. Brown: The first one is the way we think about health security. Instead of thinking about preparedness and prevention, we always talk about preparedness and response. I was saying that there are many things we can do to prevent these things, and not just prepare for them. We can encourage better population health, look at upstream determinants, and think about how to do that with more sophistication.

The main one that I was talking about is what I called the pastorium paradigm. You wait for a pathogen, you sit, and in this case, lockdown, and then you wait for the cure to come. Then, you roll that out to as far as you can to 100 percent and you’re saved. Where are the therapeutics in that?

There are other things you can do to think about this with more of a systems approach to preparedness and prevention, rather than just that model. We would need to start thinking about health systems and how you create more resilient health systems and create more adaptive health systems. It can’t just be this pastorium paradigm, which we ended up doing, and I was quite critical of that.

The WHO got it and said, “We’re working on something. We’re calling it health systems for health security, and we want to think about a more sustainable way of preparing and preventing these types of events.”

Mr. Jekielek: First of all, this is one of the few hopeful things I’ve heard about this system, that they were actually interested in your work and invited you to contribute. The response didn’t seem to go the way you were suggesting, but at least there was interest.

Mr. Brown: Yes. They knew they couldn’t change the course of the way the momentum was heading. This was a long-term project for them thinking about how to strengthen health systems in a way that actually has routine health effects for the average person on a daily basis. It can also cover some of the concerns we have about health security, and not have this 1980s war-like mentality about health security. Let’s talk about population health, and let’s talk about other things like that.

I thought that was refreshing. I’ve been working on health systems and health systems-strengthening in the African context for ages. It’s really dear to me that you need robust systems that can take shocks and do routine health for people to make them healthier, in order for them to be more resilient. More resilient people are more secure. It just makes sense.

Mr. Jekielek: Most recently you’ve been working on providing analysis and research on how to create a $31 billion a year global infrastructure for pandemic preparedness.

Mr. Brown: And response.

Mr. Jekielek: And response, if I understand it. So, $31 billion a year?

Mr. Brown: $31.1 billion is the estimated need for pandemic preparedness response at all national, regional, and global levels. This is what the WHO, the G20 and the World Bank are estimating is the requirement.

Mr. Jekielek: For starters, how is this going to work?

Mr. Brown: Let’s put it in perspective. The total operating budget for the global fund, which is responsible for AIDS, malaria, and tuberculosis, three of the biggest communicable diseases, is around four billion a year. Those are already hard to finance. That is already complicated.

You have these annual replenishment models, and there’s a lot of squabbling about who’s going to pay what. They are already complicated with high transaction costs, because you have to replenish them all the time. Suddenly, you’re talking about $31.1 billion.

Mr. Jekielek: Before we go there, can you give us a sense of where that money comes from?

Mr. Brown: You mean the money for the global fund?

Mr. Jekielek: The global fund of the WHO.

Mr. Brown: A mixture of donors, usually high income countries, the United States, the UK, the Bill & Melinda Gates Foundation. The usual funding sources. Overseas development. Aid for health is what they call it. On an annual basis, the State Department will relinquish a certain amount of money to these institutions.

The leaders at the G7 will commit a replenishment package to the global fund. They are willing to pay a certain amount on an annual basis for the next two years or three years. That’s where the money is generated from. Usually, high income countries pay into this.

Mr. Jekielek: It’s mostly from high income countries, and then also from these large private foundations?

Mr. Brown: At the moment, the big one is the Bill & Melinda Gates Foundation, obviously, but there’s others. The Wellcome Trust has moved from a research organization to a policy organization, and they’re putting money into health.

Mr. Jekielek: All right. Let’s go back. $31 billion is an extraordinary number. Please tell me about this.

Mr. Brown: The $31.1 billion, I’m not quite sure how that cost was calculated. My research team gave some raw material and lots of others gave raw material and then a report was suddenly generated saying that these are what the costs are. One of the questions is whether or not this is really what pandemic preparedness and response should cost, and how we can justify those numbers. But those are the numbers being used.

The idea at the moment is that $4.7 billion is what’s required at the global level in terms of coordinating surveillance and coordinating other mechanisms that they think are necessary. There’s something like 92 indicators called buckets.

At the national level, we’re asking states for their national programs to be aligned with the global programs. That’s going to be about $26 billion a year. The problem with this now is you’re asking low-income countries to pony up this money, and so the donors will have to cover that as well. They’re thinking that at the global level, donors will be required to come up with around $10 billion to $15 billion a year to cover those costs and the global level costs.

Mr. Jekielek: You don’t even know exactly how this $31 billion was reached. There’s different groups that contributed. Now, your job is to try to figure out how to do that.

Mr. Brown: Can we finance that? What are the warring trends around current financing of pandemic preparedness and response? We tracked the official development assistance [ODA] for health. Every year the OECD [Organization for Economic Co-operation and Development] comes out with line items. What are we spending our development aid on? They added one for Covid for 2020, and it was an extraordinary amount of money.

Mr. Jekielek: It’s funny when you say that. They added a line item, but it was big.

Mr. Brown: It was a huge line item. If you start unpacking it, almost all the new development aid money went to Covid or into infectious disease control. A lot of them were Covid-based and a lot of that money went into vaccines. We started to ask, “What are the effects of this?” We saw some staggering numbers.

Basic health is a line item, and basic health fell by 34 percent. You’re shifting money from basic health into pandemic preparedness and response. Basic nutrition fell by 10 percent. Nutritional programs have seen money depleted. We started looking into this further and what about task shifting at the national level? We saw that too.

For example, there’s a study out of Indonesia where Indonesia has just basically suspended their polio program and moved those human resources into vaccines to administer vaccines. We saw this with malaria, tuberculosis, HIV, Aids, and reproductive health.

Those resources were being shifted from certain national budget lines into pandemic preparedness. The worry is that if you’re asking nations to pony up roughly $26 billion, where are they going to find that money? They’re going to find it in existing programs.

Mr. Jekielek: You said this is close to your heart. On the ground in Africa, when you pull 34 percent from basic health and 10 percent from nutrition-

Mr. Brown: It has impacts.

Mr. Jekielek: What are the real world impacts on people?

Mr. Brown: There will just be less resources available to combat malnutrition, and there will be less resources available to strengthen health systems. If you think about some of these health systems, definitely in very remote areas, they have difficulty staffing them because no one wants to live out there. They have difficulty getting materials out there, and they have difficulty keeping the lights on sometimes.

Health is important. You can talk about rights and freedoms, but none of those matter if you don’t have good health. You can’t exercise any of those things. It’s a fundamental part of what it means to be human and have a minimally decent life.

Once you start taking from that, there’s a cascading effect on people’s ability to engage in the economy, people’s ability to engage in their government, and the people’s ability to take care of their children. Then, those have knock-on effects.

So, the number is extraordinary. I do question the number. I’m not saying we shouldn’t have pandemic preparedness. I’m just wondering if it needs to be $31.1 billion a year. My guess is, it doesn’t.

Mr. Jekielek: I don’t know if this is the elephant in the room. I’m sure you’ve thought about this, but the pandemic response, as it happened, was largely poor. That’s an understatement. You have a very subdued academic way of talking about these things. Let’s just say it didn’t work very well.

Mr. Brown: Yes, it didn’t work very well.

Mr. Jekielek: The cost of that was 100 million people descending into poverty among other things, with an upward transfer of wealth. Also, I would argue a lot of death that didn’t need to happen, if there was a smarter way of doing things. Is this being looked at?

Mr. Brown: It is being looked at, but I don’t know if it’s being looked at seriously. There’s a recognition, at least where I live, that the lockdowns didn’t have the effect they wanted them to have. In the end, they were highly costly and not very effective.

There were other externalities that came from it like increase in mental health issues, domestic violence, and increase in children not being educated. Those have effects. We haven’t quite calculated all those yet. One of the numbers I hear batted around is that Covid cost us somewhere between $12 and $20 trillion in stimulus packages and lost GDP [Gross Domestic Product], when you factor everything in.

Mr. Jekielek: When you add up everything.

Mr. Brown: No one has come up with a really good solid number yet, but they’re starting to figure that out, and it’s massive.

Mr. Jekielek: It’s unfathomably massive.

Mr. Brown: Those are opportunity costs, because if you just think, “What if we put $20 trillion into something else? What if we did something else with that money or have that money used in other ways at a more micro-level in an individual’s life?” It would be profound. What did we get for that 20 trillion in the end?

Mr. Jekielek: As a society, and certainly among our leadership and policymakers, we forgot about the idea that everything needs a cost-benefit analysis. What you need to undertake is cost-benefit analysis. The profound positive impact that money could have in different places is also unfathomable.

Mr. Brown: Or the money just staying with you, and not coming to you from somewhere else. Ultimately, this is being paid for by sovereign debt. There are massive opportunity costs with $31.1 billion.

Mr. Jekielek: Quickly, just for the benefit of our audience, please explain what opportunity cost is.

Mr. Brown: What could you do with that money otherwise, and what benefits would you get from that? Everything has an opportunity cost. What could have been the opportunities available to you, if you would have done something else with that money or that time?

Mr. Jekielek: Or just kept going with whatever you were doing in the first place.

Mr. Brown: Yes. There are some major health issues that we should think about at the global level, like antimicrobial resistance. There are things that are spooky out there that we are not very good at coordinating responses to, and that we’re not taking seriously. Because of Covid-19 and because people are angry about what happened and the loss, we are now thinking about pandemic preparedness. There’s a lot of focus on it.

We should be prepared. Of course, we should be thinking about these things. But my worry is that there’s so much focus on that and so much interest on it and we’re moving very, very quickly. The pandemic treaty is moving very, very quickly. The pandemic fund, which already now exists in the World Bank, moved very, very quickly.

Are we thinking these things out in the right way? Are we thinking about the opportunity costs here and are we using the right numbers? Is it even feasible to generate $31.1 billion? The answer is, “No, it’s not feasible.”

Mr. Jekielek: Well, and-

Mr. Brown: It’s not going to happen.

Mr. Jekielek: I’m just going to-

Mr. Brown: Maybe that’s a good thing.

Mr. Jekielek: Right. There was some kind of global coordination with the deployment of these genetic vaccines. There was a strong push, not just in the U.S. and Canada, but everywhere. There was very similar messaging that everybody needs to get the vaccine, when the epidemiology from the beginning clearly didn’t demonstrate that.

Is it a good idea to put so much control for a global response in one place? This pandemic treaty and some of these international health regulations, as I’ve been looking through them and talking to experts, really do push a lot of control.

Mr. Brown: You need to have coordination mechanisms at the global level. To suggest that you can operate solely on a national level in today’s world is a non-starter. We do have to have coordination and that could be good. That could also be bad.

There’s a lot of regional laboratory networks in Africa post-Ebola. Great idea. Not every nation needs to ramp up all their laboratory facilities to the same level and have duplicating systems that are literally a hundred miles away from each other. There’s just a border in the middle.

By networking your laboratories, you increase information flows between them. You also increase your alert system between them and you get economies of scale. At the same time, you don’t have to have all the expertise in every single state. Those types of coordination mechanisms make sense to me.

What doesn’t make sense to me is when you remove context from these debates. In health systems we always say context matters. Context matters. Contextual moderators, meaning how external factors influence the way a health system can operate, are important. You need to understand those.

The only way you can understand those is by understanding the context. We’ve removed that. I’ll just give you one example. The WHO comes out early on and says, “We need to vaccinate 70 percent of Africa. African countries rightfully said, “A, we can’t afford this. B, we’re not sure about this.”

People like myself were saying, “You should not be sure about this, because your mean age is 19. Your context is different from Italy where you have an older unhealthy population. You have a younger, more healthy population, and this may not be right for you.”

That’s a contextual concern that moderates how you roll out any kind of program. We have to keep that in mind when we think about these coordination mechanisms at the global level, while also thinking there’s nothing wrong with having the right kind of international health regulations.

It would have been very good if China sent this material up within 72 hours. It was open source and people could start working on it. They didn’t do that. But that’s what the IHR [International Health Regulations] say, and that makes perfect sense to me. It’s a cheap thing to do. It’s just about thinking more smartly.

They’re also revising the international health regulations. I’ve had a look at them. A lot of it’s the same old stuff. Some of it’s better, some of it’s worse. These debates are taking place. My concern is to make these debates a little bit longer, more nuanced, and more sophisticated, so that we can get to a better answer.

Mr. Jekielek: I don’t know if you want to comment on this or not, but there’s also this reality that certain players like communist China are interested in co-opting such systems for their own benefit, with not a lot of interest in public health. This is a profound national security issue for any nation.

Mr. Brown: Everyone has interests and that’s what politics is—trying to come to some intersubjective agreement through interest. Of course, communist China has their interest, and so does the United States. We saw this with big pharma, and we saw this with other interests. These interests are playing out. They’re aligning their interests where they can. They’re competing.

Early on, the WHO and the World Bank were competing for control of this pandemic fund. Where is it going to be housed? Is it going to be in the global fund? Is it going to be a new FIF in the World Bank? Which it turns out it is going to be. There was a debate there.

Once decisions were made, you see that contestation moves to cooperation or to alignment. Yes, there are interests at all levels. Years ago, there was this argument that we need to depoliticize health. You can’t depoliticize something as political as health, because politics is about who gets what and why.

It’s not that we need to depoliticize it. We need to make better politics, more legitimate and accountable politics. What we have now is poor politics. But you can never depoliticize health. It’s a deeply political issue. It should be, because that’s how you make decisions.

Mr. Jekielek: My concern is that you have players who say they’re going to play by the rules, but they’re absolutely uninterested in doing that.

Mr. Brown: No. Let’s go back to the IHR. Only 47 percent of countries were compliant with it by 2015.

Mr. Jekielek: That’s the International Health Regulations.

Mr. Brown: That’s what they said. You have five years to become compliant by 2015. No one made it. They extended it and it only got to 47 percent. You can have these regulations and think they’re draconian, but it doesn’t mean that people are actually going to follow them. There’s no enforcement mechanism for them.

You can name and shame, and you can make development aid conditional on you meeting those. You can inject money to try to help them do that. You can relieve sovereign debt to free up money for them to do it themselves. There’s different ways to do it. But one of the problems is people aren’t compliant with the rules that are there. China was a bad citizen on this and that should be noted.

Mr. Jekielek: I keep hearing that the treaties have more force of law. As we’re filming here, we just published an article in The Epoch Times last night, talking about how the current U.S. administration hopes to ratify this treaty without the typical two-thirds Senate approval, and that they have a method to do that.

Mr. Brown: I didn’t know that.

Mr. Jekielek: Again, a lot of these accountability questions are coming to mind.

Mr. Brown: I’m not in favor of the treaty and it’s just going to duplicate problems we already have anyway. But yes, a treaty is the highest form of international law you can have. But even so, country’s break treaties all the time.

That may not be the kind of coordination mechanism we need. It’s really a knee-jerk reaction. No one was following the IHRs, and no one was living up to their requirements, and there were bad citizens. China was a bad citizen on this.

We need to elevate it to this extreme level. I’m just wondering if there’s other measures we can do that can get people together for cooperation without having to be a treaty.

Mr. Jekielek: You’ve already explained why you’re not for the treaty, but please expand on this. Is the main reason just because it’s so inherently coercive?

Mr. Brown: I don’t know if it would be coercive. This is part of the problem. I don’t actually know what the treaty’s going to do. I know what they want it to do, but there’s not a lot of voices in the treaty in the early stages. It got moved very quickly and the enforcement mechanisms are unclear. Treaties do have enforcement mechanisms, but they have to be written into the treaty. That’s where the debate is right now.

There’s pushback from a lot of countries on this, because the fear is that the enforcement mechanism is going to be conditioned development aid. If you don’t use your development aid in these ways to meet the treaty, then we’re going to pull it. If you are desperately in need of development aid after any sort of event and that gets conditioned, then you’re going to comply.

That’s kind of a form of coercion where you say, “You don’t have to take this money. You have this cyclone and you need this money. You don’t have to take it, and we’re not coercing you to take it, but you’re actually desperately in need of it.” It is a form of coercion, because you’re suggesting that to get this money, you have to comply with what we want you to comply with. That will most likely be the strongest enforcement mechanism.

I also heard another rumor that you could use the WTO [World Trade Organization], which is a quite powerful global institution. They have a pretty high compliance rate. I make this joke. The two strongest global institutions are FIFA, the football organization, and the WTO. If you want to duplicate that kind of authority model, then look at those two organizations.

Mr. Jekielek: At least one of them is deeply corrupt from what we know, the FIFA [International Federation of Football Association].

Mr. Brown: I thought you were going to say the WTO.

Mr. Jekielek: We could have debates about this, but I was just thinking about the WTO as you started speaking and I’ll tell you why. I’m someone who’s a student of the realities of communist China vis-a-vis the international system and how they’ve used it. There is a high level of accountability for following WTO regulations, except for communist China.

They use the system to enforce compliance around other countries, but they themselves are constantly out of compliance. I would argue the global system has funded their rise through this particular mechanism. I would be against a treaty for precisely this reason.

Mr. Brown: Strong states are always able to push back. Where the WTO is very powerful is on weaker states or smaller states, because they can’t push back. They have to comply quite quickly or they’re going to feel the force of the WTO. China’s in a position where it can push back, and the United States does this too.

Mr. Jekielek: I’ll just jump in. The irony is that China was allowed in as a special case. They hadn’t actually met the entry requirements. The US said, “We trust these guys. We should let them in.” I don’t think anyone would argue that they’ve been true to that. But my point is, now we have a treaty and we’re all signing it.

Mr. Brown: We’re talking about a treaty. I don’t think anyone signed it yet.

Mr. Jekielek: But it’s moving fast.

Mr. Brown: It is moving fast.

Mr. Jekielek: What moves fast in these international organizations? Not a lot. This is moving fast. I want you to comment if I’m wrong.

Mr. Brown: No, they’re moving extremely fast without a lot of input.

Mr. Jekielek: Without a lot of input.

Mr. Brown: If you look at the pandemic fund, that thing moved super fast and there were no civil society organizations involved. Finally, after setting the foundations of what the fund was going to be, where it was going to be, and how it was going to be managed, they allowed two seats there. As to how they were nominated, it’s the same old civil society organizations that are in these other organizations.

The argument for that is that it creates better networks, so that people know what other people are doing in other institutions. But you could also say that fosters groupthink and enclave thinking. My whole position on this is that maybe we need a pandemic fund, and maybe we don’t need a pandemic fund. But can we just slow down and think about if we want it housed in the World Bank? Do we want it to be operated like an FIF?

Mr. Jekielek: What is an FIF?

Mr. Brown: It’s a financial intermediary fund. It’s like a bank account. The Global fund has their money as a FIF inside the World Bank, and they’re separate. For the pandemic fund, they’ve decided to keep the governing body inside the World Bank. I’m curious about why those certain decisions were made? We know that you can run these funds in different ways, and manage them in different ways.

Why were certain ways chosen and other ways not chosen? Who made those decisions and how those decisions were made? Where were the inputs and what was the debate about? That’s what I’m curious about. It’s very hard to find that information. Some minutes are available, and some are not available. Some you can request, and some you won’t get back.

If we could just slow down and think about it a little bit more, I bet you we could come up with a better way of having a fund. Any organization is organic. It’s self-preserving in a way. When money like $30 billion is being discussed, and you’re the WHO, or you’re the World Bank, or you’re the Gavi Alliance, or you’re the global fund, you want to be part of that.

Some of that might be for good reasons. We think we do good work and we think we can add value here and use that money in real positive ways. Some of it’s self-sustaining. Some of it is moving up the hierarchical rank of who’s a more important institution. That all plays out. These debates were largely taking place between the G7 and the G20 about where we are going to house these.

Who’s going to be responsible for the pandemic fund? How is it going to look? Those interests were all playing out there. When we were doing the cost estimates for the WHO, they wanted to generate their numbers. The World Bank was also generating their numbers for the G20. It became very clear to me that they were all going to come around the same number, regardless of the methods of how you would generate the number.

That was because somewhere in the G20, it was already determined that was the number. We were kind of meeting a number, instead of inductively figuring out, “What would it cost?” The numbers we were actually looking at were far less than $31.1 billion.

Mr. Jekielek: Given that we’ve witnessed the largest upward transfer of wealth in history over the past three years, there is a lot of suspicion about big numbers these days, where those numbers come from, and who is benefiting at the top of the food chain.

Mr. Brown: Absolutely. Certain big winners will benefit from the $31.1 billion, because there’s a large package for research and development. There’s a lot for vaccines, for surveillance systems, and for field epidemiology. Some of those are good, and they’re for public good.

It’s good to have a field epidemiologist out there collecting and surveying, and then, you pass that public good up. “Here, we have some information on a new virus or a pathogen.” But then, it immediately gets shifted into a private good.

This is public money, this $31 billion. It might be partly financed by the private sector, who knows. But you’re taking a public good, information about a potentially dangerous pathogen that we should know about, and then, you’re turning it into a private good.

We do that with the flu for flu countermeasures. Every country collects their flu samples and sends them into these five WHO laboratories. The WHO laboratories look for the ones that they think are either going to be the most suspicious, and then they send those out to pharmaceutical companies to make the countermeasures. Public good turns into a private good.

When you have that kind of relationship, the interests come in right there. Who’s going to get access to that raw material? Who’s going to be able to make pharmaceutical countermeasures out of that material?

Mr. Jekielek: And profit.

Mr. Brown: And profit. These are big interests. Countries have interests too as we saw with the vaccines that we did have. AstraZeneca was a British product, and they quickly made that a national product. Pfizer was a U.S. product. There’s prestige, there’s politics, there’s money, and there’s protecting your industries. All of those kinds of factors played out.

Mr. Jekielek: Let’s talk about your analysis here. You were intimating that this $31 billion is not remotely achievable. There is this huge opportunity cost. Even trying to achieve that will actually cause a lot of harm. Please explain this to me.

Mr. Brown: We ran a series of models to see if we could meet these costs. The first one we ran was about can nations afford this $26 billion annually, and what would that take? We looked at growth, and assumed a certain percentage of GDP growth by low and middle income countries. We found that they would have to spend 77 percent of that money from their new growth on PPR [Pandemic Preparedness and Response] exclusively in their health system.

Mr. Jekielek: And PPR being?

Mr. Brown: Pandemic preparedness and response.

Mr. Jekielek: Got it.

Mr. Brown: To meet this $31.1 number, the $26 billion component of it.

Mr. Jekielek: Over three quarters of their growth money for the entire country-

Mr. Brown: Would have to be sunk into this. That’s just unfeasible. That’s not going to happen. It’s an untenable number. The only way for us to meet the global number would be if high income countries significantly contributed. We assumed a 2.5 percent growth between now until 2027 for health.

We found that even in our best case scenario where all the countries paid in, we still wouldn’t be able to make that amount. That’s also an untenable number. The only way to meet these, if we want to make them meet them, is by injecting a significantly more amount of money on overseas development assistance for health than we do now, and dedicating more of that towards pandemic preparedness and response.

What do you do here? You either have to find new innovative methods of financing these things, or you need to rethink and prioritize those five buckets for pandemic preparedness and response, and prioritize where’s the best value for money, and what ones are going to have the greatest effect.

It goes back to your cost-benefit analysis. That’s probably where we’re going to go with this, because at the moment, the pandemic fund only has $1.7 billion in it. They’re not already generating the numbers that they need. That means we’re going to have to rethink our approach and come up with prioritization models that ask what are the big key priorities and how do we finance them with the money that we have.

The concern for me is how do we make those determinations of what are the priorities, what are not the priorities, and where the money goes. That’s what worries me, because at the global level, global health governance is not fit for purpose. It doesn’t represent a vast majority of global needs and wants and desires of people on the ground, and what’s going to affect them. It gets captured.

Mr. Jekielek: Right. I’m thinking back to what you said, there are these epistemically important players, as you described them.

Mr. Brown: Epistemic authorities, I call them.

Mr. Jekielek: Epistemic authorities. For example, the head of a big pharmaceutical company, just to give an example.

Mr. Brown: The Lancet.

Mr. Jekielek: The Lancet.

Mr. Brown: A special issue of the Lancet has a massive amount of epistemic authority. People look at it and say, “It’s in the Lancet. This must be definitive. The pharmaceutical companies know more about pharmaceuticals than anyone, so it must be definitive. The WHO. They’re the ones who are supposed to be coordinating all these policies. They must be definitive.”

It’s never that easy. I don’t think it’s ever that easy. Those authorities should be reason giving, as I call it. There needs to be more reason giving within the political process. I’m all about actually extending things, adding more deliberation, and coming to a better intersubjective agreement. The only way you get there is by reason giving. You can ask them, “Why do you think that’s the best way to go?”

Everyone can say, “This is what I think. I tell you that, and then you tell me,” and it’s all done in good faith, hopefully. You come to some kind of agreement. These mechanisms are just not available. The World Health Assembly is two weeks long. There are a million subcommittees. It’s impossible to know everything. Most countries can’t put members in all those committees.

You have a team of four and there’s 20 parallel committees going on. There’s just no mechanism for that kind of dialogue in a way that’s meaningful or legitimate. That’s where big interests with big money behind them or power behind them like the United States or China or other countries can capture those processes and steer agendas very strongly, for better or for worse.

Mr. Jekielek: There’s an inordinate focus on this new vaccine technology as being an important part of what we do. From where I sit, I see this as a largely failed technology.

Mr. Brown: Right.

Mr. Jekielek: But there seems to be a doubling down, perhaps because of these epistemic authorities, which doesn’t reflect the reality on the ground of the effectiveness of this vaccine technology, and also the harms of the products themselves.

Mr. Brown: It’s an awkward social phenomenon, and I don’t think I have my head around it. The usual suspects are there. People don’t like to lose face. People are going to double down because they don’t want to lose face. People get pathway dependent and say, “We’ve already invested so much money in this, it would be a huge loss if we shifted directions now.”

People don’t like to admit they’re wrong. Governments don’t admit they’re wrong anymore. They never say, “We got this wrong.” You have a group on one side trying to give you a universal answer to health, and you have a group on another side trying to give you a universal explanation for what happened. You’re not going to be able to do either one of those.

It’s way more complex than that, and it’s more nuanced and sophisticated and multilayered. On both sides, the critics and the advocates, these simplified universal explanations aren’t going to capture it. It’s not the reality on the ground, because it’s much dirtier, complex, overlapping, and contradictory. If I was a philosopher, I’d say dialectic, where it’s both good and bad at the same time.

The big question, in the next 10 years, is to try to figure out this social phenomenon that you talk about.

Mr. Jekielek: Garrett Brown, it’s such a pleasure to have you on the show.

Mr. Brown: Thank you very much. This was fun.

Jan Jekielek: Thank you all for joining Garrett Brown and me on this episode of American Thought Leaders. I’m your host, Jan Jekielek.

This interview was edited for clarity and brevity.

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