Annual Reflections: Islands of Good

“This year has been nothing short of eye-opening on so many levels. Hopefully the beginning of a renaissance in global public health and beyond, where our desires to build a new society with fresh, transformative ideals will eclipse the comforts of staying connected to an outdated status quo.”

My outlook has always been of the “glass is half-full” variety. This year has been no exception. Despite the tremendous challenges faced by so many around the world[1], I have tried hard to focus on the islands of good that have arisen during this pandemic - unprecedented innovation and collaboration; a greater awareness of our interconnectedness and relationship to the natural world; and a greater focus on family and self. 

Innovation & Collaboration

In November, I was invited to support the Secretariat of the Independent Panel on Pandemic Preparedness and Response as a Consultant. Co-Chaired by President Ellen Johnson Sirleaf and the Rt. Hon Helen Clark, the mission of the Panel is to provide an evidence-based path to prepare for the future. Analysis and recommendations will be grounded in lessons of the past and present, and will aim to ensure countries and global institutions, including the World Health Organization, effectively address health threats. The Panel will present its findings and recommendations at the 74th World Health Assembly, scheduled for May 2021. 

This work builds on research we at Antara Global Health Advisors conducted earlier in the year exploring factors that contribute to the success of R&D for poverty-related and neglected diseases, focusing specifically on the role of Product Development Partnerships. 

What becomes abundantly clear from the work we have conducted this year is the unprecedented innovation that has been spurred around the world.  This innovation has involved co-ordination across multiple sectors (public, private, non-profit, academia, civil society), and at multiple levels (regional, national, global), which together provide new considerations for the development and scaling of new tools. One obvious area where this has been demonstrated is vaccine development. 

The genetic sequence of the new coronavirus was published within two weeks of the first case being reported, spurring a race to develop vaccines and therapies. Since then, over 200 vaccine candidates have been announced to prevent the worst outcomes of COVID-19 infection, with a handful having already achieved regulatory authorization. Consider this in a context of long-standing efforts (going back to the 1800’s) to develop an effective vaccine for tuberculosis, a leading cause of infectious mortality worldwide. Today, Mycobacterium bovis bacille Calmette-Guérin (BCG), a partially effective vaccine developed in 1921, with a number of limitations, remains the only licensed vaccine against TB.

Conventional vaccine development averages 10-15 years between discovery and licensure. Clinical development alone usually runs between 2-10 years, with the process prolonged by lengthy and sequential review and approval processes (Lurie, 2020). COVID-19 vaccines, in contrast, have been brought to market faster than ever before, within a year – an incredible scientific achievement. This was due to rapid and advanced funding availability, as well as by leveraging approaches like parallel development, 'plug and play' platforms, manufacturing scale-up and innovative clinical trial designs - similar mechanisms used in the recent H1N1 influenza and Ebola vaccine development processes. Product development partnership models like the Coalition for Epidemic Preparedness Innovations have also made a huge difference.

While the jury is still out on whether we will achieve equitable scale of these vaccines globally, several innovative mechanisms have emerged to drive and scale development, as well as procurement and distribution. One of these mechanisms is the Access to COVID-19 Tools (ACT) Accelerator, including the COVAX Facility (the vaccines pillar of ACT-A). COVAX aims to distribute two billion doses to participating countries by the end of 2021 (covering at least 20% of their population, a low floor), with a primary focus on 92 low- and middle‑income countries (LMIC) that may not otherwise have the resources to purchase adequate vaccines. While this is one of the only multilateral mechanisms developed to ensure access to vaccines in LMICs, it still faces critical shortfalls in funding and support. COVAX currently estimates a need for an additional US$ 6.8 billion in 2021. Overall, global roll-out seems poised to be inequitable. Recent estimates from the Duke University Global Health Innovation Centre find that many people in LMICs may have to wait until 2023 or 2024 for vaccination. 

Meanwhile, if vaccines that have been developed by China and Russia demonstrate that they meet international standards for efficacy and safety, they may also help overcome shortages. India’s Serum Institute, the world’s largest vaccine manufacturer, will play an important role in manufacturing vaccines for LMICs. Certainly, it will take a global response to end a global pandemic. Here at home, Canada has pre-ordered approximately 10 doses of COVID-19 vaccines per person (including options), with plans to share any excess with other countries, likely through COVAX, to which Canada is a top contributor. 

Given the fact that in order to truly end the COVID-19 pandemic everyone, everywhere must have access to vaccines and treatment, equitable access will be a defining challenge of 2021. 

Amidst all of this, we must also remember that successful public health is invisible; a prevention paradox. When nothing happens it's the sign of a successful outcome. Investing in things that are invisible to the majority is difficult. But it is a lack of investment in such things (e.g. surveillance; strong health systems; stockpiles of PPE and other essential health supplies; R&D of countermeasures; coordination and leadership with appropriate authorities; capacity building and human resources for health; focus on equity; etc.) that played a role in getting us to where we find ourselves today. 

Quotes that have inspired me this year: 
 
“I fundamentally believe that we as human beings are not defined by the conditions we face, no matter how hopeless they seem—we are defined by how we respond to them.”
                                                
 
                        —Dr. Raj Panjabi, co-founder and CEO of Last Mile 
                         Health, one of TIME Magazine’s 100 most        
                         influential people
 

Interconnectedness and Relationship to the Natural World

Pandemics, like COVID-19, are a mirror for humanity. As societies, we create our own specific vulnerabilities. Studying the dynamics at play during this pandemic, both at country levels and on a global scale, gives us insight into standards of living, political and personal priorities, and reflects the moral relationships that we have towards one another and the planet. Whether in relation to the emergence of new diseases, or how we respond to them, the importance of understanding indirect relationships has been thrown into sharp relief.

During a recent interview with the University of Waterloo, where I teach Global Health Innovation, I spoke about some of these important connections as part of a larger interview on COVID-19:

Expanding on some of these themes, and exploring critical linkages between global health and climate change, one of the highlights of my year came as part of the Opening Plenary of this year's, Canadian Conference for Global Health. It was a great honour for me to interview the amazing Dr. Jane Goodall on behalf of the Global Health community. 

The focus of this year’s conference was planetary health— defined as the health of human civilization and the state of the natural systems on which it depends. Dr. Goodall and I discussed a variety of related themes including the emergence of COVID-19; the interconnectedness of animals, people and the environment; political action and the importance of storytelling; indigenous perspectives; youth engagement; mental health and mindfulness. Readers can learn more about our work at the Jane Goodall Institute by visiting www.janegoodall.ca. 

Undoubtedly, this pandemic has left its mark on every one of us – a shared, human experience that has reached every corner of the globe and whose consequences will be felt for decades. It has given us insights into our inextricable linkages. A key aspect of preparedness for facing these events is that, as human beings, we must realize that we’re all in this together. Decisions of the few, can affect the many. 

Quotes that have inspired me this year: 

"People normally cut reality into compartments, and so are unable to see the interdependence of all phenomena. To see one in all and all in one is to break through the great barrier which narrows one's perception of reality." 
                                                                                                
                                   - Thich Nhat Hanh
 
"Lost in awe at the beauty around me, I must have slipped into a state of heightened awareness... Self was utterly absent: I & the chimpanzees, the Earth & trees & air, seemed to merge, to become one with the spirit Power of life itself" 
                                                                                               
                                   -Jane Goodall, Reason For Hope
 

Focusing on Family and Self

Finally, this year led to a new depth of family engagement. While I have always been an engaged father/husband, with balancing work-from-home, travel restrictions (typically I am in the field ~30% of the time), intermittent lockdowns, home-schooling our kids, etc. this year, like many of us, I “leaned-in” in a way I hadn’t before. 

My career has tended to focus my perspective towards the macro, working to improve health on a global scale. My lens has been trained to think about things at a population level. Applying this broad lens has allowed me to maintain perspective, understand larger trends and relationships, and see things more holistically while strengthening systems and health access for the most vulnerable. 

While this focus continues to drive me, this past year, much of my thinking and reading has also focused on the micro - mastering the self and my role as a householder. Books like Waking Up by Sam Harris, Atomic Habits by James Clear, and Practicing the Power of Now by Eckhart Tolle have helped recalibrate my thinking and approach to life. Attempting to develop a habit of meditation has been an important accompaniment, for the mind is the basis of everything we experience in life and of every contribution we can make to the lives of others. So, it makes sense to train it. 

We know what it’s like to have a restless mind. It’s what allows us to be less than happy, even when things are about as good as they can get. It’s easy to spend much of our time stressed out, thinking about all the things we need to do, or want to do, or wish we hadn’t done, rather than spending our time truly content and focused in the present. As a result, we can fail to really connect with the people around us. Understanding our minds more deeply, directly through meditation, is perhaps the best way to approach this. 

As a result, more and more, I find myself asking, “Do I really need to solve this particular problem right now?” 90% of what my brain runs off and tries to do, I don’t need to tackle at that particular moment. If the brain is like a muscle, I’ll be better off resting it, being at peace, and focused on what I’m meant to be doing at that time, such that when a particular problem arises, I can immerse myself in it fully. 

I cannot expect to effectively change global systems, if I cannot change myself first. The ability to change oneself is one of the greatest superpowers we have. The time we invest in optimizing ourselves is one of the best ways to invest in our children and others we care about. When family life is strong, our ability to do good for the larger whole is fortified. This pandemic has led to me having more moments of deep presence with my family, and for that I am grateful. 

[1] Over 1.9M deaths and >88M cases as of this writing, a global economic impact the World Bank has predicted will trigger the worst recession since World War II, global extreme poverty expected to rise for the first time in >20 years