Dean Jamison, Chair Professor of Global Health Emeritus, UCSF, Principal Investigator, Disease Control Priorities, Network, USA, 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:
Gordon Liu, thank you so much for that introduction. And as the other speakers have said, of course, it really is an honor to be able to join you at the beginning of what will be undoubtedly exciting journey. Both within the university, and with your institute relationship to the world. Congratulations to you, and university, and it's my pleasure to join you.
When you work in bureaucracies, as I did for quite some time to world bank, random things happen at the time. An important random thing happened to me, as a member of research economist, and that was by mistake, I was asked to join the world banks first large economic mission to China. By mistake, because I was at the time an education economist, I was heading a division that was mostly health economists so my seniors at the world bank assumed that I was a health economist, and so I was invited to this mission. That changed my life in two ways. It changed my main profession interest in education to economic theory to health. It began a relationship for many years the China, and Chinese institution that has been just an enormously enriching in my life. I'm looking forward very much to the personal relations to being continue to collaborate with Gordon and with the institute.
The topics to me have been extraordinary interesting. One of the things I think first successful institute is to put together this very interesting form, and I would like to reflect on just a few points that are not the sort of larger pictures that we heard, but a few things that have struck me in the course of the day, and the course of my work in shadow of COVID-19 of last year.
The first fairly obvious point is the importance of speed in responding to pandemic. The speed at one dimension that have is the economic dimension. Justin LIN talked about the importance of China’s having had achieved high level health as underpinning for such rapid economic growth. Gordon Liu has been a leader in the economic relationship between health, and economic outcomes, and the other way around.
So you have potentially vicious or virtue circle here that has been working at the world mostly as a virtue circle -- better health to better economic outcomes to better health. And the jolt of COVID-19, as we heard today, threaten to reverse that circle into a vicious downward spiral, and early actions, speed in response, I think is one of the main ways of changing the trajectory of the academic.
The second point that I would make is around speed, fast speed alters the trajectory of pandemic and therefore has a long-term effect depended on what happened the outside.
Third point is as Summers emphasized about aborting potential unfortunate evolution of the virus to greater transmission ability that we are now seeing in England. And that the quicker and more fully the epidemic is under controlled, the higher the probability that would be able to avoid that kind of revolution.
Criticizes leave us in terms of some the main points raised today. One main point is, even in the middle of the pandemic, we need to begin to draw the lessons, not only to closing up this pandemic but to preventing or attending maybe swirly on the next pandemic.
We’ve heard a range of discussions about that. Victor Dzau spoke very compellingly on the need to reform that kinds of preparedness measures that individual countries putting in place that world health organization has provided, kinds of those measures have turned out, that several speakers said to, correlated very poorly.
So what we do next in terms of preparation. The question Jeffrey Sachs posed on very dramatically about extreme differences and outcomes we seen around the world. Most of difference outcomes have resulted from NPIs –Nonpharmaceutical Interventions that has required for success as we heard -- good leadership, degree of trust between populations and governments and openness to a right kind of behavioral change. So, it is clear from the experience we have so far, NPIs can pretty much do the job better especially by increased technologies we have for testing that strongly help to guide NPIs.
There is a big downside to the observation, that good leadership is required, trust is required to make the NPI approach work, as it works much in Asia, hasn’t work so well in Norther America or Europe. What implication this have for preparedness?
To me it points to important of as rapidly as possible bring in the technocratic solutions. It is clearly true that been a phenomenal scientific and industrial success in bring in a number of vaccines quickly to market. But quickly is still a year, extremely quickly by historical standards to vaccine market and drug market. But a year is a very long time in a course of the pandemic. Are there ways that year can be shorten before as soon a major technocratic alternative to NPIs, compliment NPIs, in many countries successful NPIs, is going to be vaccination. What can we do to speed that up?
As George GAO spoke to this is to try to understand where those viruses are coming from. I had the privilege to work on a subtle project that is trying to identify, and sequence of viruses. Hundreds of thousands of viruses that have some reasonable for making the transition from animals to man. One technocratic solution, approach to making things go faster next time is if there is this well-developed laboratory where the genomes of far more viruses are on hands to understanding of the locations, hypes of hosts, types of the characteristics that are mostly to cause problems later will allow earlier more.
Second, much more speculative approach to preparation on the vaccine side is the potential use of old vaccines for new diseases. What does that mean? The aspiration with some very strong empirical basis, the aspiration is that vaccine is made with live attenuating viruses, like Ebola virus, BCG bacteria, vaccines of that sort have a nonspecific effect that can be actually quite strong in preventing diseases.
Other disease vaccine is designed to effect. One type of experience with that, was in the former Soviet Union, four large studies involving over 80,000 people against seasonal INFLUENZA and other respiratory viruses, they found efficacy on every course study, around 60 to 65 percent which is actually about the same as efficacy for typical seasons proved vaccine. Why would it make a difference to have these old vaccines available? First, they're available today. Secondly, there's a safety profile that is established over basically decades of use. And on a vaccine hesitancy point that safety profile provides a familiarity use of these vaccines, and the familiarity of safety of pharmaceutical regulations, can ease their introduction. There are in some cases substantial stock piles in all cases from the nature of these vaccines, there are 4 or 5 are important. There needs some very substantially existing manufacturing capacity, and the capacity to divert from current use of vaccines into the emergency use on preventing for influenza.
One of the things that has puzzled me as an outsider to science, that the science community seems to be slow on this, maybe for good reason, but it doesn't seem to me quite that way. So we're going here for strong investments on the technological side, the scientific side, to compliment better understanding of preparation and NPIs. As we think about finishing the job with COVID, and very importantly, facing about the next big pandemic, likely to be influenza but not certainly so.
Thank you and congratulations to the important team, best regards to you, and the hard work in front of you.
