Erik Berglof | Leveraging the Pandemic to Improve Basic Health


On December 22, 2021, on the first anniversary of the establishment of the Peking University Institute for Global Health and Development (PKU-iGHD), the “2021 Peking University Global Health and Development Forum: Human Health and Medical Innovation in the Era of Low Carbon Economy”was successfully held. Dr. Erik Berglof, First Chief Economist of Asian Infrastructure Investment Bank (AIIB) delivered a keynote speech at Health Development in the Post-Pandemic Era Session.

I come from AIIB. As you know, AIIB is a new institution. It will turn in six this year. We are even newer when it comes to health. Before the pandemic, AIIB had done essentially nothing in health. Now, in the pandemic, we have done almost everything related to health, and we have decided that we wanted to do something more strategic.

About a year ago, on the second week that I came to my new job, I was asked to lead an exercise inside the AIIB where we would discuss across the whole bank, what should we be doing in health? That was a very interesting experience for me because I had been working in my previous life at the EBRD, European Bank for Reconstruction and Development. We had a lot of activities in health, but it was almost always just about building hospitals, and that was frustrating in a way, because healthcare is so much more, and the hospital is a small part of the whole picture. It was very difficult to get buy-in for something more ambitious.

Now, we had a chance here at AIIB to think through how we would do it. What we came up with could help illustrate what multilateral development banks (MDBs) can do in the health area to some extent. We are an infrastructure bank, we want to use infrastructure as a concept that includes health. Social infrastructure or soft infrastructure is a very important part of the total infrastructure space. Every infrastructure project is embedded in a social context. The health dimension of that is extremely important. So, one thing we can do is to add health components to existing infrastructure projects, whether it is zoonotic or virus surveillance related to waste treatment or some antimicrobial resistance. There are many ways you can think about reducing the use of antibiotics.

Simultaneously, we also want to find some niches where we can make a difference. Now in the pandemic, it was very clear that trying to help finance the vaccine and vaccine delivery was very important. But we can also get involved in vaccine production, which is longer-term work and will help us more in the next pandemic. It's an area where we are already involved and are doing projects. One Health is the intersection of human health, animal health, and ecosystem health and is very appropriate for us. Over a year ago, the Bank has adopted its first corporate strategy which has emphasized very much climate. We want the ratio to be 50% about climate finance by the year 2025. One Health is an area that is very close to thinking around climate and broader issues around climate or health. So, that's certainly an area. We're also looking at elderly care and some other aspects. But we are new to this area, we are still very much in the learning mode. That's why we try to participate in this type of event, we want to have a chance to talk to other MDBs, but also talk to all the different players in this very interesting and very complex sector.

We want to subscribe to the core elements of healthcare. Universal coverage is a very important element. People-centeredness and integrated access are other notions that we very much subscribe to. We have to find our niche and the way we're intervening within that space.

In this area between One Health and biodiversity, and related to climate, these are areas where we can play a role. Maybe, in the beginning, more as a convening power, and this is a very important role for MDBs, to use the fact that we have many governments. We have 104 governments engaged and many clients. We can play this role and bring together the biodiversity community and the One Health community. The climate community is much more developed in many ways, in terms of metrics, carbon footprint, means of finance, the rapid explosion of green finance, and so on. We could see how we could learn from climate, and bring this into the One Health space and the biodiversity space. It is very much an area where we think that we can contribute.

We are in the middle of a pandemic. We have to think about how we can use the pandemic. The pandemic poses enormous challenges to us. The first part of the pandemic response was the very deep division between countries having access to or not to vaccines. It is very much a division between the advanced economies and the emerging and developing world, but It's also to some extent a division within the developing and emerging world. We need to think about how we can, as an MDB, contribute to reducing that division and restoring some of the confidence in the global governance or the multilateral institutions. We shouldn't have had this kind of outcome if the system worked more effectively, but that is what it is and we need to think about how we can use this global vaccination effort. This is arguably the most ambitious coordination exercise we have ever undertaken. Even though we didn't do very well in the first part, we had to think about how we could do better in the next part.

In this vaccination effort, the procurement of vaccines has been very difficult because all the challenges have been around securing contracts and countries’ willingness to export. It's not only about vaccines, but particularly vaccines when all the needs domestically are not satisfied. These are lessons that we have to see how we can organize vaccine production differently, maybe, in the future. But some elements may be more suitable for an organization like AIIB, which relates to how do you get from having bought the vaccine to make sure that it comes into the arms of your citizens, and so on. You have to build the whole logistics such as the digital architecture to keep records on who has been vaccinated at what time with what vaccine and so on. All those are areas or types of investments that AIIB is very used to, and that's where we can contribute.

As a global community, we should think about how we can make use of this effort. We should not only achieve the short-term gains of getting vaccines which is extremely important and probably the most important investment we can make of any kind today, but also think about how we could use this opportunity once we have made that investment. We are reaching out to so many parts of the world and in often very remote and hard-to-get-to areas, and hard-to-get-to parts of the population. We know all about the issues of vaccine hesitancy and so on. When we are making this enormous effort to reach so many people, how can we use this to get more basic improvements, and more long-term improvements, in public health? The state of your health system was a very important determinant of how you respond. It was certainly not the only one, that's another lesson we have to learn. It's not sufficient to have a strong health system. You also need to have a lot of procedures in place. For instance, how does the political process work in these kinds of situations? Given that we have made this very fundamental effort and very ambitious effort, we need to use this to reach so many parts of the world.

Health has been actually on top of the agenda for the first time or at least for the first time in a very long time. Health and finance ministers talk to each other in a way that wasn't the case before. If we can seize this opportunity not only in terms of how we invest in pandemic preparedness and response and resilience to pandemics, but also in terms of how we address the fundamental questions in health. We could get those goals as I mentioned earlier achieved, for instance, accessibility, basic healthcare working, people-centered and integrated accessibility.

We have a unique opportunity to achieve those goals now, and we should make use of that opportunity.

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