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.  Victor J. Dzau, M.D., President of US National Academy of Medicine delivered a keynote speech at Health Development in the Post-Pandemic Era Session.

Dr. Han Qide and Prof. Liu, It’s my great honor to participate in this very important meeting. The topic of this session is Health Development in the Post Pandemic Era.

One cannot talk about health development in post pandemic era without discussing what we've learned from the pandemic, which is still devastating our world.

There's so much more work to be done to end the pandemic and to prepare for the future. As the first speaker of this session, I'll frame the topic for the rest of the session by first examining lessons learned. And then for the second half of my talk, I will discuss actions to be taken to address impact of climate change and health based on lessons learned also from the pandemic.

We are now nearly two years since the report of the first case of COVID-19. The world is still suffering from its devastating effects. COVID has taken millions of lives and disrupted our communities. And so we can't talk about this without asking what do we learn and how can we do better?

The report from Global Preparedness Monitoring Board (GPMB), which I serve, and Dr. George Gao, China CDC, Dr. Tony Fauci and others also serve, came out in September 2020 in the midst of first year pandemic, essentially says, that the world is unprepared and we suffer from a collective failure of in fact the pandemic.

And importantly, we know that we live in an interconnected world where a shock anywhere can become a catastrophe everywhere. And we all know that COVID-19 is well beyond health impact but also economy, society, and really disrupting everything from education to jobs, et cetera. What we do know is current measures of preparedness are not predictive and so we need a global preparedness which is together as said by Dr. Qin and not simply the sum of national preparedness. No one is safe until everyone is safe. The world of pandemic preparedness needs consolidation, not further fragmentation.

So looking at what are the major gaps. The report from the G20 -- High Level Independent Panel on financing on which I serve as advisor and secretariat -- basically says the following: first, there was a lack of surveillance capacity to be able to detect a pathogen with pandemic potential. In other words, the current tools that we have in surveillance are designed to monitor known pandemics and ongoing influenza and pathogens. But there's a need to detect the pathogen with such a potential before it's spread widely and transmitted.

We also need a holistic  health approach to target surveillance across domains of human, animal, environmental health, and being able to detect and monitor existing and novel zoonotic pathogens.

The next point says the national healthcare and public health system became overwhelmed and struggled and of course the world didn't have the system in place to respond quickly. So, there's a need to strengthen national health system as a critical foundation for pandemic response and preparedness.

And of course, we recognize the R&D system, ecosystem is greatly fragmented. There's a need to quickly move towards enabling countermeasures such as tests, therapeutics of vaccines. And finally, there's a lack of governance structure as well as a sustainable financing to support the pandemic preparedness and response.

So given all that, we also learned the importance of science. We have learned that COVID-19 shows important science in everything that we do from public health, to surveillance to countermeasure and to preparedness. Vaccine has showed how important science is in the unprecedented speed of vaccine. But we also of course understand the importance of science in all policy decision making.

COVID-19 also revealed the importance of information, particularly accurate information for decision making for the public, and the devastating effect of misinformation and disinformation in a world full of social media, hunger for media information and distrust to govern.

So, we also learned that human dimensions are extremely important. Great importance of responsible leadership, in fact, leadership that looks at what's important decision based on science and protection of its people and engaged citizenship that acts together protecting each other and think about the global public goods. In a study done by Sheila Jasanoff at Harvard, she looked at 23 nations, whether they are authoritarian, democratic, and studied all the factors and the most common denominator or predictor of good response and preparedness, and social cohesion and trust in the society and its government.

I think COVID-19 also revealed inequality, inequity, particularly in areas of testing, access to healthcare, access to countermeasures. And if you look at globally, there's a big disparity between high income countries and low income countries. And of course, within each country, we also see tremendous disparity in socioeconomic differences as we see in the United States in particular.

Finally, we also know that the overall response globally was poorly orchestrated. At the very outset it was slow. There's a lack of strategy and coordination. There is in fact many independent actors and of course WHO which has the role of being the global coordinator has the lack of financing and political problems that hindered it from being able to do its job.

As I said, the R&D system is fragmented. And the problem is every country actually reacts by looking for its own self, protecting citizen, the issue of nationalism. So these are many problems.

And of course, what happened in response to all these in COVID is the creation of ACT-Accelerator. I'm a principal and founder of the ACT-Accelerator, which brings together the major global health organizations such as WHO, CEPI, GAVI，Global Fund, Unitaid, UNICEF in order to collaborate to accelerate development, production and equal access to test, treatment and vaccines.

As you can see, ACT-Accelerator has very lofty goals:  Vaccines: deliver at least 2 billion doses, with global target of 40% population by end of 2021 and 70% population by mid of 2022;  Diagnostics: 500 million tests by mid-2021, advance testing rates to a minimum of 100/100K people/day by September 2022;  Therapeutics: 245 million courses of treatment by mid-2021, and treat 120 million people and protect 2.7 million Health Workers, with delivery of O2 and access to Personal Protective Equipment by September 2022. Unfortunately, as results we have fallen short of the goals: only about 738 million doses were shipped in December to 144 countries. Much fewer doses, tests procured, insufficient oxygen supply, and the challenge of insufficient financing. And still has a $23.4 billion gap from now to middle of 2022. It's difficult to engage all countries to work together in a bilateral fashion. And of course the problem of implementation of vaccine diagnostics and therapeutics were significant.

I just want to show you about vaccine as an example, while there's unpresented speed to develop vaccines, there's massive global inequities. As of December 20th, 56.9% of the world population has receive at least one dose of a COVID vaccine, but only 7.6% of people in low income countries have receive one dose. Every stage of vaccine has inequity from procurement. Very early high income countries prioritized securing doses for their own populations and bought up many of the doses. In manufacturing there are supply shortages and the lack of distributed manufacturing. That is the poor countries that have no manufacturing and do not have access. And those countries with manufacturing have actually used export restrictions such as in India. Finally, foreign distribution is a big problem in many countries which is not prepared.  Inadequate  infrastructure, workforce, et cetera, makes the distribution extremely slow and there is public mistrust and vaccine hesitancy.

So I want to say that many groups have done really important reports, including Global Preparedness Monitoring Board (GPMB) which I serve on, the G7-International Pandemic Preparedness Partnership, the Pan-European Commission on Health and Sustainable Development, WHO IHR Review Committee, Independent Oversight and Advisory Committee of the WHO Health Emergencies Programme, and of course the most important two reports which are the Independent Panel for Pandemic Preparedness and Response (IPPR), and then the G20 High Level Independent Panel on Sustained Financing Preparedness and Response.

Let me summarize and show you what's been in fact recommended. There's great commonality in the recommendation, and this is what we need to go and do during the future. We need strategy and coordination at the national and global level. Currently as you know, there's a pandemic convention treaty being developed by the World Health Assembly in order to look at countries having a much better governance structure for preparedness.

We need to strengthen WHO. We need to strengthen health systems and public health surveillance. We need to accelerate countermeasures. There's a goal laid by G7 and CEPI for 100 days from this onset of infection to in fact having a vaccine, or diagnostic, or therapeutics. We need to have equitable manufacturing, sustainable financing, multilateralism and coordination, and of course an independent and consistent science advice by this high level scientific panel of G20 which I co-chair. And finally responsible leadership and citizenship.

So these are the lessons learned. And if we're to think about the development post pandemic, we have to implement many of these recommendations in order to be sure that we don't have this happen again.

But COVID-19 pandemic is only one of the excessive threats for our world. It is only a harbinger of what is to come. We need to be prepared for Climate Change’s impact on health.

Climate change is a public health and equity crisis. And in fact, 20 million deaths each year globally are due to key factors linked to climate change, e.g., Air Pollution: 7 million deaths globally, 100,000 plus deaths in US; Vector-Borne Diseases: where with global warming the vectors are moving mosquitoes further up north and bringing in a lot more pathogens and causing outbreaks in dengue fever, malaria and others, about 700,000 deaths each year, and rise in new pandemic such as COVID-19 with 3.2 and more million deaths; Water and Food Supply: the shortage of clean water and food supply resulting in 500,000 deaths for children because of no access to drinking water, malnourishment causing stunting and impairment development; Climate-Fueled Disasters: 475,000 deaths from 2000 to 2019.

Climate Change Impacts Everyone’s Health, But Not Equally. Much like COVID-19, the most disadvantaged and poor income countries and historically marginalized and vulnerable populations bear the worst impacts.

We have people in sub-Saharan Africa, South Asia and Latin America who were displaced as climate refugees because of climate change. Since 2008, 21.5 million people have been displaced by weather-related sudden onset hazards each year. By 2050, the number will reach 143 million. In addition, by 2030, more than 100 million people could be forced into extreme poverty due to climate change as predicted by WHO. In 2019 alone, 140 million children under age 5 in low income countries experienced stunted growth due to malnourishment. In addition, more than half a million children die each year because they don’t have access to safe drinking water which is due to variability in rainfall patterns.

Equity, crisis, public health is what we are now facing. There's a close link between pandemics and climate. Climate change is contributing to rising temperatures which enable vectors such as mosquitoes to proliferate and travel much further North. Urbanization and resulting deforestation contribute to lots more carbon dioxide accumulation in climate change and remove natural buffers between human and diseases-carrying animals resulting in increased frequency of zoonotic diseases. Climate change is reducing agricultural productivity (e.g., crop yields) forcing humans to cut down forests to increase farming, which can lead to increased zoonoses. And finally, rising temperatures and other impacts caused by climate change are forcing animals to relocate to new habitats, often bringing animals that can transmit disease in contact with humans more often.

It's really important to understand that we in health sector have a great obligation to act, because climate change is a public health crisis. We must treat climate change as a public health crisis and an equity crisis. And in the health profession about medical community, we are one of the societies with most trusted professionals. So we can and should raise our alarm and communicate about these strengths. We have a duty to advocate for health and equity to be at the center of climate change planning and policy. And importantly, we must do no harm because globally the health sector is responsible for 5% of global carbon emissions. In US alone the health sector is responsible for around 8.5% of US carbon emissions. That's really large.

So we must hold ourselves accountable, be part of the solution. At the same time, it will reduce carbon emission. We'll have the chance to improve health for everyone. The time to act is now. The 26th Climate Change Conference (COP26) held in Glasgow in November 2021 identified climate and health as a priority.

National Academy of Medicine (NAM) has launched the grand challenge in climate change, human health and equity (Climate Grand Challenge). Climate change represents one of the most significant threats to human health in the 21st century. The Climate Grand Challenge is a multi-year global initiative to improve and protect human health, well-being, and equity by working to transform systems that both contribute to and are impacted by climate change. We have four strategic objectives:  Communicate the climate crisis as a public health and equity crisis; Develop a comprehensive and long-term roadmap for transforming systems; Prioritize and catalyze multi-sectoral actions to drive health sector transformation; Stimulate bold and interdisciplinary solutions to accelerate the pace of innovation and transformation. These four objectives will leverage NAM’s unparalleled independence, objectivity, convening power, and community of experts to advance the evidence, catalyze national and global communities, and accelerate the pace of research and innovation necessary for systems transformation.

In the article“Decarbonizing the U.S. Health Sector-A Call to Action”which was just published on New Journal of Medicine, which I wrote with my co-chairs Secretary Rachel Levine from HHS and the United States Health Women Services, George Barrett, Andrew Witty, we call to action to decarbonize the entire US sector. What we've done is we have activated and collaborated to decarbonize the entire US sector that will mobilize full spectrum of actors and institutions in the health community to prioritize and implement a specific actionable set of projects by having a public private partnership. We will bring together leaders from the federal government, hospitals, health systems, payers, financing entities, health profession education, industry (including supply chain, Bio-Pharma, and medical device), non-profits, academia and more together.

We have assembled all these leaders together, and together we have divided ourselves into four working groups to work towards decarbonizing the US sector. And we have supported President Biden's goals for 2030 and 2050. We are now in creating measurements of metrics, reporting and setting goals together.

So what does this all mean to our friends, to China and elsewhere? We believe that our effort in US，we live in the global world，should be across global and working in collaboration with all of you. The opportunity in terms of what we do, we can therefore provide evidence that can be used globally.

We can bring together scientific and equitable partnership, to bring scientists to global community table, to build a scientific community that work together. We can provide assistance, technical and financing to those low income countries. We can have open source tools and data and partners with health and science academy worldwide, particularly with the InterAcademy Partnership, which has 140 academies in which Depei Liu of China is one of the co-chairs.

China has recently set forth a 'dual carbon' national goal – reaching peak carbon emissions by 2030 and achieving carbon neutrality by 2060. A new high-level climate “leaders group” is formed to direct the country’s emission-reducing efforts. At the COP26 climate summit in Glasgow, the world's two biggest CO2 emitters, China and US, pledged to act in a joint declaration to boost climate co-operation. It says both sides will "recall their firm commitment to work together" to achieve the 1.5℃ temperature goal set out in the 2015 Paris Agreement.

The world faces multiple existential threats. Pandemics and climate change are two major ones and they can cause major health crisis. We need an all of society approach, collaborations within our country and globally. And of course, global public good necessitates working together for common purposes to share benefits. 

Thank you very much.