We were on a global panel looking at the staggering costs of COVID – 17.7m deaths and counting. Here are 11 ways to stop history repeating itself

A global report released today highlights massive global failures in the response to COVID-19.

The report, which was convened by The Lancet journal and to which we contributed, highlights widespread global failures of prevention and basic public health.

This resulted in an estimated 17.7 million excess deaths due to COVID-19 (including those not reported) to September 15.

The report also highlights that the pandemic has reversed progress made towards the United Nations Sustainable Development Goals in many countries further impacting on health and wellbeing.

The report, from The Lancet COVID-19 Commission, found most governments were ill-prepared, too slow to act, paid too little attention to the most vulnerable in their societies, and were hampered by low public trust and an epidemic of misinformation.

However, countries of the Western Pacific – including East Asia, Australia and New Zealand – adopted more successful control strategies than most.

This had resulted in an estimated 300 deaths per million in the region (around 558 per million in Australia and 382 per million in New Zealand to September 12). This is compared with more than 3,000 per million in the United States and the United Kingdom.

The report also sets out 11 key recommendations for ending the pandemic and preparing for the next one.

Read more: Imagining COVID is 'like the flu' is cutting thousands of lives short. It's time to wake up

Co-operation lacking

The report is the result of two years’ work from global experts in public policy, health, economics, social sciences and finance. We contributed to the public health component.

One of the report’s major criticisms is the failure of global cooperation for the financing and distribution of vaccines, medicines and personal protective equipment for low-income countries.

This is not only inequitable but has raised the risk of more dangerous variants.

The report highlighted the critical role of strong and equitable public health systems. These need to have: strong relationships with local communities; investment in behavioural and social science research to develop more effective interventions and health communication strategies; and continuously updated evidence.

11 recommendations

The report made 11 recommendations to end the pandemic and prepare for future ones.

1. Vaccines plus other measures – establishing global and national “vaccination plus” strategies. This would combine mass immunisation in all countries, ensure availability of testing and treatment for new infections and long COVID, coupled with public health measures such as face masks, promotion of safe workplaces, and social and financial support for self-isolation.

2. Viral origins – an unbiased, independent and rigorous investigation is needed to investigate the origins of SARS-CoV-2, the virus that causes COVID-19, including from a natural spillover from animals or a possible laboratory-related spillover. This is needed to prevent future pandemics and strengthen public trust in science and public authorities.

3. Bolster the World Health Organization and maintain it as the lead organisation for responding to emerging infectious diseases. Give WHO new regulatory authority, more backing by national political leaders, more contact with the global scientific community and a larger core budget.

4. Establish a global pandemic agreement and strengthen international health regulations. New pandemic arrangements should include bolstering WHO’s authority, creating a global surveillance and monitoring system for infectious disease outbreaks. It would also include regulations for processing international travellers and freight under global pandemic conditions, and the publication of an annual WHO report on global pandemic preparedness and response.

5. Create a new WHO Global Health Board to support WHO decision-making especially on controversial matters. This would be composed of heads of government representing each of the six WHO regions and elected by the member states of those regions.

6. New regulations to prevent pandemics from natural spillovers and research-related activities and for investigating their origins. Prevention of natural spillovers would require better regulation of domestic and wild-animal trade and enhancement of surveillance systems for pathogens (disease-causing micro-organisms) in domestic animals and humans. The World Health Assembly should also adopt new global regulations on biosafety to regulate international research programs dealing with dangerous pathogens.

7. A ten-year global strategy by G20 (Group of Twenty) nations, with accompanying finance, to ensure all WHO regions, including the world’s poorer regions, can produce, distribute, research and develop vaccines, treatments and other critical pandemic control tools.

8. Strengthen national health systems based on the foundations of public health and universal health coverage and grounded in human rights and gender equality.

9. Adopt national pandemic preparedness plans, which include scaling up community-based public health systems, investment in a skilled workforce, investment in public health and scientific literacy to “immunise” the public against dis-information, investment in behavioural and social sciences research to develop more effective interventions, protection of vulnerable groups, establishment of safe schools and workplaces, and actions to improve coordinated surveillance and monitoring for new variants.

10. Establishment of a new Global Health Fund where – with the support of WHO – there is increased and effective investment for both pandemic preparedness and health systems in developing countries, with a focus on primary care.

11. Sustainable development and green recovery plans. The pandemic has been a setback for sustainable development so bolstering funding to meet sustainability goals is needed.

Unlock a new approach

To improve the world’s ability to respond to pandemics we need to unlock a new approach. The key component to any meaningful transformation is to collaborate and work towards a new era of multilateral cooperation.

Governments in Australia, Aotearoa New Zealand and elsewhere have talked about “building back better”. We need to take the lessons learnt from the failures of the past few years and build a stronger framework. This will not only help reduce the dangers of COVID-19 but also forestall the next pandemic and any future global crisis.

By reassessing and strengthening global institutions and co-operation, we can build and define a more resilient future.

Chris Bullen, Professor of Public Health, University of Auckland, co-authored this article and The Lancet COVID-19 Commission report on which it was based.