About a dozen people sat around a boardroom table at the emergency hub of the World Health Organization (WHO) just outside Nairobi last Thursday, their eyes glued to an animated presentation on a screen.
Health workers in eastern Chad have reported several deaths among patients with respiratory failure, they are told. Initial samples suggest a novel variant of bird flu, but confirmation requires sending samples to a foreign laboratory. International health regulations require notification within 24 hours of assessment, but Chad’s government is hesitant to notify the WHO, fearing economic repercussions and stigma.
It is a hypothetical pandemic outbreak, and the people at the table include some of the continent’s most revered figures: members of the Elders, a group of former presidents and world leaders founded in 2007 by Nelson Mandela, the idea being to use their collective wisdom to tackle global crises.
This group of the Elders are, alongside WHO representatives, taking part in the simulation to better understand how Africa is preparing for the next pandemic, to counter emerging infectious diseases and health security threats, and enable them to advocate for greater readiness and a better response.
The prompt for the first scenario is direct: if you were Chad’s head of state, how would you ensure that the country’s health minister complied with international health regulations to report the development, and what assurances would you need from partners that timely notification would be supported?
Ernesto Zedillo, a former Mexican president, fires off the first response. He thinks incentives for governments “to do the right thing” are needed. “What will the international community do to reassure governments that this is not only their duty but that they will be acknowledged as being compliant?” he asks, citing South Africa’s feeling of being punished with travel bans and restrictions for detecting a new Covid-19 variant during the pandemic in 2021.
On the opposite side of the table, Zeid bin Ra’ad bin Zeid al-Hussein, a former UN high commissioner for human rights, says that health policymakers should model their response on what is working in other sectors. “What I think we need to do,” he says, “is look at the stronger systems that we have – where you have really strong verification – and say, ‘Why don’t we bring up the rest of these systems to meet them?’”
The former Liberian president Ellen Johnson Sirleaf offers a different take, saying the problem is often caused by weak healthcare systems in the reporting countries that lack the capability to identify and report pandemics properly and are therefore unable to put pressure on governments to report their findings. “Most times, it is not a lack of political will as much as it is a failure of the systemic capability,” she says.
For about an hour, the Elders go through scenarios and exercises demonstrating real-time decision-making on how geopolitical, climate and conflict risks can worsen response to outbreaks. They draw on their collective experience and wisdom from past outbreaks during their times as leaders.
The session is preceded by a presentation from WHO personnel about how the organisation supports African countries in preparing, detecting and responding to health emergencies, and another about a new AI-enabled system to support decision-making on health threats.
The simulation happens amid the hantavirus outbreak and – coincidentally but as proof of the growing global threat of disease emergencies – just a day before health officials announce an Ebola outbreak in Uganda and the Democratic Republic of the Congo that has so far killed at least 139 people.
It is also on the minds of everyone in the room that negotiators missed this month’s deadline to finalise a global pandemic treaty announced during Covid in 2021. The agreement was supposed to lay out how nations should share information on pathogens that could cause pandemics and on the access they should be guaranteed in return in the form of vaccines, tests and treatments.
The delay in agreeing such a treaty highlights the lack of trust between richer and poorer countries, especially in Africa, which experienced vaccine inequity and received few doses during the pandemic. Many believe the continent was in effect abandoned as wealthier countries stockpiled vaccines.
At the simulation, the Elders are presented with another scenario. Chad has finally notified WHO, but only after two weeks when the situation has deteriorated sharply, with cases starting to appear in northern Cameroon and severe flooding cutting off transport routes and causing further delays in sending pathogens to an international laboratory. How can WHO and its international partners better prepare for health and climate crises that will increasingly be hitting at the same time?
To get “a complete picture”, Hussein urges collaboration between science and climate experts to integrate and synthesise knowledge. “Many of us work both in the climate space and even climate science space,” he says. “And I don’t see too many health experts in that space, and I don’t see it vice versa either.”
Sirleaf agrees: “The international integrated system or integrated response is not there yet.”
Speaking afterwards, Denis Mukwege, a Congolese gynaecological surgeon and Nobel laureate, points to his country’s response to outbreaks of Ebola and mpox. He says the simulation stresses the importance of multilateralism, reacting quickly to outbreaks, and the political will for countries to collaborate.
“We need to work together because we never know where it will happen. And we need to get all the people to be ready when it happens,” he says. “We need really to understand that when we have the outbreak, it can go far and sometimes it can go beyond our borders.”
Dr Mohamed Janabi, WHO’s regional director for Africa, says the exercise has offered a window on the frontline reality in Africa, where the organisation recorded 146 emergency disease outbreaks last year. “You have seen what we face here,” he tells the Elders. “Outbreaks will continue; how we manage them, that’s the issue.”