Professor Jeffrey Sachs is an economist, United Nations adviser and expert on sustainable development and the fight against poverty. He is now chair of the Lancet Covid-19 Commission - a wide ranging inquiry into the causes of the pandemic and future solutions.
Here he talks to The Telegraph about the failure of the West to respond to the pandemic, the politicalisation of the origins of the virus and why lockdown alone was never going to suppress Covid.
How would you characterise the pandemic and what do you hope the Lancet Covid-19 Commission will achieve?
We haven't seen anything like this in 100 years; the drama of this pandemic is unmatched since the 1918 flu epidemic and the disruptions are profound. We're still very much in the crisis; I would say this is unprecedented in our lifetimes.
The main idea of the Commission is to take a holistic view that incorporates the science and public health side, as well as the economic and humanitarian side of the pandemic. The idea is that we can have a quick, very fruitful, very high level discussion across many of the domains that are deeply involved in the response to the pandemic.
Given my own engagement and of others with the UN agencies and the other multilateral institutions and national governments, we can also interact at a high level effectively in a very short time. We hope to see where there are gaps in the international response, and make recommendations.
Do you have a sense yet of where the problems are?
I think there are gaps everywhere, the world as a whole has not been as effective as it needs to be in responding. There have been huge shortfalls in basic equipment, diagnostics, personal protective equipment (PPE) - the basic things are still missing in a number of places, partly as they're quite overwhelmed.
There is also a major humanitarian crisis that is rising and the international system is not very effective at responding to that because resources are so scarce. We don't have the right instruments. The poor tend to be quite unseen and hungry people go quite unnoticed. My own guess is that there's a brewing humanitarian crisis beneath the surface.
The pandemic is also going to cast a very long shadow on global finances, especially in developing countries. We also have a very big scramble and challenge on vaccine development.
We want to see that the [political] rhetoric on global fairness and inclusion is actually reflected in global policies - and that's far from certain.
The origins of the pandemic have become explicitly political. How are you going to handle that side of the inquiry?
I believe that there has been a lot of rumour mongering and statements that are way out of line, that are part of a political agenda by some people, senators in the US and others that have really gone far beyond what we know.
I don't know what will be possible in terms of identifying the origins, but we're certainly going to try with whatever goodwill we can muster to have a serious and deep look at this question.
It is not just an academic or a political question, it's actually a real life question of understanding how this virus emerged. Not just lab versus not, but: what is the animal reservoir? Where did this come from? What could come next?
All evidence points to the frequency of these zoonotic events increasing. Tracking this down is really important.
How might we prevent future spillover events?
The striking points in that regard are the following: first, experts have been saying for years that new epidemics were coming. And indeed, once this hit, we also realised experts had been saying coronavirus epidemics were coming.
This point is absolutely pertinent - our politicians don't listen very well, our systems don't listen very well to this kind of warning. We're going to have more of these events and that means being much more prepared on surveillance and early detection.
In the US, the government under Trump removed some of that early surveillance capacity in the last couple of years - we effectively dismantled part of the early warning systems.
Second, we have learned that even though this is a devilish virus, it is controllable. Around two billion people live in countries that have substantially suppressed the virus. They've been able to do that, primarily because of public health means and especially non pharmaceutical interventions.
If we look at the UK, the US, Western Europe - we failed to put such policies in place, basically until now. In the US we still don't have an effective control system.
This second area is crucial. We have a lot of emphasis on hospitals, but far far less on public health. I think that's a basic point here.
Do you have other early observations you can share?
What I have found notable about this pandemic from the start is the incredible variation in the response to it across the world, with the best response being in the Asia Pacific region.
Perhaps that’s because they were much more tuned to Sars and other epidemics. Perhaps because face mask wearing came earlier and was more familiar. Perhaps because governments have more capacity to put in place politics on an urgent basis.
For whatever reason, the variation of the global response has been huge and countries like ours, the UK and the US, have done quite badly in this, in relative terms.
I think there are also lessons that still need to be drawn about how safer land use practices might prevent zoonotic events, or at least reduce their frequency.
How do you see vaccine development working out?
The extraordinary speed at which the process has been rolled out compared to previous vaccines is very positive. But there are also weak points to do with how it's getting done. It’s been a mad dash with a lot of potential dangers. I think there's going to be a lot of lessons to be drawn.
Which side of the suppression versus mitigation debate do you fall on?
I think in general we should be aiming to get the number of infectious cases down to very very low levels. It's not possible, most likely, to eliminate the virus anyplace because even if domestic transmission were eliminated, which is very hard, countries cannot be completely isolated from the rest of the world, so there will be continued new introductions.
But what is very clear is some countries have been able to keep the number of new cases very low, whereas in others that has not been the case - in the US it was running recently above 100 new cases per million per day.
That's two orders of magnitude, and not because the low transmission countries were more locked-down or more blockaged economically - quite the opposite in general.
Countries at near zero have done it by using very aggressive public health means, especially a lot of monitoring and testing and a lot of tracing and rapid quarantine, as necessary. We should be interrogating that intensively. Why is that? How is that? What can we learn? What's the difference from what we're doing?
But what about the economy vis a vis transmission? Is there a trade off?
The US, I think, has proved the point. The thing that stopped the economic recovery, or put it into a total stall, was the resurgence of the virus. So the idea that no controls would be good for the economy was refuted in practice and I believe it was to be expected.
The way to open an economy is to have few cases, that's the basics, and the way to have few cases is by public health measures, not by lockdown.
How would you characterise national lockdowns?
Lockdown, which I favoured at the beginning, comes when you've lost control completely.
But the idea of the lockdown is that you use that period to build up public health capacity rapidly - that's the purpose. It's not just to bring the virus down, then release the lockdown and watch cases go back up.
If massive testing, tracing, and related policies of infective control are not introduced during the period of lockdown, then the virus will re-surge. However, with non-pharmaceutical interventions in place, you can release economic lockdown and prevent resurgence, because when clusters reappear you can pounce on them quickly and stop them from spreading majorly.
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