Transcript of Global Strategy to Manage the Long-term Risks of COVID-19 Press Briefing

April 5, 2022

Gita Gopinath, First Deputy Managing Director, IMF

Jeremy Farrar, Director, Wellcome Trust

Richard Hatchett, CEO, CEPI

Peter Sands, Executive Director, the Global Fund

Ruchir Agarwal, Head of Global Health Practice, IMF

Gerry Rice, Director, Communications Department, IMF

Gerry Rice: Hello, everyone, and welcome to you all. Thank you for joining us for today's press briefing here at the International Monetary Fund, where we will be briefing on a new staff working paper and it's titled "A Global Strategy to Manage the Long-term Risks of COVID-19". This is actually a joint working paper. It's been done in collaboration with the Coalition for Epidemic Preparedness Innovations. That's the acronym CEPI, the Global Fund and Wellcome Trust. And at today's briefing, we are very pleased to be joined by the IMF's First Deputy Managing Director, Gita Gopinath and the head of the IMF Global Health and Pandemic Response Task Force Ruchir Agarwal. Along with Gita and Ruchir, we have the principals from those coauthoring global organizations that I mentioned. We have Sir Jeremy Farrar, who is Director of Wellcome Trust, and we have Dr. Richard Hatchett, who is the CEO of CEPI, and Peter Sands, Executive Director of the Global Fund. We'll hear from each of our speakers, and then we'll turn to your questions. I want to begin with our First Deputy Managing Director, Gita. The floor is yours.

Gita Gopinath: Thank you, Gerry, and thank you all for joining us today to discuss a global strategy to manage the risks of COVID-19, the one that reflects a changing reality where COVID-19 may be with us for a long time to come. Last year, when we wrote the pandemic plan, it was expected that high enough levels of vaccination were the key to ending the pandemic. However, with a fast-evolving virus, it is now clear that vaccines, while highly beneficial, are by themselves, not a silver bullet and COVID-19 is likely to be with us for the long term. Now, given the many possible scenarios for the evolution of COVID 19, for some benign to some very severe scenarios, and given the limited resource constraints countries have, we need a new strategy. The paper lays out what the new strategy might look like at its core. It's about providing countries with a more comprehensive COVID 19 toolkit for fighting the pandemic that includes vaccines, tests, treatments, but also requires R&D and genomic surveillance and bolstering the resilience of health systems. So, countries with limited resources are in a better position to tackle both COVID 19 and other deadly diseases in a sustainable and effective way. You may ask why we at the IMF are so focused on this? It's simply because health security is economic security. As recently as our January World Economic Outlook update, we estimated the cumulative losses from the pandemic to reach around $13.8 trillion dollars. This is going through 2024. The international community should recognize that its pandemic financing addresses a systemic risk to the global economy. Thus, we are calling for additional funding to fight pandemics and to strengthen health systems. This will require about $15 billion in grants this year and $10 billion annually after that. Together with our partners on the Multilateral Leaders Task Force and with the Act Accelerator, the IMF stands ready to help countries meet the challenges of the pandemic and their financing needs, including through a resilience and sustainability trust. The costs of inaction for all of us is very high and we need to act now.

Rice: Well, thanks very much, Gita. Let me just introduce Jeremy by placing him in the crossfires with a question. Jeremy, the paper emphasizes that COVID 19 is with us for the long term. How do you see this pandemic evolving and why call for greater global cooperation now?

Jeremy Farrar: Thanks, and I would like to pay tribute to my coauthors, in particular the International Monetary Fund, for picking this up, but also from CEPI and the Global Fund. Three points. We've had multiple warnings over many, many years of an impending pandemic, and truly, we failed to act. The second is that this one ain't over. The pandemic still continues to reverberate. I'm sitting here in Washington, but yesterday I was in London. One in 12 people are infected in a country with incredible vaccine uptake and vaccination. We have many parts of the world without access to vaccines, and we have many parts of the world where transmission remains very, very high. That throws in the possibility of new variants that will escape our current vaccination and our current immunity. So, if we did not take the previous warning seriously, let us make sure that we take these warnings seriously. And whilst the political and the societal desire among all of us, we're fed up with this pandemic, we want to move on. But the truth is it is not over. And the actions that we take now, the reforms that we put in place, the financial support we give will enable the pandemic and its acute phase to come to an end quicker and allow wolf societies, all of education, all of our economies to get back on track faster. And lastly, this will not be the last pandemic. So, I'm afraid unless we take the warning seriously, unless we act now and unless we make sure we give all of our countries the true toolkit to respond, whether that be vaccination, social measures, diagnostics, treatments and etc., then I'm afraid this pandemic will continue to reverberate and disrupt the whole of societies for many, many years. So, I applaud what the IMF has done, providing the leadership in order to bring us together. And I applaud what my colleagues, Richard and Peter on the CEPI and Global Fund did, but now is the time to act before the pandemic rushes away from us again.

Rice: Thank you very much, Jeremy. As I mentioned at the outset, let me turn to Dr. Richard Hatchett. And of course, Richard is the CEO of the Coalition for Epidemic Preparedness Innovations. Richard, if I could introduce you by asking you: looking at some of the global policy actions, how should the world prioritize research and development investments to upgrade its toolkit to handle the new COVID variants, novel coronaviruses, and other threats?

Richard Hatchett: Great, thank. Thank you, Gerry. And like Jeremy, I want to pay tribute to our colleagues at IMF and to my coauthors, Jeremy, and Peter, for putting this paper together. I think it offers us an important opportunity to reflect on living with COVID. I just want to pick up where we're Jeremy left off on. The crime has revealed again that the virus continues to evolve. We're very fortunate at this point that the disease does appear to be milder and in many countries with high rates of vaccination, that they are managing their way through the epidemics that have resulted. But it speaks to the potential of the virus to continue to evolve. And certainly, we have no way of predicting whether we may see variants in the future that are as infectious or more infectious than no crime, but that managed to evade the immune system more effectively and evade our current vaccines, potentially creating the opportunity for new pandemics to emerge from within the subsiding current pandemic.

I think we face a triple challenge at the moment. We need to continue to stay ahead of the virus, and that means building on the vaccines that we have developing better basic scenes that are more broadly effective. Potentially even that can protect against not only COVID and its future variants, but against other coronaviruses. That would be the ideal, but we also have to reconfigure our global system for production and distribution so that we can more effectively deliver vaccine products to the world. And we need to do that in a way, as I think Peter will talk about, that does not draw critical funding and attention away from other critical global health needs for COVID 19.

I think we need to continue to focus on investing in research and development for new, better, more effective, more durable vaccines. And we need in the longer term to build capabilities in which future viral pathogens not just COVID, not just coronaviruses, but other potential viral threats no longer pose an existential threat to our way of life. We will do that by investing in platforms and capabilities that have already been validated. They will be the foundation for future global health security. Thank you.

Rice: Thank you very much, Richard. And just before turning to questions from journalists, let me turn to Peter Sands, who, of course, is executive director of the Global Fund. Peter, how can investing in health systems and community networks help defeat COVID and prepare for future pandemics we know will come?

Peter Sands: Many thanks, Gerry, and look, this is a very [inaudible] panel to be part of. You have economists Gita and Ruchir and you have two renowned scientists in Jeremy and Richard, and then you have me. The paper makes the argument that we need to recognize and shift our strategy on the basis that COVID is here for the long term and that there are huge uncertainties around what kind of variants will face and thus a spectrum of potential outcomes. The implications of those are quite profound. First, the fact that it's a long-term fight means that we need to integrate our activities in response to COVID 19 with other health priorities. And that, as you mentioned, means that we have to think in terms of the systems, including community systems, that can help us fight not just COVID 19, but other infectious diseases, such as the ones.

The global fund's mission is about HIV, TB and malaria and prepare to prevent and respond to future pathogens. So that involves both investment and systems that are deliberately designed to be able to counter multiple different types of pathogens. But it also involves some tradeoffs that will need to be made at a country level, reflecting the different kinds of disease burden and threats the different communities face in many of the poorest countries of the world. It is diseases like malaria or TB that are actually killing more of the people than COVID 19, which is not to argue for underinvesting in COVID 19, but to recognize that we need to take a very integrated, holistic approach as we proceed against this disease. The fact that we face a wide spectrum of scenarios as to how COVID 19 will evolve has two very practical implications. One is that there's a significant premium to investments that deliver benefits across those scenarios, and this is exactly where the priority for investing in systems for health makes sense because they deliver benefits, regardless of whether you have a mild scenario for how COVID unfolds or even more. If you have a severe scenario. And they also deliver benefits against other diseases.

And it also leads to a premium to investments that allow us to detect early how the pandemic is evolving and hence the huge importance of testing all the way through from ADT at a community level to rapid diagnostic tests to genomic sequencing. We have seen with Omnicom how quickly a new variant can run across the world in a matter of weeks. So, you don't actually have much time when a new variant occurs, but the earlier you can detect, the earlier we can start thinking about how to shift strategy.

What other medical countermeasures may be needed? Underpinning all of this is the fact that when it comes down to it, the systems, the infrastructure, the human resources that you use to fight a new disease are very much the same as those you're using to fight existing diseases. It's the same supply chains, laboratory networks, primary health care facilities, community health workers and so on. And collectively, we need to get smarter at maximizing the synergies between building resources to fight diseases such as HIV, TB and malaria. The new threat of COVID 19 and to enable countries to prevent, detect and respond to future threats. And that's where the investment in systems for health, including community systems, is so vital. Back to you.

Rice: Thanks very much, Peter. Thanks to you all. Let's turn to questions from our colleagues in the media. And let me ask you to if you will turn on your camera and raise your hand. We'll take as many questions as we can from you, and I see Ashleigh Furlong has already switched on. Thank you, Ashley, and raised your hand, so you get to go. Come on in. Ashleigh Furlong with Politico,

Speaker 5: Thanks so much. My questions about long COVID, you know, are we talking about the unknowns about the future of the pandemic and how we recover from the pandemic? And I'm wondering how long COVID fits into that picture, as we, you know, likely going to be having millions, even millions more people with living with long COVID. How does that affect the economic recovery and sort of health systems recoveries as they cope with sort of the backlog of cases as we sort of emerge from a pandemic scenario?

Rice: Thanks very much, Ashley. If you have questions directed to a particular panelist, do let us know. Given the economic impact of that one, I'm going to throw it first to Gita and perhaps Ruchir and then others may wish to join in, Gita.

Gopinath: Well, thanks, Gerry, I think we should start with either Jeremy or Richard on what the impact is of long COVID in terms of health consequences, which is what the question was about. But since you've come to me, I will just make a point on the economic costs of this particular pandemic. That hasn't ended yet, as several of the coauthors have made up made that point really in January. Based on our projections for global economic activity, our estimate at that time was that the pandemic was going to cost around thirteen point eight trillion dollars for the global economy cumulatively over the period of 2020 to 2024. So, we're talking about trillions of dollars in costs. We also are living a tiny world where inflation is very high in many countries. We have supply chain disruptions that continue, and we know that the pandemic is one of the factors that is contributing to these disruptions in the world. So, it's economically incredibly important and which is why we need to address it now.

Rice: Thanks to Jeremy.

Farrar: Yeah. Thanks for your question. It's a hugely important question, we should just remind ourselves we are two- and a-bit years into this pandemic and anybody that tells you that they know everything about this infection and its long-term consequences is to be treated with a pinch of salt. We don't yet know the consequences of long COVID. We don't yet know. As has been reported in many reports over the last just over the last month, that it seems that there are impacts on many parts of the body, including on the brain, including on susceptibility to things like diabetes. If you think of the number of people infected around the world, you would only have to have a small percentage of those impacted for the long term to have a massive health and economic consequence. We do know that vaccines help prevent some of the impact of long COVID, so it makes another argument to me for vaccination.

It also makes an argument for early treatment, which goes to Peter's point about early testing and treatment. But we need studies around the world to try and document what the long-term health consequences and broader societal consequences are of long COVID and those are being forgotten about as the political expediency says. Let's move on from this. Let's deal with it like we deal with flu. Let's deal with it as living with COVID. Things like long COVID are being forgotten, and I would counsel everybody to not think that the long-term consequences of mass infection across the world probably five, six billion people will ultimately be infected by this infection, and therefore there will be longer term consequences that we need to be aware of. Let alone on children. Sorry, children are often forgotten in this pandemic. We don't know the long-term consequences of infection on their children's development, on their education and their long-term life consequences. So, these are critical in questions. Humility in the face of a brand new human infection is absolutely critical, which is why this IMF paper is so important because it lays out different scenarios that may be forgotten in otherwise political discussions.

Rice: Thank you very much, Jeremy. I'm wondering if any other panelist wants to come in on this particular question. Ruchir, yes,

Agarwal: Perhaps just to build on what both Gita and Jeremy have said, the one of the consequences also on the social side is on the human capital. So, we've looked at, for example, school closures around the world and there are deep inequalities in terms of how the long-term impact of COVID will stay with us. A lot of future generations are going to carry that impact for decades from now. And in developing countries, those school closures have been about twice as long as in developed countries. And we know that school age children, there are about twice as many school children in developing countries done in advanced countries. So, when you just take those cumulative effects, that's quadruple the impact from school closures. What we just don't know yet is how would that impact in these two years, how we are going to carry that for decades into the future. So, a lot more attention is needed to that and a lot more studies to understand the size of the impact and how to remedy those impacts. Thank you.

Rice: Thank you. Richard, did you wish to come in?

Hatchett: Yes, thanks. Just to make a general comment it does kind of build on all of the preceding comments. This cumulative burden of morbidity and mortality of the social impacts that were mentioned from the prolonged school closures will unfold over time. And it is an easy cost to neglect or to assimilate without fully appreciating in the way that Jeremy described it. I think it illustrates the dangers of new pathogens, particularly when you multiply that any fraction multiplied by billions ends up in a very large and frightening number. And I think it speaks to the importance if we have the capability, and I would argue we have the technical means to dramatically reduce future epidemic and pandemic risk, not only from COVID, as we were mentioning, but from other pathogens. Those are investments which are tiny compared to the cumulative cost of a global experience of the new disease and certainly are worth making and investing in now.

Rice: Thank you very much, Richard. Let's go back to our colleagues online, and I see Naomi Grimley of the BBC. Naomi, would you like to come in?

Speaker 7: Yes, thanks very much for doing this, it's very useful. Could I ask what China in particular needs to do to get out of the zero Covid quandary?

Rice: Jeremy, take the first crack, please.

Farrar: Naomi, thanks very much. Firstly, I would give credit to all countries that have so far managed to control the epidemics in their countries with minimal loss to life and impact on their broader health systems. And I, you know, China has done that. New Zealand has done that. And there are other countries that we could, I think, learn from, and take great credit, too. But their exit from this phase of the pandemic is a very complex one. And China in particular, is something I've talked about regularly. It is home to what 17 per cent of the world's population, 1.4 billion people. They in China have managed to control the pandemic to the point that there is no natural immunity. Effectively, they've had no real waves of this epidemic. Yet the numbers have been tiny. The vaccines that China has access to and is using, I would argue, perhaps not quite as effective as some of the vaccines available in other parts of the world and China have struggled, as it's publicly said, with ensuring vaccination among their most vulnerable populations people, particularly over the ages of 70.

So, I think China has a very complex and difficult path out of this pandemic. What I hope that they do and in discussions with colleagues in China, is to use the current program of trying to reduce transmission whilst having a very active and inclusive ability to get vaccines out to everybody, the whole population, but particularly those who are most vulnerable. If they can buy time like New Zealand did, like Australia did to get their vaccine program out to as many people as possible, including boosting doses, I think that gives them the best strategy of trying to exit from the pandemic, but it will not be easy. It will not be without real problems. And I think as a world and a lesson the last few years, we should come together and do everything we can to work together as a world to make vaccines and treatments available globally, including within China, where that is possible and appropriate.

Rice: Thank you, Jeremy. I'm just looking at other colleagues on the panel. Anyone else looking to come in on this one? Okay. Back to our our journalist friends online. I see Andrea there of Reuters. Andrea Shalal. Good to see you, Andrea. Come on in.

Speaker 7: Good morning. Hey, thanks so much for doing this. Really, before I wanted to ask you if possible, to weigh in on this estimate that it's going to be thirteen point eight trillion is the cost. I know that that was the previous estimate. Are you expecting to revise that estimate up when you release the new WEO in April later this month, given the kind of recurring outbreaks that have happened, but also the lockdown in China? And then I wanted to ask is this amount of money that is being asked for the grants? Is it not dissimilar to the amount that was being asked for before, which  was hard to raise?

Are you reaching out separately to, you know, institutions like the G7 to ensure that this funding becomes available? I mean, you know, particularly given the war, obviously funding availability is limited, and we saw recently that in Afghanistan, you know, the donors conference was only able to raise half of the amount of money. So, given all of the conflicting demands that are out there for costs and how do you assess the prospect of getting to the $15 billion?

Rice: Thanks, Andrea. Let's turn to Gita and Ruchir and then others may wish to follow on. Gita. can we start with you?

Gopinath: Yes, Andrea. So, you're right, we will have an update to our forecasts very soon in a couple of weeks. What becomes tricky to do is to separate out now the consequences for the global economy coming from the pandemic, which are interacting with the costs of the Russian invasion into Ukraine. And so  our estimates will include both those factors. We are heading towards a downward revision and extent of which will be put out in a couple of weeks. So, the cost to the economy going more general disruptions and the war in Ukraine is going to be very significant in terms of the effect, I think this was a point that Richard made, which is taking our last forecast, which is thirteen point eight trillion dollars. And since the pandemic is not over and we have disruptions in supply chain that continue and other costs, including human capital that Ruchir mentioned, that number is only going up.

But when we're talking about already at $14 trillion, that is huge compared to what needs to be paid for in terms of preventing such pandemics from happening and from if we're ending the acute phase of the pandemic, which is on the low billions, to your question about the number and the $15 number for this year. When you wrote a pandemic plan last year, the required growth was around. The required grants were 35 billion and the global community did step up. And so we are now down to a residual amount of $15 billion. So, I would first recognize the fact that the international community did make funding available, it is just not enough, and we need to go the extra mile and close the vast gaps and also do this on a multi-year basis.

Now, yes, you're right that countries are in a situation where they are being hit with multiple shocks. Their budgets are under strain and this is another point that we're making you. We choose when we make these kinds of investments it cannot no longer just be about COVID 19, but a systemic approach. This is what Peter mentioned. We want a systems approach so that we are trying to help not just with COVID 19 disease, but with all the other kinds of health risks that exist. So, we want complementarity. We want to amplify the effect. And again, these costs are small, very small relative to the benefits of preventing future pandemics.

Rice: Thanks very much. So just looking at other panelists, if they wish to comment on this particular question, Richard, please?

Hatchett: Sure. Now I'm just to pick up. I mean, of the billion-dollar estimate, it triggered doubts of the current debates on Capitol Hill about the COVID supplemental budget and the fact that international funding for COVID responses has now been removed from that. That current bill. That's of course, disappointing. It is understandable that the donors are seeing multiple calls on resources. I mean, CEPI has just completed its Global Pandemic Preparedness Summit, which was part of our resource mobilization effort, Peter and as a resource mobilization effort underway later this year on the COVAX, AMC is seeking to secure funding.

This is a very challenging time to secure resources. But  just to build on this point that I think governments that have conceptualized these kinds of expenditures, particularly related to ending the acute phase of the pandemic in the global south, have often looked to their development budgets, which are quite constrained. And I don't think they are conceptualizing the problem in the right way because of the kinds of ongoing costs that the Gita has underscored. And so,  failing to find the resources to end the pandemic now when the costs are so huge is terrible. Accounting within governments and its many crises. As we're facing, this is a crisis of crisis that will continue to unfold and unspool over time if we don't put the resources against it that it requires.

Rice: Thank you very much, Richard. Let me turn to Peter.

Sands: I mean, just to repeat the obvious, the world is facing multiple simultaneous challenges. But in this kind of situation, I think it's imperative that we focus on efficiency, that we're making every dollar work as hard as we can, which is why I emphasize the importance of investing in systems that deliver not just for COVID 19, but for existing diseases and for future pandemic preparedness. And just to pick up on the point Richard made the global fund this year we replenish on a three-year cycle. And we're targeting to raise $18 billion so that replenishment conference of President Biden will be hosting later this year, which will add to the various demands on the rich nations of the world.

But what I would also say is that it's incredibly important right now that we don't forget the poorest and most marginalized in the world because all these overlapping crises, whether it's COVID 19 or the unfinished fight against pandemics like HIV, or the impact of higher energy prices and food prices as a result of the horrible war in Ukraine, they all end up piling onto and exacerbating the misery, the deprivation of those who are poor, marginalized, displaced populations and so on. And it's critical, I think, that we don't forget them as the world has to make some very, very difficult tradeoffs.

Rice: Thank you very much for that, Peter. Let me go back online and I see the Economist is with us today, Natasha Loder. Natasha, would you like to come in?

Speaker 8: Hi, thank you for taking my question. So, we're moving into an era of plentiful COVID vaccine supply, and I wonder if I could challenge the panelists on the 70 percent target that the report talks about this. And it's not clear to me what the ongoing health or economic basis is for this 70 percent target was. Hope to prevent infection with some kind of herd immunity and very clearly, we're in a situation where that's just not possible with the vaccines that we have to hand. And it's also a target which is set globally and actually isn't what many nations want or the individuals in them. All that seems possible. I mean, you can only need to look at America, but actually many, many individual countries don't have that target.

And then related to that, I just would like so I'd like you to talk about, you know, realistically, is this something we actually need to do given the other health priorities as well? And then related to that and the fact that we are facing a glut of vaccine this year and that supplies are starting to trim the quantities, it seems to me that the kind of most pertinent question that we're faced with now with regards to vaccines, which is one of our major tools, is how much government should continue to support the production of this vaccine., these vaccines this year and next year.

Rice: Thanks very much, Natasha, we'll probably make this the last question. So, I'm going to give everyone an opportunity to come in on this one. It's just a question of who would like to go first on this question of vaccine targets, vaccine production and so on. Looking to go,

Farrar: I'm happy to. But Richard may want to come in, but I'm happy to follow Richard.

Hatchett: Yeah, sure. Happy to jump in. I mean, I think the value of vaccination in reducing the severe morbidity and mortality of COVID is quite clear. In countries that have achieved high vaccination rates, especially in their most vulnerable populations, are now entering a phase where Omicron is sweeping through causing tremendous amounts of diseases. As Jeremy pointed out in his opening remarks. But yet being managed and systems are not crumbling under the wave of disease. So, achieving high rates of vaccination is something that should be a target for every country. Achieving very high rates of vaccination in the most vulnerable populations is an absolute priority, and I think we attach it to your point. We're now coming back to two conversations that are emphasizing the importance of getting vaccines to the highest, most vulnerable populations as a high priority. I think we're also as we enter an era with a plentiful vaccine supply where supply constraints are no longer the problem. We're also shifting towards through at least through the COVAX mechanism.

In our efforts with COVAX to meeting countries, country driven efforts are to letting countries take control and tell us what they're trying to achieve, and we're trying to provide them with the tools to meet those goals and in different countries will, over time, I think, defined different targets and goals for themselves. And I think it is incumbent upon those of us working in the multilateral community to try to support countries in those efforts. Jeremy, I don't know if you want to add anything.

Farrar: Yeah, I would. And it's really, it's related to the humility of two years into a pandemic, Natasha, and a sense of a no regret policy. A few things scientifically. I think we are very clear now that a combination of vaccination on top of all, not natural immunity gives you better protection, and boosting doses gives you better protection. Vaccinations, as Richard said, prevent remarkably severe illness, hospitalizations, and deaths. They don't have zero impact on transmission. They do have some impact on transmission. And we should remember that all societies are integrated so the vulnerable don't exist in the absence of linking to their children. Their grandchildren. Younger individuals as well. Because in most countries, the cycle has been transmission through younger individuals passing it on, then to their parents and their grandparents. On the low herd immunity in the sense of vaccination and transmission stops is not something where we believe we're going to see now with this infection. It's not true to say that vaccination and or natural immunity doesn't have some impact on transmission.

And then we've got the final bit, which is about the conversation we had earlier, about long COVID. And I just want to portray a scenario, which is why this item of paper is so, so important. Imagine a scenario where we downgraded all the manufacturing capacity, where we didn't vaccinate as many people in the population we could, including a focus on the most vulnerable, but also on other sectors of society. And we had another wave economic from plus, and we had to upscale that manufacturing capacity again. That would be a three to six months delay again. So, I think at this stage of the pandemic, any idea that we're going to start downgrading our manufacturing capacity on a global level or we're going to start pulling back from offering vaccines to the majority of a population, if not 100 percent, or that we're going to stop vaccinating certain sectors of society, I think would be a wrong decision to make.

And I can imagine this scenario where in one or two years’ time, we would deeply, deeply regret doing that. If the rosy tinted spectacle, which politicians are pushing very hard, that we're going to somehow live with this and it's really flew didn't pan out to be true. So, I would be cautious about shifting away from the existing targets the 70 percent, the focus, yes, on the vulnerable, but appreciating that societies are integrated. And the last thing I would do at the moment is to downgrade the manufacturing capacity because we do not know when we're going to need it again in the next year or two.

Rice: Thank you, Jeremy. Peter, I'm wondering, do you want to come in on this? And then I'll turn to Gita.

Sands: Yeah, I mean, I think we all recognize that vaccines have been and are our most powerful weapon. In the fight against COVID 19. But as the paper argues, we do need a more comprehensive response. The inequities in vaccine distribution have actually been exceeded by these inequities in, say, testing or the provision of oxygen. And we now have the prospect of novel antivirals that could also have a very significant impact on mortality and the advantages of moving from a vaccine only or very heavily vaccine approach to one which is kind of vaccine.

Plus, with a great with more emphasis on these other aspects of the response is that it it's more resilient. It gives you better ability to protect variants and also more resistant to different types of variants that might evolve. The other thing that I think we will have to, and I think your question was sort of pushing towards that. Inevitably, countries are going to have to wrestle with difficult tradeoffs because the priorities the disease burdens in their countries vary enormously due to demography, due to the environment, due to the particular history of what diseases are prevalent in each location.

And therefore, I do think that there isn't going to be necessarily a universal answer as to what is the appropriate or optimal approach, because the disease burdens will be different because the resource availability will be different. But this is not a sort of slow down. It's more, I think, more broadly about the approach and think in a longer-term way about how we are fighting this disease alongside others.

Rice: Thank you, Peter. Let me turn to Gita.

Gopinath: Thank you. I think, the main points as we see it, as just looking at where countries are. Natasha, you're absolutely right that over 100 countries are not on track to get to 70 per cent vaccine coverage by the middle of this year. And this includes the United States, which is plateauing a 65 percent, but then also many other countries, including in including African nations, which are plateauing at much, much lower numbers. And we know that the Africa CDC has also called for a, you know, a halt to sending vaccines because they are facing absorption capacity and vaccine hesitancy.

So, we do see around the world is some plateauing of many countries plateauing of vaccination rates. And this is even in countries with very low levels of vaccination. So that's important to keep in mind. But I would just emphasize a couple of points that have already been made, which is one it's absolutely utmost important to get very high levels of coverage of the vulnerable population. And we're not there yet in many countries in the world, and this is extremely important. This is also in line with the W.H.O. prioritization. So that's the one point to make. Second is just to emphasize a point Peter made, which is what the paper is about, which is that given not given that no single instrument in this toolkit is perfect and there are no silver bullets here, we need all pieces of it, including testing treatment to prepare for us to prepare for future scenarios and also to make sure that the vaccines stay fit for purpose.

Because if we need to further develop the vaccine to new variants, we would need to be able to test to make sure that we actually know and do the surveillance to make sure that we have a vaccine fit for purpose. And then lastly, in terms of the fact that countries have resource constraints. And so, while we should certainly push for as big vaccine coverage as possible, sometimes it's going to be like pushing on a string. You're not going to get very far. There are very high levels of hesitancy. So, we need a multi-pronged approach and that's what this paper is about.

Rice: Thank you very much, Peter. I'm going to give the last word to Ruchir.

Agarwal: Perhaps just to add one point to build on everything that has been said. We should also recognize the yes, Natasha, that there is demand for now for vaccines may be reaching a saturation point. But that is just a point in time assessment. We should not accept that as a reality. And in fact, I want to recognize the work of COVAX partners, UNICEF, Gavi. They are really stepping up their efforts in in working on the demand management and engaging countries, helping them with flexible financing on vaccine deliveries. And so, we are already seeing some of those efforts paying off. And from a systemic risk perspective, it's also important, yes, to consider, as you said very rightly, the national goals, but also bring that global perspective into because of the spillover risk. So having more high-level engagement with countries where the vaccination coverage is blasting off at very low levels, we have high returns. I just wanted to add that. Thank you.

Rice: Thank you, Ruchir. And thanks to all of our panelists today and thanks to all of you out there in the media for joining us today. I think this was a very important discussion, and I think the engagement of media is a testament to that. So, thanks again for joining us at the IMF and we look forward to seeing you all again soon. Stay safe and see you all again. Bye bye.

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