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in 1945, after the deadliest and most destructive war in human history finally came to an end, countries around the world came together to discuss the establishment of the united nations to prevent another tragedy from happening again. one focus of the discussions was the establishment of a global health organization to promote human health, keep the world safe and serve vulnerable populations. countries around the world are deeply aware that health is not only a basic human right, but also crucial to peace and security.

over the past half century, as a specialized agency of the united nations, the world health organization has played a vital role in the development and implementation of public health policy at the global level and has made significant progress in protecting people from disease and destruction. , including eradicating smallpox, reducing polio incidence by 99%, and saving tens of millions of lives through childhood immunization.

the world has changed dramatically since the united nations adopted the sustainable development goals (sdgs) in 2015, changes that have profoundly affected the health and well-being of countries and communities, especially the poorest and most vulnerable. but to this day, 30% of the world's population still does not have access to basic health services, and inequality continues to erode the health of the world's most vulnerable groups.

“our world is off track—and we need to make hard decisions to get back on track.” on september 22, united nations secretary-general guterres said at the 79th session of the united nations general assembly in new york.

the reflection brought to the world by the new coronavirus pandemic is not over yet. the 194 members of the world health organization held intense discussions on the "pandemic agreement" at the world health assembly in june this year. unfortunately, after two years of negotiations, countries failed to reach agreement on some key issues. , causing negotiations on an agreement to deal with future crises to be extended for another year.

on the other hand, the shadow of infectious disease outbreaks has never been far away. in the past three years alone, the who has twice issued public health emergency of international concern (pheic) due to the monkeypox epidemic. behind this, climate crisis and environmental degradation have become major threats to human health in the 21st century. demographic changes, population aging and increasing urbanization have made it difficult for basic public services to keep up.geopoliticschanges and a growing number of crises are complicating the outlook for who targets.

but at the same time, advances in science and technology have also brought the world into an era with great potential to further promote human development. interactions between global diplomacy, economics and health have become more dynamic, and international governance has undergone profound changes to respond to emerging needs.

with attention to these major issues, at the end of august this year, the paper (www.thepaper.cn) accompanied a team of chinese media representatives to the who headquarters in geneva, switzerland, to discuss with the who leadership team their reflections on the covid-19 pandemic and how to deal with it. more than 4 hours of in-depth exchanges and discussions were conducted on current hot topics in global health such as preventing the next pandemic, climate change, technological innovation and inequality, pandemic preparedness and financing.

public health is like a mirror of human society, reflecting the various conditions in the world. none of us wants the next public health crisis to come, but we must be prepared for when it does.

illustration 1 sculpture in front of the new who building

reflections on the covid-19 pandemic

"this is the first time we have received such a media delegation from china, and we are very excited." gabriella stern, who's head of global communications, said in her opening welcome speech.

in a large conference room on the first floor of the new who building, ms. stern, who once worked at the gates foundation, had already prepared a rich and compact agenda for the whole afternoon. although it was a pity that director general tedros could not meet because he was on a business trip in africa, two-thirds of the senior leaders of the headquarters showed up with a total of nearly 30 high-level officials including the directors of their subordinate departments and participated in the exchange. dialogue.

gabriella stern and catharina boehme

catharina boehme, assistant director-general for external relations and governance, is perhaps the best person to start this conversation. dr. boehm is responsible for leading who’s strategic engagement in the areas of governance, resource mobilization and partnerships. during the covid-19 pandemic, she was a co-convenor of the accelerator for access to covid-19 tools (act). our conversation begins with reflections on the coronavirus pandemic.

"we declared a public health emergency of international concern (pheic), but there was little response from member states. it was basically ignored by many countries." dr. bohm said that one of the reflections brought about by the new crown epidemic , seeing some challenges with the existing mechanism. “so one of the lessons we learned from this was the need to bring member states together quickly to really drive action and to quickly give member states an opportunity to discuss, reflect and engage with each other.”

one of the new steps in the who response is to strengthen the global health architecture around emergencies: from prevention to preparing for them to responding and then taking action with different stakeholders.

dr. bohm gave an example, “during the recent monkeypox outbreak, we convened a health emergencies subcommittee meeting among member states within 24 hours so that member states’ responses to this global emergency could be quickly implemented. response.” previously, the who declared monkeypox a global public health emergency for the second time on august 14.

but it’s not just about speed, it’s about the broader response. a glaring problem during the covid-19 pandemic is that vaccines, treatments and virus tests are not reaching all the people who need them fast enough, especially vulnerable groups. in this monkeypox epidemic, african countries that submitted vaccine applications as early as a year ago still had no vaccine available until the who declared it a global public health emergency for the second time in august this year.

in this regard, ms. yukiko nakatani, assistant director-general in charge of vaccine and drug approval, explained that this monkeypox epidemic is different from the last time and is mainly caused by new strains. therefore, the safety and effectiveness of the vaccine needs to be re-evaluated. secondly, the who's approval process also includes an assessment of the suitability of the vaccine to ensure the smooth progress of vaccine promotion in africa. for example, the storage temperature can reach 2 to 8 degrees celsius instead of minus 20 degrees celsius; the storage time can also be longer , reaching 4 to 6 months, while previous monkeypox vaccines did not meet these conditions.

yukiko nakatani

“a major difference between the work of the who and the drug regulatory authorities of developed countries is that european and american countries are only responsible for safety issues for their own populations, while low- and middle-income countries need to rely on the who to make judgments, so they must make decisions on vaccine safety issues. a high degree of caution and scientific judgment must be made based on data," yukiko nakatani added.

two weeks after this interview, the who finally approved the first monkeypox vaccine to promote its use in africa.

the who’s “war room” during the covid-19 pandemic—inworld health organizationin the strategic health operations center (shoc) conference room, the directors of the four major departments took turns introducing the responsibilities of their respective departments and answered our question: what lessons have been learned in this pandemic response?

shoc team

several officials shared their thoughts. they talked about the need for change in their understanding of pandemics, even as professional health officials — they never expected to experience a pandemic of this magnitude in their lifetimes.

they said that the covid-19 epidemic has highlighted the global insufficient investment in epidemic prevention preparations, resulting in huge losses. it is necessary to break the "cycle of panic and neglect" and increase investment in daily health emergencies. the uneven distribution of resources during the epidemic, especially critical supplies such as vaccines, highlights the unfair distribution of global medical resources and the need to establish a more equitable distribution mechanism.

in addition, the community plays a key role in epidemic prevention and must be placed at the core to ensure the accurate flow of information. multi-sector cooperation is also crucial to building trust and effective epidemic prevention, and requires strengthening collaboration among public health, science and communities. in addition, global surveillance and early warning systems are insufficient and need to be strengthened to identify early epidemic signals. emergency logistics and supply chains are under pressure during the pandemic and need to improve preparedness to ensure rapid response and supply of supplies.

"but i think we've also seen another risk in past covid-19 outbreaks," dr. jeremy farrar, chief scientist of the world health organization, shared his observations and thoughts from another level, "science association it won’t increasingly only apply in certain places – what i mean is that science can be seen as a way to improve health, provide opportunities for young people, and reduce inequalities around the world. or, if we’re not careful, science can also exacerbate inequality. artificial intelligence is a good example.”

farrar has deep roots in asia. he was born in singapore and worked in vietnam for 20 years, during which he had close cooperation with china. since 2017, faller has chaired the who research and development blueprint scientific advisory group. he was appointed to the uk government's expert advisory group on vaccines during the coronavirus pandemic.

jeremy farrar

in his sharing, farrar described his observations and thoughts about the era we live in today. "we're in a golden age of science, and a lot of scientific research is making progress, and just this week, new cancer vaccines were evaluated for the first time. if you had said this to me 30 years ago, i wouldn't have believed it. what we're going through now an extraordinary period of scientific disruption and technological disruption," he said.

he believes that we need to think about how to make technological progress benefit a wider range of people, not just an elite few. "rapidly evolving technology poses challenges, and trust in science is critical to sustaining its support system. in recent years, questioning of scientific evidence, both on climate change and basic scientific principles, has been cause for concern. we we must ensure that science is not disconnected from society because it is an integral part of society. we expect science to promote human progress in key areas such as health and well-being.”

yukiko nakatani also recognized this. "part of our mission is to help those who need it most, who don't have a health system, don't have infrastructure, don't have a strong economy. my concern is that in terms of those people, we're going to create two worlds where some people can use these medicines to fight the disease, while those with low incomes who cannot afford the medicines will have to live with the disease," she said.

the covid-19 pandemic has provided an opportunity. never before in human history have so many effective vaccines been successfully developed and put into use in such a short period of time. this can be said to be the key to reversing the epidemic. how to apply this research and development mechanism inspired by abnormal conditions to the wider field of normal public health and infectious disease prevention and control? this is the question that the new crown has left us to think about.

climate change brings new challenges

as the covid-19 pandemic gradually fades away, countries' requirements for the who have undergone great changes. boehm said that countries are paying less attention to infectious diseases and paying more attention to health promotion and behavior change. "ageing and global climate change and its health consequences are key issues. seven million people die every year from asthma and air pollution. it's a big problem," she said.

li ailan, assistant director-general for universal health coverage and healthy population from china, specifically mentioned the climate crisis. the health impacts of climate change are real and will continue to increase in the future.

li ailan (second from left)

"first of all, heat waves have increased temperatures, and even in european countries, even in switzerland, people are dying from heat waves. because they are not prepared. second, extreme climate events are happening more frequently, which will bring more disasters . because of climate change, both communicable and non-communicable diseases are changing, and previously cold areas now have mosquito-borne diseases, which are among the most vulnerable when heatwaves occur. it's really impacting the health care system in the region," she said.

li ailan served as the who representative in cambodia during the covid-19 epidemic. prior to that, she served as director of the who health emergencies program at the who regional office for the western pacific.

li ailan gave an example of personal experience, "when i was in cambodia, a local river flooded, and the only hospital in that province was flooded. it was a poor province. they called me and asked me to go. we were there finding out that the lives of all the survivors depended on the water levels of the floods and that local hospitals had no emergency plans was a real example of the impact of climate change on health," she said.

over the past 12 months, the earth has again reached its hottest temperatures on record. various extreme weather and climate events are becoming more frequent around the world. high temperatures, typhoons, and floods bring huge harm to people. however, it was not until last year’s united nations climate conference (cop28) that “health” was officially listed as a theme day. why are people only now starting to discuss the health impacts of climate change?

li ailan’s view is that climate change is not new, but when government representatives from various countries discuss climate at the negotiating table, there is very little interaction between them and other departments (such as health).

"in the early days, people always felt like climate change was someone else's business. it seemed like the link between climate and health wasn't well established, and it's only recently that we've really seen all this evidence. sometimes we feel like health is someone else's business. naturally, you get the sense that health should be at the center of policy and politics in many countries, but it is not. we have been saying very loudly that health is not a cost, it is an investment. it should not take so long for people to put health and climate together. but better late than never. if you look at the cop29 agenda this november, health is not on the agenda on day one, and maybe they will change it," she said.

in the exchange with li ailan, the paper reporter shared that he began to pay attention to climate change and the health impact on vulnerable groups because of reports on the new crown epidemic. he also became a father during the epidemic and hoped to do his best for his children to have a better future. responsibility. unexpectedly, this triggered a reaction from samira asma, the other assistant director-general in the room.

"i'm so moved by your personal story. talking about data or health information systems or strategies is conceptual, i think what you do in your field is bring it to life and demonstrate why it matters to policymakers and the public are important,” asma said.

samira asma

asma was born in hyderabad, india, to an aerospace engineer and businessman. she once mentioned in an article her father's huge influence on her. richard peto, emeritus professor of medical statistics and epidemiology at the university of oxford, uk, once commented: "asma is committed to changing this sad concept: 'the death of one person is a tragedy, the death of a million people is just a tragedy. it's the numbers', and she strives to bring mortality statistics into the global spotlight."

in public health, data plays a vital role. asma and her team introduced the latest applications of data tracking and analysis in informing health policy.

“while we see increasing challenges such as climate change, geopolitics, migration, and increased spillover effects of events, science, innovation, and technology are also rapidly making positive progress. i believe that despite serious challenges, technological innovation, multilateralism, and other challenges are increasing. and diplomacy, there is still a glimmer of hope. for that, we need good data, data that is timely, reliable, actionable and accessible to everyone," asma said.

for example, in recent years due to the impact of global warming, the number of perceived high temperature days and heat have increased globally. although high temperature has an increasing impact on our lives, most people still do not pay enough attention. one important reason is that the number of deaths caused by high temperatures is far underestimated.

according to who estimates, between 2000 and 2019, 490,000 people died from heat-related deaths globally every year. but for many complicated reasons, many heat-related deaths are not included in the official figures, and the actual number may be far higher than that. this highlights the data system challenges in addressing the health impacts of climate change.

“we have indeed made important progress in health and have good momentum. but what worries me is how we can sustain this momentum even though we have the evidence, policy tools and execution capacity to drive this forward at the national level. it’s still a key issue,” li ailan said.

preventing the next pandemic

the world health organization recently released a list of diseases most likely to cause the next pandemic. as the chief scientist, how does dr. farrar interpret it from a scientific perspective?

"from our perspective, these are pathogens that may cause problems in the future, and humans cannot ignore them." faller replied, "unfortunately, pathogens that do not cause major problems today are often ignored. before 2019, there's not a lot of research on coronaviruses, even though we had previous experience with sars."

he said the role of the who was not to do all the work, but to highlight where there were gaps in existing knowledge. "the list of pathogens that need to be prioritized is a very good way forward, but don't ever feel like it's easy to predict the future, i think what needs to be done is to make sure as much as possible that we don't have gaps in preparedness."

farrar believes that it is crucial to understand the origins of all emerging pathogens, because unless their origins are known, there will be no way to prevent them. one needs to keep an open mind and make sure no areas are overlooked.

jeremy farrar communicates with reporters from the paper (first from right)

li ailan emphasized the synergistic role of the media, “during my stay in cambodia, i learned to work closely with the media to contribute to saving lives, promoting health, and serving vulnerable groups. this mission goes far beyond doctors, nurses and health professionals. the scope of the department. do you realize that the media is also an important partner?" she asked.

li ailan's duties involve prevention. "50% of deaths worldwide today are avoidable. examples include tobacco and alcohol use. if we focus on prevention, we can save more resources. we all know that serious diseases are often accompanied by high medical costs, which not only pushing people into poverty also makes the health system unsustainable," she said.

the covid-19 epidemic may be a thing of the past in most people's minds. yes, we will always coexist with some diseases. but the key question is, have we learned any lessons from past epidemics? an important positive message is that we can save many, many lives through the work we already do. we must not only reflect on past pandemics and pay attention to possible new infectious diseases in the future, but also to pay attention to existing epidemics. because health, climate, and everyone are all interconnected.

as li ailan said, "we believe that a healthier population is the foundation for a healthier society, economy and sustainable development. we have a historic opportunity, which is the lesson of the covid-19 pandemic, as the sustainable development goals continue to mention that way, if your health is at risk, everything is at risk."

(interns su hang and zhan chenle contributed to this article)