DG Okonjo-Iweala was invited to deliver the Annual Pumphandle Lecture, hosted by the John Snow Society at the LSHTM. The lecture series is named in honour of John Snow, the British anaesthesiologist who became the father of epidemiology in 1854 when he tracked a London cholera outbreak to a public water pump on Broad Street. He convinced the local authorities to remove the pumphandle and render it inoperable. The most recent lectures were delivered by Sir Andy Haines in 2022, Dr Anthony Fauci in 2021 and Dr John Nkengasong in 2020.

The lecture, titled “Global Health Equity and the Role of Trade”, provided an overview of how globalization, in terms of the flow of knowledge, goods and services, has carried with it the solutions to public health crises. It also covered how trade and cross-border cooperation were vitally important elements of the collective response to the COVID-19 pandemic.

The lecture highlighted the “stark and cruel inequities in access to COVID-19 vaccines,” especially during the first year and a half of vaccines mass production. DG Okonjo-Iweala said that vaccine inequity cost 1.3 million lives by the end of 2021, according to the mathematical epidemiologist Sam Moore and his co-authors at the University of Warwick.

DG Okonjo-Iweala said that while trade was on balance a force for resilience during the pandemic, the disruptions to the supply of medical goods stand as a reminder that supply networks were not resilient enough. “While attempting to manufacture vaccines, therapeutics and personal protective equipment (PPE) within individual countries would have left us all worse off, too many people, in too many countries, were left behind even though we had multi-country supply chains at our disposal.”

She pointed to the complexity in the interplay between innovation, access, concentration and distribution. “A wide range of tools, including manufacturing investment in the necessary human resource skills, regulatory convergence, procurement policies and financing, need to be deployed in a coherent manner to achieve equity and build future resilience,” she said.

Looking at what the multilateral trading system can do now and in the future, DG Okonjo-Iweala stressed that the WTO promotes predictable and open trade, but it does not promote untrammelled trade. “In fact, it consciously preserves governments’ right to regulate, with extra policy space for measures necessary to protect human, animal and plant health.”

Looking ahead, new challenges will require new solutions, she said. “There will always be scope for all actors — the public and private sectors, and civil society — to do more to find an optimal balance among intellectual property protections, innovation and access.”

“Ensuring that trade contributes as fully as possible to global health equity goes beyond intellectual property issues and ensuring that goods keep moving around,” she added. “It also requires attention to procurement policies and the geographic diversification of production capacity — and, of course, it requires financing.”

The multilateral trading system needs to do better because “another crisis is inevitable, whether it comes from a known threat like anti-microbial resistance, or something unexpected,” she noted. To meet these challenges, the world would be better positioned if more countries “have the means or the external support to build stronger health systems, where scientists share information across borders, and expanding access to medical innovations is a shared global priority.”

“Meaningful global cooperation in the service of shared interests may seem like a great deal to hope for in today's fractious world. And yet, we have come together before under even less promising circumstances. In the 1970s, a much poorer world divided by the Cold War managed to eradicate smallpox,” DG told an audience of mostly health students and researchers.

Quoting the late Dr Paul Farmer, a champion of global health equity who said that “any time there’s a new tool developed — whether they are vaccines or therapeutics — there must also be a delivery plan,” DG Okonjo-Iweala stated that trade and institutions like the WTO are part of the delivery plan. They provide key mechanisms for getting the solutions that scientists and researchers come up with to everyone who needs them, wherever in the world they live, she added.

“In our interconnected world, diseases may travel faster than ever — but so can solutions, provided we cooperate. As my favourite Igbo proverb puts it, “Aka nni Kwo aka ekpe, aka ekepe akwo akanni wancha adi ocha” — if the right hand washes the left hand, and the left hand washes the right hand, then both become clean. It is a call for collective action to get the job done,” she said.

“Back in 1854, to put the Broad Street pump out of commission, John Snow only needed to persuade the local authorities. To successfully remove today's pumphandles — and tomorrow's — we will need to work together,” she concluded.

Read her full speech here.