Below the Radar Transcript

Pandemic Conversations: The World Health Organization and COVID-19 — with Kelley Lee

Speakers: Paige Smith, Am Johal, Dr. Kelley Lee

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Paige Smith  0:06 
Hi, everyone. Welcome to the first episode of our Below the Radar Conversation Series. Our first guest speaker is Dr. Kelley Lee, Canada Research Chair in Global Health Governance at Simon Fraser University. She chats with Am Johal about the World Health Organization and COVID-19.

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Am Johal  0:31 
Welcome, everyone, we're really excited to be able to interview Dr. Kelley Lee, who's with us today. Welcome, Kelley. 

Kelley Lee  0:39 
Hello, hi. 

Am Johal  0:41 
Yeah, wondering if you can maybe start by just introducing yourself a little bit in your area of research.

Kelley Lee  0:47 
Sure. I'm Canada Research Chair in Global Health Governance and what that means is that I study health issues that require collective action across countries. So things like, obviously, pandemics are a clear subject of mind, but also things like non communicable diseases, how companies impact on the patterns of things like diabetes, cancer, and so on across countries. So any issue that countries require cooperation.

Am Johal  1:18 
Now, for me, this is a fascinating thing to watch unfold, because I think for many people, this is the first time they've really experienced, in a kind of real global sense, a pandemic. Pandemics, of course happen but the extent and how wide this is quite unprecedented for a lot of people. And historically, since the post Second World War period, where a lot of international organizations were formed from the UN to the World Health Organization, wondering if you can in regards to your research, what are the how would you characterize the different approaches that are being taken by nation states, regarding in responding to COVID-19, but also kind of the role of the World Health Organization as well? 

Kelley Lee  2:08 
Sure, well, the WHO is the UN specialized agency for health and people may know it was formed in 1948. So after the Second World War, and it was designated as the coordinating body for international health cooperation, there's now around 194 member states. So WHO is coordinating the actions of all those member states. And there's two roles that it plays when we have a major outbreak like this. The first is to gather information. So Epidemic Intelligence, and that comes from official government sources. But it also comes from public health institutions from the WHO's regional and country offices, from collaborating centers academic institutes, and including, you know, places in Canada, and nongovernmental organizations. So there's lots of sources feeding to intelligence gathering. And then WHO also then alerts and advises on what to do when an outbreak is detected. So WHO issues these regular reports, they're called disease outbreak news reports, and you can track you know, all sorts of outbreaks going on in the world, and WHO issues advice and recommendations on what to do. So that's its role. And it has, you know, played this role primarily. And we see this every day on the news. And then what happens is countries that take that advice, and they move forward, and they initiate national level action. So this is all obviously playing out in real time. So how countries have performed during this outbreak, this pandemic will, will need to be you know assessed later on. But you can see already there's been a lot of variation in how countries have responded, the types of measures that have been adopted, the timing of those measures and who they've applied to. That's a really interesting analysis to do in due course. So we'll see, you know, which countries have got it right, which could have done better. But importantly, I think, what is what the evidence shows is that if countries coordinate together, they're sort of aligned and they're following best evidence, they will, they're likely to do better than if, you know, if countries go it alone, and they just do whatever, you know, they think is right, whatever basis. So that's the kind of work that I do, I try and understand how countries work together or don't work together often times, and what the impact is on controlling an outbreak. 

Am Johal  4:38 
The World Health Organizations, in many respects, has the same types of governance challenges that other international organizations like the UN do, in terms of being comprised of uh membership of nation states, and that has, you know, power relations embedded into it. There's funding challenges that come through, but The WHO has dealt with previous pandemics in recent memory from H1N1 to Ebola and other things? And so how would you characterize sort of historically how the WHO has dealt with epidemics as it was moving into Coronavirus in terms of recent challenges related to pandemics?

Kelley Lee  5:25 
Yes, so the WHO is always been well, since 1948, the coordinating body so we've had various pandemics, we can think about, you know, uh SARS, more recently. And then as you say, H1N1, Ebola virus and so on. We haven't had the International Health Regulations as they currently stand since 2005, when they were revised, and under those uh regulations, this is how WHO operates and how countries operate. So that's what defines how cooperation happens. In the past, WHO has played you know a variety of roles, whether it says, they say, you know, epidemic intelligence gathering or alerting, it has played a role in disease eradication programs, it's played a role in bringing people together in terms of research and developing interventions and so on. For these more recent outbreaks. It's, it's had a variable role in terms of its impact, uh largely, it's to bring countries together and to alert the world. But you know, during SARS, what you saw was a more forceful role in some ways that in when we had SARS, there was some hesitation about, you know, whether we're getting the full information from the Chinese authorities, whether countries had accessuh  to the right information, and so on. So WHO acted quite forcefully at that time under very different circumstances, I guess. And that outbreak, fortunately, was brought under control. But for more recent times, there's been more criticism of the organization, I'm aware of, a lot of questions being asked about whether it was forceful enough in this pandemic. And you know, it's hard, it's hard to know, at this point, things are moving fast. And I think the key thing is, we need to really reflect on what do we want from WHO? What do we need the organization to do? And to recognize that it does have limited authority and a limited amount of resources. And if we want, WHO to act more like it did during SARS, than it did say during Ebola when it was, you know, considered too slow, then what resources do we need to give the organization to, to be more effective? Those are the kind of questions that I think we need to focus on rather than perhaps, you know, um, being a bit of a bit of, you know, armchair pundits trying to pick the organization apart at a time when we're actually needing it to be as effective as possible right now. So being, being more, you know, constructive, looking forward, seeing what we can do to, to build a different, WHO if we need one. 

Am Johal  8:11 
Now, as the the virus has proliferated, there's been a lot of real time intelligence in terms of healthcare responses to the virus from where it originated in Wuhan to uh places like Iran and Italy, which had a significant expansion, a lot of mortality as well related to the virus and in the United States as well, where it really accelerated after the fact. But there were uh certain responses that seem to have been praised in a comparative sense in South Korea or Taiwan, these other places, and I'm wondering if you could sort of characterize some of the differences in approach the different nation states have have taken in relation to responding to the virus because it I guess, in each of these contexts it arrived in a different context with certain or more intelligence known about the virus, but in each of those healthcare systems also are different in some of those approaches from a public health point of view are slightly different as well.

Kelley Lee  9:17
Yes, it's been great diversity in how countries have responded for sure. And it's, you know, there are many variables involved. I think, you know, what we saw early on in Asia was was, you know, we all watched it on the news unfolding, was governments moving fast and moving quite strong to contain the virus. So you see, we saw lockdowns, we saw, you know, contact tracing, we saw quite an extensive amount of testing. And, you know, this what we didn't know, I guess at the time was that this was going to come to us very, very soon in a few months. So it seems like countries that moved quickly and most forcefully were the country that were able to suffer fewer cases and fewer deaths. What you're seeing now and parts of Europe, and in obviously, to our neighbors to the south is a slower response, and perhaps more partial responses. So, social distancing, for example, was kind of introduced much slower or less extensively. And then, you know, cases within community, was able to spread more and more widely. So, you know, I say the data coming through, you know, slowly from different countries is going to have to be analyzed to see which measures were effective at the time, when should they have been adopted, how strong, which geographies, and so on, it added to that mix, of course, with a role of private companies. So remember the cruise ship situation when we had cases on various cruise ships, and that caused clusters of the disease as well. And, what's really difficult at this point is I think everything is playing out in real time. So you know, saying that one country did better than the other is difficult to say, we can say that countries that tend to perhaps pull together and emphasize solidarity, and looking to maybe the most vulnerable members of society, are likely to be more successful at controlling this pandemic. Those countries that perhaps are ignoring those that are vulnerable, allowing the disease to spread in communities that don't have effective ability to social distance, for example, those those countries are going to do less well. And the most—an interesting example I had read recently, it was from the former UN ambassador from Singapore, Kishore Mahbubani. And Kishore Mahbubani was saying that, you know, if we think about these cruise ships, and you think about these cruise ships like a country, so if you have an outbreak on a ship, would you just clean a few of those cabins and leave the rest? You know, which is like leaving members of society to kind of fend for themselves. But of course you wouldn't, because you know that on a ship, you have to clean the whole ship, you have to make sure the ship is, you know, protected as a whole, and not just parts of it. And then you think of a country like that we can't just, you know, pretend that we can all, you know, make sure that some members of society are protected, are tested, and so on. We need to think about every member of society, if not for humanitarian reasons, but for, you know, self interest. These are the kinds of things that I think governments have been learning variable lessons on, and we see this being played out around the world.

Am Johal  12:57 
It's interesting to see now, when looking at pandemics throughout history, and if people don't come from the Health Sciences, or study this from a historical point of view, that you know, many people uh wrote about this in previous times, from Aristotle to Foucault, to others. And the history of quarantine even goes back to the 14th century during the Bubonic uh Plague, where there were quarantines placed on ships in Dubrovnik and in Venice and other places. But for many people seeing uh forms of restrictive measures being taken place like social distancing, this is very new, it's a new phenomenon that comes up very suddenly. And trying to get people to participate in a way for the overall public can be a really difficult thing for them to, to understand and also a kind of disorientation without uh knowing when these restrictive measures are going to uh be lifted up. But you also see, I guess, in some sense, beyond National Health Organization's also at a city level, decisions being made or emergencies being declared. Um and in some sense, when it, when you look at disaster planning in the general sense, like in Vancouver, for example, there's been far more resources into planning for an earthquake than there is for a pandemic. And I'm just wondering from your work, looking at the World Health Organization, what is it that can be done at the city or regional levels in terms of preparation for future pandemics?

Kelley Lee  14:35 
Yeah, that's a great question. We all want to be more prepared in the future. And we certainly don't seem to have been as well prepared as we thought. So during major emergencies, it's true. You want to have a clear command structure, first of all, which enables rapid mobilization of resources and decisive action. So we you need predetermine protocols about who's in charge, where are resources, what resources are available, you need preparedness plans. And we have some of those, of course, especially, you know, after SARS, we created those across the country. When a pandemic occurs, uh you don't you just don't have time to deliberate about all of these things, of course, and you don't often have time even to consult widely with stakeholders. Ideally, you do, you want to do that, of course, but you really want to do that before an emergency occurs. And you don't want to be scrambling around, you know, asking people, what they, what they need, what they think. So we're seeing this kind of swing into action, you know, in Canada, so there's a public health emergency command structure, which is swung into action created after SARS. And in some countries, that's not so much the case. And you know, it's not perfect, we're seeing that there's things that weren't anticipated. We're seeing shortages in personal protective equipment, for example, we're seeing an inadequate maybe surge capacity in our health systems, if not in Canada, so far around the world. And you're seeing an unexpected loss of livelihoods which we would not have anticipated to such a degree. So, so the role of cities is an interesting one, the nature of the emergency, I think it dictates the level of government that needs to take responsibility for all of these things. The West Coast, as we know, is prone to earthquakes, um, so it makes sense that municipal authorities with resources towards that sort of planning. However, climate change, and pandemics are uh global scale risks, they have local consequences, but they have global causes, and you know, global reach. So I think national and global level institutions need to take a lead role in these kinds of emergencies. And then municipalities can um, coordinate with those. So that, that's kind of how that works. So there are things that can be done at provincial and municipal level to coordinate and to be more resilient during emergencies, such as COVID. We need to, for example, think about how we can strengthen our health care and public health systems we've done that maybe we need to do more, we need to make sure we have trained healthcare workers and public health officials on the ground so that they can, you know, um, swing into action when we need them to, we need to maybe reduce the social inequities in our societies. They are touchpaper when it comes to emergencies. And we can see this in, in Vancouver, for example, the Downtown Eastside is seriously a vulnerable situation. And um, you know, there hasn't been so far a huge outbreak of COVID. But it won't take much for that to set off. Um, so we need to think about, you know, how do we deal with that before an outbreak occurs, and just take a whole of government approach to this, we um, this is a public health emergency, but we have to think about up transport, education, employment, all of these other sectors in our society, which are impacted. They need to have a plan as well and they need to be part of that plan. And as I was saying earlier about cruise ships, private sector actors are are extremely important in these situations. And perhaps what we're seeing is that the public and private sectors aren't necessarily aligned in this case. The pandemic unfolded, different cruise ship companies did different things  and um airlines did different things. So that needs to be better aligned, we need to learn lessons uh from that. And perhaps Finally, I would say that citizens I know are well informed in BC about earthquakes. And we all know about those shakeout exercises, what perhaps we need to do now is add to that how we can be informed and prepared when there's a um public health emergency such as this, and that requires education, from schools up and it requires local planning so that we are all prepared and we don't uh need to panic but we do need to be aware of the risks and we need to use the time that we get when when a pandemic occurs to prepare properly. Those things can be done locally, and then again, they need to feed into national and global planning processes.

Am Johal  19:11 
Now, there's some, when a pandemic occurs, there's a series of options that governments be they national, provincial or local are given in terms of emergency powers, and they're very rarely evoked particularly in a Canadian context. And so when a pandemic comes in, as quickly as this one has, you see the use of these public policies, the federal government hasn't gone right up to the, The Quarantine Act, and there's a range of options available. But for many people who haven't seen these policies uh enacted, it's quite a large use of public power and there can certainly be restrictions on civil liberties that raise other social questions and countries such as Hungary, for example, where an emergency has been declared where there isn't an end point to the measures taken by the government, people view it as you know, part of the politics of the country which have moved in a more anti democratic direction, that in some ways, the suspension of civil liberties and democratic rights can be extended and play into the local politics of a country. In Canada, we, the people who were protesting on Sunday, were probably more in the conspiracy theories zone of things but in other places this is a very real concern, and wondering in terms of looking at governance related to responding to pandemics, how some of these questions are thought about and adjudicated.

Kelley Lee  20:50 
Yeah, so I thought it about a lot. And you know, there's going to be much debate, no doubt in the coming period, as we move through this pandemic, as we go beyond it, uh, which countries responded most effectively, how different countries balanced this protection of individual rights, and the need to act decisively and quickly to protect collective interests. We saw early on, as I mentioned, you know, the Chinese government adopting very strong measures in Wuhan, particularly, to stop the outbreak spreading to other parts of China. And, while these actions appeared to have been effective, and and it could have been a much more serious trajectory, of course. These actions, I think, set a new precedent in that country in terms of the government's role. So I know history shows that when state powers are expanded during emergencies, and we we've seen this in seeing emergency measures have been adopted across Canada as well. There sometimes not rescinded in some countries when the emergency is over. And I think that's what people are concerned about is that, you know, that these powers like states, uh, or governments acquired during emergencies are not then removed. And so there's a concern, there's also an innovative use of technology, of digital technologies to do things like contact tracing and social distancing. And quarantine, we've all seen those films, you know, the drones have flying over people, you know, telling them to go back to their homes, and so on. There's a lot of other things going on with artificial intelligence, that is creating a new world of state based surveillance. So those things are certainly raising concerns whether those will all be kind of receding, once the outbreak is over. At the same time, there's also a need, you know, we have to reflect on broader issues around societies that are built on individualism. So we have countries around the world that, you know, the ethos is individual self interest, freedoms, personal freedoms, and so on. And we'll have to think you know, did these societies and they're largely Western societies, did they act quickly enough to adopt the measures that were needed to bend the curve, as we, as we're now used to saying, or did they actually move too slowly? And does this have to do with the fact that they were concerned about individual rights. So when, more fundamentally, you know, societies built on values of individualism and competition, they've tended to invest less and resources that are collective in public institutions, and we see you know, societies which have not invested these, these resources are faring worse. So I mean, you know, the tragedy playing out in the US, is in part because of a deeply unequal society, which has not invested sufficiently in basic health care and public health systems. It's been, you know, a very divided response in the US. And so this, the sense of individualism is not something that's uh sacrosanct, and that we need to think about what is the right balance between individual rights and collective needs. When an emergency occurs, that debate needs to happen again, before these emergencies happen, but also afterwards, when we think well, how did we, how did we do? Did we do get this right? Did we, you know, do we need to rebalance between those, those two important things? For sure.

Am Johal  24:13
Yeah, and my next question was sort of related to the Canadian and American uh responses. In one context, you have what's largely still a public health care system and in BC, there were changes made a number of years that reduced the number of health authorities which made, maybe perhaps decision making a little bit faster. But in the American context, not only do you have a largely privatized system, you have a governance at the state level that's maybe not as regulated or centralized federally, uh in terms of the coordinated system we have in the Canadian context and wondering if you can sort of characterize the issues in both places because the responses were slightly different because of that public/private difference, but then the decentralized nature, of the state level responses in the US as well. And you certainly see that in the incredible expansion of numbers in the, in the United States. 

Kelley Lee  25:07 
Yes, it's been very startling for sure. I check the numbers every day, and it's just doesn't seem to slow down. Well, it's important to distinguish between the health care system and the public health system. And, you know, we, we see differences in both between the countries, the healthcare system, of course, is the primary and tertiary care that we see the family practices, the community health centers, the hospitals where clinicians see patients. So that is incredibly important. And we see, we know that there are historical differences between the two countries, there's also the public health system. So that's composed of institutions which are responsible for preventing and detecting and responding to disease outbreaks in populations, among other things. So we have PHAC, we have BCCDC, we have lab services and so on. And you know, the,y they investigate and respond accordingly. And, again, the systems are very different in the two countries. So if we compare Canada in the US, it's interesting, you know, we share the world's largest undefended border with you know, I think there's 200,000 people before the outbreak, crossing the border every day, we have a lot of connection with the US. And yet, what we're seeing is the US is suffering about, you know, two to three times the rate of deaths and cases per million people. And these differences, I guess, can be explained eventually, maybe through a number of things. But from a public health perspective, I think one of the things is that we've been very affected by the SARS outbreak, we learned from that we had 44 people die in, largely in Toronto, and we created this institution called the Public Health Agency of Canada. And that was formed because of this experience of not doing very well during SARS, we learned that you know, our systems were not connected up, we didn't have hospitals linked to labs and data wasn't flowing. And there was all sorts of things that we realized we didn't have in place. So a lot of the work with, been to, to addressing that. We also have BCCDC here in British Columbia, which we're really fortunate to they have played an outstanding role. There's also Public Health Ontario, so some provinces have these public health bodies, not all provinces, but some do and, and of course, our healthcare system is publicly funded, it's universally accessible. So there's this direct contrast there with the United States, which as we know, is sort of kind of privatized model of health care. But we also see a public health system that was dismantled under the Trump administration. So the Obama administration following Ebola virus outbreak in West Africa in 2014, actually set up a number of mechanisms, the, to detect epidemics, and to have a command system. And that was based in the National Security Council, and the Department of Homeland Security. And those two bodies would then look to the US National Institutes of Health, or the USCDC, for the kind of scientific leadership that they needed. So it was it was all in place. And then in 2018, the Trump administration decided to actually dismantle all of that, if, for whatever reason, in the way of maybe reducing government they didn't think, you know, it was needed. And so as a result, when you have the COVID outbreak happen, the US government at the, in the White House found it did not have a pandemic response chain of command. It was, there was no coordination, um no central coordination across the entire country. So, what you see is states responding, and increasingly a kind of fractious relationship between the federal government and the state governments, uh in many cases, and then a lot of citizens not getting access to health care, to testing and so on because of cost, or because of just availability. So it was, you know, the, the contrast is very sharp.

Kelley Lee  29:04 
I don't think it's all down to those things, but certainly a large part of it. So we're very fortunate in Canada, that PHAC and the provincial public health bodies swung into action when the first reports of COVID-19 began to emerge from China. And we have universal health care. That's a distant dream and a political football in the US. And I think that's going to come back to haunt people. And I  do hope for the sake of Americans that those, you know, those lessons are won. So that's the, the public health healthcare system. What you're also seeing is it’s really a different tone being adopted by political leaders in the two countries. So in the US, as I said, the scientific and public health expertise of the NIH and CDC was, was, you know, in previously at the forefront of other outbreaks, but now you're seeing it put under, that both institutions are put under tight control by the White House by the current administration. And there's this combative tone that's being taken, you know, who's to blame for what? How many ventilators should go where? You know, were they prepared? You know, it was all this arguing and that really clashed parlty with what we're seeing in Canada, where you see Dr. Theresa Tam and her team at PHAC, front and center every day, giving briefings to the media, to us as citizens, and our political leaders are amplifying that message. They are, you know, working in, more in unison, uh of course, there are disagreements, but they're not major ones. And so we're seeing politics and public health working together, which is what you need in an emergency, you can't have, you know, these arguments happening, you know, as, as a, as a pandemic, is, is running through your population. So, I think that those values as well, of you know, of solidarity come through with with our political leadership, there's a lot of messaging around, we need to pull together, we think about the members of our society who are vulnerable, we, we have to prevent discrimination. I mean all of these messages are really important. And I think our our government's doing, I think, a pretty good job at just kind of getting those messages across. It's, it's rolling down into our provincial uh governments. You know, Dr. Bonnie Henry's been outstanding, really, you know, clear in her messaging very, very, I guess, encouraging of all of us. And I think that's extremely important. So, yeah, there's so many contrasts with the two countries. I hope that the US can learn from this and maybe take a page out of, you know, how it's important to pull together in these situations, at all different levels of government. 

Am Johal  31:50 
It seems like in depending on uh where the country's people have been praised for the type of communication that's been happening. And certainly there's a level of public trust that's required in these moments for crisis, certainly Jacinda Ardern, the Prime Minister of New Zealand has been praised for her communication around this work. In other parts, there have been criticism for parts of this, be it Donald Trump in terms of initially not viewing this as a major issue. There have been some areas of communications where there might be construed as mixed messages should one wear a mask or not wear a mask, it should be kept for healthcare professionals. And so sometimes, there were pieces that didn't get articulated maybe, as well, or there was even a time here and Bonnie Henry has been widely praised, uh, in terms of her work articulating the situation here in BC. But even going into the middle of March, people were being encouraged to go out to Whistler and restaurants and by the following Monday or Tuesday, it was a very different tone, because of the numbers that were, that were coming in and wondering if you could sort of speak a little bit to the different ways that governments have communicated around this and maybe what some of your critiques might be as well.

Kelley Lee  33:19 
Of course, and I think no country is getting an A+ in this outbreak, for sure. And, there's been lots of lessons to learn. Now I can understand why people might think that the advice is, keeps changing, you know, why would you tell us no masks and now it's masks, and so on? And there may seem like a lack of consistency in the messaging. And though, and there will need to be reflection, just like there was after SARS, about what could be done better in terms of communication. But it's also important for people to understand that when you're dealing with a novel pathogen, such as this Coronavirus, decisions are being made in real time, very quickly and with incomplete information. That information is changing, accumulating, perhaps growing over time. And then so decisions are being made with imperfect information. And so they can only, decision makers can only give us their best advice at the time. And based on maybe previous outbreaks and how maybe previous pathogens have behaved and there are diverse contexts within which, you know, this is playing out. So public health officials are undoubtedly running, running to keep up, you know, this is the way I see it, they're working extremely hard, and they're trying to analyze things as they're unfolding. It's incredibly difficult. And so for example, when we were talking about you know, now there's recent reports about asymptomatic individuals potentially transmitting this virus, this is not usually the case. So then the measures that we've, you've thought were effective need to be thought again, about again, and this is why masks are now considered something that we might need to think about as we go forward. So, the virus, this particular virus is novel, and it's acting in ways that are, you know, unusual, from other coronaviruses. So we're, we're learning from that, and there's also people being tested, and then they're, you know, seem to have got over the virus and then they're being tested positive again. So that's another example. You know, there's, there's wrinkles that we're they're trying to work out, there's lots of things about antibodies that are not kind of  going the way we expected it to. So there's a dynamic situation, and public health officials are kind of dealing with that. So they can only act on the information that they have at the time before them. And when you have a novel pathogen, when the, when the intelligence keeps changing, you know, we have to also then adapt the, the advice that that people get. And so people need to recognize that they that they are, you know, dealing with this, but the other point I wanted to make was that, in addition to the kind of scientific data that's coming in, and the epidemiological data that's, you know, changing and how the virus is behaving, and so on, policymakers also have to think about the societal impacts of what they advise. And so you know, what I was saying earlier that some countries went earlier and harder on social distancing, and shutdowns and so on, and some didn't. The reason for that is that when you do have a lockdown, and we've seen this, there's huge impacts on our society. So there's you know closing schools, uh closing businesses, these have huge impacts on everyone. And of course, this is a public health emergency. First and foremost, we need to protect lives, we need to stop the transmission, but we can't take those impacts lightly. So you have to be really sure that, you know, it's the right time to shut down a society. We've never, of course done this before. This is like something, you know, we don't have data to say, okay, we do this, this will happen to people's lives, we can only guess. So. So what I'm saying is, with all this scientific, information changing, we're also seeing a sort of lack of data on the societal impact. So decision makers are in a really difficult situation, having to balance stopping an outbreak from spreading further and saving lives, but also trying to have as little impact on people's wider lives as possible. And that's, you know, under, of course, time sensitivity, and under a lot of political pressures. It's an incredibly difficult thing. And I think our officials are doing the best they can and under the circumstances, that are truly unprecedented. And that's what people just have to keep in mind when they see advice changing and they, you know, have to understand what's going on behind the scenes. 

Am Johal  37:53 
And Kelly is there, is there anything you'd like to add? 

Kelley Lee  37:56 
Well, there's a couple of points, if you don't mind, I'd love to just just maybe put in the minds of people as we're kind of like, reflecting on what's happening. I think the first thing we need to do is each of us as individuals, as human beings, we need to think about how we might change our own lives going forward. So I've seen a lot of finger pointing, you know, blaming about why this pandemic has occurred, and so on. What I think would be more productive is that we each take responsibility for how we live our lives in this, on this planet, that, you know, zoonotic diseases are arising because we're having an adverse impact on our wild environment on that, and wild animals, the way we live our lives in an unsustainable way. So I think, you know, we could all do our part, and I know a lot of us are, but you know thinking more about how we might live more sustainably. The second thing is I did mention the private sector. And I think the private sector, in a way is impacted obviously by this outbreak, but needs to think more about how it is also part of the solution. So part of this whole story is about how our societies are interconnected. And the reason why COVID is so different is because we are so closely connected across societies, because of economic globalization. So the, the problem though, is that over the past 30 years, market driven globalization has hollowed out our states, has hollowed out our governments. And I include the hollowing out of WHO. So the capacity of WHO to do what it needs to do, has been limited because there's this trend or ideology that states need to be smaller governments need to be minimal. And I think that has been a mistake. We've under invested in um, governments, we've, we've, you know, not just public health systems, but worldwide and a lot of big companies have been part of this. And so you know, I'm analyzing for example strategies that companies have pursued to minimize their tax liability, tax avoidance strategies. This is part of the trend of hollowing out the state. So states, governments don't have the resources to build effective public health systems if governments don't have tax revenues, and um WHO won't have those, you know, resources that you need, because governments don't have money to pay into WHO so it's all it's all connected. So if big companies want to operate in a globalized world they have to start paying their taxes, and they...

Am Johal  40:36 
Certainly the cruise ship industry would fit into that zone. 

Kelley Lee  40:39 
Boy, yes. Aren't they seeing that, you know, being, you know, registered in places where they could pay the least tax, and now they're seeing, oh, well, maybe that wasn't such a good idea. And so these kinds of industries are, you know, part of the problem, we need to see, you know, that they're paying their fair share, but also that strong markets depend on strong states. They're not mutually exclusive. And I think we're seeing that played out. So those are the two messages really, I think need to get out there and that we can all do something to prevent this being a repeat performance for the world. 

Am Johal 41:15 
Kelley, thank you so much for joining us.

Kelley Lee  41:18  
You're very welcome. Thank you.

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Paige Smith  41:25 
Thank you for listening to this conversation between Dr. Kelly Lee, and Am Johal. Stay tuned for the next episode from the Below the Radar's Conversation Series.

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Transcript auto-generated by and edited by the Below the Radar team.
April 21, 2020

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