I first visited the University of Guelph in Ontario, Canada, in 2019 to curate dialogues that centred around the unique food systems challenges in Canada. There are complex issues to be tackled when fostering food systems that are beneficial for both people and the planet.

For me, being involved in these dialogues and collaborating with the Arrell Food Institute, led by the charismatic Evan Fraser, has been a transformative experience.  So I was delighted to hear, earlier this year, that I had been nominated to receive the honorary degree of Doctor of Laws, Honoris Causa, from the University of Guelph (UoG). I received this degree on Tuesday, 13^th June 2023: it was an unforgettable experience and I am privileged to have been awarded the degree.  It was the high point in a three-day visit to Canada.

Monday, June 12^th

On Monday I was invited by the Arrell Food Institute to curate a dialogue to shape a new project that is exploring the value of innovations in agriculture.  Could innovations foster high productivity and nature-positive farming systems that enable both people and animals to have better standards of living?

The dialogue brought together experienced practitioners from different parts of Canadian food systems, including producers of food for different value chains, advocates of agroecology, proponents of biodiversity in farming, and representatives from agribusinesses.  It was part of an ongoing series of dialogues designed to encourage the exploration of food systems from diverse perspectives, to investigate the potential benefits and trade-offs of emerging technologies within different food systems, and to assess what is needed to allow for the full potential of technologies to support a more sustainable food system.  The dialogues enabled me to appreciate the potential of targeted investments in novel farming systems, especially within farms managed by women from marginalised communities. This reaffirmed, for me, the significance and value of inclusive approaches to food systems dialogues.

Evan Fraser and David Nabarro during filming. Photo credit: Arrell Food Institute.

Later that day I was interviewed by Evan Fraser for a film about food systems and their transformation. As part of the film, I had an engaging interaction with two senior doctoral students from the University of Guelph, who asked me some hard questions: Emily Duncan, who is a geographer doing research on farmers’ use of technology for sustainable intensification, and Deus Mugabe, who is a Plant Scientist focusing on plant breeding, genetics, and international development. They asked about whether the 2021 UN Food Systems Summit prioritized collective over individual action, and were keenly interested in the potential for integrating systems approaches into scientific education.

In the evening Alice Tamblyn Raine, who is Director of Operations at the Arrell Food Institute, jointly with her twin sons Theo and Thomas, hosted me together with approximately 30 faculty members and students from all over the globe. I enjoyed learning about their different projects, interests, and aspirations.  They want to contribute to just, sustainable, and equitable food systems that emit fewer greenhouse gases and are resilient in the face of climate change.  It was an inspiring and stimulating evening, setting the stage for my graduation the following day.

Tuesday, June 13^th

David Nabarro and Chancellor Mary Anne Chambers during the graduation ceremony. Photo credit: Grant W. Martin Photography.

The graduation ceremony at the University of Guelph on Tuesday involved several hundred women and men.  I sensed the grandeur of the occasion as I donned the iconic red robe, and met up with University Chancellor Mary Anne Chambers and University President (and Vice-Chancellor) Charlotte Yates.  Chancellor Chambers enthusiastically shared with me the essence of Guelph University’s values, and how both systems thinking and interdisciplinary approaches come naturally to Guelph students and faculty.

Then it was time for me to receive my degree and address the graduating students. I am always apprehensive when giving talks to large groups like this and my nerves were especially active this day. My speech was an opportunity to share my views about the professional skills that are essential for navigating the uncertainties of the future. First and foremost, I underscored the importance of welcoming complexity, and maintaining an exceptional curiosity that drives us to explore, learn, listen, and seek inspiration from the ideas of others. I highlighted the transformative potential of connecting with diverse individuals, as it often leads to the discovery of innovative approaches. I suggested that there really is no alternative to operating collectively and collaborating with others when trying to make things better for all. Then I drew inspiration from the motto of the Guelph Athletics Teams – the Gryphons – and emphasised the importance of caring: the most important characteristic of all.

The graduation ceremony was a joyful and wholehearted affair. Each graduate ascended to the stage to be adorned with an academic hood and be captured in a forever photograph. Witnessing their radiant smiles, I couldn’t help but reflect on the immense amount of hard work and dedication they had invested throughout their academic journeys. It became evident that behind each smile lay a profound sense of accomplishment, reflecting the culmination of countless hours of effort. Throughout the ceremony, I watched as President Yates privately offered a few words of encouragement and support to each student as they graduated.  It was a nurturing environment, in which I sensed each graduate was determined to make a meaningful difference: it fostered a sense of belonging with everyone seeking to make a positive impact.

(From left) Evan Fraser, President Charlotte Yates, David Nabarro, Anne Arrell, Tony Arrell, Senator Robert Black Photo credit: Arrell Food Institute.

Subsequently, President Yates hosted a reception for the guests at the ceremony. I couldn’t help but admire her genuine concern for the health and well-being of all her students and faculty. I was honoured to be alongside the esteemed Senator Robert Black – with his impressive focus on sustainable agriculture and commitment to completing Canada’s soil survey.  I met with Tony and Anne Arrell, who are passionate champions for food security and sustainable food systems.  They are the benefactors of the pioneering Arrell Food Institute. Their tireless efforts exemplify the values of the university.  Also at the reception was Guelph-based multi-media artist Christine de Vuono whose work celebrates people’s needs for beloved care and lived beauty.  Evan Fraser, leader of the Arrell Food Institute, was as warm and welcoming as ever.  All these great people left a lasting impression on me: they are powerful and enriching change-makers.

Later on Tuesday, I was interviewed by members of the UK Science and Innovation Network from the British Consulate in Toronto. The interview was conducted by Kathryn Chen, the Head of Science, Innovation and Policy, who was supported by Lucy Whichelo, Media and Public Affairs Officer: they went into the story of my life, the significance of my degree, and work I am doing, at Imperial College, on the impact of climate change on people’s health and wellbeing.  Kathryn described her experiences when working with First Nations communities whose lifestyles are being upended by the impact of changing weather patterns.  I realized that some of these communities are close to Toronto and directly affected by the devastating forest fires that are burning across the country. As we unravelled the links between climate change and food systems, we realized the urgent need to face up to their meaning and implications.

Wednesday, June 14^th

On Wednesday I joined a seminar convened by the Maple Leaf Centre for Food Security in downtown Toronto on ways to help Canadian people tackle food insecurity and alleviate associated health burdens.  The programme was well organized by the Centre’s staff: my role was to be the facilitator and I found this to be truly captivating.  The focus was on the potential for prescribing food in healthcare settings to reduce the impacts of low energy and nutrient intake on people’s health.  The meeting explored options for integrating food prescriptions into federal, provincial, and local health policies.

To ignite the discussion we heard from Jennifer Reynolds, the Co-Executive Director of a group called Nourish.  She combines humility with courage: her passionate advocacy for universal food security as a moral imperative in Canada was awe-inspiring.  Another starting panellist was Dr Andrew Boozary, the Executive Director of the Gattuso Centre for Social Medicine at the University Health Network. As a primary care practitioner, he was unequivocal about the need to include the option to prescribe food as a component of health care when treating patients who are food insecure.  He explained why it is important to tune in to the social and economic determinants of health within Canada. We then had a set of 5 simultaneous facilitated dialogues on issues that need to be resolved if food prescribing is to be expanded. These harnessed the collective energy and ideas of the participants and used techniques with which we are familiar in the 4SD Foundation.  It was a constructive and collaborative atmosphere that allowed for meaningful progress in the field of social prescribing.

Big thanks …. 

A lunch meeting between (from left) Alice Tamblyn Raine, David Nabarro, Erin Doherty, Evan Fraser and Janice Leboeuf. Photo credit: Janice Leboeuf

I am super grateful to everyone involved in supporting me on this experience.  Special thanks go to colleagues from Guelph, particularly President Charlotte Yates and Chancellor Mary Anne Chambers, as well as Evan Fraser, Alice Tamblyn Raine, Erin Doherty and all the dedicated staff and students from the Arrell Food Institute.  The Agri-tech dialogue on Monday 12th June showed great promise.  Special gratitude to Erin Doherty who was my guide and support while I was in Guelph.

I am also particularly grateful to Lynda Kuhn, Sarah Stern and Merryn Maynard of the Maple Leaf Centre for Food Security, as well as all the participants in the convening on Food Prescriptions. The meticulous organisation at the event and the Centre’s warm hospitality made my visit a truly memorable and impactful experience.  Most of all I thank Faculty and Students at the University of Guelph for such a warm and powerful welcome.  I very much hope to stay connected to and collaborate with all of these amazing changemakers and their networks….

Receiving the invitation from the University of Pretoria to visit the campus and be awarded an honorary doctorate filled me with immense joy. It wasn’t just any invitation, but an opportunity to visit one of the world’s most prestigious universities—a renowned institution with a forward-looking vision, actively tackling the ongoing challenges in South Africa and across Africa.

David Nabarro (third from right) with Vice Chancellor Tawana Kupe (second from left) with Faculty and students. Photo credit: University of Pretoria.

Upon my arrival, I was warmly welcomed by my hosts, the Faculty of Health Sciences. Their impressive standing in academia was evident across the four esteemed schools: medicine, dentistry, healthcare sciences, and health systems and public health. I had the privilege of meeting distinguished deans, engaging in discussions with vice deans and chairs of different schools. These initial interactions affirmed that my visit would be an extraordinary two-day window to learn from an academic community known for its excellence and innovative approach.

During my visit, I explored how this institution effectively engages with diverse entities to foster collaboration and create meaningful impact. This university functions as a vast ecosystem, recognising the importance of the intricate connections that it must establish and nurture with local authorities, government bodies, and stakeholders across various segments of the healthcare system.

Photo credit: University of Pretoria.

Shortly after my arrival on the 11th, I enthusiastically participated in the first of two significant sessions, where I had the privilege of listening to different researchers sharing their work and collaborative efforts. These sessions provided a valuable platform for me to absorb their insights and contribute my own perspectives. The discussions were filled with lively exchanges, extending from noon until 5 p.m. A notable aspect was the informality that fostered the perfect atmosphere for open and engaging dialogue. This kind of setting is something I truly cherish and actively seek during my travels, particularly when I can take the time to embrace and appreciate diverse perspectives.

Given my particular interest, I had the privilege of engaging in organised discussions regarding the spread of zoonotic diseases (those transmitted between humans and animals), as well as the viruses and other agents responsible for infectious diseases and pandemics. Notably, the latter group played a crucial role in characterising the COVID-19 Omicron variant when it first emerged. Additionally, I gained valuable insights into the various strategies employed to control malaria, especially in anticipation of the changing incidence of malaria in Southern Africa due to global warming and climate change.

Photo credit: University of Pretoria.

One aspect that impressed me greatly was the concerted effort to integrate various scientific disciplines and foster interdisciplinary collaboration. This approach ensures that the knowledge generated is directly applicable to the real-world contexts in which people live. For example, the university’s commitment to prioritising the wellbeing and capacities of the people who work in health care, and working with healthcare systems as living systems – influenced, and managed by people – was evident throughout. This reflects the principles of living systems that are so important at 4SD Foundation. The experts in the University understand that achieving equitable public health outcomes, where priority care is available for those who need it, not just those who can afford it, relies on health systems that function well with people’s needs at the centre. In this university the faculty are prepared to think hard about what makes a health system make a difference to the lives and livelihoods of people. They don’t see hospitals as the primary place for improving public health, instead, they recognise the integral role that communities play in health systems.

Overall, my visit to Pretoria university helped me appreciate its dedication to cultivating a holistic and multidimensional approach to research and application. While I realized that I lacked expertise with the local context, I offered some advice on maximising the efficiency of policies and procedures, ensuring optimal resource utilisation, and striving for outcomes that align with the aspirations of the people. A key aspect I emphasised was the importance of recognising the unique identities of different groups and investing in relationships that promote open sharing of ideas and knowledge.

I was able to delve into the five characteristics exhibited by living systems leaders:

1. Hold competing perspectives simultaneously
2. See the whole system differently to its separate parts
3. Feel into the pace, rhythm and readiness
4. See the system in relationship to its environment
5. Meet people right where they really are

These discussions underscored the significance of identity, relationships, and the act of sharing openly — all essential for building long-term, trusting relationships. The exploration of these themes served as a rich source of insights that resonated deeply. It became evident that the principles governing living systems could be harnessed to navigate complex challenges and pursue meaningful change.

Photo credit: University of Pretoria.

One particularly captivating aspect of my visit was witnessing the university’s engagement in the process of reconciliation and forgiveness, as well as observing how the broader society is structured. Through various art forms and exhibits, they vividly portrayed this transformative process. As we collaborated, I realised that there was much to learn from their profound understanding of trust and the characteristics of living systems, which they actively apply in their endeavours.

To conclude the day, we were deeply moved by the inspiring story of Dr. Bongani Mayosi, a brilliant cardiologist who tragically passed away at a young age. Dr. Mayosi had a profound realisation that heart health is profoundly affected by one’s poverty status—a stark reminder that poverty breaks hearts. It reinforced the pressing need to address the profound impact of poverty on individual well-being and overall heart health. It was a poignant moment to be in the presence of Vice Chancellor Tawana Kupe, who had played a pivotal role in developing Dr. Mayosi’s narrative. His involvement highlighted the university’s commitment to recognising and uplifting individuals who embody the values and actions required to drive positive change.

Being immersed in a society actively engaged in the process of reconciliation added another layer of significance to the experience. It underscored the collective effort to heal wounds, reconcile differences, and forge a path towards a more inclusive and harmonious future. Witnessing their willingness to identify role models who exemplify the necessary steps for progress was truly remarkable.

Photo credit: University of Pretoria.

On the final day of my visit, I had the opportunity to explore the Future Africa campus, a hub dedicated to interdisciplinary research on the African continent. I was particularly intrigued by two key initiatives.

• The first centered around understanding the interconnectedness of animal, human, and environmental health—an approach commonly known as “One Health.” I engaged in enlightening discussions with Professor Wanda Makota, delving into the critical relationship between these aspects and the implications for overall well-being.
• The second initiative focused on food systems, and it was truly exciting to witness the enthusiasm and innovative approaches demonstrated by the postdoctoral fellows in their pursuit of interdisciplinary collaboration. We dedicated time to exploring practical ways of making these initiatives a reality, recognising the barriers of the systems in which they work.

Later in the day, I had the privilege of attending the graduation ceremony where I received an honorary doctorate (click here to watch a recording of the event). The atmosphere was vibrant, with academics and the community coming together to celebrate their enormous achievements. The Vice Chancellor delivered a powerful speech, and the Dean shared a statement, emphasising the significance of their milestones. Witnessing the graduates receiving their awards was a moment of shared pride and accomplishment.

As I prepared to depart and return to Geneva, I couldn’t help but reflect on the invaluable lessons I had learned during my time in Pretoria. I was deeply impressed by the country’s resilience in the face of significant ongoing changes and its unwavering commitment to fostering collaboration across different scientific disciplines, sectors, and stakeholders. The collective community’s dedication to driving meaningful change through partnerships was truly inspiring. It became evident that our expertise and experiences held value in supporting activities in Pretoria and other universities. It was a realization that we were not merely observers, but active participants to support the change.

Overall, my visit provided an opportunity to offer capacity-building support, learn from others, and provide valuable feedback. I was honoured to witnessed first-hand the value that academics found in embracing the principles of living systems in their respective journeys. The living systems approach offered a fresh perspective and practical tools that enhanced their work and enriched their academic pursuits and I look forward to accompanying their change.

—

On Friday 5 May, 2023, the World Health Organization (WHO) downgraded its assessment of the pandemic, indicating that it no longer qualifies as a global public health emergency. The WHO approach was spelt out by the Director General during his opening remarks at a media briefing which can be watched here.

The background

On January 30, 2020, WHO’s Emergency Committee, constituted to advise the Director General as per the International Health Regulations (an intergovernmental treaty), had recommended that a public health emergency (PHE) be declared. This was before the disease had been named COVID-19 and when there were only 100 reported cases (and no deaths) beyond China.

The declaration that a health threat as a global emergency is a warning by WHO that the threat is extraordinary, affects multiple countries and requires a coordinated containment response. It is designed to encourage national decision makers to introduce special containment measures and arrange the release of extra funds. It indicates that low-income countries will need financial help to participate in the global response.

The present situation

On Thursday May 4, 2023, the Emergency Committee met for the 15th time to discuss COVID-19 and concluded that it was time for a change and made its recommendation to the Director General.

The Director-General said on 5 May 2023, the pandemic has been “on a downward trend for more than a year, with population immunity increasing from vaccination and infection.” That, he said, has allowed most countries “to return to life as we knew it before COVID-19”.

The present situation is that COVID-19 is still a pandemic: the virus is here to stay and that thousands of people continue to die every week. Nearly 3 million people were reported with COVID-19 in April 2023: there were 17,000 COVID-19-related deaths recorded. There is a residual risk of new variants emerging that could cause surges in illness and deaths.

High immunization levels, both from vaccination and previous infection, have helped dramatically reduce the severity of disease. So, while COVID-19 will continue to spread among people for a very long time, the threat level is lower and does not justify extraordinary measures to curb the virus’ spread. COVID-19 needs to be managed alongside other infectious disease threats.

What is WHO doing next?

• WHO is setting up a review mechanism: Now that the Public Health Emergency has ended, WHO is establishing a COVID-19 review committee under the auspices of the International Health Regulations (the current global treaty within the context of which WHO does its infections control work) to develop long-term recommendations for countries on how to manage COVID-19 on an ongoing basis.
• Advising Governments: WHO is advising Governments on actions to be taken now to deal with risks that could result from COVID-19 in the months and years ahead. Last week WHO published the fourth edition of the Global Strategic Preparedness and Response Plan for COVID-19, which outlines critical actions for national authorities. It highlights the importance of maintaining regular assessments of the spread of the virus (including for new variants), protecting people who are vulnerable with vaccines and boosters, the use of non-pharmaceutical measures (distancing, masking and protection) for reducing the likelihood of exposure among those who are more likely to experience severe disease (people who are older, immune-compromised, or affected by diseases that increase risk such as diabetes). It also emphasises the need to ensure that health workers and carers are able to reduce their exposure too. It includes recommendations on how to maintain safe health care, with the capacity to scale up if necessary, if there is a surge in people affected by the virus and experiencing severe illness.
• New Pandemic Treaty: WHO is also hosting negotiations between its Member Nations on the development of a new pandemic preparedness treaty to learn lessons from COVID19 and handle future mega-threats more effectively.

People are partners in the response

Simon Clark, Professor of Microbiology at the University of Reading, is quoted as saying that the message to the public should still be to take care and think of others. That means if you’re ill with a respiratory infection, like a bad cough, don’t put others at risk, especially not those who are vulnerable. If you pass on a COVID-19 infection, no one will thank you. Even if you are fit and young, COVID-19 can still be nasty and if you’re old and frail, it can kill you.

Mike Ryan, Director of the WHO Health Emergencies Programme, is quoted as saying, “It took decades… for the pandemic virus of 1918 to disappear,” when referring to the Spanish flu pandemic which is thought to have killed at least 40 million people.

So there is still much more work to be done even though the Public Health Emergency is over!

From his days working in South Asia, East Africa and the United Kingdom, to his leadership of Roll-back Malaria, the Scaling Up Nutrition (SUN) Movement, the #SDGs, food security crisis and #foodsystems transformation, as well as his response to Avian Influenza Pandemic and Ebola, David has alway placed people at the center of his efforts, promoting a living systems approach as a means to understand complex challenges.

David continues to be a powerhouse of inspiration globally as he creates learning opportunities for people through 4SD – Skills, Systems & Synergies for Sustainable Development where he serves as Strategic Director and at Imperial College London as Co-Director and Chair of Global Health at the Institute of Global Health Innovation. His role as COVID-19 Special Envoy and as a workstream co-lead of the United Nations Secretary-General’s Global Crisis Response Group, keep him and his dedicated team at the forefront of responding to some of the most critical challenges we face.

We are currently in the middle of the largest cost-of-living crisis seen in at least a generation exacerbated by conflict, climate change and COVID. In addition, one in 20 of those who get infected by COVID have been left with lingering problems affecting their heart, respiratory system, and their general well-being. Many people have lost their jobs because of COVID. Politicization of responses to this difficult virus has led to the stigmatization of groups of people and a lack of trust in authority. COVID has also caused anxiety to those with chronic non-communicable illnesses not being able to access healthcare.

Society re-opening has led to more visceral fears- not just of catching COVID-19, but also of the fear of passing it on to a loved one, the stress of being faced with new realities of working from home, unemployment, home-schooling of children, or the lack of physical contact with other family members, friends, and colleagues. All these factors along with system disruptions caused by climate change and conflict are drivers of social and health inequalities, having the greatest effect on those most vulnerable.

Without meaningful interventions, an even greater burden will be placed on our health and on our health systems, only further deepening inequalities.  How we deal with it now can either strengthen our societies or set us back in the progress that we need, to make our societies equitable and durable. And that means we need a global response that focuses on the needs of those most vulnerable. We need all people to be protected, and we need to prepare all our systems and all our communities to be more resilient.

To assist with the challenge of the conflation of crises including COVID, conflict, cost, and climate change, the United Nations set up the ‘Global Crisis Response Group on Food, Energy and Finance’ to help decision-makers mobilize collective solutions. At the same time to address the mental well-being of individuals and communities, the World Health Organization released a report on Climate Change and Mental Health at the Stockholm + 50 conference. More recently, the ‘Grantham Research Institute on Climate Change and the Environment’ of Imperial College London, put together a comprehensive document on the impact of climate change on mental health and emotional well-being. The publication shows the relationship between increased temperatures and number of suicides and gives evidence for severe distress following extreme weather events. It goes on to show how climate change amplifies mental distress, particularly among young people, even for individuals who are not directly affected (e.g. ‘eco-anxiety’).

With the help of these initiatives, governments everywhere are urged to include mental health in their response to the climate crisis, to develop community-based approaches to reduce vulnerabilities and close the large funding gap that exists for mental health and for psychosocial support.

50% of mental health problems are established before children are aged 14, and 75% before adolescents are 18. Children and adolescents are particularly vulnerable to negative mental health impacts of climate change, and they do need to be equipped with knowledge and skills to be able to steer themselves through this, to be able to lead their communities, their organizations, and to make their voices heard in their spheres of influence.

Advocacy by young people is particularly important in moving the needle for systems leadership. For interconnected crises, interconnected solutions are needed. Systems leaders know how to weave the different issues together. They understand the need for whole system responses while still being able to focus on their components.

Young people can bring awareness and drive behaviour change by engaging with systems from multiple perspectives at the same time. They can appreciate the relationships between systems and their environment. They can feel the pace and rhythm of systems and assess their readiness for change. They are more likely to meet people where they are, rather than where they would like them to be. Young people are ready to make these changes and provide the systems leadership that is needed for the future, but they can only do so if they are able to function at the interface between climate and health.

In summary, climate change combined with food shortage and conflict on top of COVID is having an extreme impact on the mental health and well-being of people everywhere particularly those that are poor or vulnerable.  This is manifested in the interconnected problems that we see today, and they need systems solutions and leaders who are systems thinkers and practitioners. The mounting pressures and increasing triggers for mental ill health need collective attention now. Community-based approaches to provide mental health and psychosocial support to all people particularly those who are hard to reach, poor, and those who are vulnerable, needs to be the centre of our attention now.

COVID-19 is an infectious disease caused by a virus that is easily transmitted between people. Outbreaks of COVID-19 are contained by preventing the virus from moving from person to person. As efforts are made to reduce the risks to populations, ways to encourage specific behaviours are considered.  In some settings, mandates for vaccination, wearing masks, physical distancing, and isolation, are being considered.  Yet decisions about the control of COVID-19 are never straightforward.  The virus is new and there is much that is not known both about its behaviour in populations and its impact on people.  What we do know is that the people worst affected by the virus are those who are vulnerable and the poor.

When decisions are made about how best to minimize threats posed by the virus, decision-makers need to know how it moves within populations, the risks and consequences associated with infection, and the effectiveness of preventive measures. This is the focus of efforts among scientists in different countries: their efforts are analysed by the World Health Organization (WHO) and used to develop the WHO’s recommendations.

Collaboration between scientists and policymakers

Responses to infectious disease outbreaks are best devised and delivered through public health systems that function well and adapt to changing circumstances.  The underlying values of public health should always be explicit. In my view these are about enabling all people to be as healthy as possible throughout their lives through offering health care that responds to their needs, with a focus on people who are hardest to reach and on leaving no-one behind.  This means connecting and partnering with those who have differing perspectives on how best to contribute as the pandemic is continuing to advance, wave by wave, across the world.

Multi-stakeholder collaboration with scientists and specialists can make the act of influencing policies more effective when they ensure that the well-being of all people is their central concern. Specialists may seek to position themselves as politically neutral, but most find that this is, in practice, just not possible.  Understanding the political context and navigating power asymmetries is vital in working towards restoring agency to persons who feel diminished or seeking to examine issues that have been set aside.

Specialists and decision-makers interact best for public health when they ensure that people are kept at the centre of all decisions.  For me there are six words that illustrate what this might mean in practice: cadence, consistency, connection, credibility, contracts, and conviction.

Cadence

Specialist advisers and decision-makers work best when they are adept at feeling into the pace and rhythm of their work, sensing whether things are ready to move or not. This means that – when they are together – they should seek to meet each other where they are and be comfortable with holding contradictory points of view.

Consistency

Being consistent when given a chance to communicate doesn’t mean maintaining a fixed opinion when it is not warranted. It does, however, mean making a point of being transparent, offering reasons for changes in position, and providing evidence to support them.

Leaders make difficult decisions every day.  They have to balance people’s health and well-being, the state of the economy, and the political space for shifting position. This will diminish when there is fatigue with responding but making quick decisions is part of the process and leaders must be vigilant and ready to re-evaluate and adapt those decisions if they notice things are not going to plan.

Connection

The steps involved in implementing public health directives are never straightforward: the implications of the directive must be spelt out clearly to make it understandable for different audiences.  This is where it may be difficult to combine the approach of the scientist and the belief systems of different groups of people.  If belief systems are influenced by ideology the interaction between science and politics can emerge as an issue:  it is important that all who communicate are authentic. This is where narrative and stories can help: they may better connect science and people than statistics and charts.  The narratives help with putting issues into context.  Here are some narratives which I use now:

1. When looking ahead, it is important to protect the vulnerable, prevent transmission and prepare for surges: This is a virus that is affecting everyone everywhere. It is a global issue. When thinking of public health policies, equity matters.

As with any kind of infectious disease, the starting point is to prevent people from being infected. We know that Public Health Social Measures prevent the transmission of the virus. Face-masking in closed or crowded spaces, frequent handwashing, ventilation, and fewer social interactions help prevent people from being infected.

The second is to protect those who are exposed from being seriously ill and dying. Vaccines have separated disease from death and help protect vulnerable populations. Immunity from vaccines seems to wane after six months or earlier depending on the person’s age or the type of vaccine they received. Keeping up to date on being vaccinated helps protect people from more severe symptoms, and even death.

Thirdly, surges seem to occur every three or four months. The window of time between surges is a moment to be used to prepare by putting systems into place at local, regional and global levels. During this time, listen to health workers who know what is happening and where it may lead. Bring together all stakeholders so they are well-integrated around a shared plan. Engage the people in their communities, connecting with them where they are, and to fill gaps in the response.

2. When planning responses, everyone involved should remember that the virus is the problem, and the people are the solution: Transmission starts and ends in communities. Responses should be locally integrated with central direction based on expertise and experience.

3. As the pandemic evolves all people are called on to be partners in the response: There are bound to be people with diverging perspectives. Avoid stigmatizing and demonizing any group even if they are a small number. Stigmatizing only pushes people further away and undermines social cohesion.

Credibility:

Scientists and policymakers need to earn people’s trust to be effective.

When dealing with COVID, the first part of being authentic is being clear that this virus is not going away anytime soon and threatens all of humanity. It is global and encompassing and we must ensure that no one is left behind.

People need to respond to COVID in a holistic way. The truth cannot be arrived at by only viewing its separate elements. Mandates and lockdowns on all people everywhere have had catastrophic effects in some cases and has had a knock-on effect on a vast spectrum of communities economically, politically, and also psychologically.

Thirdly scientists and policymakers need to avoid making any false promises or pledges. They need to be honest with people, and this matters when seeking to build trust. As the pandemic has evolved the world is faced with an infodemic. Misinformation has generated mistrust between people, as well as between people and governments.

Fourthly, the virus is new and there is so much that is not known. There is uncertainty about what variants are going to come next, or how they will behave. Being humble about this virus – acknowledging that there is so much which is not known and that scientists have to collaborate across national boundaries to help societies work their way through it.

Finally, being hopeful matters. My personal hope is that humanity will emerge from this pandemic a lot better, with a greater understanding of how to deal with multiple threats – including destruction of nature, mass migration, violent conflict, and more. Much ingenuity is needed for people to tackle them together, especially in poorer settings.

Contracts

Professionals involved in responding to COVID need to be clear with different audiences on what is at stake and what is important. The pandemic is still advancing.  The virus itself is changing. It is affecting people, businesses, governance, and nations. It is causing massive suffering. It is not going away anytime soon. After infection or immunization, individuals have some immunity but this fades over time. People should act in ways that prevent transmission and keep the virus at bay.  Concerted investment in a worldwide response is of vital importance, now more than ever: fragmented responses are less effective.

Multistakeholder platforms are established to inform integrated, people-centred responses.  Interdisciplinary scientists are welcome because their engagement permits deeper connections among diverse actors and stakeholders, especially if they focus on people as well as disease, and on connecting science with decision-making.  This can strengthen the ‘contract’ between society and the State and take trust and partnership to a new level.

Conviction

We have come a long way since the coronavirus was first discovered. We have adopted good habits to protect ourselves and to shield others. We have gathered tools and know what is required to fight this virus. We have seen communities come together and we have seen people connect with each other in beautiful ways.

There is hope for us to emerge from this as a more unified collective, and it all depends on how we manage this problem together with a concerted effort to increase levels of both political engagement and global investment.

The consequences that the pandemic has had on all other systems will only start to become apparent in about ten years’ time. The failure for concerted economic and political investment in an equitable response would leave us cleaning up the pieces for not just one decade but more realistically, for closer to two decades. Part of the learning curve of working in the science-policy interface involves finding out that we have made mistakes and then finding ways to do better. To do better, sometimes, it is necessary to think about the context within which scientific expertise is being offered.

I urge every scientist and specialist who has the opportunity to work with decision-makers, to make their voices heard in every possible avenue. It is still not too late for putting people back in the centre of the context.  It is people – how they behave, what they believe, and what they are prepared to do together- that could make all the difference. Only with people as partners can we protect those who are most vulnerable, prevent transmission of what is a dangerous virus, and prepare our systems for further surges, after all, it is the virus that is the problem, and people that are the solution.

About this 4SD Reflection

This article is a reflection by Dr Oommen John following the COVID-19 Open Online Briefings of Dr. David Nabarro. Dr Oommen John is a physician researcher and digital health expert. He works at The George Institute for Global Health India and a Professor at Prasanna School of Public Health, Manipal Academy of Higher Education. He is an elected fellow of the International Academy of Health Science Informatics.

Trained as an internist, he has worked in primary care settings in resource-limited contexts across LMICS and has extensive field level experience in designing, implementing and evaluating innovative solutions and its applicability in health service delivery. He has served with WHO in Immunization Strengthening and Vaccine Delivery, Research and Development at WHO SEARO. At George Institute for global health India, he leads the India Health Accelerator Programme. His research involves evaluating the role of digital health interventions in improving clinical outcomes. He serves on the expert advisory panel for the Market Access Programme of National Health Authority, India.

He is a member of the scientific advisory committee at Foundation for Innovative Diagnostics (FIND), advisory board of Commonwealth Centre for Digital Health. He has contributed to WHO Digital Health Guidelines development group. Follow @Oommen_john and @GeorgeInstIN to keep up-to-date on social media.

After COVID-19 was declared a public health emergency of international concern, on March 11^th, 2020, it soon became clear that people living with obesity were more susceptible to severe SARS Coronavirus 2 (SARS-CoV-2) outcomes. We now know that the risk for hospitalization for people living with obesity is increased by 113%, whilst the risk of death is 48% higher when compared to individuals of normal weight.[i] Adding to growing concerns are the lockdown restrictions and mental health consequences of the pandemic that threaten weight maintenance and weight-loss efforts, with increased levels of physical inactivity worldwide. Obesity is thus considered an effect of the pandemic and cannot be ignored in both developed and developing countries that bear the highest burden of the disease.

We have nine years to meet the UN global development targets, also known as the Sustainable Development Goals(SDGs). We must act swiftly if we are to do so and fix the catastrophically off-track global obesity targets that are further threatened by the COVID-19 pandemic (SDG3.4, SDG3.8, SDG2). Why so? A lack of progress on obesity jeopardizes achievement of the World Health Organization (WHO) Triple Billion Targets that promises 1 billion people living healthier lives.

As an optimist, I do believe that within a crisis, lie seeds of opportunity. There is hope.

But what is the solution?

From the early days of the COVID-19 outbreak in Wuhan, I followed prevalence trends and response priorities. Having finished my MPH two years ago I never imagined living through a pandemic, at least just yet. Dr. David Nabarro’s Open-Online Briefings provided a platform for interactive discussions and a community to grow with. It exposed me to complex systems thinking – a framework to identify and account for interacting influences on COVID-19 and obesity that will be key to progress.

‘Holding the virus at bay requires following the well-established disciplines of disease outbreak control.  There are no shortcuts and no quick fixes. Different systems need to be woven together at a local level and be well supported by both national authorities and international programmes.  There is a need to do it all and do it well.’ Dr. David Nabarro rightfully says.

What is the missing piece of the puzzle? Youth Voices!

Young people have the innate capacity to see the ‘bigger picture’. They can discover complex interdependencies, including the components of a system that may affect and interact with each other. Their critical tendencies can help us identify barriers in implementing policies, including the incentives and stakeholders that need to be brought to the table. Youth have always been at the forefront of movements for justice and social change, including the Black Lives Matter and Climate Justice movement. They have shown their commitment to activities and improving lives for all.

‘Confronting Obesity: co-creating policy with youth’ (CO-CREATE) a project funded by the European Commission works for youth, with youth. By using a systems approach, the project addresses the unresolved challenges around childhood obesity. Just recently, the perceptions of 257 adolescents  (16-18 year old) on the drivers of childhood obesity across Portugal, Poland, Norway, the Netherlands, and the UK were explored.[ii] Collectively youth identified marketing, access to food (both availability and price), stress, anxiety,  depression, and low body positivity as factors contributing to the obesity epidemic. Not only did they identify such factors, but they also used a process of ‘mapping’ to illustrate how they are causally related to each other and obesity (see figure 1).

Figure 1 – Commercial Drivers of Obesity. Eur J Public Health, ckaa251, https://doi.org/10.1093/eurpub/ckaa251

We must listen to, and work with the important but often most neglected population group in obesity and COVID-19 research. It will build capacity and support decision-making on key issues that are ahead of us:

1. How to re-open schools safely, including the measures that are likely to receive collective support from students.
2. How to address the mental health crisis coming in COVID’s wake.
3. How to roll-out COVID-19 vaccination programmes, particularly amongst populations with low acceptability.
4. How to mitigate and prevent future infectious disease and pandemic outbreaks and the climate change emergency.

We have all lived with COVID-19 for a year now. The virus is here to stay for the foreseeable future. Equally, not one person has been untouched by confinement, and the hardships that the pandemic has given rise to. If not directly, then indirectly due to the lack of support from neighbouring countries during a local emergency. But this makes us powerful!

We are more united than ever, and It is time to take action as a collective. To engage and support one another for equity and justice for the planet. Every Body needs everybody to address obesity & COVID-19, and this includes youth.

Are you struggling to see systems and appreciate them? Dr. David Nabarro provides excellent guidance here. You can also watch the 4SD narrative on COVID-19 and systemic inequality here.

And remember – ‘Great things are not done by impulse, but by a series of small things brought together’.

[i] Popkin, BM, Du, S, Green, WD, et al. Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships. Obesity Reviews. 2020; 1– 17. 

[ii] Savona, N., Macauley, T., Aguiar, A., Banik, A., Boberska, M., Brock, J., Brown, A., Hayward, J., Holbæk, H., Rito, A., Mendes, S., Vaaheim, F., van Houten, M., Veltkamp, G., Allender, S., Rutter, H. and Knai, C., 2021. Identifying the views of adolescents in five European countries on the drivers of obesity using group model building. European Journal of Public Health,.

About this 4SD Reflection

This article is a reflection by Claudia Batz following the COVID-19 Open Online Briefings of Dr. David Nabarro. Claudia is an emerging public health professional and a youth advocate with 2 years of experience in global and public health, Currently a Policy and Projects Coordinator at the World Obesity Federation and a Core Team Member of Young Leaders for Health.

At WOF, she supports the dissemination, communication, and utilisation of outputs from 2 EU consortium childhood obesity projects (CO-CREATE & STOP), and the development of youth-friendly materials, briefings, and resources to help policymakers and others seeking to implement obesity-related policies in their countries. Her previous role involved supporting the enhancement and delivery of the Strategic Centre for Obesity Professional Education(SCOPE).

Claudia is keen to improve health literacy and strives to elicit and bring the perspectives and skills of young people into the strategic design and delivery of health-related programs and policies through her engagements.

By Dr Carlos Madrigal- Iberri

During this Open Online Briefing with Dr. Nabarro, I realized that local efforts are crucial in order to stop and overcome this pandemic. My opinions of this session will address one main topic: What can we learn from governments that are successfully controlling the virus and how to implement those learnings in developing countries?

According to WHO statistics, COVID-19 is affecting 213 countries and territories around the world, and the number of new cases are rising at an astonishing rate. So far, we have learned many lessons but probably, one of the most important is that we are just at the beginning of this sanitary crisis.

Different strategies had been taken from some countries where they really took on board many communities’ members, such as heads of states and business, civil societies, universities, local entrepreneurs, etcetera and this is how they could put themselves ahead of the virus.

New Zealand for example, has declared itself as a COVID-19 free country. Aware that they cannot close the borders and live forever in the lock down, they teach every citizen in the country about the threat that this virus represents to their lives.  The Public Health Department focused on preparing the entire population to know what to do in case someone gets sick and explained the importance of how these measures can get them ahead of the virus.

Germany and Ireland are other good examples of how the adequate organization and straightforward communication between government and society truly works. The measures taken by these countries are focused on assure to their citizens that if there is a new outbreak they are prepared to stop it as soon as possible and they can offer protection to the most vulnerable people, the older and the factory workers.

So far, we have learned that strong leaderships and deep commitment to face this crisis is the more solid strategy to overcome the pandemic that is going to live with us from now on. Unfortunately some other countries, are not dealing with the situation by these learnings. USA, Mexico and Brazil are three particular cases where their leaders had diminished the danger of this virus to their population and by not setting a clear direction, the amount of cases continues peaking every week. Because of not having a nationwide effort to make citizens conscious of what this threat means to their lives, these three countries are some of the most deadly places where you can get sick of Coronavirus. It still does not seems like they can stop the transmission soon.

Despite the beliefs and non-logical declarations that had been made for these three leaders of state, the COVID crisis will not disappear from one day to another a huge effort is needed between governments, academia, healthcare systems and citizenship in order to reduce the risk of infection. The message must be sent loud and clear: The virus will not magically evaporate; we need to increase the physical distancing and adequate hygiene measures. Continuous education and disease awareness are imperative to isolate contagious persons, particularly in very dense populated areas if we want to stop deaths due to coronavirus.

The virus is becoming almost endemic in many places and also the economic crisis is arising, by being certain that the population really understands the nature of the disease, we are closer to reduce the transmission and adapting ourselves to a new reality. We must recognize that this condition affects specially people living in poverty and we need to keep a constant and intensive effort to clear away the barriers that endangers these minorities.

Against presidential obstruction, local communities can and empowering themselves to defeat this condition, we do not need government permission to change our behavior, to getting organized, to keep physical distance and frequently wash our hands. Being part of the change is a personal decision and spreading the adequate information should be our responsibility. If we want to make a sustainable change, we must start by ourselves and to involve our communities.

Follow Salvando Latidos on Social Media @salvandolatidos

Follow One Young World on Social Media @OneYoungWorld

About this 4SD Reflection

This article is a reflection by Dr. Carlos Madrigal- Iberri following the COVID-19 Open Online Briefing of Dr David Nabarro on 9 June 2020. It forms part of a collaboration between 4SD and One Young World to inspire greater systems leadership amongst youth during the COVID-19 pandemic.

Carlos is a Medical Doctor & One Young World ambassador who is deeply committed to Global Health. He serves on the Board of Salvando Latidos a non-profit organization, which provides free medical care to low income populations; during this pandemic, they are fundraising to provide protective personnel equipment for hospitals facing COVID-19 in Mexico. He has also been actively working for Novartis Mexico to bring to public agenda Chagas Disease, which is one of the 17 Neglected Tropical Diseases determined by World Health Organization and the second cause of heart failure in Latin America.

Carlos states, “In order to make a difference in public health, the world needs people that are willing to join forces to make this problem a part of our past, and not a new threat to our future”.

COVID-19 Open Online Briefing #23
Tuesday, 9 June 2020
17:00 – 18:00 CEST

The views and opinions expressed in these reflections form part of the collaboration between 4SD and One Young World to inspire greater systems leadership amongst youth during the COVID-19 pandemic. They do not necessarily reflect the official policy or position of 4SD as an organisation or it’s associated personnel. Any content provided by authors are of their opinion and are not intended to malign any religion, ethnic group, club, organization, company, individual or anyone or anything.

One Young World (OYW) is the global forum for young leaders. OYW identifies, promotes and connects the world’s most impactful young leaders to create a better world, with more responsible, more effective leadership. The annual OYW Summit convenes the brightest young talent from every country and sector, working to accelerate social impact. Learn more about OYW at https://www.oneyoungworld.com/