Interview with Garrett Wallace Brown
Convoco talked to the global health expert Prof. Garrett Wallace Brown about:
COVID-19 and the Future of Collective Action in Global Health
Garrett Wallace Brown has acted as a scientific advisor for governmental and non-governmental health organisations.
The conversation addresses the problems of the WHO, the legitimacy of private actors, the possibility of coming-together as a global community, and his new approach to strengthening global health systems.
"COVID-19 exposes the humungous cracks in global health governance. National governments weren’t linked up to each other, they were not linked up to any institutions at the global level, and they had no preparedness themselves. They just didn’t know what to do."
Convoco: Governance in global health has experienced a boost since 2000. How has the global health landscape changed?
Garrett Wallace Brown: The last 20 years have witnessed a massive increase in global health institutions, initiatives, and financing. As one example, in the year 2000, at the G8 Summit in Japan, two major initiatives were launched: the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) as well as the Gavi Alliance, which is also known as the Vaccine Alliance. In the case of the GFATM, it received an initial investment of $10 billion. Between 2000 and 2013 development aid for health tripled with an annual growth rate of over 11 percent. This marked the start of a number of major initiatives. One of the more recent is the Global Financing Facility, which was introduced to improve child and maternal health.
These increases were aligned with new policy directives such as the health targets of the Millennium Development Goals (MDGs) and the subsequent Sustainable Development Goals (SDGs). Within the SDGs we saw unique consensus on the normative goal of Universal Health Coverage (SDG3.8), which included coverage of “financial risk protection, access to quality essential healthcare services and access to safe, effective, quality, and affordable essential medicines and vaccines for all.” These new governance policies have together resulted in the proliferation of a huge number of global health institutions. In many ways, unlike other global collective action problems, global health has maintained a fairly consistent level of interest. However, it would be a big stretch to suggest that global health policy, as a whole or holistically, has improved drastically. Nor is it reasonable to suggest that we are managing global health sufficiently. Where there has been success, it has been piecemeal and fragmented, and the current COVID-19 crisis has exposed many of the existing cracks in global health policy.
C:You have argued that one reason for the slow progress in global health is a form of institutional gridlock. How so?
GWB: One key principle of gridlock is that in global health governance you simply have more actors to coordinate. Each of these actors has their own agendas and interests. When you have more actors working on a single policy you’re going to have larger transaction costs in the process of getting them to agree. In current health diplomacy the biggest problems are transactional delays and policy fragmentation where interests are pursued unilaterally. This creates a situation in which you have a substantial number of global institutions with different funding streams and different approaches to global health. For example, in 2018 there were 3,401 registered global health institutions. This number does not include national and bilateral institutions (such as DFID or USAID), nor any of the UN-based institutions such as the WHO or UNICEF.
Overall, we probably have about 4,000 actors pursuing various health initiatives, some trying to coordinate at the global level, some not. Having these many organizations creates fragmentation.If we look at COVID-19 as an example, the first question exposing fragmentation relates to who is in charge of monitoring, responding, and setting policy? Where do we go for accountability and effective results? The intuitive response would be the WHO, but they’re having difficulty coordinating the various institutions due to poor financing, a lack of cooperation from states, and complex political processes in the World Health Assembly. During the Ebola outbreak, the main effort was led outside the WHO, by Doctors Beyond Borders, a non-governmental organization with limited resources. You could think “okay, maybe it’s at national level where we should look, because most of the work on the ground is being done there.” Yet this perpetuates disjointed programs that increase risks. The UK, Sweden, Germany, and the United States, for instance, are following different lockdown strategies, with varying and potentially dangerous consequences.
”The fact that there was still international travel from parts of China, despite authorities having closed off cities at a local level, baffles the imagination. That’s the first principle of quarantine or lockdown: you do it fast, at the smallest level possible, with the infected population, and you do it well.”
C: To what extent can we see these institutional problems now at play during the COVID-19 pandemic?
GWB: Let’s take the International Health Regulations (IHR) as an example. This is a set of international regulations that are supposed to help us track and close off trans-border health emergencies. However, the IHR are hugely underfunded by signatory countries and fewer than 50 percent of the states who signed up to them are compliant. This includes high-income states such as France. They were supposed to become compliant in 2016 and it just did not happen.
In the case of COVID-19, not only were states not compliant, some actually violated the International Health Regulations by not raising the alert early enough or implementing the guidelines. The WHO has no authority to enforce this policy, so even if the WHO knows of a threat, they have no ability other than “naming and shaming” a country. But if that country is the United States or China, how are you going to do that without cutting off your arm in terms of funding? President Trump’s recent policy response to freeze WHO funding for three months illustrates exactly why the WHO has to moderate its actions in order to keep powerful states on board.
In addition, we had national governments unwilling to take the threat seriously early on. The UK and the United States are perfect examples of two countries that sat back and waited for things to unfold. The one thing Trump probably got right was when he said that if there’s a hot spot and a cluster, we must isolate it, restricting travel from China. The fact that there was still international travel from parts of China, despite authorities having closed off cities at a local level, baffles the imagination. That’s the first principle of quarantine or lockdown: you do it fast, at the smallest level possible, with the infected population, and you do it well.
Then there is the Pandemic Emergency Fund that was launched by the G7 in Germany in 2015. At that summit the G7 leaders professed that “Ebola had been a wakeup call.” In response, the G7 announced a financial facility where up to $500 million was meant to be available to a country when an epidemic is threatening to become a pandemic. Nevertheless, it didn’t get the full amount of funding promised, nor has it been utilized in the current crisis, largely because it is set up as a loan mechanism at the World Bank. You have to prequalify. China doesn’t qualify for it; neither does India. I don’t know what the qualification process would look like as an epidemic was unfolding, but I assume it would be shambolic. One senior official at the World Bank said the whole initiative was “a total embarrassment.” Moreover, countries that could qualify for the money are already under incredible national debt. So, why would they take out this extraordinary loan amount when they can’t pay off their current loans? Or, why would you take out this loan when you know that financial assistance will come anyway if things threaten to get bad enough for other states? The end result is that this is not a way to devise effective health strategies or deliver health security nationally or globally.
”The notion that health is not political or that it needs to be depoliticised is probably the biggest nonstarter and fallacy within policy debates. Health is deeply political.”
As a means to better coordinate efforts, the G7 launched the Global Health Security Agenda, which was endorsed by the G20. Nevertheless, the agenda remains underfunded and there are very poor coordinating mechanisms. A lot of countries have simply not stepped up to the plate. There was supposed to be joined-up thinking and shared technologies on serious threats like antimicrobial resistance (AMR). Sadly, not enough of that happened, and AMR is a huge global threat. We’re talking here about an estimated 300 million deaths by 2050. These are just infections that you can get from antimicrobial resistant bacteria when you cut yourself. That’s going to be a huge problem. COVID-19 exposes the humungous cracks in global health governance. National governments weren’t linked up to each other, they were not linked up to any institutions at the global level, and they had no preparedness themselves. They just didn’t know what to do.
C: You mentioned that global health policy is getting more politicized. Is that not a problem that exacerbates fragmentation and ineffective institutions?
GWB: Yes, it is getting more politicized, but I think it has to be. The notion that health is not political or that it needs to be depoliticized is probably the biggest nonstarter and fallacy within policy debates. Health is deeply political.Getting a treatment that you need is most likely based on a political decision about that treatment being made available. If we want to save massive numbers of lives tomorrow, we give people clean water and soap. That is not a technologically advanced solution, but a solution often not made available for political reasons or due to political failures. I think that to try to depoliticize health is probably the wrong way of thinking about it.
The right way of thinking about it is how to make those political processes more effective and legitimate and how to get compliance with policies—compliance, for example, with the IHRs that are supposed to help trigger alerts and a call to arms when there’s an epidemic that threatens to be a pandemic. We also have financial mechanisms that are supposed to be designed for these situations, and there needs to be political commitments to keep them funded properly. Yet in the current case, China did not raise the alarm soon enough for all sorts of incentivized reasons such as direct foreign investment and not looking weak as a government. This is dangerous behavior, since compliance to rules that provide global public goods is crucial.
Regarding the WHO, even though they had information about COVID-19 in November and potentially even in October, they were not able to sound the alarm because their hands are tied to some extent. Part of this is due to history. They’ve been blamed in the past for raising an alarm too soon; in other cases they called it too late. And, they don’t know how to handle their political position. Having a WHO afraid to play its role properly and to show leadership deeply undermines any chance for a coherent global system, especially when we’re talking about pandemics. In my view the way around this is to ask: how do you get political buy-in from someone like China? How do you get institutions to have the effectiveness that is required to address these types of threats? How do you get countries like the United States to back something like this, particularly when their domestic political ideologies don’t match up with globalized thinking? This is where politics is actually needed, because those are all political questions that can only be resolved through political processes.
”[Private actors] come in from outside existing pathway-dependent mechanisms to solve a problem. They tend to be focused on one or two health issues, so they can attack something in a functionalist way.”
C: Among the many actors in global health are private ones such as the Bill & Melinda Gates Foundation. These have significantly grown in influence over the years. How do you view their influence?
GWB: There are two ways to think about this. The first is to suggest that these new foundations, private and multilateral initiatives, create opportunities for innovation. They come in from outside existing pathway-dependent mechanisms to solve a problem. They tend to be focused on one or two health issues, so they can attack something in a functionalist way. People like Bill and Melinda Gates have certainly underwritten a number of innovations in global health. For example, they supported the invention of low-cost and easy-to-build mosquito traps in Africa, which are an inexpensive way to help control malaria in some areas. There have also been new app technologies, lab research, and advancements in health information systems.
The other way to look at these initiatives is to argue that they add to fragmentation and perpetuate the lack of joined-up thinking in global health. With each new initiative and organization, you create additional overlapping jurisdictions, parallel programs, input from massive egos, and personal pet projects. Often these initiatives are tied to businesses, where there is a belief that a particular product or market capability is transferable to the global health context. For example, since 2000 there has been an extraordinary rise in software or app solutions intended to promote public health. In many cases these are novelty projects or lack contextual specificity, often turning them into technological wonders with limited purchase on the ground. This raises many questions about funding sources, epistemic authority, and the power dynamics involved.
Take, for example, a country like Tanzania where 47.5 percent of the health budget is reliant on external funding. Bill and Melinda Gates are significant global health funders. If they put certain conditions on their aid, a country like Tanzania will likely accept it even if the local authorities know that it undermines local ownership or know that the program is not contextually sensitive enough to be the right fit.
This raises big concerns about power and epistemic authority, but also about sustainability. What happens when the funding ends? If the country is not developing, how realistic is it to assume that the country can pick up the slack? Again, that creates go-nowhere, fragmented policies that have a limited shelf life and suddenly terminate. This does not promote long-term, global health, at least not in the way that people like Bill and Melinda Gates say they want it to.
There is a worry that money buys you access to policy making and to setting the agenda. This raises additional questions about accountability and transparency.”
C: What about questions of legitimacy, given the extent to which they can shape the agenda for global health?
GWB: Going back to Bill and Melinda Gates, there’s a huge concern about the issue of epistemic authority that I alluded to before. They are knowledge authorities, similar to influential journals. Yet, this raises questions about the source of that authority. Why should an individual like Bill Gates have the same vote on the Global Fund board as the EU or the United States? Why should Bill Gates, as a single person, be the second-biggest donor to the WHO after the United States? And with what policy consequences? Why is he on TV telling us that Trump is wrong about cutting funding to the WHO?
There is a worry that money buys you access to policy making and to setting the agenda. This raises additional questions about accountability and transparency. President Trump is accountable to Congress, to the Supreme Court, to the checks and balances in the US State Department, and ultimately to the US voter. Who is Bill Gates accountable to? There’s no constituency. The same goes for transparency. Trump, who’s making many errors when it comes to COVID-19, is heavily scrutinized by the media. But you don’t see that same level of scrutiny for Bill Gates, a man who single-handedly underwrote the Global Fund for almost two years during the financial crisis.
If there’s a perception that Bill Gates has little legitimacy with no accountability and transparency, you will lose buy-in quickly. There will be compliance problems or more dead-end, go-nowhere policies. On the other hand—and this is the innovation argument—if people think he has a lot of legitimacy and is doing good work, then we may welcome this one person taking charge, since he can sidestep the gridlock that exists at the global level. The question is: do you take a utilitarian approach in the sense that the end justifies the means, or do you take a procedural approach and say “one has to have appropriate procedures because what’s good today may not be good tomorrow and one person shouldn’t have that much authority?” I favor the latter.
C: We could say that they provided much needed funding in recent years, but in the long term there are all these legitimacy questions that could undermine the whole structure of the global health system.
GWB: Yes, absolutely. I think all of us agree the WHO needs serious reform or should be replaced by a different institution. And nobody thinks that the WHO is completely hopeless - although it is getting close to becoming inert. Part of its hopelessness, unfortunately, has been due to ring-fenced funding. Members used to pay their dues and the WHO could spend that money on global policies directed by the world health assembly and other programs in the WHO.
Today, only about a third of their budget is free for them to choose how to spend it. The other two-thirds are ring-fenced around national-interest, pet projects or aligned programs. The WHO can only use that money in certain ways, as specified by the states that give them the money. This adds to fragmentation, an inability to generate economies of scale, and a lack of joined-up, long-term thinking.
I’m a firm believer that an ounce of prevention is worth a pound of cure. COVID-19 is going to cost us trillions of dollars, but it didn’t need to.”
C: The approach of nation states to global health is often characterized as one of securitization, focusing on containment and surveillance. Do we need to do more in respect to prevention and strengthening health systems?
GWB: I’m a firm believer that an ounce of prevention is worth a pound of cure. COVID-19 is going to cost us trillions of dollars, but it didn’t need to. It would cost an absolute miniscule fraction of that to get a fit-for-purpose institution at global level and to strengthen health systems in countries where these threats usually originate. It’s not a surprise that Ebola started in West Africa with their weakened health systems. Even wealthy countries suffer from a lack of comprehensive and preventative medicine, while ignoring upstream social determinants of health. SARS and now COVID-19 originated in China. This is not a poor health system and they should have been able to respond to this. The fact that they did not respond appropriately shows that the Chinese health system also needs to be more comprehensive than it is. Furthermore, it demonstrates how contextual factors like politics and non-epidemiological economic considerations can greatly influence health outcomes. Culture also plays a huge role. Popular food markets known to foster zoonotic diseases should not be allowed to continue to operate in the way they do. That is a basic sanitation and epidemiological no-brainer that should have been addressed after SARS.
In summary, my position is that proper disease control requires strengthened health systems, a rethink of the IHRs, proper monitoring and compliance systems, quick response to emerging pathogens, and total isolation at the smallest level possible before spread, while supporting the global common good of public health. These are small investments when you compare it to the expenses and costs caused by COVID-19. We knew this was going to come. Coronavirus is not a new pathogen: it’s been around for a long time, even if not in this form. Health professionals have been warning seriously about the threat of the next big pandemic for the last hundred years.
To suggest that we’re going to get a vaccine for COVID-19 quickly—it may or may not happen—is a really naive way of thinking about how to prepare for a pandemic. [...] There is still a very 1950s’ view that science will save us—much like a religion.”
C: Do we need a more holistic approach to global health? Many people don’t seem aware of the importance of social and environmental factors, particularly in the case of infectious diseases.
GWB: Yes, a big problem is what some colleagues and I have called the Pasteurian paradigm, which suggests that each pathogen has one cure. You wait for the pathogen to arrive, you go into lockdown, and you wait for a vaccine to show up. This is the current COVID-19 strategy, yet there is no guarantee that a vaccine will be found anytime soon. Now the logic of this Pasteurian model suggests that there is something fundamentally wrong with the way we are thinking about where pathogens—viruses—come from. They don’t just emerge from a vacuum; they emerge from certain environmental and social determinants. Like you said, we often don’t think about the social origins of these pathogens.
Think for example about markets that handle food, how they cohabitate animals that shouldn’t be next to each other, allowing them to cross-pollinate pathogens. Or consider how we destroy ecosystems, causing humans to live in closer proximity to certain animals or insects that are known to carry diseases, such as forest bats and deer ticks. Or consider how our lifestyles enhance the danger of this disease with its mortality rates linked closely to comorbidities. These are all social factors that could be changed, or areas where we could apply preventative measures in a more longitudinal fashion.
My colleagues and I are trying to suggest that this “one pathogen one cure” mentality, and the idea that science will vaccinate us out of problems, reduces long-term preventative thinking. It simply fails to comprehend sufficiently the need for strengthened health systems, thinking about the way we come into contact with certain animals, or reducing the amount of antibiotics we give to our animals unnecessarily, which, when done badly, helps to create antimicrobial resistance. These are social behaviors. If we take those into account more thoroughly, we won’t have to rely on always finding a vaccine in a hurry.
We need to put existing paradigms in perspective. In the case of HIV/AIDS we still don’t have a cure; we just have a way of keeping people alive and it’s very expensive to do so. To suggest that we’re going to get a vaccine for COVID-19 quickly—it may or may not happen—is a really naive way of thinking about how to prepare for a pandemic. Many scientists don’t like it when you suggest that the Pasteurian paradigm is part of the problem. There is still a very 1950s’ view that science will save us—much like a religion. Many of my scientist friends just cannot see beyond narrow disciplinary boundaries, ranking the “hard sciences” as hierarchically better than social approaches and thus undermining many of the suggestions I’ve made about prevention. For me, the hierarchical distinctions are a fallacy: it is not a zero-sum equation, the approaches are not mutually exclusive. In fact, in this case, they are necessarily co-constituted.
"We have to also start thinking about factors like planetary health, ecological systems, and environmental determinants of human health. Corporations and corporate behavior are also a significant determinant of health. In other words, we need joined-up thinking that looks at global health as a system, with corresponding functions and delivery mechanisms.”
C: You have already said a lot about what can be improved, but in your opinion, what is the most important thing the international community can do to curb the risk of future pandemics?
GWB: Different ideas have been mentioned recently: there has been talk of a European health system, of a G20 for health, and Gordon Brown even suggested a temporary world government for health. The BMJ featured an article with the idea of a vaccine-purchasing agency at the global level to respond to the fact that there are too many actors trying to buy things up, creating shortages and competitive markets that price people out. I think these are all good, short-term, minor iterative responses, but they’re not sufficient. They still look temporary, ad hoc, disjointed, and state-centric.
Instead,some colleagues and I have been floating an idea about what we call world health systems thinking. Health system thinking has been central at the national level for years. It is a holistic approach that covers the six WHO building blocks: service delivery, health workforce, information systems, access to medicines, finance, and governance. These functions must be sufficiently covered by a health system and joined up.
At the moment we are bringing health systems thinking into debates at the global level and would use these six core functions (plus an additional one on populations) as a way of examining and exposing current gaps in the system. There are issues with the building blocks and they are not uncontroversial, so part of this project is to address those issues, as well as make sure that the principle of subsidiarity and local health system strengthening and contextualization are factored appropriately when we scale-up to the global level. A colleague and I are working on this project now and aim to get funding to apply the model, conduct feasibility analysis, and create a series of recommendations. Once we have identified the gaps, we can start thinking about how to fill them: what goals associated with financing, health workforce, information systems, governance, access to medicine, and service delivery would be necessary to fight something like COVID-19.
The approach gives us a toehold on the huge amorphous thing that is how to think about effective global health governance. It provides us with a particular way of looking at it more holistically and an analytical, heuristic tool to get in there. Beyond health systems thinking we have to also start thinking about factors like planetary health, ecological systems, and environmental determinants of human health. Corporations and corporate behavior are also a significant determinant of health. In other words, we need joined-up thinking that looks at global health as a system, with corresponding functions and delivery mechanisms.
"It is just a matter of time before these viruses will mutate and adapt. They don’t care about borders, they don’t care about egos, they don’t care about money, they don’t care about political power. These pathogens are singular in their design—they just want to replicate and they need hosts to do so."
C: This approach would call for more centralization at governance level to escape fragmentation.
GWB: It could be more centralized, or it could be layered with mutual accountability mechanisms. There are all sorts of creative ways you can think about it. You don’t want to just replicate the state at global level; it’s not the same animal. The key is to be reflective and creative. For example, perhaps the WHO building blocks, which we’re using for our current model, aren’t appropriate and we have to think of something new. The key is to remember what the famous essayist Montaigne said about the idea of change, and I paraphrase: we must start by recognizing that what we are currently doing is bad, and that we would like it to be better.
Unfortunately, my guess is that the international community will only fix the pandemic monitoring system and that some individual states will create emergency stockpiles and rethink their own internal policies. This will be better, but still insufficient. It will be done on the cheap with market solutions where possible to finance it. Why? Because that’s how it is always done. However, half-solutions will not alleviate long-term problems. As we reach 10 billion people on this planet, the number of epidemics turning into pandemics is going to increase. Nature has a wonderful knack of figuring out ways around every countermeasure we can think of. So we need those measures to be as strong as possible. It is just a matter of time before these viruses will mutate and adapt. They don’t care about borders, they don’t care about egos, they don’t care about money, they don’t care about political power. These pathogens are singular in their design—they just want to replicate and they need hosts to do so.
"COVID-19 and its physical and social impacts might be enough to spark greater global cooperation at a functional and practical level, in turn seeing each other as being more in a relationship of solidarity that will strengthen greater identification with each other as global cohabitants."
C: Any major overhaul of the global health system will require a lot of political will. For example, the idea of a European health system that you briefly mentioned has long been discussed but never seriously approached, partly because it appeared too difficult to get citizens on board. Do you think global health crises like the one we are experiencing will help citizens to recognize the world as a global community, increasing our concern for the health of those abroad?
GWB: My immediate answer is no. COVID-19 will not build solidarity in some sort of metaphysical way, in the sense that we accept some kind of moral obligation to other human beings based on our humanity alone. That said, I believe that COVD-19 could build mutual self-interest. With time, and if properly harnessed, this mutual recognition of interest may underwrite greater sentimentalities towards others, which could form a basis of solidarity.
Basically, the process would be that through our own self-interest we recognize that others have mutual self-interests and that a collective action problem like COVID-19 cannot be solved by one single country, one individual, or even a group of individuals or states. Thus COVID-19 may increase our conception of shared goals and common interests and lead to an emergence of solidarity. Whether or not that means we’re going to see others as citizens of the world in a metaphysical sense, in the kind of way that cosmopolitans like Immanuel Kant or the Stoics wanted us to, I doubt that will happen anytime soon.
Yet COVID-19 and its physical and social impacts might be enough to spark greater global cooperation at a functional and practical level, in turn seeing each other as being more in a relationship of solidarity that will strengthen greater identification with each other as global cohabitants. Now this form of solidarity building happened at the state level many years ago, when people started to recognize that they shared mutual self-interests, which then called for a super-state or some sort of institutional binding agent to secure those mutual interests. History is full of empirical examples of communities coming together to form wider societies. Therefore, I don’t think it is impossible to think about these processes taking place at the global level.
The personal and communal motivation offered by COVID-19 toward a larger world-view is driven by what is often called a world risk society. This is an idea by the late German sociologist Ulrich Beck. Beck argued that large human existential threats like COVID-19 create a common understanding of collective risk and that this collective risk can underwrite social change towards common or cosmopolitan identities. He was a historical sociologist and looked at history to try to bear this out convincingly. His best example relates to the fact that you would have no UN without World War II and the Holocaust. It took a world risk society generated by the prospect of total war to get that kind of global solidarity. And many of the international laws we know today, such as the Geneva Convention, would not have emerged without those terrible human tragedies.
"COVID-19 and its risks, real or constructed, is palpable, it is experienced, it is immediate, and we all understand the costs [...] I think this lived immediacy is a really important psychological driver for a shift from self-interest to mutual-interest."
In his writings, Beck speculated that climate change was the next risk catalyst that would bring us to a world risk society and create cosmopolitan identities. But I think that is wrong: climate change is too slow burning and not immediate enough. It’s just not at the same level of consciousness as COVID-19, which has affected everyone and is estimated to have half the world’s population in lockdown.
In other words, COVID-19 and its risks, real or constructed, is palpable, it is experienced, it is immediate, and we all understand the costs—the cost to our social lives, cost to our wellbeing, cost to our jobs, cost to our economic security, from mass unemployment to the rise of domestic violence. The crisis is now, not tomorrow, and we are experiencing it in real time. I think this lived immediacy is a really important psychological driver for a shift from self-interest to mutual-interest, to new sentimentalities, to understanding a shared history, to emerging values, to solidarity and collective action. If any event has a chance to create a world risk society with a future of more solidarity, then this would be it. This crisis has the potential to help us to rethink our paradigm.
As Hegel says, “the Owl of Minerva only spreads its wings with the coming of the dusk,” the idea being that knowledge is only found when the day has ended and you can look back on it reflectively. Most people read Hegel’s statement negatively, but I think that the horizon is upon us now and Minerva, being a symbol of knowledge, has the opportunity to spread its wings, not because it is the end of the day, but because there is a transition to the beginning of the next. Let’s hope that we all reflect on the coming darkness properly.
C: What a wonderful, hopeful statement at the end.
GWB: I am an idealist after all.
Prof. Garrett Wallace Brown is Chair of Global Health Policy and Co-Director of the Global Health Research Theme at the University of Leeds. He has published widely on global health governance and policy, health financing, health systems strengthening and global health security, with a particular research interest in African health and development policy. He has acted as a policy expert for the media at the G7 and G20 Leaders Summits and has acted as a scientific advisor for a number of governmental and non-governmental health organisations. Professor Brown also conducts research in political theory and legal philosophy, which includes work on cosmopolitanism, global constitutionalism, and the political philosophy of Immanuel Kant. His recent non-medical publications include The State and Cosmopolitan Responsibilities (Oxford University Press, 2019) and Kant's Cosmopolitics (Edinburgh University Press, 2019). His most recent work on COVID-19 has been published in the British Medical Journal (April 2020).