Speeches
“Rebuilding Global Health”: Speech by President Tharman Shanmugaratnam at “Building a Healthier Asia”, Temasek Foundation Networking Dinner With the World Health Organization at Pan Pacific Hotel on 6 May
6 May 2025
This article has been migrated from an earlier version of the site and may display formatting inconsistencies.
Director-General of the World Health Organization, Dr Tedros Adhanom Ghebreyesus
Minister for Health, Mr Ong Ye Kung
Minister for Health, Indonesia, Mr Budi Gunadi Sadikin
Chairman, Temasek Trust, Ms Ho Ching
Chairperson, Temasek Foundation, Ms Jennie Chua
Distinguished Guests,
Ladies and Gentlemen,
Thank you for inviting me to join you.
Let me first congratulate Dr Tedros on the agreement reached on the WHO’s Pandemic Treaty a few weeks ago.
It was three years in the making, and lays the foundation for the world to address the major gaps in the global health ecosystem – and particularly the huge inequities in access to vaccines and therapeutics that we saw during COVID-19.
The agreement owes much to your leadership in building a consensus between members states who started off with widely diverging interests, and in particular a compromise on the issue of technology transfers between the needs of many in the developing world and the developed world and pharmaceutical industry.
Challenge of complacency and insularity
There is much work ahead.
When COVID-19 hit the world five years ago, there was panic. But there was also, before long, a collective determination to build up our systems, nationally and internationally, to prevent anything like what happened in COVID-19 from happening again.
Anything like the 15 million excess deaths that COVID-19 is estimated to have wrought in the first two years of the pandemic.
Or the loss of over US$12 trillion in the global economy over the same two years.
Or the generational crisis that pushed 70% of children in low-and middle-income countries below basic reading levels, costing $17 trillion USD in lifetime earnings.
And the many other palpable, long-term impacts on physical and mental health, and on society cohesion in many countries.
Yet barely five years after COVID-19 first hit us, we are at risk of forgetting its lessons. We are at risk of losing the resolve that the world had summoned up during the pandemic, and the understanding among nations that much bolder joint and cooperative action was needed to prevent the same or worse from happening.
Our greatest challenge now is complacency, wishful thinking and insularity.
We have to counter that challenge creatively, and without forcing a further polarisation in positions.
We have to do so through arrangements that appeal to nations’ sense of self-preservation, and which recognise the practical reality that we can only prevent and prepare for the next pandemic through a major step-up in internationally coordinated investments and actions.
As the scientists make clear, the next major pandemic is a matter of when, not if. It could come in 10 years, or next year. It could also be more easily transmissible, or more lethal, than the coronavirus behind COVID-19.
Zoonotic spillovers – where pathogens leap from the animal life into human communities – have accelerated over the last few decades, aided by deforestation and the loss of natural ecosystems.
We are only waiting now for any one of a broad class of pathogens to evolve, or different strains to be combined, and to become efficiently transmissible between humans.
The Pandemic Treaty must therefore lend urgency to efforts to stop future epidemics in their tracks.
Reclaiming lost ground
We have to first reclaim lost ground, as COVID-19 set back healthcare systems by more than just the few years of the pandemic.
It means rebuilding local and especially primary healthcare systems, as it is there that we build immunity, and there that we detect the next new outbreak. We also have to recover the capacity to deal with many other illnesses which are now seeing a surge, post-COVID-19.
Through its regional and country offices, the WHO is working with governments to build these local capacities – from improving maternal and child health, to expanding vaccine coverage, to responding to health emergencies.
Investing in global health prevention and preparedness
Second, we have to invest at much higher levels in the global health ecosystem, and especially in pandemic prevention, preparedness and response. This is not a one or two year effort, and has to be sustained.
We know the broad outlines of what needs to be done, from the upstream investments to the furthest downstream:
Upstream R&D in developing vaccines against a broad range of viral families that pose epidemic risks.
We were lucky in COVID-19 because we had almost 20 years of R&D on the coronavirus. We knew a lot about the spike protein before the pandemic struck.
We cannot be so lucky the next time around, so we have got to invest now in developing prototype vaccines for the major viral families, one of which is going to hit us the next time round.
The development of multi-plex or multi-product vaccine facilities, such as mRNA platforms that can pivot between different infectious threats, presents a promising solution.
The Coalition for Epidemic Preparedness Innovations, or CEPI, is advancing this, working with laboratories globally to develop potential vaccines.
Specifically, CEPI and Wellcome Leap are jointly funding the RNA Readiness + Response (R3) programme, which aims to establish a worldwide network of biofoundries with the ability to accelerate production of next-generation medical products.
Locally, Singapore has also advanced our mRNA manufacturing capabilities, such as with the opening of the Nucleic Acid Therapeutics Initiative mRNA Biofoundry under the Agency for Science, Technology and Research.
These efforts, both nationally and globally, are essential and paradigm shifts in vaccine development that will improve our global resilience against future pandemics.
But there is also much work downstream in R&D that needs to be done to make vaccines and treatments affordable and accessible.
For instance, developing vaccines that do not need to be kept at below freezing point. It is extremely important in large parts of the developing world.
And developing vaccines that are potentially needle-free - again, very important in tackling the challenge of skilled manpower for administering vaccines.
But another very important priority has to do with developing a globally distributed manufacturing ecosystem for vaccines and treatments. We did not have it during COVID-19, and we must now build up this system. It requires global coordination.
It needs coordination because we need a diverse set of facilities across the system globally to cater to a range of possible pathogens and to invest in a range of technologies – not just mRNA, but different viral protein subunit technologies to be prepared for the next pandemic. We cannot tell in advance which pathogen will cause the next outbreak, now which technology will be effective in countering it. This diverse network of facilities can only be economically feasible if it is operated across geographies and with each facility serving local needs in non-pandemic times.
We have to organise this network well ahead of the next pandemic, so we do a much better job than we were able to do mid-flight in the last pandemic.
Strengthening international and regional cooperation
I do want to highlight the work of the WHO in seeding and growing collaboration in these and other areas.
The WHO Hub for Pandemic and Epidemic Intelligence serves as a global platform to support Member States in detecting risks, fostering collaboration in data sharing and analysis, and enhancing decision making;
The mRNA Vaccine Technology Transfer Hub operates as a centre of excellence and training to build capacity in low-and middle-income countries to manufacture mRNA vaccines;
The WHO BioHub System offers a reliable, safe, and transparent mechanism for Member States to voluntarily share novel biological materials, including pathogens with epidemic or pandemic potential.
Regional disease surveillance and control networks have also become crucial pillars of our collective defence:
The Africa Centres for Disease Control and Prevention coordinates surveillance across 55 countries serving 1.3 billion people, while the European Centre for Disease Prevention and Control strengthens preparedness across the European Union.
Other multi-country initiatives focusing on various aspects such as vaccine development and genomic data sharing are essential for strengthening global health responses. This includes UNITEDengue, which promotes cross border monitoring of dengue virus variants and sharing of information across 11 jurisdictions.
The National Environment Agency’s (NEA) Environmental Health Institute (EHI), designated as a WHO Collaborating Centre for Reference and Research of Arbovirus and their Associated Vectors, supports regional capacity and capability on the surveillance and control of arboviral diseases. EHI co-organises regular workshops with WHO, the MFA Singapore Cooperation Programme, and the National Centre for Infectious Diseases.
ASEAN, too, is stepping up in safeguarding regional health security.
The ASEAN Centre for Public Health Emergencies and Emerging Diseases (ACPHEED) will be established as a regional hub to strengthen collective ability to detect, prevent, and respond to health threats by building capability across member states.
The Saw Swee Hock School of Public Health (SSHSPH) under the National University of Singapore, is partnering with ASEAN member states to build research capacity, develop evidence-based policy recommendations, and conduct joint studies on pandemic preparedness and antimicrobial resistance.
WHO Health Systems in Transition (HiT) series are country-based reports that provide comprehensive descriptions of national health systems and reform efforts. SSHSPH is working with the Lao Tropical and Public Health Institute, supported by the WHO Asia Pacific Observatory of Health Systems, to update the Lao HiT report – an important capability for health ministries to evaluate the progress of their health systems and health reforms.
Building the new global health architecture
More broadly, the Pandemic Fund, hosted at the World Bank and run jointly with the WHO, has been an important first step in pooling resources to support pandemic prevention, preparedness, and response efforts in countries most in need.
As of 31 October 2024, the Pandemic Fund has secured over US$2.8 billion in international financing. This includes US$982 million in commitments from 10 sovereign donors – a mix of both developing and developed countries – and over US$1.8 billion in co-financing from international organisations.
Through its first two funding rounds, the Fund has awarded US$885 million in grants, which have catalysed an additional US$6 billion in co-financing and co-investment for pandemic prevention, preparedness, and response initiatives across 75 countries.
However, much more needs to be done.
The G20 High Level Independent Panel report, which I co-chaired, that proposed the Pandemic Fund, had conservatively estimated that it would require US$10 billion dollars a year of contributions from willing nations and philanthropies, over a sustained period of years for us to build up a working system for pandemic prevention and preparedness.
The amount each nation would contribute to the $10 billion dollars is in fact minuscule compared to the costs we would each face if we did not invest in these capabilities – because the next pandemic, even if it is not as severe as the last, will cost us vastly more than that amount of money we invest today. It would cost far more losses to all our economies, and in losses to human lives globally, the loss of collective human potential.
So this is a matter of straightforward financial prudence – putting aside a sum of money each year, collectively, to build up the capabilities to prevent the huge costs of another pandemic.
The gradual pullback in spending on international development and global health is now a new reality for multilateral institutions like the WHO, as well as for the other plurilateral and non-governmental bodies that comprise the whole health ecosystem.
We have to find the best ways, nevertheless, to build a resilient financing global health ecosystem within these constraints.
We cannot wait for the most ideal multilateral architecture to be rebuilt, and we are not even sure what it would look like.
We will therefore have to work with broad coalitions of the willing – broad coalitions of governments, together with the plurilateral bodies like Gavi, the Global Fund and CEPI, philanthropies and leading businesses, working together with the multilateral organisations like the WHO and UNICEF.
Working together in pursuit of both national interests and the global public good that ties together our national interests.
And in this global health ecosystem, it has to be the WHO that plays a coordinating role - mobilizing these coalitions and working jointly with them, effectively working as one, without overlapping or duplicative functions.
We have to put our minds to building this new cooperative arrangement, so we can still scale up the most important efforts to prevent and prepare for the next pandemic. So that we live with the reduced funding of the system as a whole, but seek to achieve the needed impact.
We know the broad outlines of what has to be done. Let's not let the perfect, or waiting for the ideal multilateral architecture, get in the way of moving in the right direction, and moving with resolve.
Thank you.