Our way of life has never been as threatened as it is today. While the urgency brought about by COVID-19 may subside as vaccines become more widely available, the pandemic has laid bare the brutal impact that socioeconomic factors have on health. Coupled with the global climate crisis, the US National Academy of Medicine (NAM), which aims to create a healthier future for everyone, has its work cut out for it. Its president, Professor Victor Dzau, speaks to MEDICUS to reflect on what we can learn from the pandemic, how the Academy will deliver on its vision and why the little red dot, where he is an honorary citizen, will always have a special place in his heart.
MEDICUS: The NAM has recently marked its golden jubilee. How did the pandemic affect your institution?
Victor Dzau: COVID-19 has made us better and given us more purpose. We have become more resilient and are doing things very differently. We have made our work much faster and timelier, and we are more creative. Importantly, we are more committed than ever to devote ourselves to making a difference nationally and globally under these difficult times.
MEDICUS: Looking beyond the pandemic what are the NAM’s priority areas?
Victor Dzau: We’re focusing on three existential threats: COVID-19, systemic racism and climate change in human health.
On the COVID-19 front, we are advising governments and stakeholders on COVID-19 responses in public health, research and development and equitable access to global common goods. We have worked with [the] Singaporean leadership to develop vaccine multilateralism. We are also working on monoclonal antibody and therapeutics allocation, the reopening of schools, what lessons we can learn from COVID-19, how we can transform healthcare in the future and how we can build a resilient society.
At the same time, COVID-19 has really unmasked the problem of structural racism. But the tragedy is that people of colour and under-resourced populations not only have a great vulnerability to COVID-19 but are also most impacted by health and social inequity. This vulnerability stems almost exclusively from socioeconomic factors. We have to be willing to confront this issue and find out the root cause of why things are this way. That’s why we have a programme called Culture of Health that will study structural racism and other issues that can be corrected through policy and action. I believe that we're never going to get there if we don’t address these issues.
We are [also] looking at the climate change and its impact on human health. We are launching a Grand Challenge on Climate Change to mobilise the health sector to find collective solutions to net zero [carbon emissions], such as the decarbonisation of the health sector. We will shine a light on vulnerable populations. Whether it is COVID-19 or climate change, it all boils down to socioeconomic circumstances.
MEDICUS: You also serve on several global boards and panels. What are the biggest achievements of the global response against COVID-19?
Victor Dzau: I serve on the global preparedness monitoring board, which is co-convened by the WHO and World Bank. In March, still early in the pandemic, we called for the injection of $8 billion for the development of vaccines, diagnostics and therapeutics globally. The European Commission led a global pledge, raising $18 billion. In April, the WHO, leaders of G20, major foundations and stakeholders co-founded the initiative Access to COVID-19 Tools (ACT) Accelerator to provide speed and equitable access to vaccines, therapeutics and diagnostics. I serve as a Principal of [the] ACT Accelerator, which brought together key actors from the WHO, CEPI (Coalition for Epidemic Preparedness Innovations), vaccine alliance Gavi [and many more] to collectively coordinate end-to-end solutions from R&D to procurement and distribution. Together, the COVAX alliance (the vaccine pillar of ACT Accelerator) was formed, and Singapore played an important role here in vaccine multilateralism by leading the Friends of COVAX.
I’m very pleased to have had a chance to work on this and very proud of what has been achieved.
MEDICUS: Keeping that global perspective, what are the lessons that the world would do well to remember from this pandemic?
Victor Dzau: First of all, we have to have global solidarity because ‘no one is safe until everyone is safe’. With global travel so accessible and affordable, a respiratory pathogen can spread anywhere. You have to come together to solve this problem.
Second is multilateralism. You don’t work alone; you work together. The ACT Accelerator is an exemplar of multilateralism. You put your resources together because when you help other countries, especially the low-income ones, you also help yourself. By working together, you have more resources and solutions than working alone. Multilateralism not only improves health but also helps economy. Many rich countries have lost a lot of GDP because international trade and travel are a big part of their revenues. If you stop all that, your economy is affected profoundly.
And equity is a key issue—equitable access, equitable allocation and distribution, you name it. Everyone in the world deserves the right to get care and access to treatment. The WHO recommends that all countries reserve the first doses of vaccine for the 20 per cent of the population who have a high risk, but not everyone will be vaccinated until high-risk groups around the world have been vaccinated.
Leadership and human dimensions are also so important. If you look at countries that responded well versus countries that did not, it’s down to the leadership—leaders who take clear and decisive actions based on science—and people who protect each other by wearing masks and practicing social distancing. Societies [that] believe in public health and believe in protecting each other, like Singapore—they did better. For the longest time, global health security has been all about measuring how well prepared a country is based on resources, etc. In this context, the US has ranked at the top. But look at our response! Whereas countries like South Korea, Japan and even countries in Africa, which don’t come up as the richest or the most prepared by global security measurements, have performed well in their responses.
MEDICUS: On 8 December, a 90-year-old UK grandmother became the first to receive a licensed COVID-19 vaccine. Can we now look forward to a brighter future? And when, in your opinion, do you foresee a return to normal?
Victor Dzau: I’m going to say… We will not return to normal until the end of 2021, but things will get better over time. By late Spring, early Summer, it will be much better because more people will have been vaccinated. So, I think in the Fall, people are going to feel better.
MEDICUS: Thinking about these latest vaccine technologies, will they displace existing vaccine technology?
Victor Dzau: This new technology is really good news. The new technologies, such as the RNA platform, show that you can take a virus, sequence it and, from knowing the sequence, make a vaccine. The speed is amazing. It took just ten months from the time the SARS-CoV-2 virus was first sequenced last January to the time when the Phase Three trials [for the first vaccines] were completed. This success is a strong statement on the importance of investment in science.
This technology could revolutionise how we make vaccines, like the seasonal flu vaccine. In fact, the NAM has an international committee that is looking at the lessons learned from COVID-19 for influenza preparedness and response.
MEDICUS: Coming now to the little red dot and the SingHealth Duke-NUS Academic Medical Centre (AMC) that you helped to set up. Looking back at the vision behind the AMC, has it lived up to its promise?
Victor Dzau: Credit must go to Ivy [Ng, SingHealth Group CEO] who is a terrific leader and has been a great partner in creating the AMC with us [from Duke] and to Tom [Coffman, Dean of Duke-NUS] and Ranga [Krishnan, former Dean of Duke-NUS] from Duke. Because an AMC is all about partnership, sharing the same vision, goals and priorities and bringing your relative strengths to the table to make things happen. We’ve shown that we can do all that we set out to do, integrate research and clinical medicine and create a new generation of physicians who are both doctors and researchers.
MEDICUS: Your ties to Singapore stretch back to the early 2000s and across many projects. For your contributions, you were made an honorary citizen. Can you tell me more about what the most meaningful ties are to you?
Victor Dzau: Aside from the fact that together we have created a top notch medical school and an outstanding AMC, I had the opportunity to make friends, make a difference and contribute to Singapore while at the same time contributing to Duke [University] and the United States. It is the friendships that I’ve built with many people in Singapore from the government to the biomedical sector and also the common vision and commitment that we all share to moving things forward that are most meaningful to me.
My honorary citizenship is particularly meaningful to me because I am now a member of the Singapore family.
MEDICUS: Thank you for sharing your insights and we look forward to welcoming you to Singapore again soon.