ร่าง concept paper ของ PMAC 2021

1. 1
PMAC 2021 Option title:
a) COVID 2019 pandemic: A wake-up call to the world – Never Again! preferred by: David Harper and
Timothy Mastro and Dennis Carroll
b) Mega crisis – Mega trends – Mega solutions (Peter Friberg)
c) COVID-19: Current disaster and future opportunity (Jesse Bump)
d) A failure to prepare, an opportunity to plan (Jesse Bump)
e) Growth and Pandemics: Advancing health and wellbeing in the wake of disaster (Jesse Bump)
Background
The Prince Mahidol Award Conference (PMAC) is an annual gathering of global health experts to
deliberate and forge a path for better health for the world population. The COVID-19 pandemic has
defined the year 2020 and has challenged the collective might of the world in a myriad of ways. The new
virus has infected every region of the world and currently, there is still no vaccine. As we observe,
COVID-19 drastically changes the way we live and work, and it will also change political and economic
order, regionally and globally. The pandemic poses challenges and questions on many fronts. It
challenges government and health system responses, preparedness, and capacities all over the world.
COVID-19 exposes government leadership and capacities in handling the pandemic and other issues
entail with it. COVID-19 has shown that it is not only technical preparedness that determines actual
performance (arguably the countries hit most hard were better prepared as per JEEs and SPARs).
Leadership, decision making, governance, decentralization matter. It also lays bare the implications of
the prevailing economic order, economic and social inequalities and environmental crisis, raising
questions about the nature of the post-COVID world. We also see diversity of policies, measures,
innovations from different countries to tackle the disease leading to a vast diversity of success and
failure, and we can learn from this and make progress. We should also learn on how society at large
have performed during this crisis. Apart from present challenges, many questions toward the future
emerge. For example, the questions of how to prevent future outbreaks of infectious diseases with
pandemic potential, or what the world after COVID-19 will look like. These are the issues to be address
at PMAC 2021.
This current pandemic is an opportune moment for PMAC 2021 to review, share lessons and provide
feedback to each other in the global health community on how to prepare and respond more
effectively, including those actions necessary to prevent and mitigate the impact of the next small-scale
outbreak or Public Health Emergency of International Concern (PHEIC). PMAC 2021 will address three
important questions (1) What has the world learned from COVID-19? (2) What does a post-COVID-19
world look like? and (3) What should we do for the future?
Modality
Given the uncertainty in travel and face to face meeting in 2021, the current working plan is that PMAC
2021 will be a virtual conference, with only a limited number of speakers invited to Thailand (if possible
at that time) while all other participants join online.

2. 2
Prior to the main conference in January 2021, a series of Webinars will be organized to discuss different
issues. Three plenary sessions in January are the synthesis sessions building on input from webinar
discussions. This means the series of webinars will replace the usual parallel sessions.
The main conference will be 3 days, with one plenary session each day, lasting 2-3 hours, live to all
registered participants and recorded for access by global audiences.
Objectives
PMAC 2021 will seek to address the issue of global health security and pandemic preparedness and
response through the case study of the COVID-19 pandemic. More specifically, the conference will aim
to:
1. Draw lessons from the national and international preparedness and response to the COVID-19
pandemic.
2. Assess the impact of the COVID-19 pandemic on health and non-health sectors and mitigation
efforts.
3. Lay a roadmap and make action for a better-prepared, resilient and sustainable system for the
next PHEIC and to ensure global health security.
Suggested outline of Plenary sessions and sessions prior to the main conference
Plenary 0: How historical political economic changes have culminated to produce this pandemic?
This plenary session opens up a broader perspective of the COVID-19 situation. The pandemic might be
perceived as an unfortunate public health event. However, this global health emergency, in fact, unveils
the rising inequality, the erosion of social safety nets, and the weakening position of public health in a
world dominated by globalized commerce and private interests. By treating this problem as principally
scientific, we might lose sight of the social process that underpins this disaster. PL0 brings out the
importance of considering historical, political and economic implications of this pandemic. Strong
leadership, consensus on strengthening public health or advancing its objectives in social protections,
UHC, and equity; are among prominent issues needed to be discussed. In order invite discussions of
these issues, PL0 will broadly explain three things
1. Why this pandemic has come now, after a century of successful prevention;
2. Why different countries have performed differently and why the impact within countries has
varied;
3. The big opportunities to improve societal performance—both country level societies and global
society—and the role of medicine in public health in the transformations we need.
Plenary 1: What has the world learned from COVID-19?
COVID-19 has specifically shed light on the lack of resilience of healthcare systems around the world and
how different political decisions shape outcomes. Vulnerable populations are particularly prone to
infection and affected by the consequences of economic downturn. This also reflects the need for more
equitable and resilient health systems and state policies to ensure health security.
PL1 addresses how different countries responded to COVID-19 pandemic; assesses the impacts of
COVID-19 and containment, mitigation and recovery measures used by the governments. This session
will also draw lessons for the world and lessons for countries. These are some key questions to be
discussed:

3. 3
• How did the world respond to pandemic?
o How did the political systems respond? How did health systems respond? And what was
the interplay between the two? What characteristics enabled health systems to respond
better to the pandemic?
o How did international communities respond to the pandemic?
• What is the impact and implications of the pandemic?
o What is the profile and size and affected populations and population sub-sets of
population?
o How has COVID-19 specifically impacted human rights and gender equality? and
mitigation measures by government, international communities and civil society
organizations?
o What are the impacts of COVID-19 which hamper the achievement of SDG?
o How the complications from “politicizing COVID-19” on top of pandemic in various
countries hamper effective responses?
o How the pandemic uncovers the underlying geopolitical tension across countries; and
what are the emerging future geopolitics systems? and How did geopolitical tensions
impact response at country level? and coordination at international level?
o What is the political economy of COVID-19 pandemic, which affect equitable and
affordable access to medical products related to COVID-19, such as medicines, vaccines,
diagnostic?
• What effective mechanisms of governance for health such as more democratic polity and
equitable and ethical partnerships at national and international level which can address the
pandemic?
Series of webinars to be discussed prior to the main Conference which will form the content of
Plenary 1
1. National and international preparedness and responses to COVID-19 pandemic: what are the
lessons, both positive and negative, that can be learned?
COVID-19 has rapidly engulfed the world's population, calling into action stakeholders from all
sectors at the national regional and global levels. There has been a variation in the response among
countries affected by the outbreak including those at different income and development levels. The
responses have also been determined by the characteristics of the health system, such as emphasis on
primary health care, extent of public funding for healthcare, public-private mix in healthcare delivery
and adequacy of human resources in health. Being able to learn from these experiences (both good and
bad) would be invaluable for another one in the future. This webinar aims to include key actors from
around the world to share their experiences on COVID-19 preparedness and responses including to
present key take-home messages on what we can do better in the future. Examples of questions to be
addressed in the webinars include:
National responses
• How did different countries respond to the COVID-19 pandemics?
o Did JEE and SPAR ratings predict countries’ actual preparedness and ability to respond?
o How did some countries fail so badly and fail to follow previous plans and preparations,
including stockpiles of critical items including PPE and diagnostic reagents?
o Access to other essential services during COVID-19 outbreak

4. 4
o What was the national-level coordination and how governments were able to use
existing national disaster/crisis mechanisms to effectively respond to COVID?
o National responses to pandemic and its repercussion on economic downturn/recession
and its impact on health equity.
o What are the effective interventions public health responses such as case detection and
quarantine, social intervention such as physical distancing and clinical management of
severe cases? And What have been the implications of those public health interventions
for the poor and vulnerable populations?
o Universal Health Coverage: a resilience platform to absorb shock from pandemic.
• Data privacy and personal rights: on the use of manual and technology for contact tracing, on
tracking people’s movements (especially under isolation or quarantine).
• What was the impact of social media on how the pandemic and government responses were
understood and supported by the public, or not?
• OneHealth approach
International responses
• How did WHO and other international organizations respond to the situation, for example
through the International Health Regulation (IHR) emergency committee on PHEIC and
pandemic announcement?
• How have nations responded to support international actions, for example in funding WHO?
• What was the broader response from other international organizations and regional
associations?
• How did the research and scientific community respond to the pandemic on R&D of diagnostic,
personal protective equipment (PPE), medicines and vaccines?
• How did civil society respond to the pandemic?
• What has been the role of informal and formal networks of researchers and policymakers in
informing the response? What challenges have they faced?
• How did global supply chains affect the response?
• Solidarity and self-interest in international response – global supply chains.
• Geopolitics and pandemic response.
• Discuss on the health, legal, ethical, governance issues around global standards for health
passes and “travel bubbles”: (not confined to the concept of ‘immunity passports’, but a global
standard for recognizing intra- and inter- national movement of people, goods and services.
• Role of regional solidarity (and the glaring absence). COVID-19 is a global pandemic, and yet
responses have been unilaterally national in nature. It will be important to examine and discuss
the roles of international blocs such as ASEAN, EU, etc. and the glaring absence of solidarity in
these blocs, especially when countries within blocs start a price war for PPE, food stockpiling,
etc.
2. The impact of the COVID-19 pandemic on health and the health system
In a matter of weeks, the COVID-19 pandemic has dramatically altered the world. Economic
projections for the global economy are dire, suggesting a contraction not seen since the Great
Depression in the 1930s. In addition to economic activities, health and education as well as the
geopolitical dynamics have also changed. The series of webinar aims to summarize the impact of this
pandemic on key areas, government mitigation efforts and its outcomes. How can a country do better
now and in the future? Examples of questions to be addressed in this session include:

5. 5
• What is the impact of COVID-19 on global health security?
• How has COVID-19 impacted the One Health approach?
• How has a One Health governance approach (nationally, globally) influenced COVID-19
responses? How could it do better in future?
• What is the impact of COVID-19 on health systems? Did they strengthen and in what ways?
• How has the pandemic changed the way we deliver healthcare?
• What is the impact on health workers?
• What is the impact of COVID-19 on non-COVID services the majority cases from Non-
Communicable Diseases (NCDs), tuberculosis, maternity care, immunisation and other essential
and routine services?
• What is the impact of COVID-19 on digital health and telemedicine?
3. The impact of the COVID-19 pandemic beyond health such as on education, society, economy,
employment and poverty
• How did the world fail so dramatically when “the Big One” arrived in 2020?
• What are the collateral impacts of COVID-19 pandemic and what are the effective responses,
such as education, nutrition, employment and poverty?
• What is the impact on human health and well-being through e.g. food insecurity among the
vulnerable population, domestic violence against women and girls, impact of school closures on
poor children reliant on schools for meals?
• What has been the economic impact of the pandemic in high-, middle- and low-income
countries, taking into account the prevailing economic inequalities?
• What were the financial implications of the pandemic for the health system?
• How will global supply chains be changed by COVID-19?
• What is the role of evidence in informing strategies and assessing the impact of the policy
response to COVID-19?
• Resilience of vulnerable populations: not just health resilience but also financial protection,
extended to groups such as migrant workers, residents of asylums and prisons, commercial sex
workers, etc. includes important lessons for the urban poor, residents in slums and
impoverished communities, other neglected populations.
• How has COVID-19 specifically impacted human rights and gender equality?
Plenary 2: What does a post-COVID-19 world look like?
The "COVID-19 moment" is poised to be a turning point for the world in terms of the
megatrends of geopolitics, population, technology, and environmental factors. At the same time, the
pandemic has underscored the importance of solidarity among nations and people even in a time when
the disease requires isolation.
COVID-19 undeniably challenges the status-quo of the world order. We see its tremendous
repercussions on health, lifestyles, economy, society, environment and others particularly over the next
two to three years before a vaccine is widely available (if at all). Whereas globalization accentuates
international travel and transnational communication, it also accelerates the widespread of infectious
disease such as COVID-19. The transborder nature of the virus highlights the need for collective actions
and international cooperation. Amid this pandemic, we see countries engage in philanthropic diplomacy,
while others adopt more conservative and self- and narrow-interest policies to manage the pandemic

6. 6
with catastrophic outcomes. The interconnected global supply chain, once viewed as an asset, now
viewed with suspicion. Discourses by politicians in some countries contradicts the established public
health practice of restricted travel, physical and social distancing to curb down the spread of diseases.
We also witness the disruption of regional cooperation in some parts of the world, whereas such
cooperation is strengthening in others. The geopolitical impacts of COVID-19 also challenge the balance
of power between the West and the East. How will the world order and global health leadership look
like after COVID-19?
This plenary will provide an opportunity to discuss what this post-COVID-19 world will look like in
the coming months and the years to come. Examples of questions to be addressed in this session
include:
• How has the pandemic reshaped megatrend, geopolitics and global health architecture?
• How COVID-19 has reshaped future trends in infectious disease/global health security
governance and mechanisms?
• COVID-19 and population dynamics
• What has the experience of the pandemic shown in terms of the need for a new economic
order?
• How has the pandemic brought focus to the social and economic determinants of health?
• Change in Technology (e.g. big data prediction, contact tracing apps, trustworthy information)
and application of robot, artificial intelligence and tele-medicines in health service provisions.
• How has the pandemic changed geopolitics, global supply chains, regionalism and
multilateralism? How does this affect supranational health-related actions?
• What is likely to be the long-term impact if an effective vaccine is not available?
Series of webinars to be discussed prior to the main Conference which will form the content of
Plenary 2
1. Negotiating health protection in a new world of bilateral/regional trade agreements
This session could focus on how managing COVID-19 through lockdown restricting international
travel of people and movement of goods results in collapse of global supply chains, and challenges the
conventional forms of internationalism, creating national wealth/power competitions to source
essential health goods, breaking the 'free trade' practices of the past several decades, while potentially
encouraging more forms of national self-reliance. At the same time, many countries continue to
negotiate new trade and investment agreements, the provision of TRIPS Plus which can hamper access
to medical products, for example. The implications of a collapse in supply chains need to be assessed.
Examples of questions to be addressed in this session include:
• How could essential eco-sustainable international (cooperative rather than competitive, more
regional than global) supply chains be built, competitive protectionism be avoided?
• What has been the role of trade agreements, IPRs, public/private partnerships in COVID-19
vaccine and therapy research/scale-up/global access? How to ensure health-resilient trade and
investment policies/agreements?
• How to avoid price-gouging, hoarding of medicines, PPEs, etc. by the richer countries and
limiting access of LMICs?
• How COVID-19 could incentivize oft-delayed action on new approaches to drug research (less
private, more public, new platforms)

7. 7
2. Governance for health: towards more equitable policy-making and ethical partnerships
As with Ebola outbreaks in African countries, the global response, including international
multilateral organizations and many of the world's governments to the COVID-19 pandemic is already
raising critical questions about the ability of existing global governance mechanisms to respond
effectively to global health crises on the scale of COVID-19 pandemic. Is WHO able to direct the actions
of powerful countries? There are also issues related to the political regimes in some countries, where, in
the name of public health intervention, there can be negative impacts on civil rights and the space for
civil society voice and governance participation. Can health data be trusted in the face of a pandemic?
What plans are there for governments to return to open and democratic forms of governance in the
post-COVID era? Examples of questions to be addressed in this session include:
• How has (or might) COVID-19 lead to new forms of health internationalism/cooperation?
• How has COVID-19 affected national and international human rights (including right to health in
various covenants or articles) and civil rights and how can we ensure they survive post-COVID-
19?
3. Nationally and international displaced persons and population groups experiencing prejudice,
social exclusion, human rights violations, discrimination and trauma
The COVID crisis has uncovered the pre-COVID-19 existing social exclusion and prejudice, and the
much higher burdens of risk faced by the world's more vulnerable populations living in precarious social
conditions (e.g. the displaced, refugee camps, migrant workers, etc.). The webinar will address the
situation and identify fundamental solutions.
4. Megatrend geopolitics and global health architecture
To tackle major global challenges and to address the megatrend in geopolitics and global health
architecture.
Plenary 3: What should we do for the future?
PL3 will discuss steps forward after COVID-19 pandemic. The global community needs to
prepare for a future PHEIC by learning from this pandemic and synthesize lessons for future policies and
actions on health systems, economic systems, and environment and climate change. There are some
important questions to be considered; what needs to be done to improve preparedness and responses
to pandemic? How can we be better informed about the risk of future “spillover” events and the
potential of epidemics and pandemics? Can we be more predictive and able to target preventive
measures to disrupt future spillovers and to reduce the risk of future threats? How can we increase the
capacities of the public health and healthcare services? What is desirable health, economic and political
systems which will be able to tackle such pandemic? PL3 encourages participants to review the impacts
of COVID-19, to propose concrete recommendations and engage in immediate actions.
• How to better prepare, prevent, detect and respond to future threats at
o Targeting the animal-human interface to prevent future spillovers

8. 8
o Better characterize the global genetic makeup of viruses (virome) and other organisms
with pandemic potential
o Ensuring sustainable monitoring of spillover hotspots for early detection of emerging
threats
o Building a more comprehensive ecologic database of potential viral threats while they
are still circulating in animals to better predict future threats
o Transform the sciences of virology into big data sciences by generating a detailed
genetic profile of all high consequence viral families
o Strengthening health systems’ capacities for early detection and containment of novel
threats
o Maintaining sustainable public health and health care preparedness and response
capabilities
o Novel strategies for rapid and scalable development and deployment of biomedical
countermeasures
o Repairing global partnerships for globally coordinated action
• How do we ensure that there are adequate financial resources to support health systems in the
future?
• How can countries rebuild trust and address the ethical dilemmas brought forth by the
pandemic?
• How can the international community collaborate to better responses to the next major
outbreaks or pandemic? How can such collaborations be made more inclusive and equal?
• What is the scientific community's role in monitoring and predicting a pandemic?
• What is the role of industry and civil society in responding to a pandemic?
• Global access to treatments and vaccines. How effective treatments and vaccines, once they are
developed, will be made available to everyone who needs them.
• What are the institutional mechanisms that need to be developed at the national, regional and
global levels to effectively prepare for and respond to a pandemic?
• What would be the economic and political imperatives going forward in ensuring global health
security?
• Health related infrastructure like WASH, basic electricity, and food safety.
• WASH in health care facility
• Community empowerment and health literacy
Series of webinars to be discussed prior to the main Conference which will form the content of
Plenary 3
Going forward we need to rethink how we support the work of governments on social determinants of
health to make the society more resilient while paying particular attention to the most vulnerable.
1. Ensuring equitable financial and human resources for health and social protection, at national
and global scales
UHC, which offers equitable access to health service by all citizens without financial hardship, is a
key platform to protect health of the population and absorb health shock. How does the increase in
global debt resulting from COVID-19 affect UHC? While government needs to strengthen UHC,
challenges from COVID-19 are the economic downturn which results in limited capacity to collect tax,
contracted fiscal spaces and limited fiscal space for health. However, the pandemic has also clearly

9. 9
demonstrated the significance of well-resourced and publicly funded health systems and social
protection policies for global health security. Therefore, funding priorities for governments may need to
be scrunitised. The webinar may draw lessons and identify good practice to implement measures for
social protection and maintain the UHC momentum as committed to the UN High Level Meeting on UHC
in 2019.
2. Ensuring health security and effective health security governance
COVID-19 is a good lesson how countries and international community to accelerate investment in
preparedness and responses to emerging Infectious Diseases. The webinar may draw lessons and
identify good practice from global responses to the pandemic.
• How can we ensure the world is safe from COVID-19 and other infectious disease pandemics?
o Revisited aspects of the IHRs eg. declaration of PHEIC, pandemic etc.
o Strengthened IHR capacities: intensified laboratory and case surveillance, preparedness
and responses
o Strengthened health systems and UHC
o Equitable access to affordable PPE diagnostic, medicines and vaccines
o Effective social interventions introduced in a timely manner
o Self-reliance on production and stockpiling of PPE
o Cooperation with non-health sectors/ multi-sectoral approach
o Equity/ universal access to health care and other services and social protection
3. Transforming global strategies: from reactive to proactive
COVID-19 is a perfect example of how vulnerable we are when we wait to respond to an emergent
threat only after its an efficient human-to-human transmitter. One Health provides us with an
important paradigm for preparing for future threats. We need to be far more effective in understanding
and characterizing future threats why they are still circulating in their natural wildlife hosts and use this
insight to develop more proactive measures to prevent future spillover and to be able to respond more
quickly and effectively should they emerge through:
• Developing a comprehensive database on the viruses circulating in wildlife – spanning their
natural hosts, their geographic location and potential for spilling over into human
populations
• Building a big-data genetic profile of every viral famility enabling a transformation of the
research and development strategies for future biomedical countermeasures
• Establishing a longitudinal surveillance system spanning wildlife, livestock and humans for
known high consequence viruses in “hot spot” areas where spillover is most likely enabling
the early detection and rapid response to any future spillover event.
4. New (a session on how to link preparedness with UHC, make it a step 0 for any UHC scheme,
should be truly universal in countries as well as across the world)