Statement by Dr Hans Henri P. Kluge, WHO Regional Director for Europe, to the 70th session of the WHO Regional Committee for Europe

14 September 2020, Copenhagen, Denmark

Your Royal Highness Crown Princess Mary of Denmark, Patron of our Office, thank you so much for being with us here.

Minister of Health Dr Alexey Tsoy, President of the 70th session of the Regional Committee for Europe,

Minister of Health and Senior Citizens of Denmark Mr Magnus Heunicke, outgoing President of the 69th session of the Regional Committee,

Dr Søren Brostrøm, Executive President of the Regional Committee,

My big brother, Dr Tedros,

Excellencies, ladies and gentlemen,

Today is 1 year to the day that you placed your trust in me as the new Regional Director. I committed to honour your political vote by quickly implementing my campaign commitments through reorganizing the WHO Regional Office for Europe to better respond to the needs of each of the 53 Member States in the European Region.

Upon the confirmation of the Executive Board, I was ready to implement my plans with almost military precision. But then something huge happened – the outbreak of COVID-19. Europe was at the epicentre of a pandemic with planetary repercussions.

I immediately decided to take personal leadership of the WHO European response to COVID-19, but at the same time I could not allow myself to postpone my commitments to you. And the only way I could pull this off was thanks to the unwavering commitment of all my staff, especially the heads of country offices and their fantastic teams, and through a transparent, fast-track recruitment of a completely new executive team. And I am so proud of them.

In this context, my opening speech will have 2 parts. The first part is about laying the foundations for the future beyond COVID-19, and the second part is the COVID-19 response by the Regional Office.

I will not give you a long list of challenges that we are facing in health and well-being in the Region. There is a great publication on the core health indicators which shows the state of health as of today. I ask for your kind understanding that this year is a kind of transition year, and I promise that next year we will have a dashboard in line with the monitoring and evaluation framework of the triple-billion goals of the WHO General Programme of Work (GPW) and adapted to the European Programme of Work (EPW), once it is approved.

So how did we lay the foundations for the future beyond COVID-19? Through 3 main axes:

• keep direct contact with every single country for a more targeted response
• strengthen partnerships with other organizations working in the Region
• restructure the Regional Office to be fit for purpose.

On the first axis, I maintained the direct contact with each country that I established during my campaign marathon, thanks to the generous support of the Belgian Government. Through country field missions and digital technology, we strengthened our relations with ministries of health, ministries of foreign affairs, health leaders and health professionals at all levels. Beyond statistics and quantitative data, this direct contact gave us a very good understanding of the social, economic, cultural and political characteristics which are so important for health policy.

Straight upon confirmation of my appointment in Geneva in February, before coming back to the Regional Office, I went on my first country missions. I would like to thank Dr Alisher Shadmanov, Minister of Health of Uzbekistan, and Dr Eljan Birtanov, former Minister of Health of Kazakhstan, for receiving me so warmly.

After that, I immediately continued to the western Balkans, another very important subregion, and thank you so much to Dr Zlatibor Lončar from Serbia and Dr Venko Filipce from North Macedonia for receiving me at a presidential level. With your support, we immediately discussed with heads of State in a free, frank and friendly way the most important issues, such as tobacco control and environmental pollution.

More and more, we worked on a subregional approach to maximize country impact, for example, with our 2 weekly video conferences with the Baltic states. Thank you so much to the ministers of health for always being there for our very fruitful video conferences, which you asked me to continue. The same goes for the Balkan and the Visegrad countries, the central Asian republics and the Russian Federation, and, of course, the small countries – the small countries which are very close to my heart. At the same time, the full pan-European dimension remains critical for our Region, because its diversity is an asset for building solidarity and for knowledge exchange.

On the second axis of laying the foundations for the future beyond COVID-19 – strengthening partnerships with other organizations working in the Region – it is crucial to fight all of the other ongoing epidemics: of noncommunicable diseases (NCDs), of multidrug-resistant tuberculosis and HIV, and of environmental pollution and climate change, where the work of the WHO European Centre for Environment and Health is so important. For the big epidemic of out-of-pocket payments, the work of the WHO Barcelona Office for Health Systems Strengthening is so crucial. Always, we see through the lens of inequalities and gender, where, in particular, the WHO European Office for Investment for Health and Development has a very important role.

I would like to thank colleagues from the Global Fund to Fight AIDS, Tuberculosis and Malaria, and GAVI, the Vaccine Alliance, for increasing our collaboration. This collaboration has also transpired more and more through subregional partnerships.

And I would like to thank Dr Ogtay Shiraliyev, Minister of Health of Azerbaijan, my good friend, the longest serving health minister in the Region, for having invited me to the meetings of the health leadership of the Turkic Council, with whom we signed a memorandum of understanding last week, and also the meetings of the Non-Aligned Movement.

Thank you so much to Dr Shadmanov, again, for inviting me to the meetings of the Council for Health Cooperation of the Commonwealth of Independent States.

Thank you to the Prime Minister of Montenegro, who on my request immediately convened a meeting of the heads of governments of the Central European Initiative – 18 European Union (EU) and non-EU countries – on the COVID-19 response.

Last week, we decided with Dr Mira Dasic to strengthen our collaboration with the South-eastern Europe Health Network. And spasibo bolshoe to Dr Mikhail Murashko, Minister of Health of the Russian Federation, for giving me the keynote at a very impressive meeting of the health leaders of the Shanghai Cooperation Organization. Partnerships in the east are very important.

I am humbled that we are entering a completely new phase of cooperation with the European Union and the European Commission. Even before the COVID-19 pandemic, this process of rapprochement between the Regional Office and the European Commission was ongoing in the field of health, but also in the fields of digital technology and neighbourhood and developmental cooperation.

My warm thanks go to European Union Commissioner for Health and Food Safety Dr Stella Kyriakides. From the first day we met in your office, we decided to go for a very pragmatic, actionable collaboration beyond the traditional signing of theoretical papers. And thank you to your team for being ready today with a joint statement and always discussing issues from a pan-European perspective, including access to a COVID-19 vaccine in non-EU countries.

With Dr Andrea Ammon, Director of the European Centre for Disease Prevention and Control, we are working on an innovative agreement, with the ultimate goal of pan-European health security for the benefit of the Member States that both of our organizations serve. Ultimately, this will strengthen both of our organizations as well.

Recently, I had the opportunity to express my determination to undertake an historical collaboration with the European Union and the European Commission at the European Union informal health ministerial meeting, chaired by German Minister of Health Dr Jens Spahn. And dankeschön, Dr Spahn, for your leadership, together with French Minister of Health Dr Olivier Véran, to strengthen the role of Europe in global health and WHO global governance.

First axis: keeping direct contact with each of the 53 Member States to tailor our response. Second axis: strengthening partnerships with other organizations. Third axis: restructuring the Regional Office.

The single most frequent piece of advice I got from colleagues at WHO headquarters was: if you start a transformation, you have to finish the transformation in a limited time in order to safeguard productivity and decrease anxiety and disruption. The 2 criteria guiding the restructuring were transparency and consultation.

We had 3 objectives: to restructure the Regional Office’s work towards alignment with the GPW and the draft EPW, to have country impact and to have fiscal balance. This was a strong commitment to tackle head-on the chronic deficit as I came into the Office. Obviously, it’s a huge challenge, also with COVID-19. But I have a very good guideline, almost a cookbook on how to do it, and it is the report of February’s meeting of the Programme Budget and Administration Committee of the Executive Board, which was guided by Chairman Mr Björn Kümmel.

I immediately cut the number of technical divisions from 5 to 3 to decrease working in silos. The number of technical directors I cut from 9 to 6, the number of deputy regional directors I cut from 1 to 0. In fact, this was the advice of a good friend and secretary general in one of the Scandinavian countries, who told me, “Hans, no need to work with a deputy in the first years.” I asked him why. “Two reasons,” he said. “First: you will know the nitty-gritty of the Organization yourself: nobody will be able to fool you. And second: if you have a deputy, after 6 months this person is going to ask why he or she isn’t sitting in the post of Regional Director.”

So, I took the advice. And I asked him, “How do you pull it off?” He said, “It’s very simple: during the first 2 years, the only thing you have to do is work a little harder.” And thanks to my fantastic family, I decided for the first years to work a little harder.

To fulfil my commitment to the staff, we finished the recruitment of a 100% ombudsperson. Unique.

The 3 technical divisions are the Division of Country Health Policies and Systems with Director Natasha Azzopardi-Muscat; the Division of Country Support, Emergency Preparedness and Responses, at the core of the GPW and draft EPW, with Director Dr Gundo Weiler; and the Division of Country Health Programmes with Director Dr Nino Berdzuli.

With Dr Mike Ryan, we decided to push back COVID-19 by appointing Dr Dorit Nitzan as Regional Emergency Director with all her experience. There is the enabling Division of Business Operations, which is called BOS – but I always say “boss” with 1, not 2, S’s, as its Director is Mr David Allen. There is the Executive Director of the Regional Director’s Office Mr Robb Butler. We have Ms Oxana Domenti now heading the very important WHO office in Brussels towards the European Union, which is blossoming. My commitment to the staff was to appoint a Special Adviser on Transformation and Organizational Development to eradicate all forms of harassment; I kept my word, and this is Ms Gabrielle Jacob.

And maybe the most important decision was to have a WHO Representative on the Executive Council. By having a WHO Representative on the Executive Council, the failure rate of implementing policies from this Office decreased drastically. And it’s the WHO Representative of the biggest country in the Region – the Russian Federation – Dr Melita Vujnovic.

Every 2 weeks, I have a video conference with the 31 heads of the country offices to keep a finger on the pulse. We have an email inbox called “Ask Hans” where people can anonymously, safely send in their grievances but also innovations. Remember, innovations come from the bottom and that’s why I am advocating for a flat organigram.

None of this could I have pulled off, nor could I have come so far, without the great relationship I have with the European Staff Association. I want to pay tribute to President Shahin Huseynov and Deputy President Kitty Rasmussen for being the interface between the management and the staff in times I acknowledge are uncertain.

So this is the first part of the speech: laying the foundations for the future, keeping direct contact with countries, strengthening partnerships with organizations, reorganizing the Regional Office.

The second part of the speech: the COVID-19 response.

As in every catastrophe, we have victims and we have heroes. I would like to pay my condolences to the victims, their families and their communities who have been hit hard – too hard – by COVID-19. As of yesterday, we have had 225 665 laboratory-confirmed COVID-19 deaths, and 4 816 000 laboratory-confirmed COVID-19 cases.

This is 25% of the global burden of mortality and 17% of the global burden of morbidity, but many more people who survived have had to learn to live with what we call “long COVID”. For months, you can be thrown out of physical balance. People who never had anxiety or depression before have it now. We are now studying this phenomenon in order to serve you, the Member States, better. Thank you, Professor Martin McKee from the London School of Hygiene and Tropical Medicine for supporting us in this work.

The heroes, no doubt, are the health and social workers who sacrificed their own lives to protect society, but also all other frontline workers, such as the teachers, who have my great respect and have kept society running. The whole world has recognized their merit and bravery.

Here in the COVID-19 response, 3 main axes guided our work:

• providing each country with the specific support they requested from the Regional Office
• bringing together the energies
• learning the lessons – not for the future but for the present.

First axis: providing each of the 53 Member States with the targeted support they requested. Our assistance consisted of disseminating in real time knowledge of every single aspect of the pandemic. With the support of the European Commission and the European Observatory on Health Systems and Policies, with its Director Dr Josep Figueras, we quickly established the online Health System Response Monitor, which documents the measures implemented by all countries with an analytical component.

Whenever there was a gap in normative guidance, we stepped forward and we filled it – for example, the policy options we provided to you, the Member States, on how a country gradually and safely transitions from a lockdown, or the conference we had on 31 August with my good friend Minister of Health of Italy Dr Roberto Speranza on safe schools in COVID-19 times, the framework of which we published today. This week, we have the draft policy options for when COVID-19 meets influenza, and thank you to Dr Clemens Auer, Special Envoy for Health from Austria, for having initiated this together with us.

These are the normative supports, but the core of what we are doing has always been and will always be country support. Despite tremendous challenges in transport and customs and lockdowns, we pulled off 120 country missions to assist countries doing risk assessments and adapting policies to the local context.

I myself went to Turkey. I went to Gaziantep when we sent in the medical convoys to refugees in northwest Syria to leave no one behind. I went to primary health-care clinics where I was astonished. I spoke with nurses, doctors, social workers, refugees from Syria who were trained, certified and salaried by the Turkish Government to provide people-centred services – gender sensitive, linguistically sensitive services – like I have never seen in my life before.

The Eastern Partnership project, generously funded by the European Commission, allowed this Office to procure, for 13 million euros, personal protective equipment (PPE) in 5 months, which we have never done before. The project is now expanding to the western Balkans and to the central Asian countries, with a health system and essential public health functions component. I would like to thank all of the EU ambassadors in those countries for a fantastic collaboration.

As you can see from my social media posts, I make it a point of honour every single day to talk to ministers of health, ministers of foreign affairs, ambassadors, health professionals, patients. Together with my brother Dr Tedros we also spoke to the President of Belarus and the President of Turkmenistan to exchange international evidence.

Every 2 weeks we have press briefings, and for the first time in history we have had press briefings completely in the Russian language. As many of you know, neither my staff nor myself ever refuse when you ask us to support your health leadership by participating in national media or television interviews.

Here it is appropriate for me to salute the Standing Committee of the Regional Committee (SCRC), its Chair Dr Søren Brostrøm and its Vice-Chair Dr Iva Pejnovic Franelic. You were always there for me and our Office. Remember my commitment 1 year ago, that I would do the work with transparency and accountability.

This has been the largest reprofiling of the Regional Office in its history, and your guidance and reassurance that we are going in the right direction was most critical for me. We convened with the Chair and Vice-Chair 2 ad hoc meetings of the SCRC.

The first axis of the COVID-19 response: providing each country with the specific support you requested of us.

The second axis is based on my experience as a marathon runner. This is not a sprint, it’s a marathon: we have to gather energies. And we know that in times of crisis, when united action for better health is needed so much, a natural reflex is to look only inside. That’s why we strengthened our relations within the Organization, with headquarters and the 5 regional offices. And I thank so much the other regional directors – we have a great group of continuous exchange. And thank you for your support to me as incoming Regional Director.

And, of course, thank you to Dr Tedros for always – especially on the Sundays – being there for me. And also for appreciating that from time to time I have my own opinion, because my interest is to advocate for the 53 European Member States, of course, in the spirit of global solidarity.

Thank you to the Secretary General of the Organisation for Economic Co-operation and Development, the President of the World Bank and Regional Director of the World Bank, who immediately responded very positively to the draft EPW and our collaboration.

Every 2 weeks we have a meeting with the 24 United Nations agencies, the regional directors active in the Region, particularly eastern Europe and central Asia, which is so important for implementing health in all policies. Thank you to all of them. Straight in the beginning we developed a joint letter with the Regional Director for Europe and Central Asia of the United Nations Children’s Fund (UNICEF) Ms Afshan Khan. Thank you so much for the very good collaboration looking at comparative advantage – WHO with its normative work, and UNICEF with its procurement experience.

We established very close collaboration with the 17 United Nations resident coordinators at the country level who are helping to position health very high in the United Nations sustainable development common framework within the context of the global plan to ensure healthy lives and well-being for everyone through the Issue-based Coalition on Health.

And finally, we strengthened relations with patients and patient organizations, including for rare diseases, with civil society and public health associations, with the World Organization of Family Doctors, and with doctors, nurses and midwives, who are very close to my heart. Without you, without civil society, it is not possible to leave no one behind.

The first axis of the COVID-19 response: direct, tailored support to countries. The second axis: gather the energies. And the third: learn the lessons.

This pandemic has brought to light the strengths and weaknesses of European society. It has revealed the reality of our European health systems. We cannot wait for an after-action review. We have the flu coming up, we have the reopening of the schools and the academic year. We have excess mortality among senior citizens in the winter. We need to learn the lessons for the present, and that’s why as an Office we conducted an intra-action review with 3 main lessons that are documented in the Regional Director’s report.

The first main lesson: strong national health systems mean strong national health security. The pandemic painfully reminded us of the urgency to implement the Astana Declaration on Primary Health Care. No pandemic has been won in the hospitals alone, and we need to urgently take pressure away from our treasured doctors and nurses in our hospitals to protect them from burnout ahead of the winter.

People-centred primary health care with essential public health functions across the continuum of care is the best approach to protect us from emergencies, decrease inequalities, and protect the poor and vulnerable. Here, I would like to salute Kazakhstan and Dr Alexey Tsoy for already having brainstormed with us on how we could kickstart a 5-year process to plan the new way forward on primary health care for and with our Member States through the geographically dispersed office (GDO) for primary health care in Almaty.

There is no health without the health workforce. Their merits have been recognized globally, and this should lead to a new moral and material future for them in line with their responsibilities. And I salute here the nurses and the midwives. It is your year. But you have been so busy that in the WHO European Region I decided to extend the year into 2021. We will push back COVID-19 and I promise: we will celebrate you.

We have seen the almost infinite potential of digital innovations both in health care and public health. But we have also seen their challenges, including in health data governance and digital poverty. WHO will always stand strong for human rights, gender equality and fairness by leaving no one at the side.

Ladies and gentlemen, the unexpected delay in care for patients with chronic diseases is the black chapter in the intra-action review.

Sixty-eight percent of you, Member States, reported disruptions in services for NCDs, including monitoring of hypertension and diabetes and cancer screening. Some countries are projecting an increase of 10% in breast cancer mortality, which could have been avoided, or of 15% in colon cancer mortality, which could have been avoided.

But here we also gave great news. I would like to thank Dr Mikhail Murashko, Minister of Health of the Russian Federation, for inviting me on my first official visit to Moscow next week, straight after the Regional Committee, to sit together and further strengthen the activities and profile of the very important GDO on NCDs in Moscow – to launch 5 years of fresh thinking on how we can catch up with the NCD-related targets in line with the Sustainable Development Goals (SDGs).

For immunization, it is the same. Six countries in the Region, accounting for 22% of the total infant population, reported a disruption in routine immunizations.

As for tuberculosis, in May 2020, 28 countries reported a 50% decrease in case notification. It means the dual-track health system response is so important.

And again, we have good news. Four days ago, I signed and opened the new GDO on preparedness for humanitarian and health emergencies in Istanbul, virtually, from 4 locations, with Dr Fahrettin Koca, Minister of Health of Turkey. And I know, Dr Koca, you are watching. To you and your wonderful team: teşekkür ederim!

The first axis of the COVID-19 response: country support. The second axis: gathering the energies. The third axis: learning the lessons.

The first lesson: stronger health systems, stronger health security. The second lesson: solidarity is key to success. No one is safe until everyone is safe. I always say: if solidarity doesn’t come from the heart, at least let it come from the brain. The strongest examples of solidarity I have seen have been in the local communities – neighbours reaching out to elderly neighbours and to people with mental challenges.

I am so grateful to Her Majesty Queen Mathilde of the Belgians, who will address you, the Regional Committee, as an SDG Advocate, and who will champion the flagship Mental Health Coalition.

In the beginning of the pandemic, we remember the huge issues in access to PPE, which taught us the need for structures of international cooperation to be in place in peacetime so they can be automatically triggered in wartime. And it also taught us the essence of a pandemic stock reserve, not least for the small countries.

The International Health Regulations (2005) allowed WHO to act fast globally. There is no doubt about it. But they remain subject to national core competencies for implementing its obligations. And this instrument deserves a critical review. As I explain almost every day to my 2 teenage daughters, WHO is only as strong as the teeth it is given by its Member States. And rest assured, ladies and gentlemen, excellencies, of the full support of this Office to contribute in the most positive way to the WHO Independent Panel for Pandemic Preparedness and Response. I already had a great talk with Dr Anders Nordström, Chair of the Secretariat.

The third lesson, and maybe the biggest one, is the general awareness of the reciprocal relationship between health and the economy, which is essential if we want to move to an economy of well-being. This is no surprise for you and for me, but I saw it was a big surprise for many non-health policy and decision-makers. And that’s why, after informing the SCRC, I established the Pan-European Commission on Health and Sustainable Development to rethink policy priorities in light of pandemics.

I am humbled that Professor Mario Monti, President of Bocconi University in Milan, former Prime Minister of Italy, former European Union Commissioner, agreed to chair this very high-level commission. And thank you, Professor Monti, for addressing the Regional Committee later today, and special appreciation also to Professor Elias Mossialos, Special Envoy of the Greek Prime Minister on COVID-19 from the London School of Economics and Political Science, for being the scientific coordinator, linking the scientific advisory committee which supports the Commission.

Dear colleagues, rest assured that all of those lessons are incorporated in the draft EPW.

Let me conclude, please, on a slightly personal note. This pandemic has made me aware of the fundamental importance of confidence in managing a crisis. The crisis gave me the opportunity to deepen my relationship with so many people in your countries, within WHO, within other organizations – to get to know each other better but especially to work more effectively for better country impact.

WHO as an organization is going through tough times, and I appeal to you for this mutual trust to overcome and help us overcome these difficult times. I sincerely hope that the evaluation of WHO and its activities will be conducted in the sprit of mutual understanding of each other’s mandates so that you, Member States, feel safe with us, and in return, we at WHO feel your support to implement our noble mission of improving health and well-being for all at all ages and leave no one behind.

The WHO European Region, at critical times in its history, has undergone large-scale transformations of society to build back better as an example for the rest of the world. And those successful transformations were based on 4 ingredients. Two we have already: necessity and innovation. What we need together now is courage and collaboration. Thank you.