David Barbe, MD, MHA, with global look at COVID during World Health Day

Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

In today’s COVID-19 Update, David O. Barbe, MD, MHA, president of the World Medical Association and a past president of the AMA, discusses the importance of and challenges faced world wide regarding health equity, vaccines and more on World Health Day, April 7.

Learn more at the AMA COVID-19 resource center.

Speakers

• David O. Barbe, MD, MHA, president, World Medical Association

Unger: Hello, this is the American Medical Association's COVID-19 Update. In honor of World Health Day, we're taking a global look at the COVID-19 pandemic with Dr. David Barbe, president of the World Medical Association and past president and board chair of the AMA. He's also a family physician in Mountain Grove, Missouri. Dr. Barbe, it's great to see you. Welcome back. Last time we talked to you was in November, when you were newly inaugurated as the president of the World Medical Association. If you would just start by giving a quick refresher for the audience, what the WMA is and how it differs from the World Health Organization, which we hear a lot about in the news of late.

Dr. Barbe: The World Medical Association is the Association of National Medical Association, so the AMA and the British Medical, and the German Medical and the Kenyan Medical Association; 114 countries participate, representing over 10 million physicians worldwide. We are often confused with the WHO, which is the World Health Organization, which is the organization of governmental health services. So the WMA are the national organizations of professionals physicians.

Unger: When you took the helm of the WMA, it was probably one of the worst periods we've seen in the pandemic and perhaps in the WMA's history. Now more than five months into your term, what would you say has been your biggest challenge and were you prepared for that?

Dr. Barbe: So much like the AMA presidency, the WMA president often travels a lot. Two to four international trips per month in many of the months. Well, that has obviously been very different this year. I've had no international travel, and while we've had plenty of invitations and I've participated virtually in many meetings, as all of us know, it's not the same as being there. A 10- or 15- or 20-minute presentation is fine as far as it goes, but there's not the networking. There's not the robust discussion after the presentation. There's not the cocktails in the evening when sometimes you really get down to what is on people's minds. So not having that personal contact and the rest of a meeting has really been the biggest barrier, I think, to doing what our professional organizations can do for our members and for our countries.

Unger: Yeah, especially right now, which must be a very tough time, and very challenging to navigate a global pandemic virtually.

Dr. Barbe: Yep. I think our countries, our physicians, our patients need strong professional organizations now more than ever. And it is a challenge to get the word out, to communicate not only with our doctors, but with our patients. So it has really been a challenge.

Unger: Well, focusing on World Health Day for a minute, which is officially sponsored by the World Health Organization, but certainly has shared goals with the WMA. This year's theme is building a fairer, healthier world. What do you see as the WMA's role in helping achieve this ambitious goal?

Dr. Barbe: So it is multifactorial and I'll try to keep it brief and we can dive deeper in any of these. But the WMA, much like the AMA, is what I would call a convening organization. We bring together the national medical associations from around the world to craft policy, but then, as importantly, to message that back to our countries, back to our physicians, quite honestly, back to the governments that have a heavy hand in how health care is administered everywhere. All over the world, the issue of health inequity and health disparities has continued to grow. And I think a lot of that quite honestly, is due to the AMA and the high priority we have put on it, but that spills over into the WMA and into other countries.

As all of us recognize now, the COVID pandemic has further accentuated those disparities. Those individuals, those patients that had the most difficulty accessing health care or who had conditions that simply weren't getting treated for one reason or another often economic, sometimes socioeconomic, racial disparities. Those have been magnified and it has made our job more difficult but has also made it much more important.

Unger: Well, it's good to know that the work that AMA is doing and the focus on health equity is laddering up globally. That's impressive to hear that. I know we talk a lot about what you referenced, which is the health inequities that are being amplified by the pandemic. One of them is obviously around vaccine distribution. Can you talk about what you're seeing about that level of inequity on a global scale?

Dr. Barbe: So we knew in the beginning of this pandemic when it was clear that vaccine development was going to be accelerated and we would hopefully have vaccines within a year or 18 months, the very next question was how do we make sure everybody in the world has access to these vaccines? Not just developed countries, not just the affluent countries. And we have seen a mixed bag. The inequity has not been as bad as it could have been were it not for multilateral, multinational organizations like Gavi and COVAX, who have focused on becoming a clearing house for worldwide acquisition and distribution of vaccines they have distributed through COVAX alone 33 million doses to 70 underdeveloped countries that perhaps would not have had access to vaccine at all where it not for those partnerships on a global scale.

We have seen that many of the more fluent countries have had greater access to vaccines. We have been extremely fortunate here in the United States. We have one of the higher vaccination rates in the world. We have administered more doses of vaccine than any other country. But around the world, only 4% to 6 or 7% of all persons have received their full series. Here in the United States, we're about 16%, and there are a few other countries, two handfuls of countries, around the world that are above 10%.

Unger: I know a lot of people here in the states obviously focused on supply issues within our own country. Why is it so important, and I guess, everybody's problem in a global pandemic that these vaccines reach every country, including the poorest countries?

Dr. Barbe: So it was easy for us to talk about a world economy. We've talked for a decade or more that we've got a world economy because we are all interdependent. What happens in Europe affects us. What happens here affects China. What happens in China affects Africa. Well, now we know the same thing is true around health and very specifically around this global pandemic of coronavirus. People move. We move from country to country. We have inter-global commerce and that takes people around the world, and things that happen in one country are almost guaranteed to spread to other countries. Therefore, it behooves, let's say, us in the United States to make sure other countries of the world have adequate vaccines, so that as we have international commerce with those countries that we do that safely and that we reduce the worldwide spread of not only the original coronavirus, but of the new variants that we see developing in various areas around the world.

Unger: And that is a really important point because the longer that we countries remain unvaccinated, the more likely that we see variants popping up that, as you say, can affect the whole world. It's not limited by borders. Well, like here, as the supply increases, we're dealing with the issues around vaccine hesitancy. Can you talk about the challenges that we're seeing globally around this particular topic?

Dr. Barbe: I was very naive early on. I thought vaccine hesitancy really was something that we see in the United States among a subculture of individuals. My eyes were opened when we started talking about vaccinations and I hear my colleagues from around the world saying, "It's the same way here in England. It's the same way here in Germany. It's the same way here in Africa." We see that everywhere. Now, it is not evenly distributed. There are some countries that are much more accepting of vaccines when those are available. But the key I think to overcoming vaccine hesitancy internationally is two or three quick steps. Number one, we must acknowledge the concerns of those who are hesitant. To discount them or to simply say, "It's ignorance," is not effective and not useful. So we have to acknowledge. We have to dig into that.

And then we do have to present sympathetic, factual information, follow the science. That's been our mantra around many other activities. It is, for sure, our mantra around the COVID vaccination. And help those who have concerns or who have been misinformed become properly informed, but in a way that recognizes that hesitancy that they have.

Unger: Do you see a lot of questions around confidence around the safety and efficacy of approved vaccine candidates? I think you're seeing some concern across many European countries of AstraZeneca, for instance.

Dr. Barbe: So we do, but what I tell people, and I think it is a way we should approach this, and that is we have given 500 million doses of vaccine worldwide, almost a third of those in the United States, over 150 million vaccines here. We know more now than we knew six months ago about the immediate safety. We know that very serious reactions are literally just a few in a million. And we can say that with confidence. That's a fact. Those that are hesitant now want me to go beyond that. They want me to tell them that, well, nothing's going to happen 10 years from now. We can't do that, but we can't do that around most other things that we accept very willingly. So we have to I think be intellectually honest with ourselves about what can be known right now. We know the very serious risk of COVID disease. It has killed millions around the world. We know the immediate safety of the vaccines that are out there now and approved. We need to trust that and have confidence that this is the right direction for us to go worldwide in this pandemic.

Unger: And that could not be happening too soon, because I think you're obviously seeing the extremely high caseload in deaths in countries around the world. In the U.S. numbers are not heading in the right direction either, but we're seeing news reports out of Europe, France, also words out of Brazil, what are you seeing in terms of getting control of the pandemic in some of these hotspot areas?

Dr. Barbe: Part of the difficulty, and it goes back to what you mentioned earlier, this is global, and different countries have flare ups at different times. Just when you think you're getting it under control in one country, another country pops up as a hotspot. Well, people from that country end up two countries over and then that country becomes a hotspot. So it really does take all of us communicating and cooperating. Settling down the flare ups is probably one of the more important things. When there's a flare, how does that country respond? And in some of the countries where the rates are highest or where they have the flare ups the quickest, it is where often they may not have infrastructure to deal with it. There may be some denials about whether or not there is a flare up. And then you're too late into the curve and it takes longer to stop it.

And we see that even in developed countries, some of the lower vaccine rates for instance, are in a few of the European countries and in Brazil who were simply behind the curve. They denied the severity of the pandemic in their countries and therefore they ended up playing catch up. So we mustn't play catch up. We know now how this virus acts. We know what will slow it down and stop it. We must do those things consistently, every country.

Unger: You have a global view of how things have been going. Are there any common threads that we see in countries that you would consider have navigated this relatively well versus other countries?

Dr. Barbe: So it is like many other things, in countries where there is a good infrastructure, where the health care system is on board, where physicians are strong advocates with their patients and with their colleagues, and where vaccinations are adequately available, those countries are doing better now. Those are the ones that are leading in vaccination rates. Those are the ones who, when they have a little flare up, it goes down more quickly. So it is a partnership within countries as well as a partnership between countries to turn the tide and keep it going in the proper direction.

Unger: Well, speaking of partnerships, I know for organizations like the World Medical Association that partnerships and collaborations are really key to getting these kinds of large scale changes in place. Are you seeing that level of collaboration that you would hope for and do you want to see more? What do you think?

Dr. Barbe: So the answer is there is quite a bit of international cooperation and collaboration. I've been in on many international calls and conferences on those topics. There is a good tight vaccine alliance that we've alluded to already that includes Gavi and COVAX and the World Health Organization and others. But it's not a one and done. We must continue to learn from one another. We must continue to share our experiences. We must continue to look at vaccination rates and even PPE in some countries. And then later, availability and hospital availability, particularly in some of the more underdeveloped countries, again, where some of the disparities we referenced earlier are the greatest. They continue to need collaboration with those countries who can assist at any given point in time. And the only way for that to happen is to be in near constant communication.

Unger: Well, in terms of cooperation and collaboration, hopefully someday we'll be past this particular pandemic, but the question remains, what changes do we need to make to be prepared for future health crises of this magnitude down the road?

Dr. Barbe: This hasn't been the first and it for sure will not be the last. And if we don't learn from this current pandemic, we will be condemned to make those same mistakes in the future. Adequate physical facilities, adequate training, early recognition of trends in disease, or infectious disease in particular. We need to continue to learn from the technology of vaccine development, what works, what doesn't work, what will be adaptable to the next infectious pandemic. Many of those things we simply got caught flat-footed. We got caught a little flat-footed here in the United States and they very certainly did around the world. So early recognition is important, but preparedness in advance in facilities, manpower, training and equipment is critical.

Unger: What role do you see for the World Medical Association and for associations like the AMA in that effort?

Dr. Barbe: So, as with many other things, that type of preparedness is unevenly distributed. In the United States, we have some states that are very well prepared and have thought ahead and decided, how are they going to stockpile PPE, for instance? Or how are they going to have a reserve ventilators for when any crisis develops? Same thing is true around the world. We have well-prepared countries and poorly prepared countries. Collaborating and working together to say, "Okay, this state is lagging behind a little bit. Why? What does that take? Is this an administrative weakness? Is it an economic problem? Is there some leadership issue?" And working together and being willing to be a little bit vulnerable with one another and admit when we're just not quite up to par and prepared I think is the way we have to do it. And because we are so interdependent, it should force us to have that transparency and that collaboration. Because one state goes down, all of us go down. One country goes down, all of us go down.

Unger: That makes so much sense. A lot of lives in the balance of that cooperation. Thank you so much, Dr. Barbe, for joining us on World Health Day and sharing your perspectives for all the work that you're doing leading the World Medical Association. That's it for today's COVID-19 Update. We'll be back with another segment shortly. For more resources on COVID-19, visit ama-assn.org/COVID-19. Thanks for joining us. Please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.