[세션1-2] 코로나19 대응과 국제협력_이종구_코로나팬데믹, 한국의 대응과 과제

Let me introduce the second speaker. The second speaker is Professor Lee Jongkoo of the College of Medicine at Seoul National University. Prof. Lee served the head of the body which became the Korea CDC, namely, the Department of Infectious Disease Prevention and Control at the National Institute of Health, during the SARS outbreak in 2002. Then in 2010, he served as the Director of KCDC during the pandemic influenza outbreak, so he was pretty much responsible for Korea’s infectious disease control in the recent past. He will be presenting on COVID-10 and the Korean government’s response, and the responses of the Ministry of Foreign Affairs and Corona 19, the government’s response, and the Ministry of Foreign Affairs, the Ministry of the Interior and Safety, the Ministry of Health and Welfare and local governments. Please take the stage. My presentation falls between Dr. Jee Youngmee’s field and the next speaker, the former head of KCDC Dr. Jung Kisuck’s field. That is, Dr.

Jee concerns with international disease control and Dr. Jung with domestic, and I wish to take this time to think about the position Korea has taken and should take in-between these two perspectives. Many people today talk about post-COVID-19 using the expression, “uncontact.” I see this as the process of building a new order. In the absence of vaccines and treatments, countermeasures so far have centered on unprecedented social distance or lockdown and shutdown.

01:37 - It may be because the virus spreads faster than we had predicted, that most countries came to face the worst case scenario where unwelcomed measures must be took. The editor of The Lancet, Richard Horton said that COVID-19 may not be the end, but the worst is yet to come. That is, there exists a possibility that epidemic disasters may happen again, perhaps because open human activity and global connectivity on the interface between humans and the nature and other animals, and this inter-connectivity works as a trigger for the rapid disease transmission. From the perspective of the sustainable development of people and humanity as a whole, it seems that the “one health” aspect should be emphasized, but in a sense, this disease seems to have become a paradox – we can only solve it by breaking this connectivity. I want to talk about the major strategies taken as countermeasures to COVID-19, and the best measure was to cut off this connectivity.

03:12 - Then, there must be principles for resolving this issue without breaking the connectivity but maintaining a connection without isolation. This is the topic of my presentation. Over the past 120 days, 4.7 million people have been infected with COVID-19 and 300,000 have deceased around the world. It first spread in the Asian region. We have a lot to learn from this disease, learning from what we did well and what we didn’t. I believe it is too rash to use the expression, “K-quarantine.” This isn’t not over yet. This is going to last for a few years, and I think it’s too early to know whether we will be the winner at the end.

04:07 - Because if we standardize global COVID-19 mortality rate, it’s hard to say that Korea did well. Because of Shincheonji, a deviation occurred in Korea, creating an illusion effect. In actuality, Korea’s mortality rate is much higher than that of Japan, and compared to other countries, the country hasn’t really excelled in any way. We’re just average, and it’s rash to promote our model too much. Ultimately, the countermeasure used for this disease is non- pharmaceutical intervention, for prevention and for containment.

04:50 - So we did everything we could to drop the R value below 1. Washing our hands well, adhering to a coughing etiquette, wearing a mask, notifying the hospital in advance before visiting, quickly identifying the patient through screening then putting them under quarantine and isolation, and screening the severe patient again to treat them. As the number of active cases grew rapidly, we created a live-in treatment facility to manage patients so as to prevent our medical system from paralysis. Overall, there are about 2,000 patients who were in critical condition. So, out of 10,000 patients, there were 2,000 seriously-ill patients.

05:41 - And this caused that much trouble for Korea. Why? Dr. Jung may talk about this, but it is because our system has no reserve. Because all the medical facilities are private facilities, we had no space to put critically ill patients, which created a huge problem. So, preventing this from happening would be a countermeasure against the second wave of this pandemic. In any case, the current countermeasures, such as quarantining anyone who came in close contact with a confirmed patient and social distancing, are still important.

06:23 - But we also need to think more about what we should do when the second wave occurs. Since this disease characteristically requires a lot of effort in quarantining and isolating patients from its early stages it requires high-level political mobilization to mobilize the departments and various areas of society. Also, public participation, that is, the involvement of local communities, was a very important factor in dealing with this disease. In any country, in all countries, we need the people to engage in social distancing to contain this disease, and I think we have achieved good outcomes thanks to the people’s active participation. The second wave is likely to come from abroad for Korea.

07:23 - Then, there may be a scenario where the spread occurs in the big cities, or we fail to contain it and it spreads nationwide. I believe we are considering various scenarios and are preparing for them. But ultimately, even in this latter scenario, without a vaccine or cure, the only effective measure we have available is to lower the R value to less than 1. In the post-COVID-19 situation, social distancing is becoming a usual thing, a new normal, so to speak. What should be the new normal? This is the question we are asking in preparation for the second wave.

08:17 - I’ll briefly talk about what we have been preparing and considering over the years concerning new infectious diseases. I believe the US NASEM first thought to report and prepare for the emergence of epidemic disasters, and submitted a report in 1992 to the White House, which was accepted and led to a lot of preparations. During this time, global epidemics of cholera and the plague came and went, and the collapse of the Soviet Union led to a lack of vaccination, leading to a new spread of diphtheria. These events occurred during the mid to late 90s. In addition to these problems, avian influenza and SARS emerged, requiring the WHO to find measures quickly.

09:14 - The then-Director-general of the WHO was Dr. Lee Jong-wook, who initiated a lot of changes. At this time, Korea also amended its law on infectious disease prevention, and created the KCDC after SARS. The US started a global health security intiative following the Bioterrorism Act, and this initiative became an agenda and conducted bilateral diplomacy-oriented projects. Multilateral diplomacy is the fundamental core of the WHO, but as the US put little faith in the WHO, the country focused on bilateral diplomacy for preventing the entrance of diseases.

10:05 - And for decades, the US has been putting in measures against new infectious diseases. Dr. Fauci published a new report since the last one 20 years ago, which mentions that the development of DNA techniques over the years has contributed to the early detection system or vaccine and treatment development for new infectious diseases, expressing a cautious optimism. But what we have seen recently is not optimistic. Dr. Jee talked about the IHR, but the ultimate measure we have for new infectious diseases is still quarantine and isolation, and this is a concept that was applied for setting up quarantine system in Venice and Croatia in 1372 when the plague occurred. Korea amended its Infectious Disease Prevention Act in 2005 to implement a management system for diseases other than the plague, cholera, and yellow fever, which followed the requirements of the WHO.

11:20 - The diseases which were controlled at the borderline started to be managed from the source and contained. Then we our public health response system to include not only a list of diseases but also various natural disasters, and put in measures for real-time response in 2005. Then why, despite the IHR, did so many countries found their own way and ignore the IHR this time around? This is because, ultimately, when a problem occurs, it becomes more important to protect one’s own country than to follow an international convention. Political reasons, really. A problem like this can end a regime, and such considerations are what led to today. And the IHR’s lack of sanctions is a large weakness. There is no penalty.

12:30 - This is something we all need to think more about. Now, we are thinking about how to relieve the current lockdown and shutdown situation. We need indicators that can confirm whether the quarantine is working well, and whether the new active cases are being well managed, and a few indicators have been newly created. Specifically, these are based on social distancing. For example, if online education, videoconferencing, telecommuting, etc.

, are becoming accepted as normal, 13:08 - and the social climate has formed which accepts such social distancing as normal, then let’s lift the shutdown. There are demands to lift the lockdown and shutdown situation, in my opinion, lifting the lockdown will make the epidemic again immediately. I mentioned the IHR earlier. Is closing the border a violation of international law or not? It is a violation. Nevertheless, no one adheres to the rules because there are not sanctions. This is one of the WHO’s weaknesses.

13:55 - The WHO recommended not to close borders because there is no scientific evidence that closing borders will stop the spread of the disease. The second reason is the existence of an alternative, and when we have an alternative, let’s refrain from closing borders. But, from my knowledge, only one or two international law scholars have pointed out this fact. Dr. Lawrence Gostin of Georgetown University published a piece on The Lancet, for instance. but no one else, apart from a few scholars, have criticized the international community for cowardly violating the IHR.

14:39 - In a way, the mechanisms of international governance, such as institutes, rules, or instruments like the IHR, have pretty much disappeared. What we are seeing is US condemning China, and China fighting the US, and everyone blaming the incompetence of the WHO, but I am really worried how this situation is going to be resolved. The WHO operates through the General Assembly, and the executive body listens to all members of the WHO, but this does not work well in an emergency situation. So, the World Health Emergencies Program was created. Dr. Margaret Chan launched this program after the inadequate response to the Ebola outbreak in 2014.

15:51 - In other words, the WHO was a consulting organization, not an organization with infrastructure. Since it was not an organization that can take on the role as an actor, it lacked the capacity to respond to crises. So, Bill Gates, at the time, put for the logic that we should prepare for outbreaks by putting a reserve force in NATO and 10 million people’s worth of stockpiles. The WHO did not have the capacity for on-site response. For example, the UN has its peacekeeping troops who go on-site to maintain order.

16:24 - But the WHO only suggested guidelines and had no practical measures. This is why the World Health Emergencies Program was created. The second director was Michael Ryan from Ireland, who studied epidemiology. He led the restructuring of the organization to simplify the organization last year into two branches. On the one side, Michael Ryan was instated because of Ebola, in charge of Africa, and Bruce Aylward was the key member who went to China as the WHO representative this time around and faced a lot of criticism.

17:05 - In fact, it seems like there’s a lot of people mobilized from Dr. Jee’s presentation, but he is the only person who works in this line. I was dispatched to this office for 9 months last year and he was working alone. The operational teams for Ebola, SARS… if you look into the WHO, all of these are just committees, that is, borrowed human resources. Because of this, the WHO has low responsiveness. This is the weakness that lends itself to bilateral diplomacy. This office is international health metrics, Ebola, and SARS, and the organization was originally comprised of five countries, but it was divided into two, and the work process, which divided the stages from prevention to one-site response, was simplified. COVID-19 will bring a new order, ignoring the WHO like right now, but, personally, I don’t think that the present world order, which has been in place for a century, will collapse because of this one thing. However, the WHO, for example, the joint mission – this is in fact the right to due diligence. An investigation. This was snuck into the IHR when it was made.

18:42 - This is actually a mechanism that is used the frameworks for countering biological weapons. So, despite this authority to investigate put into the IHR, the WHO is too weak to conduct responses based solely on this one authority. As I said before, its ability for on-site response is significantly low. As I observe this organization in my participating role, on January 19, China revised its law to control this virus as an infectious disease. That is, before January 19th, the disease was an unknown.

19:22 - People were affected by an unidentified epidemic and started to die because of it, and China was unsure how to handle this internally. As a public administrator myself, I understand what they went through. That reports were not being made properly. But all of this can become translated as a lack of transparency. The inadequate administrative system and untimely reports lead to problems, which opens up the possibility to become viewed as lacking transparency. I continue to believe in the WHO’s value of “health for all.” There’s a lot of talk about K-quarantine. Other countries are trying to learn from Korea. Actually, what Korea is doing now has become a global standard, so it doesn’t seem like there is a lot left for others to learn from us. Perhaps in this aspect, we should think a lot about what kind of international public health governance Korea should work towards and promote its values accordingly.

20:32 - Public health is a right that people all over the world should be aware of, and Korea should make efforts to serve serve the international community and strive for sustainable development based on this idea, rather than try to transfer the K-quarantine model, as we transferred the Saemaul Undong Movement. I think such a direction has become nonsensical now. and that kind of cooperation doesn’t work anymore. Serving the global community and existing for certain values, participating in a sort of governance and working and making financial contributions, these are the ways Korea should play its role. In this respect, it is important to engage in multilateral diplomacy with the WHO. And promote exchanges.

21:21 - We do this when necessary, but there are still many areas where both bilateral and multilateral efforts are needed. When the influenza outbreak occurred in 2007, the ministers of Korea, China, and Japan gathered together to discuss countermeasures. We have this model for international diplomatic cooperation for resolving certain issues, and there are areas where international bilateral cooperation is necessary, in education, technological transfer, research cooperation, and so forth which should be emphasized in bilateral diplomacy. In fact, I think these areas provide more possibility for Korea’s engagement. Korea’s Ministry of Foreign Affairs was criticized strongly for failing to contain SARS and COVID-19.

22:13 - Then suddenly, as countries started banning entry of Korean citizens, they were in a hurry to try and lift the ban. Then, our situation changed completely all of a sudden and we won the battle of time compared to other countries. So, it was possible to control, and Korea is receiving great attention from other countries once again. From this standpoint, I think it is time to strengthen international health diplomacy, both bilaterally and multilaterally. Let me summarize. COVID-19 started from individual cases, then spread to groups, regions, and worldwide.

23:02 - In this context, I suggest two perspectives for considering what we should do. The suppression strategy is valid for now. However, suppression has led to the sinking of economies, to a point where we need to worry whether to die of COVID-19 or starvation. There is talk about lifting this suppression, which will increase the likelihood of resurgence. Everyone is preparing for a long battle. Equity problems are rising to the surface.

23:33 - Deaths are occurring highly among vulnerable groups, and among the people of color. We need to find solutions for all of these problems, but where are we headed? We need to reduce the influx of active cases from abroad through international cooperation, share scientific knowledge and our experiences with the international community, and take steps to ensure that borders are not closed again for reasons of preventing COVID-19 import. Vaccines need to be developed, and public health diplomacy need to be strengthened, and we need to prevent shutdowns in advance, All of these are the diplomatic issues faced by Korea as well as the challenges of international cooperation. New diseases will continue to emerge, and it is impossible to predict such events. In the end, international cooperation and collaboration as a member of the international community is the strategy to deal with this disease. Thank you. .