Biography
Gabriel Leung became the 40th dean of medicine at the University of Hong Kong (HKU) in 2013, a post he held until stepping down in 2021. He was previously professor and head of community medicine at the university and served as Hong Kong’s first undersecretary for food and health and fifth director of the chief executive’s office in government. He was director of the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control and inaugural chair of the Asia Pacific Observatory on Health Systems and Policies during 2010-14.
Leung is one of Asia’s leading public health academics, having authored more than 450 scholarly papers and edited numerous journals. He sits on the editorial advisory board of The BMJ and is a governor for Wellcome Trust, executive director at the Hong Kong Jockey Club, and was recently appointed to WHO’s strategic advisory group on emergencies (SAGE). He regularly advises national and international agencies including the World Bank, Asian Development Bank, and the Chinese Centre for Disease Control and Prevention.
What is the current covid-19 situation in Hong Kong?
This year we’ve had our so called fifth wave, which was the really big wave for Hong Kong in terms of velocity and numbers of infections. It was, unfortunately, one of those rare, intense spikes that a lot of other places did not see. And that’s really because of the insufficient vaccine coverage, particularly among older people, despite Hong Kong having had privileged, early, sustained, uninterrupted access to vaccines. That’s a lesson never to be relearnt by anybody else, hopefully.
What happened was fully predictable and fully avoidable. But we’re not yet at a stage where we are able to start looking back and say, “Never again. What happened? Should people be held accountable? And if so, how? And how do we make sure that we institutionalise mitigation measures against a repeat?” Those things will have to come.
We’re now not anywhere near zero covid but at a fairly steady equilibrium phase—you have waxing and waning of case numbers just above or just at a sort of unitary threshold. That tells you that the hybrid immunity wall built up since the fifth wave hit at the beginning of this year has held up fairly well. And like most of the world, I think that we’re now transitioning into an endemic phase where we are all going to have to learn to live with the virus. Convergent evolution of the virus in terms of fluid dynamics is, I wouldn’t say reassuring but at least not unsettling.
The major question is the eventual reopening of mainland China because it is one fifth of humanity. The other populations that drove a lot of the antigenic and phylogenetic evolution of the virus earlier on in the pandemic were Brazil, India, and Africa—the last of which has a similar sized population to China.
China is yet to go through an intense wave of infections, but eventually it will reopen. And when it does, is it going to throw a complete curve ball to the way the virus is developing? The read, from a virally evolutionary perspective, is that the rest of the world is well into a convergent evolutionary path—along the way to omicron variant dominance, with BA.5 and recombinant variants. That is something to watch very closely, over and above how China is going to manage to plan and mitigate its reopening without having to relearn some of the painful lessons of Hong Kong and elsewhere.
Is vaccine hesitancy among the older population still a big problem?
It is much better now: if you look at the older folks, third dose coverage is now 85%, much better than it was before. That’s why I think this hybrid immunity wall is holding up quite well so far. Why did the fifth wave have to happen? I think the authorities need to ask that question of themselves, of the system, and be accountable for it.
Australasian and east Asian countries seemed to learn more from the first SARS epidemic than the West. What have we learnt this time?
Not just SARS; I think it is the sociological imprinting of successive major outbreaks in Asian populations.12 I don’t think the covid-19 story is quite done yet, so I would hesitate to pass any kind of judgment on how different places and different ways of dealing with the pandemic might all end up.
But to try to generalise beyond just vaccine hesitancy, I think it’s the whole idea of social media and therefore social listening that we as health workers—global health workers—should be much better at. If we think that vaccine hesitancy has been largely driven by social media then surely we should do better at listening. As a clinician, if you can’t hear something too well, then … well, that’s why we invented the stethoscope. And now, if you know there’s too much of a guessing game with stethoscopes, that’s why we’ve got handheld ultrasounds. Psychiatrists and psychologists always say, listen to your patients. Family doctors do that all the time. So, why are we not listening more closely in the ether?
You’re a governor at Wellcome, one of the largest research funders in the world. When appointed, you said that you were looking forward to seeing what the future looked like after the acute phase of the pandemic had passed. What does it look like?
The takeaway lesson so far is that pandemic preparedness efforts are more important now than ever, and it has been demonstrably so.
Another is that discovery research and translational science—as we’ve seen Wellcome support through CEPI (the Coalition for Epidemic Preparedness Innovations, which funded many covid-19 vaccine efforts)—have again demonstrated their utility in spades. Millions of lives have been saved as a direct result of that investment in research support and translational support. Through leveraging investment from other funders as well as being leveraged ourselves, Wellcome has proved its worth in helping major projects get the resources they need. Sadly, it has taken a pandemic to show it so vividly.
I’m not optimistic about the quantity of investment in research or support in overseas development aid in global health generally—because of geopolitics, because of the energy crisis, because of national governments, national elections, and because of an increasingly fractured world.
But that to me shows exactly why we do what we do. It’s not because it’s easy but because it is vital. And I think funders like Wellcome have a unique role to play precisely because of those headwinds. We’re not going to be a second Treasury—we’re not going to be a substitute for what is being mulled over as cuts. But what we can do is provide an alternative vision to those prevailing headwinds and other possibilities that anchor people’s ambitions and aspirations.
What else are you concerned about in the health landscape?
Globalisation, to be frank. How do you do global health in an age of decoupling and globalisation? How do you do that? That to me is the greatest fundamental threat to advancing global health.
I don’t have a magic bullet. But I do know that globalisation is the fundamental driver of those headwinds I mentioned. We’ve just got to look at what each organisation can and should do, whether it’s academia, whether it’s pharma, whether it’s non-governmental organisations, whether it’s funders, or whether it’s government. How do we all pull together?
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