David Miliband on Donald Trump's response to Covid-19 and what democracies need to do

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The UN estimates that there are 70m refugees and displaced people worldwide. And your organisation, the IRC, has identified five crisis zones that are particularly at risk from Covid-19. What does that threat of coronavirus look like for people who are already living in dire circumstances, and this is a sort of crisis upon a crisis, if you like?

Well, the great danger, obviously, is that the virus is a death sentence for people who don't have access to the health facilities that can save their lives if they catch the disease. We are looking at places where population density is high, where underlying health infrastructure is very weak, where the health of the population is compromised by issues of malnutrition, and where poverty represents a second half of a double emergency. There is a health emergency because of the weakness of the health infrastructure. And there is a second aspect of the emergency in the collapse of economic life.

So in places like Iraq, northeast Nigeria, Central African Republic, even the refugees packed into the refugee camp in Bangladesh from Myanmar, or in Greece where there are 20,000 people packed into a refugee camp for only 1,500, the conditions for the disease to spread like wildfire are present. And the danger that if and when it does spread, there isn't proper access to healthcare to prevent the worst is very real. So we are sounding the alarm. By a quirk of the passage of the disease...

...we still have some time for prevention in sub-Saharan Africa, in South Asia, in parts of the Middle East outside Iran. But we've got to get on with it, and we've got to bolster the primary health infrastructure so that when the disease does come, it doesn't run rampage.

And you refer to some of the conditions there. I think you were referring to Cox's Bazar in Bangladesh. How do you fight this virus from inside a refugee camp? What is the IRC doing on the ground?

I think you have to fight it by starting simple. Prevention does mean establishing handwashing facilities at every conceivable service point. Secondly, it means strengthening the health infrastructure.

We're not going to be able to get thousands and thousands of ventilators into Cox's Bazar, but we can create the triage systems, and then the isolation space that is so important to stopping the disease running rampant. We can also make sure that health service staff in primary care get the proper equipment, because if the staff get the disease then there's no way we can even treat the mild symptoms of it.

And what about in developed countries? What about the role that immigrants are playing in the health service of many developed countries, including the US? I think the IRC's own figures show that 17 per cent of health system workers in the US are immigrants, and 29 per cent of doctors were born outside the country. What do you think of President Trump's decision to suspend immigration at a time when immigrants are providing a hugely important service and helping to fight this crisis?

Well, that's a great point. At best, President Trump's decision to try and fight the disease by limiting immigration is a waste of time because the disease is obviously already so present across the United States. At worst, the announcements are going to make the situation significantly worse because the immigrants and refugees who we support have got so much potential to contribute to American healthcare.

Just to take the US example, we know there are 160,000 refugees and immigrants in the US who have foreign medical qualifications, either as doctors or nurses, and are not working in the health system. We've responded to that by creating our own system. It's a website called refugees.rescue.org, which allows foreign-born or foreign-educated refugees and immigrants to register and try and go to work. 500 people in the first week of this website have already volunteered to join the fight in the United States against Covid. And in states like New Jersey, New York, California, the governors are trying to create the systems that allow for appropriate skills to be recognised, and for those refugees and immigrants to contribute to the work to limit the spread the impact of the disease.

And let's talk about funding for a minute. How significant do you think the decision was for the US to suspend funding to the World Health Organization during this pandemic, and does it send a dangerous message that governments can shirk their responsibilities to multilateral organisations during this crisis?

Surely people can understand that the pause in funding - and at the moment, it's only a 60-day pause in funding - threatens real damage. 27 per cent of the US funding for the World Health Organization goes to polio eradication. 17 per cent, I think, goes to nutrition and vaccines. So this decision, if it becomes a cut in funding in 60 days' time, threatens to be a death sentence for some of the most vulnerable people in the world.

My lesson from this crisis is that we need stronger international organisations, including the World Health Organization. We need stronger and better funded international health and other organisations. This disease of the connected world has not been created by the strength of international institutions. It's been exacerbated by the weakness of them.

And of course, organisations like the World Health Organization and other organisations at the international level make mistakes. But the rocket boosters have been put on this crisis by domestic decisions that have involved denialism and head-in-the-sandism of a very dangerous kind. And so I hope that the international reaction to US withdrawal or threatened withdrawal from the World Health Organization is to urge the US Congress and the US administration to see sense, and actually to recognise that the lesson of this crisis is that we need a stronger and better funded WHO. And if indeed the US does withdraw, then other nations need to fill the vacuum.

Now, if I've got the space, I'd like to just make one other point, which is, of course, geopolitically it's the worst possible signal for the democratic world led by the US, the liberal democratic world, to pull out of international institutions. Because it creates a vacuum that will be gratefully filled by those who come with a different political tradition. And of course, out of this crisis there's going to be a big argument about which countries did better in which countries did worse. But there'll also be an argument about which systems did better and which systems did worse.

And you can already see from some of the Chinese messaging that they want to argue that one-party states, notably their own, have dealt with this crisis better. We know, if you look at the facts, that there are democratic countries that have done well and democratic countries have done badly. There are autocratic countries that seem to have done well, and autocratic countries that seem to have done badly.

And one of the danger signals from the US withdrawal from organisations like the WHO is that it cedes the ground on this vital argument about which are the systems that are able to deal better. And it would be a crushing blow if the lesson of this crisis was that democracy was somehow a hindrance to public health, when no such thing shall be the truth.

On that point, I mean, are you worried about that happening?

I think there are a number of contests that come out of this crisis. One is about nationalism versus internationalism. One is about equality and the holes in the global safety net. A third contest is about privacy, and what government knows, and what Google knows, frankly, about you.

But a fourth contest that I've written about is about the contest over liberal democracy and its efficacy versus authoritarianism and its efficacy. We know that 2019 was the first year in 100 years when the global income that came from autocracies was greater than the global income that came from democracies. That's the first time in 100 years that that has happened.

And we know of the tendency that Fareed Zakaria first wrote about 20 years ago. Illiberal democracy. We've seen that in countries like Hungary, with the crisis being exploited to entrench one party, or even one person or rule. And I think it's very, very important that the facts are out. That we should recognise that democracies like South Korea and Germany have dealt with this crisis well. They've used the openness of liberal democracy to good effect to fight the disease.

And my hope is that the democracies of the world recognise the threat that exists, recognise the importance of the argument about which systems have done well, and then band together in a way that allows them not to exclude the autocracies. We need to recognise that a global connected world needs all nations within it - within organisations like the WTO. But I think the democracies of the world do need to recognise the threat that exists that out of this crisis there will be a determined push against the liberal democratic freedoms that heretofore have been taken for granted.

There seems to be a lack of global leadership in responding to this crisis. Do you, first of all agree, with that statement? And what does that mean, then, for solving the most protracted conflicts, like the Syrian war, that create refugees and displace people in the first place?

Well, I think there's undoubtedly been a crisis of global co-operation. I mean, the G7, the group of seven leading industrialised democratic countries, couldn't even agree a statement about the crisis. The G20 has been slumbering. The Saudi leadership of the G20, the rotating leadership, has had one virtual meeting, I think.

So one would have to say that there has been a striking lack of global co-ordination. Certainly the comparison to the financial crisis... I was in government, although not in an economic ministry. I was in the foreign ministry at the time of the 2008-09 financial crisis. And I saw the way my colleagues, including at the head of government, Gordon Brown, President Obama, came together to create the G20, and to recognise the international need for a response alongside domestic measures. There's been a striking vacuum at the international level.

Now, I do want to highlight, though, one potentially positive ray of light. The secretary-general of the UN made a very important statement four or five weeks ago about the need for a global ceasefire to take on the Covid crisis. And for all sorts of reasons, there is some momentum behind that call. In Colombia, in Yemen, even in Syria, there's been some coming together to try to exploit or use the Covid crisis and the fact that it doesn't discriminate in who it infects to try to ensure that there is some space for humanitarian agencies, like the International Rescue Committee, to work in Yemen, to work in parts of Syria.

Previously, we know that in the northwest of Syria, 85 hospitals were bombed. There is a ceasefire at the moment, albeit one that started just before the full depth of the Covid crisis came clear. And I would like to see much greater piling in behind that call for a global ceasefire, as well as a determined effort to recognise that the central lesson of this crisis, this crisis of the connected world, is that we're only as strong as the weakest link in the chain. And the weakest link is the growing number of fragile and conflict-affected states. States where the crisis of diplomacy has been very strongly felt in the last five or 10 years. And states where the weakness of international co-ordination threatens to run riot with the health and welfare of local populations under this double emergency.

And so I think the argument is on not just about how to ease the lockdown in those countries that have been hardest hit so far, but also to learn the right lessons from the crisis.

And in terms of helping people in those the weakest, the most vulnerable in society, and in those crisis zones you just described, do you think that government is relying on NGOs, like the IRC, to fill a gap, as it were? I mean, are they doing enough right now during this crisis?

Well, I certainly think it's the case that, for understandable reasons, governments have been focused on their own citizens. But there's a danger of that understandable domestic focus turning into myopia about the global nature of the disease. It's been very welcome to hear Chancellor Merkel and President Steinmeier of Germany, for example, recognising that Germany can only return to full normality when other countries do the same. And that's been an important message, but it's been an unusual message and an exceptional message. In most countries, there's a domestic focus to the exclusion of the international dimension.

Now, when it comes to the relationship between the multilateral agencies and the NGOs, I'm afraid that we don't yet have the kind of full partnership that's necessary. The UN appeal, for example, the $2bn appeal that was, in various ways, way too small, but leave that to one side for a moment. It reserved only $100m for the frontline staff of NGOs even though it's the NGOs who are the vast majority of frontline workers. So there's a new global humanitarian response plan due out on the 7th of May.

I'm very hopeful, or I'm very determined, to try and make the argument that that response plan needs to fashion a much more equal partnership between the intergovernmental system and the NGO system. Because the truth is that, in the end, the NGOs do have the manpower. We have the people on the ground. We have the staffing. But we don't have the resources. It's the intergovernmental system that has the power and the resources. And we need a much more balanced partnership between the entrepreneurialism and can-do and risk appetite of the NGOs, and the power and resource of the intergovernmental system.

And finally, do you think this crisis will make people see migrants and refugees differently? So take, for example, the UK. I'm sure you were acutely aware, in the years leading up to the Brexit vote, of some hostility that existed towards migrants, towards refugees. And of course, in the EU, the EU's been divided in recent years about how to handle the migrant crisis there. Is this a crisis that you think could change attitudes? And is this the type of crisis that you think unites people, or divides them?

Well, I'm an optimistic person, so I always hope that people learn the lessons of rationality and facts and reality around them. There is a dystopian version of the future in which xenophobia, nationalism - zero-sum nationalism - gain the upper hand. And devil take the hindmost, beggar my neighbour politics profits from the crisis. But there's also not a utopian alternative to dystopia, but I think a commonsense - a humane - outcome to the crisis.

You see that humanity in the cheering for health and care workers - sometimes a slightly guilty cheering that it hasn't been done enough before - that you see in Europe and the US 7 o'clock every night in New York. And I hope that that spirit really comes through. I've been very struck, for example, that in the UK the call for 250,000 people to volunteer for the National Health Service was met with 750,000 people volunteering.

It's not a draft. It's not a conscription that's going on. But there are the makings there of the social solidarity that, in the end, is vital for countries to make progress. The social trust that is vital to ease the lockdown. And so I think there is a version of the future that does learn the lessons, that does recognise that it's holes in the domestic and international safety net that have given the turbo charge to this crisis, and that need to be addressed.

And so, because I'm an optimistic person, there's too much dirge around, there's too many good reasons to be fearful. But I think that there is a version of the future where this is a reality check. It's a chilling and morbid, in some ways, reality check, but it's a real reality check. And we know that from history, out of crisis, you can have renewal.

And so I hope very much that that's the right message that comes out of this, but it's a contest. And the contest won't be won without argument and leadership.

David Miliband, thank you very much.

Thank you so much.