he COVID-19 pandemic has posed unprecedented threat to humankind. The acute crisis has already altered the landscape of public health, societal fabric, and economies worldwide. By mid-September, more than 30 million people have been infected by the virus and about 940,000 died of its complications. It is predicted that the pandemic will push 100 million more people to extreme poverty and economies of several nations are expected to contract as the pandemic is following a protracted trajectory.
The pandemic has put the global health partnership into a serious test. It has exposed the sharp and systemic divides between nations typically shaping the global health agendas. In fact, it is important to appreciate the European Union (EU) for playing a vital role in intensifying global cooperation to collectively respond to the pandemic. At this critical moment in the history of global health, it took charge of the short- and medium-term response and rallied the world to translate the early knowledge about the pandemic to effective diagnostics, vaccines, and therapeutics. Even more important, the EU has advocated for equitable access to and use of the products under development in all geographies across the world as soon they are available.
A clear notable absentee from the solidarity table was the United States, a country hitherto at the forefront of such global scale cooperation. More detrimental, the U.S. has decided to withdraw its World Health Organization (WHO) membership over China’s and the agency’s handling of the pandemic. The U.S. withdrawal may lead to twin challenges in global health: it could undermine the global response to the pandemic in the near- and medium-term and it could put the global health targets in jeopardy in the long-term. Without U.S. leadership and involvement, the anatomy of global cooperation may not have the same shape. In particular, its withdrawal from WHO membership could leave a big gap and it could severely dent the performance of this premier global health agency in a variety of areas.
Currently, health systems across the world are struggling to respond to the COVID-19 pandemic. The national responses so far have largely been labile, but it should be noted that vulnerabilities of the health systems are not homogenous everywhere. The protracted shock caused by the pandemic has far-reaching impacts on health systems of low-and middle-income countries (LMICs). The health systems of LMICs are struggling to protect essential health services and respond to multiple outbreaks like measles, yellow fever, malaria, and other outbreaks as well as other humanitarian situations while simultaneously grappling with the COVID-19 pandemic. The secondary impacts of the pandemic are also exacting a heavy toll on national economies and livelihoods as well as social structures. The scale of overall impacts will depend on the remaining trajectory of the pandemic, national government and community commitments, global cooperation, and the pace of new discoveries, particularly a vaccine.
While dealing with the headwinds of the pandemic, the global health community cannot simply relinquish its long-term commitments. It is not too soon to discuss the fate of the Sustainable Development Goals (SDGs). Specifically, SDG 3 was a landmark global consensus since it focuses not only on national-level achievements but “no one should be forced behind” has been the foundational commitment of the global health community. Since the COVID-19 pandemic hit at the end of last year, the SDG 3 has moved from ambitious and achievable to an elusive goal, and pushed to a distal part on the spectrum of the global health priority.
Compromised Pathway Towards SDG 3
A combination of demanding communities and high-quality disease prevention, health promotion, and treatment are required to improve societal health outcomes. The COVID-19 pandemic has amplified a latent mistrust in healthcare that communities already had in many nations. This has severely impacted the demand side of health care during the pandemic. Out-patients visits to health facilities have substantially declined due to the fear of hospital-acquired contagion with the virus. In particular, this has been a challenge in LMICs where the underlying infection prevention program is weak and communities are usually suspicious of their governments’ intentions even in health service settings.
The most important impediment is the heavy burden of the pandemic on the supply side of healthcare delivery. A high proportion of hospital beds have been occupied by COVID-19 patients, a chain of essential supplies has been disrupted, and health care workers are physically and mentally overwhelmed by the pandemic and its response. Poorly resourced countries do not have sufficient reserve to overcome those challenges. Also, the pandemic has worsened a background challenge with regard to infection prevention and lack of Personal Protective Equipment (PPEs), which has critically affected the continuity of essential services.
The WHO warned that more than 80 million children aged younger than 1 year could miss scheduled vaccinations because of the pandemic. The uptake of family planning services has dropped with the resultant skyrocketing unwanted pregnancies. For instance, teenage pregnancies in Kenya increased by 40% during the three months of lockdowns compared with prior monthly average. Antenatal and delivery services by skilled health personnel have plummeted.
Major disease control programs have been severely impacted as well. A modelling study for high-burden settings published in The Lancet Global Health concluded that deaths over a 5-year period from HIV, tuberculosis, and malaria could increase by 10%, 20%, and 36%, respectively. Similarly, an editorial published in the Bulletin of the World Health Organization highlighted that overprescribing antibiotics for mild COVID-19 cases, increased hospital admissions, interruptions of treatments for communicable disease as well as use of biocidal agents in non-health care settings could drive the emergence of antimicrobial resistance. Further, care and treatment for chronic illness including diabetes, cardiovascular diseases, and cancers has been compromised in many settings.
A Case for Charting a New Path in Global Health
Although the COVID-19 pandemic has severe effects on livelihoods, economic growth and others and these areas merit attention, I argue that improving health should be the priority. Improved health could catalyze the mitigation of secondary effects of the pandemic, including poverty. It is clearly evident that the pandemic has disrupted health care delivery and exposed the underlying inadequacies in health systems worldwide. This will certainly reverse the major gains the world has made in improving health and reducing mortality, particularly during the last three decades. It is imperative to sustain and intensify the response to the pandemic through implementing WHO standards in the local contexts and ultimately control the pandemic. It is also inevitable that the world will emerge from this crisis regardless of the number of lives lost and the livelihoods impacted, which highlights the criticality of focusing on the next health care delivery.
The global health community should re-establish resilient health systems that could absorb any potential shock mainly at national and sub-national levels in the new future. This may entail a leading edge thinking in global health and should go beyond national recovery efforts. A collective spirit of global solidarity is required to save the finest global health targets overwhelmingly agreed upon in 2015. It also deserves community commitment so that local communities lead the way in transforming their own health and well-being. It is time to comprehensively review the actual magnitude of reversal of recent gains or the scale of the hampered progress attributed to the COVID-19 pandemic and associated challenges across the spectrum of public health. A robust plan is required to compensate for the pandemic-related losses and re-configure health care delivery models to make them pandemic-proof. A global-scale coalition should chart its new journey, which not only effectively controls the current pandemic but puts mechanisms in place to prevent any potential emergencies and ultimately transform the health of global citizens. To this end, I recommend three actions.
First, we should accelerate testing, tracing, and isolation of COVID-19 cases by blending international best practices and a diverse set of locally-appropriate interventions. All prevention methods including hand sanitization, social distancing, and wearing masks should remain in place until the pandemic is no more a threat to human life. It is important to keep in mind that the virus is blind to national boundaries and we should aim to control the pandemic worldwide. This could be even more relevant when an effective vaccine becomes available as equitable and timely access is essential.
Second, the global health community should find time to conduct a realistic assessment of the status of SDG 3: good health and well-being. All the health targets should be reviewed at national and local levels to ensure that no one is forced behind. Based on the status of each target, it is important to craft a catch-up plan with embedded performance management and accountability framework. Although setting priorities could help, it is not acceptable to resign on any of the health targets. This clearly requires bolstering national health systems to match the next desired operation.
Lastly, cooperation at global and local levels is essential. The global health community should convert the learning from the pandemic apocalypse to a sustained preparedness. Nations across the world should be supported to establish resilient health systems grounded in primary health care. As witnessed in Ethiopia, Rwanda, and other countries, primary health care could serve as the Achilles’ heel of health care systems both during emergencies and normal times. Further, science and genuine partnership with local communities should inform the best response. The utter disregard to science by some governments has only been counterproductive to a successful pandemic response.
Several governments failed their citizens during this pandemic. Instead of focusing on saving lives, scores of governments used the pandemic as an oppressing tool to expand the boundaries of their powers by skipping elections. This has undermined democracy and contributed to deepened community mistrust in their governments, and caused unnecessary loss of lives.
The world should continue the fight to reverse and contain the COVID-19 pandemic. Concurrently, it should re-focus on its long-range health commitments. This could be done through enhancing partnership at each level and intensifying local commitments including bolstering health systems. Only unified, genuine forces could help us emerge from this crisis and transport us to a future of global health composed of cooperation and resilience.
a global affairs media network
Combine the COVID-19 Response with Long-Term Commitments
September 23, 2020
T
he COVID-19 pandemic has posed unprecedented threat to humankind. The acute crisis has already altered the landscape of public health, societal fabric, and economies worldwide. By mid-September, more than 30 million people have been infected by the virus and about 940,000 died of its complications. It is predicted that the pandemic will push 100 million more people to extreme poverty and economies of several nations are expected to contract as the pandemic is following a protracted trajectory.
The pandemic has put the global health partnership into a serious test. It has exposed the sharp and systemic divides between nations typically shaping the global health agendas. In fact, it is important to appreciate the European Union (EU) for playing a vital role in intensifying global cooperation to collectively respond to the pandemic. At this critical moment in the history of global health, it took charge of the short- and medium-term response and rallied the world to translate the early knowledge about the pandemic to effective diagnostics, vaccines, and therapeutics. Even more important, the EU has advocated for equitable access to and use of the products under development in all geographies across the world as soon they are available.
A clear notable absentee from the solidarity table was the United States, a country hitherto at the forefront of such global scale cooperation. More detrimental, the U.S. has decided to withdraw its World Health Organization (WHO) membership over China’s and the agency’s handling of the pandemic. The U.S. withdrawal may lead to twin challenges in global health: it could undermine the global response to the pandemic in the near- and medium-term and it could put the global health targets in jeopardy in the long-term. Without U.S. leadership and involvement, the anatomy of global cooperation may not have the same shape. In particular, its withdrawal from WHO membership could leave a big gap and it could severely dent the performance of this premier global health agency in a variety of areas.
Currently, health systems across the world are struggling to respond to the COVID-19 pandemic. The national responses so far have largely been labile, but it should be noted that vulnerabilities of the health systems are not homogenous everywhere. The protracted shock caused by the pandemic has far-reaching impacts on health systems of low-and middle-income countries (LMICs). The health systems of LMICs are struggling to protect essential health services and respond to multiple outbreaks like measles, yellow fever, malaria, and other outbreaks as well as other humanitarian situations while simultaneously grappling with the COVID-19 pandemic. The secondary impacts of the pandemic are also exacting a heavy toll on national economies and livelihoods as well as social structures. The scale of overall impacts will depend on the remaining trajectory of the pandemic, national government and community commitments, global cooperation, and the pace of new discoveries, particularly a vaccine.
While dealing with the headwinds of the pandemic, the global health community cannot simply relinquish its long-term commitments. It is not too soon to discuss the fate of the Sustainable Development Goals (SDGs). Specifically, SDG 3 was a landmark global consensus since it focuses not only on national-level achievements but “no one should be forced behind” has been the foundational commitment of the global health community. Since the COVID-19 pandemic hit at the end of last year, the SDG 3 has moved from ambitious and achievable to an elusive goal, and pushed to a distal part on the spectrum of the global health priority.
Compromised Pathway Towards SDG 3
A combination of demanding communities and high-quality disease prevention, health promotion, and treatment are required to improve societal health outcomes. The COVID-19 pandemic has amplified a latent mistrust in healthcare that communities already had in many nations. This has severely impacted the demand side of health care during the pandemic. Out-patients visits to health facilities have substantially declined due to the fear of hospital-acquired contagion with the virus. In particular, this has been a challenge in LMICs where the underlying infection prevention program is weak and communities are usually suspicious of their governments’ intentions even in health service settings.
The most important impediment is the heavy burden of the pandemic on the supply side of healthcare delivery. A high proportion of hospital beds have been occupied by COVID-19 patients, a chain of essential supplies has been disrupted, and health care workers are physically and mentally overwhelmed by the pandemic and its response. Poorly resourced countries do not have sufficient reserve to overcome those challenges. Also, the pandemic has worsened a background challenge with regard to infection prevention and lack of Personal Protective Equipment (PPEs), which has critically affected the continuity of essential services.
The WHO warned that more than 80 million children aged younger than 1 year could miss scheduled vaccinations because of the pandemic. The uptake of family planning services has dropped with the resultant skyrocketing unwanted pregnancies. For instance, teenage pregnancies in Kenya increased by 40% during the three months of lockdowns compared with prior monthly average. Antenatal and delivery services by skilled health personnel have plummeted.
Major disease control programs have been severely impacted as well. A modelling study for high-burden settings published in The Lancet Global Health concluded that deaths over a 5-year period from HIV, tuberculosis, and malaria could increase by 10%, 20%, and 36%, respectively. Similarly, an editorial published in the Bulletin of the World Health Organization highlighted that overprescribing antibiotics for mild COVID-19 cases, increased hospital admissions, interruptions of treatments for communicable disease as well as use of biocidal agents in non-health care settings could drive the emergence of antimicrobial resistance. Further, care and treatment for chronic illness including diabetes, cardiovascular diseases, and cancers has been compromised in many settings.
A Case for Charting a New Path in Global Health
Although the COVID-19 pandemic has severe effects on livelihoods, economic growth and others and these areas merit attention, I argue that improving health should be the priority. Improved health could catalyze the mitigation of secondary effects of the pandemic, including poverty. It is clearly evident that the pandemic has disrupted health care delivery and exposed the underlying inadequacies in health systems worldwide. This will certainly reverse the major gains the world has made in improving health and reducing mortality, particularly during the last three decades. It is imperative to sustain and intensify the response to the pandemic through implementing WHO standards in the local contexts and ultimately control the pandemic. It is also inevitable that the world will emerge from this crisis regardless of the number of lives lost and the livelihoods impacted, which highlights the criticality of focusing on the next health care delivery.
The global health community should re-establish resilient health systems that could absorb any potential shock mainly at national and sub-national levels in the new future. This may entail a leading edge thinking in global health and should go beyond national recovery efforts. A collective spirit of global solidarity is required to save the finest global health targets overwhelmingly agreed upon in 2015. It also deserves community commitment so that local communities lead the way in transforming their own health and well-being. It is time to comprehensively review the actual magnitude of reversal of recent gains or the scale of the hampered progress attributed to the COVID-19 pandemic and associated challenges across the spectrum of public health. A robust plan is required to compensate for the pandemic-related losses and re-configure health care delivery models to make them pandemic-proof. A global-scale coalition should chart its new journey, which not only effectively controls the current pandemic but puts mechanisms in place to prevent any potential emergencies and ultimately transform the health of global citizens. To this end, I recommend three actions.
First, we should accelerate testing, tracing, and isolation of COVID-19 cases by blending international best practices and a diverse set of locally-appropriate interventions. All prevention methods including hand sanitization, social distancing, and wearing masks should remain in place until the pandemic is no more a threat to human life. It is important to keep in mind that the virus is blind to national boundaries and we should aim to control the pandemic worldwide. This could be even more relevant when an effective vaccine becomes available as equitable and timely access is essential.
Second, the global health community should find time to conduct a realistic assessment of the status of SDG 3: good health and well-being. All the health targets should be reviewed at national and local levels to ensure that no one is forced behind. Based on the status of each target, it is important to craft a catch-up plan with embedded performance management and accountability framework. Although setting priorities could help, it is not acceptable to resign on any of the health targets. This clearly requires bolstering national health systems to match the next desired operation.
Lastly, cooperation at global and local levels is essential. The global health community should convert the learning from the pandemic apocalypse to a sustained preparedness. Nations across the world should be supported to establish resilient health systems grounded in primary health care. As witnessed in Ethiopia, Rwanda, and other countries, primary health care could serve as the Achilles’ heel of health care systems both during emergencies and normal times. Further, science and genuine partnership with local communities should inform the best response. The utter disregard to science by some governments has only been counterproductive to a successful pandemic response.
Several governments failed their citizens during this pandemic. Instead of focusing on saving lives, scores of governments used the pandemic as an oppressing tool to expand the boundaries of their powers by skipping elections. This has undermined democracy and contributed to deepened community mistrust in their governments, and caused unnecessary loss of lives.
The world should continue the fight to reverse and contain the COVID-19 pandemic. Concurrently, it should re-focus on its long-range health commitments. This could be done through enhancing partnership at each level and intensifying local commitments including bolstering health systems. Only unified, genuine forces could help us emerge from this crisis and transport us to a future of global health composed of cooperation and resilience.
