Skolnik: COVID-19 – The Quintessential Global Health Issue

Los Alamos

(This article is adapted from a talk given to the Global Health Interest Group of the Research Institute of Children’s National Hospital)

COVID-19 is the quintessential global health issue. We can see this clearly when we look at COVID-19 through a set of global health lenses: the globalization of disease; ethics; the economic and social impacts of health issues; the relationship between human well-being and global security and freedom; and, the need for cooperation.

When it comes to the interdependent boundaryless world in which we live, I like to say that “the health of anyone, anywhere, is the health of everyone, everywhere.” COVID highlights this in exceptional ways. The disease appears to have begun in China. It then spread to other countries.

It spread to the US, apparently from China and other countries, such as Italy. Today, the virus is nearly universal. In addition, viruses mutate. A number of prominent mutations of this virus have already occurred and begun to spread widely, including those first discovered in the UK, South Africa, and Brazil.

This virus has also highlighted a number of ethical issues, in a manner unseen perhaps since the early days of HIV. First have been the ethics of travel bans. Next is the ethics of lockdowns.

Then, there are issues related to mandatory mask wearing. After that, there are a range of ethical issues that relate to prioritization for vaccination both within and across countries. On the clinical side, there is a range of ethical questions related to crisis standards of care. COVID-19 has also highlighted issues of health equity, as minority groups die at much higher rates than majority groups but usually have less access to health services and vaccination than the better-off groups.

I don’t know if this virus will stop countries from moving from complacency to panic in the face of every emerging disease. However, the economic costs of this disease have been beyond measure at every level and if this does not wake people and countries up, I am not sure what will.

Let’s make it simple – the economic crisis that confronts many countries and the globe right now originates in a public health crisis. People have not stopped flying because planes are crashing.

They have not stopped traveling because there is no place nice to go. They have not stopped dining in restaurants because the food is bad. They are not working at home because this has been everyone’s preferred way to work. They have changed their behaviors because of a virus and controlling the virus is critical to resuming normal economic activity. The costs of the virus have been unbearable for many families. Five hundred thousand people have died. Families have lost their loved ones, their jobs, and their incomes. Many countries have seen their national economic product shrink more than at any time since the great depression.

COVID has also raised an array of questions about “security and freedom.” Children have suffered greatly from the lack of in-person schooling and for many, the lack of schooling, at all.

What does this mean for their future? People have neglected needed health care. What will this mean for their future and the costs of future care? In addition, the virus has become as much a political, as a scientific, matter. Mask wearing is a political issue in many places. Social distancing is also seen in some places as an infringement on civil rights. Important segments of different populations do not wish to be immunized, often because they refuse to recognize the importance and virulence of the disease. Moreover, COVID has often brought out the ugliness of unilateralism and vaccine nationalism, rather than multilateralism and cooperation.

Lastly, COVID has highlighted the need to work globally on a number of health issues and the dangers and costs of failing to do so. There has been a worldwide free-for-all on the purchase of PPEs. The US briefly left WHO, accusing it of being a pawn of the Chinese. Vaccine nationalism, as I mentioned, is rife and counterproductive if you believe that we are all at risk, as long as the virus is circulating in other countries.

So, What Then DOES COVID say about Global Health?

A number of lessons emerge from our experience with COVID-19 to date and can help us point the way forward.

We and the world need to prepare now for the next pandemic. Such preparation must be equitable and global in scope. It must include, for example, advance market commitments on PPEs, diagnostics, therapeutics, and vaccines. It must also include arrangements in advance for the access of low- and middle-income countries to diagnostics, therapeutics, and vaccines at the same time as they are made available to high-income countries. Arrangements like COVAX need to be put in place now for the next pandemic. These must include agreements on patents, licensing, and tiered pricing that will ensure timely and universal access to all countries.

Many countries need to urgently strengthen their own public health capacity. The US needs to do this at every level. Local public health authorities have lost tens of thousands of staff over the last decade and CDC has to rebuild itself from the rubble.

COVID-19 has led to an increase in non-COVID mortality in many countries, as people delayed or failed to seek care for acute and chronic conditions. Almost all countries need to prepare their health systems for more continued, effective and efficient operation during a pandemic or other disruption.

We need a strong and well-financed WHO, staffed to lead the world’s work on pandemic preparedness and response, and whose financing is not tied up in donor-financed trust funds.

There also has to be a universal mechanism for dealing with non-compliance with the International Health Regulations.

We also need to own up and act now on other important threats, such as anti-microbial resistance–which may have been made worse by this virus.

Editor’s note: Richard Skolnik is the former regional director for health for South Asia at the World Bank. He was the director of an AIDS treatment program for Harvard and taught Global Health at the George Washington University and Yale. He is the author of Global Health 101 and the instructor for Yale/Coursera’s Essentials of Global Health.