Skolnik: We Should Be Learning From COVID – But Will We?

By RICHARD SKOLNIK
Los Alamos

As I noted in a column in March, COVID-19 is the quintessential global health problem. One virus, and the disease that relates to it, manifest all of the major issues in global health. As such, COVID offers many lessons, some of which are noted below.

Cooperation in Global Health – COVID-19 highlights the extent to which the “health of anyone, anywhere is the health of everyone, everywhere.” It also raises substantial questions about the role of various actors in global health during a pandemic, including WHO, GAVI, and individual countries and their development assistance agencies.

The Health-Economy Link – COVID-19 has illustrated the strong links between health and the economy. We have seen more than at any time in modern history that a pandemic has upended the world economy. We have also seen that righting the global economy requires getting the pandemic under control.

Ethics and Global Health – The pandemic has raised a large number of ethical issues from the most macro to the most micro level. At the macro level, for example, we need to examine the fairness of global vaccine distribution and the ethics of travel bans. At the micro level, we have seen arguments over the ethics of government mandates for mask wearing, among other things. Developing and implementing crisis standards of care has also raised a range of challenging ethical issues.

Equity – The pandemic has also brought out a range of equity issues. Among the most important have been the disproportionate impact of the disease on minority groups and the inequitable distribution of the vaccine within and across countries.

Health Systems – The pandemic has reminded us of the importance of health systems and their weakness in many countries. Public health work in many countries was weak, poorly implemented or both. It was also stretched beyond its capacity in many countries by the large number of infections. The pandemic also raised enormous challenges for the financing, management, and staffing of health systems, and the quality of clinical care.

The Burden of Disease – COVID-19 has had a major impact on the burden of disease in almost all countries. It has led to many deaths, remarkable amounts of illness and a substantial amount of disability for many of those infected. Indirectly, it has led to substantial deaths and disability from other causes, which were not attended to appropriately during the outbreak. 

Emerging and Re-Emerging Infectious Diseases – The pandemic is “right out of the book” of emerging and re-emerging diseases. Its origins appear to be zoonotic. It spread rapidly around the world. Most countries were ill-prepared to deal with the pandemic. Other countries lacked the political will to address it effectively.

The Role of Vaccines and the Political Economy of Health– There has always been “vaccine hesitancy.” However, we are now witnessing high levels of anti-scientific, misinforming, and populist views about vaccines against this virus in a substantial number of countries. In addition, views about the disease and related vaccines have been politicized in many places.

Working in Global Health – The pandemic has become a political issue in many places, leading to attacks on science, on public health, and on public health workers. While public health workers might have been seen as “heroes” in the fight against earlier diseases, such as smallpox and polio, they now sometimes face harassment and villainization.

These and many other lessons from COVID are clear. We know what needs to be done to stop this pandemic and prevent the next one. The real question is whether or not the US, other countries, and the global collective will act urgently and appropriately to do so.

(This column is adapted, with the permission of Jones and Bartlett Learning, from “COVID-19 – The Quintessential Global Health Issue and Global Health Teaching Tool.”)

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.

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