Global Health is a critical piece in a policy forum addressing the problem of global prosperity. The current unprecedented health crisis warns us about the multiple dimensions of global inequalities. As it has been said by the Global Commission for Post Pandemic-Policy, "This global pandemic has become the Great Revealer – that postwar institutions need revitalization, that democratic norms cannot be taken for granted and above all that we are all in this together".
We have already curbed two COVID-19 waves only to learn “plateaus” aren’t as permanent as we would desire them to be. Until now, each peak has been worse than the previous-one. Of course, this time is different because we have vaccinations, and we could reasonably expect that our herd immunity will finish the virus off.
Epidemiologists warn us, however, that for a number of reasons, it’s not that simple. There are complex relationships between virus contagiousness, immune evasion capacity, vaccine efficacy, and vaccination speed, that requires many pieces to be put together and coordinated.
In this very moment a new coronavirus wave is forming in poorly vaccinated areas and disadvantaged groups of the United Kindom, Portugal, Russia, and the southern states of the US, with more young people ending up in hospitals. Not to mention the persistent outbreaks in Latin America. Even Israel, the most vaccinated country on earth, faces a surge in cases driven by the Delta variant, and as many as half of new cases occur among people who'd been vaccinated.
COVID and the Tragedy of the Commons
It is out of discussion that we require a global effort to exit this complex pandemic. And that global effort needs efficient and comprehensive local health-systems. Otherwise, many countries and areas will plunge into isolation and the disease-poverty traps that we thought were close to being overcome just two years ago.
We may be suffering from a kind of “tragedy of the commons” at a global level. In fact, a tie was found between individualism (vs. collectivism) to epidemic prevention measures at the personal level, and a relation between countries' individualism (vs. collectivism) and the mortality rate they suffered at the societal level. This tragedy of the commons is modelling the new international scenario as well. May be that in some countries, "two covid nations" or, sadly, globally, "two COVID worlds" would emerge if we failed. In this newly divided world, countries will differ not only in the incidence of COVID, but also in preventable and treatable cancer and cardiovascular mortality, as well as the increasing incidence of tuberculosis, HIV, measles, and other infectious diseases that are a direct consequence of impoverishment and the failure of health systems.
At the root of a potentially tragic divergence are three key factors that stand out from a governance perspective: state capacity, social trust, and political leadership. In terms of global health, three fundamental weaknesses emerge from this triad: lack of global health leadership, an enormous gap in epidemic surveillance, and a paralysis of governments to obtain cheaper medicines.
Global health leadership
The failure of many health systems to respond to the pandemic was the end of a long process of deterioration in its core primary functions. To take the example of the United Kingdom, probably the flagship of healthcare systems in the world, I refer to the findings of the Marmot Review. Ten years before the COVID pandemic, life expectancy in the UK had stagnated; something that has not been observed since at least 1900. And we know that the more disadvantaged the area, the lower its life expectancy, pending that it has become more pronounced in that country. COVID mortality followed the same pattern.
Similarly, a marked increase in the all-cause mortality of middle-aged white non-Hispanic men and women in the United States between 1999 and 2013 called the attention of the Nobel Laureate Angus Deaton. This shift that reversed decades of progress in mortality also occurred before COVID-19.
As expected, in Argentina, slum dwellers, despite being younger, had mortality rates two to three times higher after correction for age, sex, and comorbidities, in regression models.
As in other areas, the pandemic accelerated previous social and political trends, among which health disparities within and between countries were not the least. We are obliged to admit that health equity had stopped improving in many G20 countries before SARS-Cov-2 appeared.
Of all the changes ahead in order to strength health systems, the single most important is to promote global health leadership. A clear vision of the improvement of the health of the population based on science and global collaboration, and beyond what can be expected from the commitment of governments. If health is going to wait for politics to advance its own values in society, then let's get ready for a long wait. We need global health leadership to promote global health values to transform societies (and to influence political agenda). So our proposal is to create a G20-consistent program to foster international global health leadership.
Regarding surveillance for more effective control of outbreaks, this pandemic also showed us the future of global health. At the same time that Dr. Li Wenliang warned of the outbreak, an Artificial Intelligence algorithm operated by a Canadian-based company sounded the alarm to its clients. Ideally, managing a pandemic will require rapid feedback cycles of data-driven learning to respond effectively at each step. It implies a complex global organization to do the job. There are plenty of reasons to be afraid it will not be easy to decide who is going to be in charge, even when the results would be as decisive as it would be expected.
Nearly three decades after the first publication of the Global Burden of Disease Study, we still lack world-level quality mortality data in half the countries; there are no less than six million deaths from covid that went undetected; many of them among the richest countries.
Our proposal is that G20 countries demonstrate regional leadership and empower regional organizations to play a more active and proactive role in designing and rolling out a coordinated action to foster health care systems vis-à-vis epidemics and pandemics; the new ones and the old ones (HIV, Obesity, Lung Cancer, etc.).
Drug (and vaccine) prices
Finally, the issue of equitable access to diagnostics, therapeutics, and vaccines to confront Covid-19. It is an old issue in the developing as well as the rich world: access to medicines and medical technology.
Companies say that price is needed to attract investment to sustain research, governments pledge that price is the main cause of inequality of access, and healthcare givers prescribe. Someone must say loud and clear that without lower prices there is no possibility of expanding access to medicines.
It is a clear example of a failed global market; and it's not the only one. So are access to drinking water or the control of carbon emissions. So don’t panic. Let´s solve the issue and many people will finally survive its eighties. Malaria, Tuberculosis, Viral Hepatitis, HIV, and of course COVID, wait for that change. The disparities of COVID vaccination has proved the enormous failure in the world system. It is clear that existing governmental and market mechanisms fail to protect society against present and future public health threats, and undermines access to medicines.
Drug pricing and the policies that shape it have a significant impact on the billions of people who rely on medications in the entire world, now and in the foreseeable future. Our proposal is a global initiative for drug pricing regulation. It could inversely tax imports and exports, modify current intellectual property regime, and promote scientific networking to produce cheap medicines for all.
Believe it or not, It will encourage instead of discourage innovation; it will make venture capitals run into medical goods manufacturing, and we will have the entire scientific community on our side. This challenge is as important as global commitment to clime change.
At the beginning of the Divina Commedia, Dante states that in the middle of his age he got lost, and had lost the right way. This pandemic is the Great Revealer that we are lost, and we need to regain a sense of justice to rediscover the path towards a healthier world. Global health leadership, a sophisticated global pandemic surveillance, and a clear initiative towards making medicines accessible, could help us to resume the right way without the countless adversities that Dante had to overcome.
Global Policy Forum:People, Planet & Prosperity, 22-23 June 2021. https://events.ispionline.it/en/global-policy-forum/
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