The COVID-19 pandemic has wreaked havoc on every aspect of society, be it our mental and physical wellbeing, our health sectors, our education systems, our economies or our social lives. It has exacerbated existing inequities, leaving the poor poorer and the sick sicker. The pandemic has also revealed our inability and unwillingness to work in solidarity to bring an end to this crisis. Instead, the world insisted on a “Me and my people first” approach, completely disregarding the fact that there is no “me” and “you” in a pandemic. Moreover, the world failed to follow scientific evidence and advice in its pandemic response: instead, political and economic incentives as well as nationalistic motives became the world’s north star.
A majority of these devastating impacts could have been prevented. Even early 2020, scientists emphasized the importance following the science, responding to the health threat collectively and adopting an equity approach to fight the pandemic. Yet, as we draw nearer to the 2021 G20 summit, it is clear that these recommendations were simply left on paper. We write this call to action based on recommendations put forth by the T20 to urge leaders at the G20 summit as well as leaders across the globe to turn into reality what was left on paper during COVID-19 in order to end this pandemic and prepare for and respond to the next health threat.
On regional and global partnerships
When dealing with pathogens that know no borders, concerted efforts are required at all levels: national, regional and global. The Africa Centres for Disease Control and Prevention stands as a prime example of an organization that rapidly mobilized the continent for a concerted preparedness approach early in February 2020. Regional organizations must facilitate data sharing to monitor the emergence and the spread of pathogens. These centres can also provide guidance and technical advice on matters relating to health ranging from the protocol for treatment to public health measures to respond to disease outbreaks. They can act as intermediaries, fine tuning health regulations and advice to the local context. Moreover, regional centres must organize the production and the procurement of diagnostics, therapeutics and vaccines during health crises and beyond.
On data sharing
Obstacles to data sharing continue to hinder or slow down the discovery of solutions to health threats. Siloed research can also result in the duplication of efforts and prevent the synthesis of information from different sources, wasting both time and resources. Thus, we need to actively challenge the systems that discourage data sharing. Funding agencies for public good should have data sharing as a requirement and connect grantees working on similar topics or questions. Peer-reviewed journals should innovate ways to provide researchers with free access to research publications in their fields, especially to those in LMICs. We need to build institutions such as the International COVID-19 Data Alliance (ICODA) that seeks to promote data sharing, provides a working bench and technical support for researchers and is committed to research capacity building, especially in LMICs.
On building self-sufficiency
As of the 24th of October 2021, 50% of the North American population and 55% of the European population have been fully vaccinated against COVID-19. However, this number is only 5.4% for the African population. After all the failed calls for global solidarity in vaccine distribution, we have learned that an over-reliance on the external world for domestic health needs will result in a significant unmet demand. For instance, Africa produces only 1% of the vaccines it consumes overall but accounts for the 25% of the global demand. This mismatch between Africa’s demand and its production capacity fuels the COVID-19 vaccine shortage on the continent.
High-income countries and private companies need to finance production capacity in LMICs through investments – investments in an industry expected to have large returns. Another area of support is in the development of the necessary curricula and training programs for the human resources needed to fulfil the entire production spectrum of diagnostics, therapeutics, and vaccines. It is also critical that intellectual property rights and know-how are transferred through licensing. This will ensure that pharmaceutical firms can continue to make profit while Africa produces the medical products that will save its people and prepare it for future health treats.
LMICs need to strengthen regional collaboration to streamline production and regulatory processes. The recent ratification of the African Medicines Agency (AMA) is a prime example of progress. As LMICs move from packaging and filling to research, manufacturing, and quality control, they need to increase national investment in research as it has historically been a critical driver of scientific discoveries. Moreover, LMICS need to establish and strengthen education and training programs for researchers and quality control specialists.
A critical step to addressing inequities is understanding them. Collecting national level data does not shed light on the disparities that exist between individuals or groups. We recommend establishing a Global Health Equity Observatory that combines data on health inequity within and between countries and the underlying drivers of this inequity, supplemented by complementary systems of global accountability. Moreover, we need to evaluate the impact of policies on different groups – be it across genders, ethnic groups or skin colours. For instance, a gendered approach to understanding the impact of lockdowns on physical wellbeing will reveal that gender-based violence has increased with movement restrictions.
Once we understand where these inequities stem from, targeted strategies need to be implemented to address the contributing vulnerabilities. We can take the example of COVID-19. In the developing world, lockdowns need to be accompanied with social safety nets for informal sector workers who lack savings and are thus disproportionally affected. The vulnerable need to be prioritized in vaccination plans – not just those such as the elderly and the immunocompromised who are clinically susceptible but also groups such as refugees whose individual circumstances predispose them to a greater exposure to the virus. This equity approach is beneficial not only to the vulnerable who directly benefit from such strategies but the globe at large. For instance, equitable vaccination across the globe could have prevented the emergence of variants in LMICs that have increased infection and deaths rates in HICs.
On lessons we teach the youth
The global response to the COVID-19 pandemic was largely a failure. It was characterized by national interest and a disregard for those who bore the greatest burden of both the direct and indirect impacts of the pandemic. It is also a crisis that has overturned all lives, including that of the youth, and has received much attention, bringing discussions about inequity and lack of solidarity to the forefront. However, it is not too late for our generation to show the youth examples of solidarity to instill values of equity and give them the opportunity to ensure that we take this approach in future crises. If we improve regional and global collaborations and base them on solidarity, honesty, and mutual benefit, the youth of today who will be leaders of tomorrow will leverage them to challenge the existing structures that create and exacerbate inequities.
From lessons to actions
The COVID-19 pandemic has taught many lessons that we had previously known. As such, the recommendations put forth in this paper are not novel. By emphasizing these key points, we write this urgent call for action for the leaders, the global health community, and beyond to enact the lessons that we have learned from this pandemic to ultimately prevent repeating the same mistakes during future health threats. As leaders gather for the G20 summit, discussions need to be centered around actions rather than empty declarations that have proven ineffective during this pandemic.
Agnes Binagwaho is Vice Chancellor of the University of Global Health Equity and Co-Chair of T20 TF1 on Global Health and Covid-19.