by JOANNA NURSE
Pandemics cause panic, fear, and chaos. We have seen this pattern unfold repeatedly across the world with waves of the COVID-19 pandemic, rippling through our populations. When humans are stressed, we tend to close doors and borders to protect ourselves, make impulsive decisions, to be suspicious of others and even to deny the situation.
In the past, when travel and human interactions were relatively slow, this instinct served to protect families and communities from new infectious diseases such as the plague. However, in today’s complex and globalised world, with large and mobile populations, these instincts do not serve us well, and we need to find alternative solutions in order to find a pathway out of this pandemic.
To be able to do so, we need to recognise the frailty and weaknesses of what it is to be human, and our intrinsic and biological links with the health of animals and our planet. We are all interconnected, and the health of all relies on valuing the health of each and every one of us, including the animals that we depend upon and live side by side with. Aside from the fearlessness needed for honest reflection, combined with objective evaluation to understand why the world is in such chaos, we need to also learn from the many successes and stories of compassionate action that every community and country brings, to help guide us going forward.
There is a clear need for a global strategy, as the panic caused by the pandemic has permeated political leadership and the ability of multilateral agencies to provide a clear pathway out of this chaos.
The COVID-19 pandemic has already had a devastating impact upon the global economy, with an estimated loss of US$10 trillion or 4.3% GDP for 2020-2021. Inequalities within communities, across and between countries are widening around the world, and are visibly evidenced by vaccine nationalism –with only 2% of low income countries vaccinated, and a significant drop in life expectancy in many parts of the world. This represents a significant threat to our wider global security – aside from the very real threat of death, the pandemic has impacted our basic needs, including income and food security, and has resulted in civil unrest, the loss of elections and risks the collapse of nation states.
Inequalities are also exaggerated by the global response to the pandemic, which has been overly dominated by political and nationalist agendas within high-income countries and coalitions such as the G7. The dominant narrative and pandemic response from many of these countries is driving the pandemic everywhere to an endemic scenario, which risks further pandemic waves with the emergence of new COVID-19 variants that our vaccines are not effective against.
With the Delta variant, vaccine coverage – or the level of herd immunity - is estimated to be in the range of 70-85% of the total population, and due to waning immunity after 5-6 months, booster doses are required. High-income countries may be able to ride these further pandemic waves if they keep ahead with new vaccines, however the reality of supply and roll out of vaccine programmes has proved to be challenging in countries with comprehensive health systems, yet alone those with minimal infrastructure.
The global focus has so far been on a single-issue solution, dominated by vaccines; when in reality the complex nature of the pandemic requires a strategic framework that allows a flexible multi-solution, multi-country coordinated response. Focusing primarily upon vaccines and achieving an endemic steady state, risks the emergence of new variants. This approach will inevitably result in high death rates and overwhelmed health services, especially in countries that are unable to protect their populations with vaccines. Aiming for a steady endemic state, threatens the health of everyone on our earth. None of us are safe, until we are all safe.
Moreover, the economic impact of not achieving global vaccination, as low- to middle-income economies continue to not have adequate access to COVID-19 vaccines, has been estimated to cost the global economy up to US$9.2 trillion and high-income xountries up to US$4.5 trillion. Furthermore, the impact upon international trade and travel is substantial even if one country has good vaccine coverage, it experiences a sluggish recovery if trading partners are not vaccinated – with an estimated loss of 3.9% GDP in high-income economies.
Ultimately, for us to be able to bring this pandemic to an end, will require heroic and collaborative leadership, driven by values and an ambitious vision to create a safe and secure world where all can flourish. The InterAction Council has been working with experts and partners to achieve such a courageous vision, and drawing upon our collective learning, has formulated a pathway to enable a coordinated response, Global Strategy and Recovery Plan. A summary is presented in the diagram below, and builds upon guiding principles to navigate uncertainties, including an emphasis on addressing risks, and valuing all people from all communities and countries as a basis for a global strategy.
The flexible framework builds upon successful pandemic responses from around the world, and presents a range of measures that enhance our ability to increasingly control the pandemic. The ambition is to achieve elimination, however it is recognised that even if this is not achieved, a very low prevalence state lowers risks and is much easier to control than by continuing to allow a pandemic or endemic steady state.
The health, security, and economic risks of our current national and global approach to the pandemic clearly underlines the need to enhance a strategic and coordinated global response. Additionally, we need to apply emerging lessons from independent reviews, that highlight the need to strengthen international governance mechanisms, combined with ensuring robust public health systems – from local to global. In particular, we need to identify solutions to prevent pandemics in the future, for example through the establishment of a global health threats council. Modernising the architecture of the UN Security Council to include a committee for global health threats could provide such a solution.
We may never fully understand the origins of this pandemic, however China has applied learning from its early experiences, and has largely succeeded with its ambitious elimination strategy. Going forward, China has the potential to play a significant role in bringing this pandemic to an end and in strengthening our future global health security. In particular, there are many successful lessons of the application of public health interventions that China is able to share and help bring to scale across the world, combined with innovation and investment. For example, as from the end of September 2021, China has exported 1.1 billion doses of vaccine to other countries, compared to Europe, which has provided 850 million doses, the USA 178 million doses and India 66 million doses.
Moreover, China can draw upon its deep cultural values of the interconnectedness of human and planetary health, and display courageous leadership humbled by its historic noble principles. Going forward, these attributes will be instrumental in guiding the establishment of a coordinated, collaborative, and accountable governance mechanism to prevent future health threats and as a basis for a secure and healthy world for all.