UNIFI trainees
The unpreparedness in facing the COVID-19 pandemic should have served as a lesson: the great global powers must put aside their geopolitical rivalries by working together to prepare for any future pandemic events and to face other global crises, through strengthening the multilateralism in all its crucial dimensions (political, health, cultural, institutional and financial).
On 4 May 2023, the Director General of the World Health Organization (WHO), Dr. Tedros Adhanom Ghebreyesus, has officially declared the end of the health emergency from COVID-19, broke out just over three years ago. But the Sars-CoV-2 coronavirus – after having caused about 20 million deaths – continues to circulate in the world, and to produce deaths; therefore it remains an important public health problem to be managed with careful and constant monitoring.
Taking a cue from the Lancet Commission Report on the COVID-19 Pandemic (The Lancet Commission on lessons for the future from the COVID-19 pandemic) we have published two posts in the past weeks.
Il primo – COVID-19 and health systems – by examining the distribution of mortality in various areas of the world, highlighted the glaring paradox of this pandemic: the most catastrophic levels of mortality occurred in the richest and most developed areas of the planet, in Europe and the Americas (Figure 1), in health systems equipped with enormous resources and sophisticated technologies, first of all the United States of America. Systems that found themselves unprepared (as they could not and should not) to face a respiratory pandemic, also because they had previously dismantled the public health and primary care structures necessary to represent the first, indispensable barrier to the spread of the virus.
Figure 1. Cumulative deaths per million population, worldwide as of May 24, 2023. Source Our World in Data
The second one – An unequal pandemic – denounced the profound inequalities in health documented by multiple epidemiological studies: a pandemic that has hit the weakest sections of the population: elderly people with multiple pathologies, the poorest, women, ethnic minorities, children and adolescents
The catastrophic outcomes (not only health, but also economic and social) of the pandemic are also to be attributed to the failure of the multilateral system based on the United Nations and its agencies, above all the WHO. A multilateral system for years weakened by neoliberal policies hostile to the financing and protection of global public goods, excessive nationalism and tensions between the major powers. The failure of the global response to COVID-19 is similar to that of other pressing global challenges, such as the climate emergency, global biodiversity loss, air, soil and water pollution, the persistence of extreme poverty in half the world, and the large-scale displacement of people due to conflict, poverty and environmental stress.
The third part of the Lancet Commission Report is dedicated to the recommendations to prevent the repetition of a new epidemic catastrophe, which can be summarized in the following points:
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Monitoring the development of possible new variants. Vaccine accessible to all.
Strong monitoring and surveillance systems need to be established coordinated around the world to assess the risks of new waves of COVID-19. The patent system must be made flexible to ensure that all countries have access to anti-Covid vaccinesproceed with mass vaccinations and close the intolerable gap in vaccination coverage between richer countries and low- and medium-developed countries.
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Strengthening of WHO
Since 1980 the WHO budget has been frozen, reducing in value due to inflation, and at the same time extra-budgetary financing from governments and also from the private sector (eg: Bill Gates) has become increasingly preponderant. This method of financing has generated “vertical” programs, based on individual pathologies (eg: AIDS, Tbc, Malaria), generating priorities established “elsewhere” and weakening local health systems. All of this has reduced the strategic capabilities, technical quality and ultimately the authority of the WHO, as has been clearly seen in the course of the pandemic.
A substantial increase to WHO’s core budget is needed and provision for the ability to tap into large-scale emergency funding in the event of a global health emergency. The commission strongly supports the creation of an integrated and flexible Global Health Fund which should be funded with USD 60 billion annually (equivalent to 0-1% of GDP of upper-middle-income countries) with 3 main funding windows :
- 15 billion for the creation of the pandemic plan, i.e. the pandemic preparedness and response plan;
- 20 mld per le Medical Commodities (pandemic control tools), such as drugs, PPE, medical tools;
- 25 billion for the strengthening of primary health care in less developed countries.
It should also be strengthened governance dell’OMS to give him greater political power, with the establishment of a new body, the Global Health Boardwhich should be composed of heads of government representing each of the six WHO regions and elected by the Member States of those regions.
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Prevention of spillover (the transmission of viruses from animal to human habitat).
Primary prevention of pandemics is needed through the implementation of preventive measures both against natural fallouts and against fallouts deriving from activities related to research. Preventing natural fallout requires a One Health approach, an integrated and unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems — including strengthening veterinary services, regulating the pet trade and wild animals and breeding of wild animals and livestock, the prevention of deforestation and the strengthening of surveillance systems of pathogens in domestic animals and humans.
4. Strengthening health systems. National pandemic preparedness plans
Governments should strengthen national health systems on the basis of public health and universal health coverage, grounded in human rights and gender equality. Strong public health systems should include several aspects such as: strong relationships with local communities and community organizations; surveillance and reporting systems; robust medical supply chains; structural projects and operational strategies that promote health; investment in behavioral and social science research to develop and implement more effective interventions; promotion of prosocial behavior; strong health education for health promotion, disease prevention, and emergency preparedness; effective health communication strategies; active efforts to address public health misinformation on social media; summary of constantly updated evidence.
Health systems should include universal health coverage, focused on primary health care, ensuring patients have access to quality care for pandemic-related and non-pandemic-related health issues, including mental health. Community health workers should be well trained and the organizations to which they belong adequately supported.
In addition to strengthening health systems, each country should define and expand national pandemic preparedness plans to prevent and respond to newly emerging infectious diseases. Preparedness plans should include: improved surveillance and monitoring; the definition and protection of vulnerable groups; international notifications; cooperation within WHO regional groups; emergency financing; guidelines on behavioural, social and environmental interventions, travel protocols and school and workplace safety; robust supply chains of healthcare goods (e.g., personal protective equipment, diagnostics, therapeutics, and vaccines); effective risk communication and active opposition to disinformation and misinformation; the training of public health operators and the availability of adequate personnel.
In conclusion, the unpreparedness in facing the COVID-19 pandemic should have served as a lesson: the great global powers must put aside their geopolitical rivalries by working together to prepare for any future pandemic events and to face other global crises, through the strengthening of multilateralism in all its crucial dimensions (political, health, cultural, institutional and financial).
This post is the result of the collective work of a group of doctors in specialist training (from the first year of the specialization in Hygiene and Preventive Medicine at the University of Florence) on the Lancet Commission Report on lessons for the future from the COVID-19 pandemic
This work involved the analysis and re-elaboration of the Report, the presentation in the classroom with discussion and the production of 3 posts. The third and last post in the series, published today, was preceded by “COVID-19 and health systems” (May 2, 2023) and by An unequal pandemic (May 10, 2023)
The group is made up of: Simone Baldacci, Manjola Bega, Andrea Benincampi, Raffaele Caldararo, Ludovica Costantini, Erika Del Prete, Debora Fontana, Veronica Gironi, Elena Morelli, Giulia Napoli, Neda Parsa, Concetta Francesca Rosania, Gianluca Pollasto, Francesco Toccafondi, Marcello Settembrini, Lediana Spaho, Elvis Vassallo.