The COVID-19 crisis has reminded us that our economies depend on our health, and our health depends on how we work together. With the future of billions determined by decisions the G20 leaders take now, we cannot afford the costs of inaction
When the COVID-19 crisis hit, many governments dithered, or made it worse through denial, hiding information and using punitive measures in desperate efforts to stop its spread. Later, even after scientists identified effective treatments, monopolistic approaches to intellectual property held down production and left millions of people out. It took far too long for leaders to understand that our ‘hard’ economy depends on our ‘soft’ health, that the most important competition is with the virus, not each other, and that health care is an investment, not an expense. A broken global system marked by a lack of knowledge sharing, adequate public health financing and global solidarity cost millions of lives. That is what happened with AIDS; we must not let it happen again with COVID-19.
With AIDS, it was not until this century began that drug production was massively increased and prices reduced, public investment and aid for treatment and prevention shot up, and life expectancies returned to former levels. This shift was prompted partly by the moral case, emphasised by dramatic images of unnecessary suffering and partly by political pressure – but it was also driven by recognition of the huge economic cost of allowing a pandemic to spread. The impact of AIDS on productivity contributed to Africa’s lost decade. AIDS showed too that borders are insecure barriers against pandemics, and devastation left unaddressed anywhere threatens devastation everywhere.
COVID-19 is rapidly exploiting inequalities and the frailties of systems that could have protected societies. It reminds us of the lessons from AIDS: the world has not invested or organised itself to enable a robust response to epidemics. Controlling the virus and recovering from COVID-19 will depend on international cooperation. Three urgent actions stand out.
Three urgent actions
First, G20 leaders must ensure that the COVID-19 vaccine reaches everyone, free of charge at point of use, as set out in the popular call for a People’s Vaccine. G20 members need to use their leverage to demand that what is made possible with public money is shared in ways that maximise the public good. This can be achieved by sharing all knowledge, technologies and intellectual property through the World Health Organization’s COVID-19 Technology Access Pool. Only mass simultaneous production using all possible manufacturing capacities across the world can ensure the levels of production needed; no monopoly producer can match that scale, however ‘generous’ its donations or deals of doses, while controlling the intellectual property and know-how. All G20 members need to support global initiatives to ensure equitable access to treatments and vaccines, such as COVAX and the WHO’s Equitable Access Framework. The economic damage across all industries from the pandemic will far exceed any gain to a tiny few from a vaccine monopoly. Vaccine nationalism is ultimately bad for every country.
Second, as the battle against COVID-19 will be won or lost on the front lines of health services, G20 leaders must lead by example by strengthening free public health care, available to everyone as a right. Now is the time to remove all financial barriers and step up public investment to ensure universal health coverage that includes publicly funded community delivered services. Strong economies are not undermined by strong public services; they are underpinned by them. A higher contribution from the wealthiest individuals and businesses through taxation is a reasonable and affordable way to protect everybody from health crises, and to protect businesses from the economic havoc that health crises wreak.
Third, G20 leaders must help give developing countries the fiscal space to invest in health, education and social protection, as former global leaders highlighted in their letter to the G20. There is an urgent need to deepen action on debt. The Jubilee Debt Campaign shows that the debt payments of developing countries are at their highest levels since 2001, with many spending more on debt than on health, education and social protection combined. G20 leaders must build on the Debt Service Suspension Initiative with a legally binding agreement that encompasses all low- and middle-income countries and all lender categories, including private and multilateral creditors as well as governments, and avoids any payments through the end of 2022. G20 leaders must also support the issuance of new special drawing rights by the International Monetary Fund to boost countries’ spending power, as was successfully done after the 2008 crisis. G20 members must confirm they will not cut international aid but will instead increase it, as none are safe until all are safe. The G20 must also act forcefully to close tax loopholes and havens to strengthen countries’ domestic revenue collection and sustainability.
Health is wealth. If our institutions are not reinforced immediately, we are destined to repeat our AIDS history, including preventable deaths, social and political instability, and huge lost economic opportunity. If leaders invest in resilient health systems now, we can beat COVID-19, finish the fight against AIDS, prevent and treat other illnesses, and prepare for future epidemics. We do eventually learn our lessons and do what is needed. The question is how fast. The costs of inaction on AIDS exceeded the costs of action. We cannot afford a repeat.
The COVID-19 crisis, awful as it is, is a once-in-a-lifetime opportunity to tackle the structural inequalities that make our societies and economies so vulnerable. The actions that G20 leaders take this year will determine the world’s recovery – the future of billions of people is being written now; so, too, are leaders’ legacies.