Unprecedented challenges breed unprecedented opportunities: to create a more robust world, to strengthen primary healthcare systems and to make lifesaving innovations available to all
Earlier this year, the world was preparing for a hard conversation: evaluating progress towards the Sustainable Development Goals. With just a decade remaining, our progress has not lived up to our promises. Profound change is needed if we are to make health equity and universal health coverage a reality.
If I were writing in a typical year, I would encourage leaders to reinforce their commitments to the SDGs. I would call for thoughtful innovation to help overcome barriers to equitable health. I would pursue deeper partnerships between governments, multilateral organisations, non-governmental organisations and the private sector. I would beseech every individual and organisation working in public health to contribute to the Decade of Action so that together we can move humanity forward.
But this has not been a typical year.
COVID-19 has transformed the world we live in today, changing lives in every country and every community across the globe. We have made enormous strides in addressing COVID-19, but we must also acknowledge the opportunity costs of this rapid, global response. And the fact remains: we are not on track to achieve the SDGs.
More children have died this year from preventable diseases than from COVID-19. Diseases such as malaria, tuberculosis and HIV still pose real threats – and COVID-19 has caused massive disruption to health services that protect communities. One in six countries reports that routine immunisation programmes have been severely affected. Treatment and diagnosis for children with illnesses such as malaria, pneumonia and diarrhoeal diseases have been upended by COVID-19. In countries such as Kenya and Nepal, the number of facility-based births has been cut nearly in half. We are at risk of losing decades of progress.
We cannot ignore COVID-19, nor can we deprioritise it. Rather, we must pair our COVID-19 response with the continual strengthening of health systems so that diseases of poverty and inequity are not forgotten.
The Decade of Action has only just begun
We are facing a reality where we must accelerate progress towards the SDGs in a time of pandemic. And we must do so in a way that does not reinforce historical – or modern – injustices. If we do this right, we have an opportunity not only to meet the SDGs, but also to create a foundation of health equity that gives everyone a fair chance at health.
This may feel like an impossible task, but there is reason for hope. The COVID-19 pandemic has captured the world’s attention and re-emphasised the importance of public health. If we can harness the momentum of this moment and learn from our past, we can make progress.
The words I would have written in January still hold true. Political commitments, partnerships and innovation will be critical to this progress. With COVID-19, there are other considerations we must make.
Stop the cycle of panic and neglect
Pandemics, and other public health emergencies, can unlock new resources and expand funding from existing donors. However, when global attention shifts, these resources often dwindle. Commitments are not kept for longer-term capacity building and recovery. The 2014 Ebola epidemic saw billions of dollars committed to the response, but long-term funding for health systems strengthening did not materialise. As part of the International Health Regulations and the joint external evaluations, many countries created national action plans for epidemic preparedness and response, but they may have not been adequately resourced. If we are to make the COVID-19 response sustainable – and contribute to more resilient health systems – governments, international donors, multilateral organisations and the private sector must make sizable, coordinated, long-term investments.
Hold on to our sense of urgency
COVID-19 has fundamentally changed innovation in global public health. We have seen incredible progress in the creation of new diagnostics, vaccines and treatments in the pandemic – demonstrating what is possible when we have a shared sense of urgency. For example, a landscape of vaccine capacity, conducted by the Coalition for Epidemic Preparedness Innovations and the Bill and Melinda Gates Foundation with support from PATH, will contribute to the rapid fabrication of COVID-19 vaccines. This work will also help identify possible bottlenecks and better plans for future vaccine development and distribution – if it can be kept timely and applied as a global public good.
However, many diseases and health system barriers do not inspire this same urgency, simply because they affect communities that have been historically marginalised. Without urgency, innovation lags. If we can deepen our collective urgency to tackle all health challenges and continue to innovate how we work, we can find new and better ways of delivering health care to everyone.
Systematically prioritise equity
When a COVID-19 vaccine is ready, we have a responsibility to ensure that communities everywhere have access. If demand forecasts are not right, if the supply chains are not in place, if health workers are not trained and if communities are not prepared to accept it, the vaccine may not reach the people who need it. This is true in every aspect of public health. New technologies and treatments will remain in the hands of the privileged unless we intentionally and systematically ensure access for all people, everywhere. Achieving universal health coverage is about strengthening health systems that can deliver for all individuals, preparing for the next pandemic and creating a world where the health of every person matters.
We live in unprecedented times and face unprecedented challenges. But we have an opportunity to make unprecedented progress: by creating a world where robust, resilient primary healthcare systems and lifesaving innovations are available to every single person. And I believe we can.