Thinking globally about Covid-19

As a dark year draws to a close, there is at least some solace that the future promises to be brighter with the roll-out of Covid-19 vaccination programmes. The development of these vaccines for a new disease in so short a time is an historic achievement. It shows the progress that is possible when there is sufficient will and, of course, funding to find a solution.

However, reports of the first vaccinations taking place in the UK would have been more galvanising were it not for the jingoistic triumphalism exhibited by its government about how it was the first jurisdiction to approve the Pfizer-BioNtech vaccine.

It is the latest example of what is termed ‘vaccine nationalism’, with Russia and China also going it alone with their own programmes. The UK’s decision to issue first approval has been criticised as a political ploy to justify Brexit (even though EU members could also issue approvals on an individual basis).

In a way, however, its plan is in keeping with the global response to Covid-19 in general. While the EU is responsible for vaccination approval among its members, since Covid-19 emerged, public health decisions have been taken on a national basis, even by those who wish to stay within the EU.

The World Health Organisation (WHO) has been criticised significantly since the beginning of the Covid-19 crisis – sometimes justifiably, sometimes unjustifiably. However, the limitations of the WHO have been exposed by the pandemic.

Unlike other international bodies, such as the World Trade Organisation, it does not have the power to fine individual members, or compel them to follow a particular path.

All it can do is offer advice, leaving national governments to decide upon the best course of action themselves. So while at a research level international collaboration has been strong, the political response to Covid-19 has been fractured and varied from country to country.

Lockdowns have been a common strategy, but these have been employed to different degrees at different periods in different countries. A more coordinated response could have reduced the risk of international travel contributing to the spread of the virus.

Would a more powerful WHO have made a difference in mitigating the crisis? Maybe. But look at the criticisms thrown at our national public health emergency team (NPHET). Even though NPHET is an advisory body, it has been repeatedly denounced by a vocal minority, the loudest of whom have been industry lobbyists, for setting the agenda in terms of a pandemic response (even if others believed it did not go far enough and should have recommended a ‘zero Covid’ strategy).

Many governments, and their citizens, simply would not welcome an international agency telling them what to do. The pandemic has revealed again the scepticism of expertise that has been much commented upon in recent years, as well as the intransigence of nationalism.

It raises questions as to how public health messaging can be made more persuasive, but more fundamentally, how public health policy cannot be disentangled from economic and social structures. A nuanced understanding of the relationship between public health and economics was often absent in the simplistic debates on whether to keep the economy ‘open’ versus lockdown.

Even with the new vaccines, the next few months will not be easy, and public health campaigns will need to be convincing to combat the significant hurdle of ‘vaccine hesitancy’. Equitable access to vaccination is also vital, and the WHO’s Covid-19 Technology Access Pool (C-TAP), which aims to make the health technology, intellectual property and data behind Covid-19 vaccines as accessible as possible, should be supported by our own Government and the European Commission.

This year has been hard, and few will mourn its passing. But everyone, especially those in power, should reflect on the global trauma Covid-19 has brought and think about what it has to teach us about the type of world we want to live in.

As this is the last 2020 issue of the Medical Independent, we wish all our readers a happy and safe Christmas and New Year, and thank all healthcare workers for their Trojan efforts during the pandemic.