Our vice president for global health strategy, Kate Dodson, reflects on 2020, what COVID-19 has meant for the state of global health, and what key priorities lie ahead for 2021.
Many people were caught off guard by 2020, a defining year that placed the implications and impacts of a global pandemic front and center in everyone’s lives. Once reserved for the worlds of public health and health care, a new lexicon — N-95 masks, social distancing, personal protective equipment (PPE) — has become commonplace in households around the world, taking on urgency as people navigate keeping themselves and their loved ones safe in a rapidly shifting information environment.
The pandemic has resulted in more than 1.5 million deaths and families in mourning, disrupted livelihoods, and a feeling of perpetual uncertainty and limbo. It has led to significant disruptions in essential health services, including lifesaving immunizations, and has shined light on an acute mental health crisis. Most important, the virus has highlighted just how interconnected our global family is, and the fact that one weakness in one corner could just be the domino that wobbles the rest. As we reflect on 2020, the clarion call of investing now in strong, equitable health systems and preparing for future threats through global cooperation is ringing loud and clear. The question is: Will the world finally listen?
The Global Health Impact of COVID-19
Data paints the devastating impact of COVID-19 across all facets of public health and well-being. In an early survey, the World Health Organization (WHO) discovered that 90% of countries faced an interruption of health services, including routine immunization, family planning, mental health programs, and cancer diagnosis and care. In particular, lockdowns, supply scarcity, staff redeployment, and other COVID-19 constraints disrupted immunization services for vaccine-preventable diseases such as measles. This comes amid measles cases reaching an all-time high in 23 years and measles-related deaths rising by nearly 50% since 2016. COVID-19 also threatens to unwind progress on wild polio eradication, with case counts rising in the last two countries with wild polio: Pakistan and Afghanistan.
Additionally, COVID-19 has ignited a set of “shadow pandemics,” including a global mental health crisis, rising food insecurity for millions, and the disproportionate effects that the pandemic has had on women and people of color, including on the front lines.
As my UN Foundation colleagues Michelle Milford Morse and Grace Anderson have written, 70% of health care workers around the world are women, with many also working in support roles in health facilities, where they are more likely to be exposed to the virus. Domestic abuse and gender-based violence have been on a troubling (if massively underreported) rise. Several reports show that violence against women and girls has intensified since the pandemic: France, for example, registered an increase of 30% in domestic violence cases early on in its first lockdown, and in Argentina, emergency calls reporting such cases increased by 25%. Such figures only further highlight the need to place women at the center and at the table of COVID-19 response planning efforts.
The pandemic has taken a dire toll on overall mental health, with more people reporting insomnia, anxiety, and increased drug and alcohol use. Vulnerable populations have been particularly affected by the COVID-19 fallout, with more young adults and minority racial and ethnic groups reporting increased suicidal thoughts. Entrenched inequalities, including uneven access to quality health care, education, and social protection, coupled with the resulting isolation and uncertainty during the pandemic, have had devastating effects. However, while mental health programs have historically been underfunded and placed near the bottom of the priority list of national health budgets and international aid, this pandemic has underscored the need to treat mental health with the same urgency as physical well-being.
As WHO Director-General Dr. Tedros Adhanom Ghebreyesus said, “Health is not an ‘either-or’ equation,” and global health emergencies should not impede other lifesaving essential services. WHO knows this best, as its teams worked around the clock to extinguish more than 60 other global health threats at the same time as COVID-19, including ending the Ebola outbreak in the eastern Democratic Republic of Congo, achieving the important milestone of declaring the WHO African region wild polio-free, and providing mental health support to health workers in the aftermath of the Aug. 4 Beirut port blast.
The United Nations Foundation has seen the inimitable work of WHO firsthand when it launched the COVID-19 Solidarity Response Fund in March with the Swiss Philanthropy Foundation. The Fund drew from the early, blossoming spirit of global cooperation — when we watched the news with bated breath, clapping and crying with front-line workers from Rome to New York — and has so far raised more than $238 million from over 653,000 individuals, philanthropies, and corporations from 190 countries. These generous donations have helped WHO and partners overcome supply chain hurdles to deliver PPE, serve as the central information lab for updating and disseminating research about the virus, protect vulnerable populations, and support the race to develop new COVID-19 treatments, diagnostics, and vaccines. We must maintain the momentum of this show of solidarity and cooperation into 2021 to help us continue the hard work to move past this virus.
With this imperative in mind, the Access to COVID-19 Tools (ACT) Accelerator was born, bringing together scientists, governments, private sector, civil society, and other stakeholders around one common commitment: ensuring global equity in access to COVID-19 tests, vaccines, and treatments to bring life to the mantra that “no one is safe until everyone is safe.” ACT embodies the belief that a country’s gross domestic product and wealth should not be the prerequisite to whether its people have access to lifesaving treatments. COVID-19 has compounded the suffering of millions around the world who were already reeling from weak health systems, poverty, and conflict. To leave them behind would not only mean a collective moral stain, but also the indefinite perpetuation of the virus.
ACT’s vaccine pillar, COVAX, has already rallied 189 countries to deliver 2 billion doses of a safe, viable vaccine by the end of 2021. COVAX may be the only way that lower-income countries that are not able to independently negotiate with vaccine manufacturers to purchase vaccines for their populations will be able to access COVID-19 tools. It also makes economic sense for high-income countries to support this work: A recent report by the Eurasia Group found that the economic benefits of implementing an equitable vaccine solution vastly outweigh the costs, allowing these countries to stimulate their own impacted economies as well. But more investments are urgently needed to make that vision for equitable access a reality.
More Solidarity Will be Needed in 2021 and Beyond
It has been a whirlwind of a year since COVID-19 turned our everyday reality upside down, but it’s important to realize that it has been only a year. Much of the pandemic remains ahead of us, not behind us, and the test will come in how well we can work together to drive progress forward to more equitably and rapidly end the acute phase of this pandemic. As of mid-November, the ACT has reached $5.1 billion in contributions, but more — an additional $23.9 billion — will be required in 2021 (for a total of $38 billion if targets for the remainder of 2020 are achieved) in order to materialize its goals and make each one of us more safe. Initiatives such as ACT will help ensure that 2021 is less painful — physically, mentally, economically — than 2020 has been and help extend a hand to the most vulnerable among us.
Beyond the need to defeat COVID-19, 2021 will be a time to act with resolve on the lessons that the virus has taught us. First and foremost, it has become impossible to ignore the increasingly loud ticking of the clock to achieve universal health coverage (UHC) and the political leadership it takes at all levels to invest in resilient health systems that leave no one behind. It is unfathomable in the 21st century, with all of our resources, technology, and scientific advances, that some of us must bear the brunt of an emergency. As Tedros has reminded us for years, UHC is a political choice, and it requires sustained political leadership to achieve.
Looking to 2021, United Nations member states must maintain their commitments to stay on track to achieve health coverage for all by 2030 — a mere nine years away. At the same time, in the near term, we must ensure that essential health services, including routine immunizations, sexual and reproductive health services, preventative health care, mental health provision, and other health needs are maintained, per WHO guidelines. Here at the UN Foundation, we’ll be playing an integral part in trying to stop progress from eroding on malaria, measles, polio, and other important diseases that are at risk of increasing as a result of the pandemic. Through our work on integrated efforts like the Immunization Agenda 2030, which brings together emergency and routine immunization services for more efficient and quick response to vaccine preventable diseases, the UN Foundation will be looking to strong global partnerships to help safeguard advances in global health.
And finally, if 2020 has made one thing clear, it’s that we must invest in pandemic preparedness — at community, country, and global levels — so we can stop future threats to people’s health and well-being. Collective action challenges such as global pandemics, the climate crisis, or catastrophic outcomes from antimicrobial resistance must be prioritized in policymaking and financing at all levels in 2021 and beyond.
While we are still in the thick of the pandemic, what the global health community, the World Health Organization, and global partners have already achieved by coming together in such little time is a reassuring sign for 2021. But we cannot let up. Together, we can all recover better.
Featured Photo: Fauzan Ijazah/UNICEF