A woman receives a dose of the COVID-19 vaccine during an open field vaccination session in Banswada, India. Photo: Srishti Bhardwaj / UNICEF India
When it comes to global health in 2021, the science delivered, but solidarity did not.
Our Vice President for Global Health Strategy reflects on what was gained, lost, and learned this year amid the ongoing COVID-19 pandemic — and what lies ahead for next year.
Despite historic progress on developing new tools to fight COVID-19 — including nine vaccineslisted by the World Health Organization (WHO) for emergency use — inequitable access means the pandemic is actually worse today than it was a year ago. Last December, I wrote about COVID-19’s confirmed global death toll of 1.5 million. Just one year later, that number stands in excess of 5 million.
Info: UN Stats, Graphic: UN Foundation
So far, the world has delivered 7 billion vaccines and counting, but they are being distributed unequally. According to Our World in Data, more than eight times as many boosters are administered globally every day than are primary doses in low-income countries. It is a global injustice, and the most vulnerable people remain the most at risk. Only 1 in 4 health care workers in Africa have been fully vaccinated despite serving on the pandemic’s front lines, for example, according to WHO.
"It is a global injustice, and the most vulnerable people remain the most at risk."
Vice President for Global Health, UN Foundation
The notion of solidarity is itself in crisis mode. Wealthier nations have been hoarding vaccines. Technology transfers that could rapidly scale up vaccine production are being stalled by powerful countries and pharmaceutical companies. Humanitarian operations continue to go massively underfunded, leading to devastating health consequences for the planet’s most vulnerable people, particularly girls and women.
Info: Our World in Data, Graphic: UN Foundation
The Good News
This year, the scientific community defied even the most ambitious expectations and rolled out a set of new COVID-19 vaccines at record pace. And thanks to COVAX — a global initiative led by WHO, the United Nations Children’s Fund (UNICEF), the Coalition for Epidemic Preparedness Innovations (CEPI), and Gavi, the Vaccine Alliance — 40 of the planet’s most vulnerable countries were able to launch vaccination campaigns. By mid-December, COVAX passed the milestone of 700 million doses delivered in 2021 with another 700 million allocated for distribution in the near term, and even more in the months to come in 2022.
From day one of his new Administration, President Joe Biden demonstrated a markedly different trajectory for U.S. leadership in the pandemic by joining COVAX and restoring a constructive partnership with WHO. Those early signals were followed by robust commitments to share 1 billion doses of vaccine with low- and middle-income countries by mid-2022.
On August 1, 2021, Mauritania received 302,400 doses of the Johnson & Johnson vaccine against COVID-19. The vaccines were given by the United States, through the COVAX program and in coordination with the African Union and Gavi. Photo: Raphael Pouget / UNICEF
This year also brought growing recognition that climate change is a public health issue. We’re already seeing the consequences of a changing climate on global health: heat stress, air pollution, changing patterns of vector-borne diseases like malaria, even food insecurity from drought, floods, or other irregular weather patterns. By mid-century, WHO estimates that climate change could lead to at least 250,000 more deaths each year. And efforts to turn the health care sector green are also gaining momentum, which is important because if that sector were a country, it would be the fifth-largest emitter.
Setbacks and Challenges
As in 2020, this year witnessed the erosion of hard-won gains in the global health space, including a drop in overall immunization rates and a rise in malaria deaths. This year, 23 million kids under the age of 1 missed out on basic childhood vaccines. There were also 14 million more malaria cases in 2020 than in the previous year and a 12% increase in malaria deaths.
In 2021, we also continued to see the consequences of gender inequality across the global health sector. Nearly three-fourths of the world’s health care workers are female, yet leadership opportunities remain largely out of reach for most women in the field. Massive numbers of health care workers quit this year as a result of inadequate compensation, equipment, and mental health support. These setbacks have serious consequences not just for gender equality but also for global health. We can’t defeat the pandemic or reach the global vaccination rate of 70% without health care workers who are well-compensated and included in decision-making.
As we embark on the third year of the COVID-19 pandemic, our priority remains the same: Defeat it. We can’t risk complacency. Omicron is a test. Countries with resources will make choices in coming weeks about how to deploy them, from financial resources to vaccine doses to tests. Those choices will heavily influence the pace at which the pandemic ends.
"As we embark on the third year of this pandemic, our number one priority remains the same: Defeat it. We can’t risk complacency."
Vice President for Global Health, UN Foundation
Now is the time to marshal all resources as rapidly as possible — both equitably and collectively. Failing to meet WHO’s goal of 70% vaccination coverage by mid-2022 means risking a human, social, political, and economic toll that is nearly incalculable.
The world also needs more resilient, equitable, people-centric systems to get us through the current pandemic, reinvigorate progress on the Sustainable Development Goals (SDGs), and withstand future health shocks. Universal health coverage (UHC) is one of the most effective ways to do that, and it’s more important than ever. The global recession caused by the pandemic has had huge implications on access to health services. A new global monitoring report by WHO and the World Bank shows that health care costs have pushed or further pushed more than half a billion people into extreme poverty. We know that governments that have invested in a comprehensive, people-centric approach to COVID-19 were found to be more effective at withstanding the shocks of the pandemic.
Info: WHO, Graphic: UN Foundation
Low-income countries may have to increase their national healthcare spending by between 30 and 60% to meet the target of 70% coverage with COVID-19 vaccines. No government should have to choose between providing antiretroviral therapy for HIV/AIDS patients or malaria bed nets for children or COVID-19 vaccines. That’s a false choice countries may be forced to make because they have no fiscal space and donors haven’t closed the global financing gap for pandemic response.
To both defeat the pandemic and help countries reaccelerate progress on the SDGs and UHC, governments, companies, and citizens will be asked in unprecedented ways for more resources in 2022 to support the Access to COVID-19 Tools (ACT) Accelerator; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the Global Polio Eradication Initiative; and CEPI, among others. These replenishments are moments to test our collective goodwill and resolve around these issues.
Another key priority in 2022 will be strengthening our joint capacity for pandemic prevention, preparedness, and response — and, frankly, how to deal more effectively with the current one, especially given the rise of new variants like Omicron.
Peacekeepers from China serving with the United Nations Mission in South Sudan (UNMISS) provide healthcare at the local clinic in Kuda. Photo:
Gregorio Cunha / UN Photo
Several independent international reviews came out in 2021 that recommended how to do this. Conversations and decisions will be made next year on a range of these issues, including better political leadership and accountability, strengthening WHO and addressing financing for pandemic preparedness and response, which is estimated to be $15 billion per year according to a panel convened by the G20, the world’s largest economies. A G20 task force is working on a potential pandemic financing mechanism, and negotiations among UN Member States are scheduled throughout 2022 on a new pandemic accord — a potential international legal framework to address gaps in preparedness and response.
One thing worth remembering as we look toward 2022: This past year saw a truly historic achievement in global health. The world successfully rolled out a set of new vaccines at record pace.
Humanity can pull together and achieve great things. Now it’s time to show that we can finish the job, guided by solidarity and equity.