Covid-19 could set global health progress back by decades, warn global health leaders

The knock-on effects of the Covid-19 pandemic could set global health progress back decades if countries fail to take a united approach, according to a report by the Bill & Melinda Gates Foundation released this week.

The annual Goalkeepers Report, a publication that tracks progress on the United Nations Sustainable Development Goals (SDGs) for reducing poverty and improving health, found that progress on both has not only come to a halt, but also regressed.

Routine vaccine coverage, which is one good indicator of how health systems are functioning, has dropped to its lowest levels since the 1990s, which the report described as “setting the world back about 25 years”.

Progress towards combating health challenges such as HIV transmission and malnutrition have been set back by the pandemic. Economic damages wrought by Covid-19 are also reinforcing inequalities around the world, disproportionately affecting women, racial and ethnic minority communities, the report said.

Why is this important? Covid is wreaking havoc in health systems, with death rates significantly above those of seasonal flu. And there are also growing range of poorly-understood longer-term health impacts. However, HIV/AIDS, TB and malaria are even more deadly when these are left untreated, not to mention vaccine-preventable diseases such as measles, currently raging in countries like the Democratic Republic of Congo.  So it’s critical to ensure that people can access available prevention, testing and treatment.

What are some of the key findings? The report features projections on how close the world will be to meeting each SDG in the next decade, based on modelling from the Institute for Health Metrics and Evaluation (IHME). Whereas previous editions of the Goalkeepers report have been optimistic about the world’s progress, this year’s predictions are bleak. Worst-case scenarios suggest that:

• New HIV infections could more than double - from 0.26 new cases per 1,000 people last year to 0.54.

• Malaria infection rates could increase from 30 per 1,000 people to 36.

• The target for lowering maternal mortality rates will be missed.

What next? The report asserts that global health progress can still get back on track if a Covid-19 vaccine can be developed quickly and distributed widely — and if countries collaborate in their pandemic response. It sets out three tasks to get the pandemic under control:

Develop diagnostics and treatments to manage the pandemic in the short term and vaccines to end it in the medium term.

Manufacture as many tests and doses as fast as possible.

Deliver these tools equitably to those who need them most.

The report warns against “vaccine nationalism” –  if rich countries buy up so many vaccine doses that other countries can’t access vaccines for health workers, older people and other vulnerable groups. But six months into the pandemic, “it is not clear precisely how the world will organise a collaborative response.”

Release of the report coincided with Tuesday’s formal opening of the 75th United Nations General Assembly, which was accompanied by appeals by the World Health Organization to world leaders for a united approach to combating the virus - and $35bn to ensure global access to Covid-19 vaccines, treatments and tests.

While the UNGA had already approved an “omnibus” bill at a pre-session last Friday, pledging to advance multilateral cooperation in the quest for Covid solutions, leaders need to put their money on the table too, said the World Health Organisation in a statement.

The WHO pointed to a new report  by the United Nations-convened Global Preparedness Monitoring Board (GPMB), ‘A World in Disorder’, which describes the global response so far as “a collective failure to take pandemic prevention, preparedness, and response seriously and prioritize it accordingly”:

“Countries that heeded early warnings from available data and quickly mobilized whatever emergency capacities they had were more successful in containing the virus. Early success stories include the Republic of Korea, which developed extensive, flexible health emergency capabilities following a 2015 MERS outbreak.”

The high-level report notes that spending on preparedness for future pandemics needs to increase.  In fact, it would take some 500 years to spend as much on preparedness as the world is losing economically as a result of COVID-19, the report finds, using data about global economic costs of the pandemic published by the International Monetary Fund and McKinsey & Co in July 2020.  The report outlines a multi-pronged strategy that global and national leaders must take to end the pandemic and head off other similar catastrophes, including:

• Strengthen global systems for health security. The report calls for governments to renew their commitment to battered multilateral systems and strengthen the WHO.

“Viruses don’t respect borders. The only way out of this devastating pandemic is along the path of collective action.” - GPMB co-Chair Gro Harlem Brundtland, also a former WHO Director General.

• Investment in prevention and preparedness, including a mechanism for sustainable financing of rapid response to emerging crises, to be developed by the UN, the WHO and the international financing institutions (IFI).

• Responsible vaccine allocation with national leaders, manufacturers and international organisations ensuring vaccines are allocated based on the way that they can have the most impact in stopping the pandemic, rather than based on ability to pay. The GPMB suggests each country gets an initial vaccine allocation to cover at least 2 per cent of its population, so at least, theoretically to cover healthcare workers.

The GPMB report also calls on the UN, WHO and IFI to convene a UN Summit on Global Health Security, with the aim of agreeing on an international framework for health emergency preparedness and response.