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ASSESSING NATIONAL PERFORMANCE IN RESPONSE TO COVID-19
This abridged version of the COVID-19 Narratives By Dr David Nabarro will be featured in the British Association of Former United Nations Civil Servants (BAFUNCS) September 2020 newsletter and was developed with the support of colleagues at the London Imperial College Institute of Global Health Innovation, where David is Co-Director.
When the COVID-19 virus spread from Wuhan (China) across the world through Europe, the Americas and beyond in the space of a few weeks, it gave us proof, if one was ever needed, of how tightly interconnected we all are. Not only are our globalized economies interdependent, but also we ourselves are one with the environment around us, and with one another. As of end-June 2020, it is estimated that there were over 400 000 deaths and over 8 million cases worldwide. This has caused a global recession of historical proportions. Until a vaccine or a therapy are found and made available to all, the virus will continue to be a threat to societies all over the world.
In the face of COVID-19, advanced economies cannot afford to leave the developing world to fend for itself. Developing nations now suffer the impact of the pandemic, with the virus having reached their shores in the form of international travel. Major fiscal and financial crises are arising in several large emerging economies and dozens of smaller ones. This hampers efforts to bring the pandemic under control. It is triggering social instabilities and compounding existing humanitarian crises. We, as global citizens, should all be concerned about divisions in society – any politicization, violence, stigma and discrimination need to be actively discouraged in every society, on every platform, in every forum.
Even without invoking the moral imperatives dictated by our common humanity, it is in the political and economic interest of every country that the developing world is protected and spared the worst of this crisis.
As many countries around the world are entering in and out of some of the most restrictive peacetime measures that they may have experienced, people everywhere are suffering a range of moods and emotions that will impact on their lives. Such emotional swings and changes are not to be discounted lightly; they are shaping how countries, communities and citizens respond to the situation. It is important that we seek to understand them, see the overall pattern, and ascertain where we are individually and collectively in order to determine appropriate responses.
After the initial burst of energy associated with the introduction of tough new measures, we are entering a period of despondency and disillusionment as the reality of the situation takes hold, and as we begin to emerge into a new world. We need to remain conscious of how our moods change: this will help us as we navigate through uncharted territory together in an epic struggle that has profound implications for us all.
As new measures are announced, we see a surge in energy. This takes many forms: journalists trying to get the story and make sense of it for their audiences; businesses trying to put in place the activities that will ensure their continuity; families working out how they will now manage things with less income and children home from school, and how to keep in touch with elderly relatives; health-care teams, already overstretched, trying to figure out how to cope with exponentially increasing demand.
Movement restrictions are leaving people, institutions and businesses confused and anxious. All are prepared to make sacrifices and tolerate the necessary impositions but will want to be sure that their sacrifice is not in vain. Small and medium enterprises as well as larger businesses are struggling to keep going. The daily-waged and self-employed are particularly hard hit. They seek whatever protection they can get, and most governments are not able to cover needs, so that hardship is inevitable.
People want clarity on when and how the changing privations they face will end. At the same time, governments are unable to predict when there will be clear evidence on when and how the outbreaks will be contained. They want to protect any undetected build-up of transmission that leads to more intense outbreaks, hospital overload and increased deaths. That means they will also want to ensure that robust defences are in place to identify and quickly suppress any recurrences of the virus.
After a while we will settle into the pattern of living within a life with some restrictions until outbreaks are well controlled. As one French saying put it: “Our grandparents were called to fight, we are called to the sofa, we can do this”. Yet as days turn to weeks and the restrictions, inactivity and intrusion continue, the positive energy of the initial phase has disappeared. We are coming to terms with the reality of a growing threat as we see health systems creaking under the strain and hear of people, maybe friends or relatives, who have died. We are all troubled because we cannot see how it might end. We wonder where it is all going and what the new normal will look like.
The new normal
Will life return to normal after the pandemic has subsided? As governments navigate the pandemic, making difficult choices on behalf of their people, we are all coming to realize that life will not be resuming as it was before. For the foreseeable future, the world in which we live must be “COVID-Ready”. That will apply to ourselves and our households, our communities, our public health services, hospitals, local authorities, governments and international organizations. All must be prepared to act rapidly and effectively in response to reports of a person suspected with the disease, or a chain of transmission. The return of the virus must be prevented in ways that are humane, without discrimination and respecting human rights. Governments are exploring ways to enable social and economic recovery in this light even now as they advance their response strategies, exploring just what the new normal means in practice.
In many countries, the spread of the disease has started to slow down because of physical distancing imposed through movement restrictions and other measures, but the virus has not gone away. As the lockdowns are lifted and people start to move around more, there is a high likelihood of transmission restarting in some locations. This is particularly likely to happen where there is not continued attention to the need for physical distancing, and where people who develop symptoms of COVID-19 are not isolated quickly.
Societies will have to learn how to defend themselves against new outbreaks of the disease and be ready to do so at all times. Communities will need to have the means to interrupt transmission, prevent outbreaks, suppress them if they do occur and protect vulnerable people. This is the “COVID-Ready state”. It needs to be in place everywhere.
Establishing this COVID-Ready state requires the full and willing participation of people; a high level of organization within communities, with a special focus on protecting those who are most vulnerable, especially in residential settings like care homes; public health services able to organize the interruption of transmission and responses to outbreaks, and to maintain ongoing health programmes and protection efforts; as well as COVID-Ready hospitals and other health-care units.
The core of being COVID-Ready is that people are responsible for keeping themselves healthy, for preventing the illness from affecting others and for interrupting transmission when it starts. This means each person must be able to suspect they have been infected when they display symptoms, isolating themselves immediately, reporting to their public health officers and being tested for the virus (ideally) in a place away from a health facility. Those with COVID-19 will be triaged (mostly via telemedicine) and if deemed to need treatment, they would be referred to designated health-care facilities where the personnel would be fully protected with personal protective equipment (PPE). Their contacts (from days before they displayed symptoms) would be traced and required to isolate themselves. The better the contact-tracing and isolation, the more likely the outbreak will be rapidly suppressed.
Societies are undergoing widespread behaviour changes that need to be supported, promoted and reinforced by local and national authorities, employers, institutions and more. If it is to work, it has to be accompanied by open dialogue in order to encourage sense-making everywhere. The aim should be to establish communities that are free of the virus, supported by means to keep things that way.
The knock-on effects on employment, food systems, child nutrition, tourism income, women’s status and so much more will continue until high-income countries do what is needed to contain outbreaks within their own borders.
The role of international organizations
The World Health Organization (WHO), under its existing mandate, is directing and co-ordinating international health work and establishing and maintaining the global health response. Its messages are clear and are the best source for expert advice and support. The UN system as a whole is focused on the impacts of this pandemic that have implications beyond the fight to maintain health. It concentrates particularly on the plight of poorer people and nations who have much less margin for manoeuvre. The International Monetary Fund (IMF) and the World Bank are working with multilateral and regional development banks to deploy robust, coherent, coordinated and rapid financial support packages. It is important that the efforts of all multilateral organizations are joined together and that – together – they develop and implement strategies that enable societies everywhere to get ahead of the pandemic, mitigate adverse impacts and prepare the new normal.
The good news is that we know how to do this.
Our multilateral system is designed to face multidimensional challenges and has decades of experience: WHO to help keep the pandemics under control; the Food and Agriculture Organization (FAO) to help identify the food import needs and food supply bottlenecks; the IMF to promptly fund what is needed; the World Bank to help rebuild; etc. What is now needed is adequate urgent international financing coupled with unequivocal political support. We need a “pandemic Marshall plan” for the developing countries, possibly in the form of a massive open spigot from the IMF, to do what the Federal Reserve System did in the United States or the European Central Bank in Europe, to inject liquidity, help orchestrate a rollover of sovereign debts and avoid the risk of a financial crisis.
The global response to the pandemic must mitigate the impact of containment on the global economy and societies (with a particular focus on the most vulnerable) and contribute to the emergence of a post- pandemic COVID-Ready world. It should do this in ways that take account of the interests of all nations, and emphasize the needs of the poorest. The focus should be on enabling the protection of health-care workers; ensuring equitable access to protective material; managing the adverse societal effects of lockdowns; coordinating strategy and implementation; and establishing the parameters for the economic activity that emerges in the new reality. It should be ready to chart ambitious pathways with audacious solutions that are both authentic and accountable to all people, everywhere.
COVID-19 knows no borders and makes no distinctions when it strikes. In that sense it is the ultimate global challenge. But countries are not equally equipped to deal with it, and it would be bad for the world if differences between nations blunt the collective response. The world needs the multilateral system like never before; budgets should be increased and not cut, and political support should be undivided. Our world is tightly interconnected: we are only as strong as the weakest of us.
Taken together, the efforts to contain the pandemic, manage lockdowns and emerge from the response involve managing complex interacting forces. It is an epic struggle but one that – I believe – can be won through drawing on the strengths that exist within our communities, institutions, enterprises, governments and multilateral system. But it needs leadership that embraces complexity and offers direction, is inclusive of all and leaves no-one behind, while learning lessons and being guided by the best available science. It also needs to connect with people and recognize the extraordinary strength of the human spirit when confronting adversity.
The needs of people impoverished as a result of lockdowns will be acute, and there will be an urgent requirement to restore their incomes. There is an ongoing narrative that the choice is between public health and the economy. In my opinion this is a false dichotomy. The world urgently needs more leaders to step up and bring the human family together to act on the reality that economies can only thrive if public health capacity, for all, is in place.
Humanity is challenged as never before. I believe that our collective ingenuity and compassion will prevail for the good of all, to benefit humanity and the natural environment on which we all so depend.