[The original Catalan version of this article was published in L'Avenç.]
One year ago, on 11 March 2020, the World Health Organisation (WHO) announced that the outbreak of COVID-19 could be characterised as a pandemic. Since then, the measures taken around the world to combat the disease have changed our lives profoundly. So where are we today?
“À défaut de donner un sens à la pandémie, sachons en tirer les leçons pour l’avenir.”
Edgar Morin, Changeons de voie, 2020.
In case there was any doubt about it, the 21st century began in 2020, just over one year ago following the emergence in the Chinese city of Wuhan of an outbreak of pneumonia caused by an unknown coronavirus. Within just a few months, the virus had spread all over the world, causing a global epidemic (pandemic) of a new disease called COVID-19 (from the English coronavirus disease), a name that has become, by far, the most cited term of 2020.
At the time of writing—in mid-February—COVID-19 has already caused some 2.4 million deaths worldwide, a figure that makes it one of the 10 largest pandemics of all time. It is also undoubtedly the most important health event that has occurred in the last four generations, and we are still a long way from seeing the end of it.
It is also undoubtedly the most important health event that has occurred in the last four generations, and we are still a long way from seeing the end of it
While the whole world is still fully engaged in the fight against the virus and in the hope that the vaccines that have just started to be administered will mark a turning point in this pandemic, we also need to draw some lessons from the experience and identify certain challenges that—from the point of view of health—will mark the coming years.
Lesson 1. The Microbe vs. Goliath.
Following numerous mutations, a virus with generally mild effects was able to find a biological pathway through the human species, leveraging its best capabilities to achieve airborne transmission between humans, to colonise our organism rapidly (in many cases without causing any symptoms), and to succeed in multiplying and spreading without killing most of those infected.
This new tiny and, at the same time, huge evolutionary success story gave rise to a pandemic we were unable to prevent (despite the fact that it was a foreseeable and oft predicted event) and it has shaken the very foundations of Goliath—our borderless, closely interconnected and interdependent world.
THE CHALLENGE: to create global systems for microbiological, epidemiological and environmental surveillance capable of continuously collecting and analysing samples from animals, humans and the environment to facilitate the prompt detection of newly emerging infectious agents and to prevent their spread.
Lesson 2. Health is Planetary.
Our era—characterised by the intrusion of human activity into natural ecosystems and, for that reason, known as the Anthropocene—is having a significant impact on the evolution of our planet, causing, among other things, the emergence and spread of microorganisms with unpredictable consequences for human health.
Our era is characterised by the intrusion of human activity into natural ecosystems
THE CHALLENGE: to redefine our collective prosperity and well-being in such a way as to achieve improvements in health and quality of life for all without damaging the integrity of our planet’s natural systems (air, water, soil, forests, rivers, seas and biodiversity).
Lesson 3. The Syndemic: a Synergy of Epidemics.
The outcomes of the COVID-19 pandemic have been magnified by the existence of concurrent epidemics, such as poverty, obesity, malnutrition, and the effects of climate change.
THE CHALLENGE: to recognize how political and social factors give rise to, perpetuate and intensify the emergence and clustering of multiple diseases.
Gabriella Clare Marino / Unsplash
Lesson 4. Inadequate Health Care Systems.
The fear that health care systems will collapse (especially the care of critically ill COVID-19 patients) looms large every day in all of the world’s countries and communities. The pandemic has pushed millions of health care professionals working in hospitals, primary care, epidemiology and public health services to their limits as they face the added challenge of not always being able to attend properly to patients with diseases other than COVID-19.
The fear that health care systems will collapse (especially the care of critically ill COVID-19 patients) looms large every day in all of the world’s countries and communities
THE CHALLENGE: to innovate in creating and upgrading people-centred health services, to strengthen health promotion and disease prevention programmes , improve access to diagnostic technologies and effective treatments, strengthen the professional workforce, and ensure strategic reserves of medical equipment and devices.
Lesson 5. Science Is Transformational.
The power of scientific knowledge has worked small miracles at speeds never seen before, including the sequencing of the new coronavirus genome and the worldwide dissemination of the information in just a few days. This was followed by the design and production, in under a year, of at least ten new vaccines with proven efficacy, and dozens more under study—an achievement made possible by international collaboration and the mobilisation of public and private resources.
THE CHALLENGE: to plan, develop and finance the cutting-edge biotechnological and digital capabilities needed to advance the search for new solutions, strengthening international innovation and science networks and expanding their contribution to the decision-making processes of public authorities.
Benjamin Lehman / Unsplash
Lesson 6. Governance: the Puzzle of Politics.
The responses of the world’s governments have revealed the best and worst sides of politics—ranging from an attitude characterised more or less by cooperation and solidarity, for example in the case of the European Union (at least in the wake of the first wave), to the populist denialism of the governments of certain countries, such as the United States of America and Brazil. One positive aspect of the response has been the empathetic and effective leadership of a number of female heads of state around the world.
The responses of the world’s governments have revealed the best and worst sides of politics—ranging from an attitude characterised more or less by cooperation and solidarity, to the populist denialism
THE CHALLENGE: to implant a multilateral and solidary system of international cooperation capable of overcoming isolationist and nationalist tendencies and supported by a World Health Organisation (WHO) with greater independence of action and a better funding model.
Lesson 7. Freedoms and the Right to Health.
We have been faced with the paradox of having to restrict mobility and social interaction, limiting lives in order to protect them; seeking a balance between the right to health and other fundamental rights that are not only determinants of health (such as work, social support and our cultural life) but also lie at the very heart of human dignity and development.
THE CHALLENGE: The right to health must not result in a cult of biosecurity or the justification of “bio-cratic” forms of collective organisation. We need to foster a dialogue directed towards updating the social contract governing the relationship between rights and life.
Cole Freeman / Unsplash
Lesson 8. Communication: From Diffusion to Confusion.
The media and social networks have found an exceptional opportunity in the pandemic to extend their influence, contributing to knowledge but also to confusion and misinformation and even, in some cases, intentional disinformation. For the first time in history, an account of the ongoing pandemic has been instantaneously broadcast— almost as if it were an international sporting event. In this context, the emergence of various voices combining a narration of experiences (not always proven or verified) and a dogmatism tinged with salvationist aspirations has created an “infodemic” babble permeated with confusion and unease.
THE CHALLENGE: to strengthen networks and information sources that provide quality information based on scientific rigour rather than on fame and notoriety—sources that will contribute to generating knowledge, confidence and security.
Lesson 9. Global Poverty and Inequality: A Harsh Reminder.
The most negative impact of the pandemic, on both a national and international level, has been the increase in poverty and health inequities based on socioeconomic status, gender, geography or ethnic identity. The result can only be an increase, of unpredictable magnitude, in conflicts and instability, with grave consequences.
The most negative impact of the pandemic has been the increase in poverty and health inequities, based on socioeconomic status, gender, geography or ethnic identity
THE CHALLENGE: values like cooperative intelligence and solidarity together with the pragmatism of self-protection must be the driving force for the future of a world at peace in which well-being is distributed more fairly throughout the population.
IMF Photo/James Oatway
Lesson 10. This Is Just One (Further) Warning Shot.
While the current pandemic is exerting great pressure on our society, it is not crushing us completely. The extremely low incidence among children and the mildness of symptoms in adolescents and young people in general may be a consolation on this occasion, but it should also serve as a reminder that other pandemics will occur and that the next one may be much more dangerous and disruptive.
THE CHALLENGE: to take on board the nine lessons described above and rise to the challenges they pose. And to many others!
Other pandemics will occur and the next one may be much more dangerous and disruptive
It has been said that pandemics tend to accelerate trends. From the point of view of health as a global public good, the trends described—in broad strokes—reveal the complexity and uncertainty of our (increasingly) small world. Our response to the challenges of the century that has just “begun” must not be nostalgia or fatalism, but rather a shared, proactive and generous commitment to building a planetary identity committed to health, justice and sustainability.