In 2020 alone, there were at least 3 million deaths from COVID-19, though the true figure is probably 2-3 times higher. In 2021, the COVID-19 pandemic continues to rage on and is likely to last well into 2022 and beyond. For ten weeks in a row, from the first week of February, 2021, new daily cases globally rose, driven in part by virus variants and by many countries ending public health measures too soon. There are still around 600,000 new cases every day. Nations like Brazil, Canada, India, Iran, and Turkey—as well as some U.S. states like Michigan and Minnesota—recently experienced COVID-19 surges that in some places overwhelmed their health systems. India, in particular, has become a cautionary tale on how devastating the pandemic can get. While some rich nations like Israel and Britain have ended their own recent surges in part through rapid vaccine roll-outs, low- and middle-income countries have so few vaccine doses that less than 1% of their populations are vaccinated, according to Gro Brundtland, former director general of the World Health Organization (WHO).
Nevertheless, as two global health professors who collaborate with institutions like the WHO and with researchers in countries like India, Kenya, and South Africa, we see COVID-19 revolutionizing worldwide health care in ways that could have lasting benefits. The pandemic has wrought immense suffering while simultaneously accelerating the adoption of new ways to improve global health.
There has been a sea-change in how we research, develop, and manufacture new health technologies
The vaccines that were licensed the quickest all used new approaches—mRNA (Pfizer and Moderna) and viral vectors (AstraZeneca and Johnson & Johnson). Researchers and pharmaceutical companies are now using these approaches to try and develop vaccines for a range of other diseases like HIV, tuberculosis (TB), and malaria. And COVID-19 unleashed many other new ways of doing science. It accelerated international collaborations. It sparked unprecedented mobilization of research funds to develop new diagnostics, treatments, and vaccines. Multi-country evaluations fast-tracked the process of evaluation of new products. And for the first time ever, COVID-19 prompted scientists as a whole to immediately share their research online with no paywalls as soon as their papers were ready.
Nevertheless, the pandemic has also shown where the obstacles remain in the R&D ecosystem. For example, manufacturing of new health technologies still takes place mostly in rich nations, and these technologies eventually trickle down to low-income nations. Such manufacturing needs to become globalized so that low- and middle-income countries become self-sufficient in producing their own health tools. The regulatory approval process worldwide needs to become faster and more streamlined. And, most importantly, we need to put a system in place to prevent rich nations from hoarding vaccines, diagnostics, and medicines in future pandemics.
Citizens are benefiting from new modes of health care delivery
COVID-19 forced the global adoption of telemedicine. For example, a U.S. study found a 50% increase in telehealth visits in the first three months of 2020 compared with the same time period in 2019. The benefits of telemedicine, say the researchers, include “expanding access to care, reducing disease exposure for staff and patients, preserving scarce supplies of personal protective equipment, and reducing patient demand on facilities.”
Every single clinician who we have spoken to—physicians, nurse practitioners, and nurses—who have run telemedicine clinics during COVID-19 tell us that they want such clinics to remain a permanent part of health care delivery. They have been able to reach patients in rural communities and they tell us that many of their patients find telemedicine more convenient. Zeynep Tufekci, Associate Professor at the University of North Carolina School of Information and Library Science, argues that telehealth visits are a game-changer. “Such visits are clearly not appropriate for every condition,” she says, but “when warranted, they can make it much easier for people to access medical help without worrying about transportation, child care, or excessive time away from work.”
In low- and middle-income countries, telehealth has been used during the pandemic as a low-cost service to reach people in poor or remote areas. In India, right now, home-based care is the only realistic option for millions of people, as hospitals are overwhelmed. We have also seen community health workers empowered with digital tablets delivering health care in resource-poor regions, such as in the remote Peruvian Amazon.
In many parts of the world, services that were designed for non-COVID conditions such as HIV and TB prevention and treatment needed to be redirected to diagnosing and treating COVID-19. For example, a survey last year found that at least 40% of national TB programs were using TB hospitals and dispensaries for the COVID-19 response. Services for non-communicable diseases like diabetes and heart disease were also redirected to COVID-19. In order to try and maintain services for such non-COVID conditions, many health systems adopted a variety of other innovations in primary health care delivery that are likely to become permanent. These include self-testing, in which citizens test themselves at home for various diseases including HIV; self-monitoring of diseases including diabetes; and “task sharing,” in which services are provided by teams of different health workers with different sets of skills.
Rich nations are finally realizing they have much to learn from less wealthy nations
Around six weeks before the COVID-19 pandemic began, three organizations—the Nuclear Threat Initiative, the Johns Hopkins Center for Health Security, and the Economist Intelligence Unit—published the Global Health Security Index, which ranks nations on how well prepared they were to handle a pandemic. Out of 195 nations, the U.S. was ranked first and the U.K. second. These two rich countries ended up bungling their COVID-19 responses and have two of the highest death rates in the world. The complacent and often arrogant global north is at last realizing it has much to learn from less wealthy nations, including on the importance of investing in public health infrastructure, engaging communities in tackling public health crises, and using clear and consistent public health messaging.
We are getting better at fighting scientific misinformation
Conspiracy theories, bogus remedies, and anti-science ideas have abounded during COVID-19, from the bizarre notion that Bill Gates has put a microchip inside COVID-19 vaccines to the many dangerous assertions by former President Donald Trump, such as his argument that injecting disinfectant or bringing “light inside the body” could cure COVID-19. Social media, meanwhile, has given anti-vaxxers and other science denialists a bigger platform for their dangerous views.
The good news is that scientists have responded with urgency and creativity to fight against what the WHO calls an “infodemic.” New hubs for this essential effort, like the University of Washington’s Center for an Informed Public, the Taiwan FactCheck Center, and Britain’s Science Media Centre—as well as new university courses and books—have emerged to specifically tackle misinformation. Despite such efforts, vaccine hesitancy is still a huge issue during this pandemic and will require redoubled efforts to fight misinformation.
COVID-19 has been used to reimagine how we teach global health
Alongside COVID-19, the year 2020 saw calls for racial justice and for the global health and development community to acknowledge their roots in colonialism and white supremacy and become “decolonized.” We recently teamed up with 18 other academics who teach global health to write an article in which we used the COVID-19 pandemic to re-imagine our teaching of the future. We argued that COVID-19 should push us to reimagine global health education, focusing more on equity and human rights and integrating anti-racism and anti-oppression into our courses.
COVID-19 has been the deadliest pandemic in a hundred years. One in three Americans has lost someone to the coronavirus, and India is the next epicenter. The scars will be enduring. But the pandemic has also catalyzed innovations in science and health care delivery, pushed rich nations to learn from poorer ones, forced us to turn back a tide of misinformation, pushed health higher up global and national agendas and made us better teachers. Out of crisis comes opportunity.
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Contributor: Gavin Yamey and Madhukar Pai