Nations working together for global health after Covid-19?

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Nations working together for global health after Covid-19?

Can nations work together for global health after Covid-19? Dinyar Godrej writes.


Coronaman: Dehli Police made this cut-out poster to warn people to stay at home, very difficult for daily wage earners. Mayank Makhija/NurPhoto/PA images

In June 2020 the Covid-19 pandemic was at its high point in the Indian capital Delhi. A young YouTube reporter outside a hospital recorded the terrible stories of relatives trying to find treatment for their loved ones in a very poor medical system.

One man said that he could get no information about his father in hospital. So he asked a guard to take a phone in to his father. The guard returned and said his father had died.

Another man was waiting for the police to come. He heard nothing about his father from the hospital for six days. Finally they told him that his father was missing. ‘I have no idea where he is. Is he alive or not? Tell us something, it is six days now.’

Another man’s father was in a government hospital but there was no oxygen for him. He asked his son to move him to a private hospital. When they found a bed, they said that the treatment would cost $5,000-$7,000 for 10 days and $13,500 if a ventilator was necessary. Private hospitals across the country started putting up prices during the pandemic. He found the money and his father went in to the private hospital. But later the patient in the bed next to his father’s called the son. His father lost all hope. The patient told the son how his father felt after he saw the bad conditions in the private hospital from the start. One evening, the father took a few steps and collapsed. The patient helped him back to his bed. Then they started calling for help, but no one came. The father died in great pain. ‘With oxygen or a ventilator, your father would still be alive,’ the patient told him.

At the time of writing this article, tests found that nearly one in four of all Delhi’s residents came close to Covid-19.

Up until the middle of July the big difference from most of the rest of India’s health services was the communist state of Kerala. Kerala had the country’s first coronavirus case in January. With money in public health, high literacy, public engagement, and KK Shailaja, a former secondary-school teacher as a good health minister, there were many early successes.

Kerala’s public-health system focused on prevention through strong testing and contact-tracing. They quarantined people with a possible infection and fed them well. The people in hospital found the experience much better than in other parts of India. The national and international press wrote very good things about KK Shailaja. By May, Kerala with nearly 35 million people reported days with no new cases. But in July there was a big increase. People blame this mostly on workers returning from the Gulf and other Indian states. There they suddenly had no work. The numbers were too much for the health services. But Kerala has the lowest number of deaths in the country and the Kerala government is creating hundreds of Covid-19 treatment centres in the villages where the disease has increased.


Cuban Health Specialists arrive in South Africa to help1598 COVID-19/GovernmentZAFlickr

Showing the way

Perhaps it is no surprise that Cuba is showing the way in public health. It has the highest ratio of doctors to citizens of any country in the world. Because it did not want to lose tourist dollars, Cuba waited until 20 March before it stopped new arrivals. But it had already got a ‘prevention and control plan’ ready in January. When the first infections came, they started the plan. They gave the well educated Cuban people information about symptoms and what to do. They started track and trace and isolation. They sent doctors, nurses and medical students into the community to screen every home on the island every day.

It was expensive but they increased testing. They found places in hospitals for every person testing positive to monitor them better. The other side of this success is that they make sure that isolation is in hospitals and not at home and they punish or put in prison people not wearing face masks in public. But in Cuba numbers are low and there is a big drop since mid-April. The United States has 59 times the rate of infections per million people.

Difficult times

Government actions around the world show that private healthcare, which is unequal healthcare, cannot deal with a public-health crisis. And using lockdowns and expensive health care to deal with the pandemic is difficult for the richest and the poorest nations. The support for good healthcare is increasing again after years of rightwing economic policy. In many parts of the Global South the problem is worse as governments try to improve public-health systems, which international financial institutions more or less killed.

It is clear now that working together internationally could be the best idea. But think about the situation of the World Health Organization (WHO), the only organisation qualified to take useful international action during the pandemic. WHO finds it difficult to collect its membership money – the worst member is the US, which finally left the WHO because of Trump. The WHO has had to walk carefully between the politics of US and China. It cannot criticise political leaders and it has to be cautious when it is necessary for it to support health equality.

Whose vaccine?

In May 2020 the WHO called for ‘sharing of knowledge and data, and free use by WHO member countries of vaccines’. But only 30 countries supported it, of which only 4 were rich nations. The big pharma companies working together on Covid-19 vaccines did not support it There are plans to try to find a vaccine for poorer countries. The Gavi (the Vaccine Alliance) and Covax Advance Market Commitment (AMC) are trying to raise billions to buy possible vaccines to get manufacturers to increase production. People are criticising such AMCs for not ensuring the lowest price and the plan is a public-private scheme. Others criticise the public-private scheme for its secrecy and because it would use a lot of aid money.

And then there is vaccine chauvinism, with the US as the worst. Other rich countries are also spending money on possible vaccines to get big pre-orders, in the hope that if one works their populations will be OK. Some say that the UK government has spent money on as many as 12 possible vaccines. The poorest nations of the world can do nothing.

The pandemic continues to get worse. This stops work on other vaccination programmes and actions on health that will result in an increase in problems of other diseases after Covid-19.

The usual way to develop vaccines uses public money for research in academic laboratories, with later licences for big pharmaceutical companies to make and distribute them. AstraZeneca with the University of Oxford said it will make no profit from their vaccine. Global justice campaigners do not believe this.

But many medical experts say this is not the best way. There is less vaccine development after the pharma companies were less interested in one-shot drugs. So health depends on profit. Can we imagine a future where new medicines remain public and free of patent, right from research through to production and distribution? Can we imagine a future where nations work together for global health without profit? So far Covid-19 is teaching us many things about inequality. We should learn that the market and nationalism cannot solve this crisis. And we should ask how we can make healthcare a right and a public good and then do our best to achieve that.


(This article has been simplified so the words, text structure and quotes may have been changed)