The pandemic — looking back, looking forward

‘COVID-19 laid bare inherent weaknesses in health systems globally’ 
| Photo Credit: Getty Images/iStockphoto

“The only possible answer to the question of how we can survive the plague is by living.” — José Saramago

Last month, March, we marked five years of the COVID-19 pandemic around the world. By now, we have had events, conferences, editorials, policy statements and thought leadership internationally. And there could also be some of us left pondering about Saramago. Have we learnt enough as a society and moved toward a healthier, more innovative and inclusive society by picking up lessons from the pandemic?

The learnings are of course stark and have necessitated a fundamental rethink about trust, the role of technology, our responsibility towards the vulnerable, and the architecture of health and innovation in the Global South and North.

Some of the critical lessons

It was from the pandemic that we learnt about the fragility of trust in health-care institutions and public health guidance. Several studies indicated that low trust and confidence in health-care service delivery could hinder the adoption of non-pharmaceutical and pharmaceutical interventions broadly, like for tests and vaccines. This also showed up as a heterogeneity in confidence in health-care systems, impacting mobility and compliance worldwide during the pandemic.

In India, the heterogeneity in reported COVID-19 infections in the early stages pointed to a variation in confidence levels in the health-care sector — as highlighted by reports of the underreporting of excess mortality that was later published in Science. Other countries faced communication failures, as seen in vulnerable economies. Overall, this underscores the critical role of government in convincing populations about the effectiveness of preventive measures. Public health interventions are predicated on public trust, and any erosion of this foundation can severely undermine pandemic response efforts tomorrow.

Technology, a double-edged sword, has also witnessed an unprecedented acceleration in its adoption even as it has starkly revealed the digital divide between the privileged and the underserved and also impacting vulnerable populations during work or study from home.

The pandemic propelled the use of Artificial Intelligence (AI) in pharmaceutical innovation. This writer’s research at the University of Sussex with patent data showed a sharp increase in the presence and the count of AI keywords in pharmaceutical patent abstracts after the onset of COVID-19, suggesting increased use of innovative technologies in this sector (further validated by the Nobel Prize awarded to Demis Hassabis and John M. Jumper of DeepMind and the rapid progress in drug discovery and innovation spurred by AI). Telemedicine experienced a reinvigoration, offering an alternative way to providing health care amidst restrictions on movement and face-to-face encounters. While digital technology offers solutions, equitable access remains a significant challenge, particularly in developing economies, despite the global surge in digital health interventions.

Vulnerabilities were amplified

We also learnt, brutally, about an amplification of existing vulnerabilities, leading to concerns that the 2030 Agenda for Sustainable Development has been significantly compromised, particularly in vulnerable, resource-poor economies. The disproportionate effect of COVID-19 on women, concerning childcare, work and mental health, was a critical lesson. Access to health-care services became a major challenge. The experience highlighted the urgent need for policies and investments that specifically address the needs of vulnerable groups to ensure equitable access to care and mitigate disproportionate impacts during health emergencies. The pandemic also triggered a silent pandemic of global mental health challenges. The pandemic has severely affected global workplace productivity, with no stable solution as yet to address this structurally and sustainably as debates around work-from-home or hybrid models continue globally.

COVID-19 laid bare inherent weaknesses in health systems globally, emphasising the necessity of having universal health insurance coverage. The pre-pandemic health systems in India and other Global South nations had inherent weaknesses in addressing public goods and institutional capacity. National oxygen capabilities are now an important issue to address respiratory pathogens circulating for tomorrow’s pandemic, as research from U-Edinburgh has pointed out. The concept of “hybrid” solutions, coupling digital technology with existing infrastructure, emerged as a potential pathway for delivering care in a cost-optimal manner. So did public-private collaborations in research and development and health delivery. But on many occasions, these efforts have gone away in various countries after the pandemic has subsided. The need for a central public health officer to harmonise efforts and reduce coordination costs, especially in countries with decentralised health systems, has become increasingly apparent.

The crisis also brought into focus the contentious issue of profiteering. Debates surrounding intellectual property (IP) waivers for COVID-19 vaccines, diagnostics, and therapeutics highlighted the tension between protecting innovation and ensuring equitable global access. Africa suffered significantly due to vaccine nationalism, amplifying the need for South-South collaboration for future pandemics in this Anthropocene.

In perspective

Overall, five years since the COVID-19 pandemic, it seems like we may have flattened the curve on health, innovation and the economy, but there is a lot of unfinished work. Whether we will be able to usher in ‘One World and One Health’ or remain mired in protectionist tendencies globally, reflecting on national health security considerations, remains to be seen. Yes, for those left behind on this planet, we are living beyond the pandemic — to allude to Saramago. But are we learning and actively breathing to create globally health-resilient inclusive societies tomorrow? One is left to wonder.

Chirantan Chatterjee is a Professor of Development Economics, Innovation and Global Health at the University of Sussex