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Healthy Institutions, Healthy People: The Fundamental Lessons of COVID-19 and its Global Solutions

“The COVID-19 pandemic has plunged the world into an unprecedented crisis with devastating consequences for people, economies and progress towards the Sustainable Development Goals”.

—António Guterres, Secretary-General, United Nations

The World Health Organization (WHO) reports that the coronavirus disease (COVID-19) pandemic has caused more than 2.5 million deaths and led to economic downturn in the trillions of dollars, worldwide. Other recent viruses like Ebola and SARS were localized, but this was not the case with COVID-19 which first appeared in the People’s Republic of China in December 2019.

Professor Ilona Kickbusch, Founding Director of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva, points to the “enormous failure, particularly of the wealthy countries in their response”, to the emerging virus based on assumptions that it would remain localized. Despite the WHO sounding alarm bells in January 2020, including its highest alert level, it was not until Italy’s death toll surpassed that of China in March of that year did the gravity of the situation in both Europe and North America sink in.

Since then, the onset of the pandemic has shone a harsh light on pre-existing social and economic inequities in societies across the world. Toronto, the quintessential ‘cultural mosaic’ is no exception—over half the city is composed of racialized communities who account for 81% of COVID-19 hospitalizations, according to Dr. Peter Singer, Special Advisor to the Director General of the WHO.

Dr. Kickbusch says “the social determinants of health have actually led to more women being infected”, even though men are medically more susceptible to the disease.

“Many of the healthcare professionals are women, many of the more disadvantaged people in society are women, think of single mothers”, says Dr. Kickbusch.

According to Dr. Singer, “those countries that listened to that [WHO] alarm and acted quickly tended to do well”, especially those with recent SARS experience and an existing culture of disease surveillance and response. The majority, however, had neither heeded early warnings, nor fulfilled their International Health Regulation (IHR) obligations to the WHO, according to Dr. Kickbusch. For example, border closures gained popularity but were largely inadequate without additional measures working alongside them, says Dr. Kickbusch.

The lessons emerging out of COVID-19, a pandemic described by António Guterres, Secretary-General of the United Nations as “the greatest test that we have faced together since the formation of the United Nations”, are now clear.

“This may be the worst pandemic in a hundred years and it’s certainly not going to be the last one...we have to end this one and prepare for the next one”, says Dr. Singer.

His prophetic words are well chosen.

The world finds itself in a position where it can learn from the past and tackle future pandemics. However, global challenges require global solutions and cooperation. They require an understanding of the importance of human values, humility, equity, solidarity and leadership—what Dr. Singer describes as the “soft infrastructure of response and recovery”.

Never has it been clearer that the tragedies of the pandemic could have been minimized had world leaders taken a more cooperative approach and acted quicker. But, as Dr. Kickbusch says, “developed countries did not prepare well and did not think that this was an issue that would hit them to the extent that it did”.

The lesson of collective action, Dr. Singer points out, deserves greater attention. “The nations of the world have to act together in solidarity”. He adds that multilateral institutions, especially the WHO, are fundamentally important for the world.

WHO issued alerts and guidance, strove to ensure the equitable distribution of diagnostics, drugs and personal protective equipment (PPE), and brought the world’s researchers together to set a research and development blueprint. In response to a call from G20 leaders at their March 2020 summit, WHO created the Access to COVID-19 Tools (ACT) Accelerator and COVID-19 Vaccines Global Access (COVAX) facility.

The WHO’s measures were essential for combating the pandemic, but Dr. John Kirton, Director of the G7 and G20 Research Groups at the University of Toronto states that the world’s governments must also recognize that the WHO, as a member state-based organization, must have more guaranteed money that is paid on time by its members to strengthen emergency response programmes.

Dr. Kirton says, “It [WHO] needs more power to enforce International Health Regulations...and an ability to look behind the iron curtain surrounding sovereign member states to see what diseases are incubating and erupting inside”. He adds that governments and their institutions must also be more accountable and transparent, a key feature of UN Sustainable Development Goal (SDG) 16.

Furthermore, Dr. Kirton advocates that “Dr. Tedros as Director General of the made a full, equal member of the G20 summits as his colleagues from the International Monetary Fund and World Bank group have been from the start”.

Dr. Kirton says that world governments need to produce single national systems to respond to pandemics to test, trace, isolate and sequence genomes and vaccinate quickly. They need to give local territories the resources to implement such systems.

The pandemic may even be viewed as a unique opportunity for change. As a global and geopolitical challenge, it presents the world with two choices: to exacerbate or to reduce the inequities within and among countries.

“The defining feature of 2021 will be international vaccination rollouts”, says Dr. Singer.

Will distribution be equitable? Will countries make the effort to explain to citizens the importance of maintaining public health measures before and after widespread vaccination?

There is hope.

According to Dr. Singer, there are “ethical, economic and national security arguments” for fair vaccine distribution and continued public health measures. Halting the public health crisis will begin to revitalize economies. Functional and equitable health systems will combat transnational threats and contribute to peace and justice.

Commenting on support for the multilateral system, Dr. Singer says Canada remains a key supporter of the ACT Accelerator and co-chairs its Facilitation Council.

Canada remains committed to, and understands the importance of strong, well-funded international institutions such as the WHO and the UN. According to Dr. Singer, the Canadian government has made considerable COVID-19 response efforts via non-discriminatory laws and policies to emphasize equity and equality in line with SDG 16.

Efforts like this can help deliver the world from the COVID-19 crisis and promote healthier, more just and more peaceful societies.


Dr. Ilona Kickbusch, Founding Director, Global Health Centre at the Graduate Institute of International and Development Studies in Geneva

Dr. John Kirton, Director of the G7 & G20 Research Groups at the University of Toronto

Dr. Peter Singer, Special Advisor to the Director General, World Health Organization (WHO)


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