The full picture

The COVID-19 pandemic has infiltrated every aspect of our lives and societies, presenting political choices that have enormous ramifications for how we live, work and socialise. Yet as we look forwards, there is hope in a response that is collective, global and equitable, and built on determined political leadership

In September 2020, the world passed the agonising milestone of one million deaths from COVID-19. No recent health challenge has shown us to this extent how the lives, health and well-being of people depend on political choices. These choices are made at all levels of politics: local, national, regional and global. Political leadership is called for more than ever before. And it is exactly at this critical juncture that it has become more difficult for the world to come together nationally and internationally to fight this virus and its disruptive effects.

KEY POLITICAL CHOICES
The first key political choice is to achieve universal health coverage by all countries. Only last year the member states of the United Nations came together to recommit to this key pillar of the Sustainable Development Goals in a historic political declaration. Health is a human right, and nobody should fall into poverty because they need access to health care. People should have access to quality essential healthcare services and to safe, effective, quality and affordable essential medicines and vaccines for all. COVID-19 has shown us the stark reality in countries that lack such access, concentrating disease and death in the most vulnerable populations.

COVID-19 has revealed weaknesses in health system capacities to protect the most vulnerable, even in wealthier nations. The virus affects hardest those who can least cope: older persons, the poor, those with chronic disease or those living in crowded conditions. Equitable access to testing and treatment is essential. COVID-19 is compounding existing gender inequalities, with reports of increasing gender-based violence and sexual exploitation and abuse. The extended lockdown puts the lives of women and girls at risk, with a projected 31 million additional gender-based violence cases.

AGAINST CURRENT TRENDS

Resilient health systems are needed that deliver comprehensive and integrated primary health services, including reproductive health services, across all population groups, including those that are stigmatised and marginalised. But recent data show that overall financial protection is deteriorating, not improving.
If current trends continue, not more than 60%
of the global population will be covered by essential health services by 2030. We cannot accept this. The United Nations and many other partners will continue to do all they can to support countries to build their health systems.

The second key political choice is to ensure social protection and financial recovery. We have learned that there is no trade-off between saving lives and saving livelihoods. Here too COVID-19 has shone the spotlight on existing stark social inequalities and forms of discrimination. We cannot accept that some lives do not seem to matter. The World Bank estimates that COVID-19 will push 71 million people into extreme poverty, measured at the international poverty line of $1.90 per day. If we consider a downside scenario, this increases to 100 million. A large share of the new extreme poor will be concentrated in countries that are already struggling with high poverty rates and numbers of poor.

SPURRING RECOVERY

For these countries to be able to invest in their health and social protection systems, a resolution to their debt vulnerability will be needed. Many of them already had elevated levels of foreign debt and some were at high risk of debt distress before the pandemic. Reducing the cost of remittances could also spur recovery after the crisis and greatly assist in restoring household consumption in recipient countries. Incentives are also needed to encourage increases in foreign direct investment to support recovery efforts and social assistance. It is a political priority to support the financial recovery of vulnerable countries that have been severely affected by the COVID-19 pandemic.

The Global Preparedness Monitoring Board has highlighted that stronger integrated governance systems at all levels are needed for an effective response to the COVID-19 crisis.

ISSUES INTERLINKED

The third key political choice is to invest in common goods and strengthen multilateralism. The need for global leadership – and cooperation on global common goods – is as strong as ever. COVID-19 has highlighted that we cannot view health, social, economic and political issues independently. Multilateral collaboration along several fronts is essential to recover better, and the United Nations and its agencies are fully engaged in driving the expansion to providing universal, quality, essential public services, social protection floors, access to health care, water, sanitation, clean energy and the internet. This is of course the central message of the SDGs. Countries do not have equal capacities, and multilateral and multi-stakeholder collaborations are essential. Such collaboration has begun to leverage finance, science and technology across borders along with longer-term efforts for strengthening capacity.

UNPRECEDENTED COLLABORATION

The United Nations is the key platform for facilitating coordinated national responses, especially through its specialised agencies such as the WHO. One example is the establishment of the COVID-19 Response and Recovery Fund to generate an initial $1 billion to help support low- and middle-income countries in their response to the pandemic and to reach those most vulnerable to economic hardship and social disruption. The WHO has mobilised unprecedented global research collaboration in diagnostics, vaccines and treatments as well as a range of solidarity funds and programmes. The Access to COVID-19 Tools (ACT) Accelerator and its COVAX Vaccine Facility, created to ensure equitable access to COVID-19 vaccines, diagnostics and therapeutics, is an extraordinary step in safeguarding that no one is left behind. Any new COVID-19 vaccines must be available to all.

HOW TO KEEP THE WORLD SAFE

Epidemics are blind to national boundaries, and intergovernmental cooperation is essential for future pandemic prevention and control, even as individual countries need to manage their immediate domestic crises. The multilateral system can further work to enable the most vulnerable countries to provide emergency health and social services in response to COVID-19. This would include removing restrictions on trade in goods essential for fighting the pandemic and on food and agricultural products to prevent rising hunger. We must leverage multilateralism to put human well-being at the centre of policy and countries must support and strengthen the World Health Organization to drive the achievement of SDG3 and help keep the world safe.

THE DECADE OF ACTION

Therefore, the fourth key political choice is to leverage the Decade of Action for the delivery of the SDGs as an opportunity to address the multiple and often interacting threats to our world. We face not only the pandemic threat but also the threat to our ecosystems. There can be no health security without social security and without addressing planetary health. COVID-19 also reminds us that biodiversity destruction and climate change pose global challenges to health. These, too, necessitate multilateral responses. Healthy ecosystems are essential for human health by providing a diversity of nutritious foods and clean water, and by helping to reduce disease. Nature is the origin of most infectious diseases, but at the same time is the source of medicines and antibiotics for treatment. These positive links need to be strengthened by science and government protections, while the risks of infectious diseases need attention to reduce spread and exposure. We must learn the lessons on determined political leadership from the current crisis.