The World Health Organization has repeatedly called for solidarity to defeat the COVID-19 pandemic. This paper examines how the world has responded to the call for solidarity.
On 30 January 2020, the Director-General of the World Health Organization (WHO), Dr Tedros Adhanom Ghebreyesus, declared the global spread of a novel coronavirus disease (later named COVID-19) a public health emergency of international concern (PHEIC). WHO subsequently characterized the spread as a pandemic on 11 March. The impact of the COVID-19 pandemic has severely challenged governments, health systems and economies, and has devastated millions of lives and livelihoods all over the world.
Following the PHEIC declaration, WHO provided recommendations for all countries to adopt, intended to curb the spread of the virus. At the same time, Dr Tedros called for all countries ‘to work together in a spirit of solidarity’. This was the first of many calls for global solidarity to tackle the outbreak. In the ensuing speeches and press briefings, such calls were increasingly linked with the urgent need for international cooperation and coordinated action to achieve a common goal.
This research paper examines how – and whether – the world has demonstrated solidarity in tackling a global crisis of this scale and magnitude. How well have governments worked together to combat a common global threat? How well have they fostered solidarity in their own populations to stimulate an effective response to the disease? What lessons can be learned?
First, how should solidarity be defined? In the late 19th century, sociologist Emile Durkheim identified two forms of solidarity, both of which are relevant to the pandemic response. ‘Mechanical’ solidarity is where members of a society hold common values and beliefs that facilitate cooperation to achieve shared goals. Mobilizing mechanical solidarity has been particularly important in the implementation of non-pharmaceutical interventions during the pandemic. ‘Organic’ solidarity recognizes that industrialized societies rely on decentralized cooperation between individuals and organizations. Again, this form of solidarity has proved critical, particularly in relation to the production of the many tools, from masks to vaccines, that are needed to fight COVID-19.
At a global level, WHO has played a significant role in defining solidarity and shaping it as a concept relevant to pandemic response efforts. It was communicated as a choice between policies and actions that aimed to unite, and policies and actions that sowed division and competition. This choice, as articulated by Dr Tedros, depended on the ability of actors collectively to identify the virus as the ‘common enemy’ and create an effective shared pathway to stop transmission. Solidarity was presented as the best way forward for effectively combating the pandemic. The message was clear early on: ‘[We] cannot defeat this outbreak without solidarity – political solidarity, technical solidarity and financial solidarity,’ Dr Tedros said.
Internationally, this translates to solidarity between countries in recognition of the interdependencies between countries and people, and the need for mutual support. But efforts to foster such solidarity have been complicated by a geopolitical context marked by serious tensions – notably between the US and China, but also linked to the rise of nationalism and populism, and increased competition between countries. WHO considered the greatest threat to solidarity was the lack of appropriate political leadership and willingness of governments to work together.
WHO considered the greatest threat to solidarity was the lack of appropriate political leadership and willingness of governments to work together.
In the field of global health, solidarity is often invoked normatively as a moral basis for a commitment by high-income countries (HICs) to provide assistance to low- and middle-income countries (LMICs)., This is consistent with the central promise of the 2015 Sustainable Development Goals (SDGs) to ‘leave no one behind’, specifically in SDG 10, which commits nations to ‘reduce inequality within and among countries’. However, as the progress of the pandemic has revealed significant deficiencies in political leadership and health system capacities in HICs and LMICs alike, solidarity has taken on new meaning. Tackling such a global crisis in terms of levelling and addressing asymmetries in power, resources, capacities and capabilities requires mutual assistance between countries motivated by a sense of shared duty and a collective responsibility to respond to common threats.
At the national level, one of the most important considerations for solidarity is how to support the most disadvantaged, who are disproportionately affected by COVID-19, in pursuit of equity. This is not only to ensure that none are left behind, but also to enable a more effective response. Equity refers to the fair opportunity for everyone to attain optimal health and wellbeing, regardless of demographic, social, economic or geographic circumstances. Health inequities thus result from more than just differences with respect to health determinants, they also signal a failure to avoid or overcome inequalities that affect fairness and the basic right to health. The pandemic has refocused global attention on the disparities in health outcomes and on the underlying political, social and economic drivers of disease and their negative impact on effective control of the virus. Solidarity that is grounded in an equity-based approach emphasizes the protection of the most vulnerable and susceptible communities and individuals as a priority in response efforts.
This paper recognizes that solidarity – at all levels of governance – is necessary for an effective response to this pandemic. Barriers to solidarity, be they political, scientific, financial or socio-cultural, hamper response efforts and potentially threaten, or at least prolong, a swift resolution and recovery for all countries and populations. It is thus imperative that barriers are identified and confronted, not only in this pandemic, but to prepare more effectively for future global crises.
The research for this paper assessed how the global community responded to the calls for greater solidarity across states and sectors in tackling the pandemic, and presents the views and perspectives of key stakeholders and experts in global health governance, health security, pandemic preparedness and response. The paper examines, in chapters 2, 4 and 6, the state of solidarity at different levels of governance – global, regional and national – and, in chapters 3 and 5, offers case studies on the COVAX mechanism and on the test to solidarity within the European Union (EU) in response to the pandemic. It concludes by setting out lessons learned and proposing ways of strengthening solidarity in preparation for the next pandemic or global health crisis.
Methodology
The research findings presented here are based on a combination of one-to-one interviews with key stakeholders and experts from a range of organizations, and a review of academic, peer-reviewed literature and other sources.
Stakeholders were selected on the basis of a convenience sample of global health and pandemic governance experts, identified through the Chatham House Global Health Programme’s network of colleagues, partners and collaborators. The initial sample was made up of 114 stakeholders, and was designed to optimize the balance between expertise, and geographic and gender diversity: 68 stakeholders were based in an HIC, and 46 in an LMIC; 62 stakeholders identified as male; and 52 as female. The skew towards HIC perspectives largely reflects the unequal distribution and concentration of global health knowledge and resources in HIC settings, where many of the major actors and players are headquartered. This is set out in Table 1, which shows stakeholders’ organizational and regional affiliations. Although categorizing stakeholders by their physical location further adds to this skew (as many of those interviewed may have dual HIC and LMIC perspectives and expertise), this method of categorization was deemed the most representative of their position within the global health system.
Given the evolving nature of this research, the literature was reviewed purposively to support and supplement key insights and findings emerging retrospectively from the interviews. Both peer-reviewed academic and grey literature was searched between January and May 2021, using Google Scholar and Google databases respectively.
Of the 114 stakeholders initially contacted, 61 (54 per cent) were interviewed; 13 (11 per cent) declined owing to scheduling issues; and the remaining 40 (35 per cent) did not respond to follow-up contact. Of the 61 stakeholders interviewed, 40 were based in an HIC and 21 in an LMIC; 31 identified as male and 30 as female. The imbalance in HIC versus LMIC perspectives is acknowledged as an important limitation, as are gaps in regional diversity (see Table 1). Efforts to compensate for this imbalance were made in the literature review and writing phases where appropriate.
The interviews explored the extent to which different actors in the global health space have expressed and demonstrated solidarity; and the major factors enabling and undermining solidarity. The standard questions included the following:
- What is your understanding of solidarity?
- What has worked well in terms of solidarity?
- What has worked less well?
- What lessons can be learned from the experience of the pandemic to date in relation to building solidarity?
Interviewees were asked to reflect on solidarity at different levels of the governance architecture: at the global and multilateral level on solidarity between countries and international actors; at the regional level on solidarity between countries within the same region; and at the national level on solidarity within countries, namely between policymakers, the scientific and public health communities, and the population.
Interviews were conducted virtually between November 2020 and January 2021, and lasted up to one hour. Thus, another limitation of the research is that major findings are timebound, based on stakeholders’ perspectives over a particular period in the pandemic. The literature review, conducted retrospectively, helped to overcome this limitation.
All interviews were transcribed and analysed to draw out the major themes and patterns of observation. The interview transcripts were anonymized. Quotes used in this paper have been coded by organizational affiliation to protect the anonymity of interviewees (see Table 1).
