How can governments and institutions now work together to foster and sustain solidarity at all levels, to urgently address widening inequities as a result of this crisis and better prepare for the next?
In analysing how the world has demonstrated – or failed to demonstrate – solidarity in addressing the COVID-19 pandemic, the underlying theme of this paper is that solidarity is not just positive rhetoric; it is also a necessary condition for suppressing the pandemic effectively and requires strong political commitment and high levels of social cohesion.
The phrase ‘no one is safe until we are all safe’ is much used but profoundly true. This is most commonly talked of between nations: until every country has the disease under control, the pandemic is not over. But, importantly, it also applies within countries. The pandemic has disproportionately affected the disadvantaged, the poor, the vulnerable, minorities, migrants and other neglected and marginalized groups. It has ruthlessly exposed, and exacerbated, the inequalities existing in both low- and high-income countries. And it has been prolonged by the failure in many countries to adequately support and protect these groups – financially and in other ways. Where solidarity has been weak, inequities have widened, and effective responses to the pandemic have been frustrated.
There are many lessons to be learned from the experience of the pandemic to date, and many other important questions that need to be addressed. Several bodies are undertaking this, including the Independent Panel on Pandemic Preparedness and Response. This paper, however, concentrates on lessons that can be learned in relation to solidarity.
Solidarity between countries
Any new governance structures established in response to this pandemic, or reform of existing ones, must have at their core the objective of fostering global solidarity and addressing inequity.
The paper notes that the pandemic struck when global solidarity was at a very low ebb, with multiple geopolitical tensions. The pandemic has escalated those tensions, most notably those between the US and China, but has also exacerbated others, such as between the UK and the EU post-Brexit. Throughout 2020, this lack of global solidarity was reflected in the absence of significant global initiatives coming from the UN General Assembly or Security Council, the G7 or the G20. These bodies have previously come to the fore in a global crisis (as for instance in the 2008 financial crisis), but their lethargic leadership in response to this pandemic has highlighted the need for more agile and inclusive governance mechanisms that embody the values of solidarity. The G7 summit in June 2021 did something to address these deficiencies in multilateral cooperation, but still fell far short of what is needed to bring the pandemic under control globally by 2022.
In addition, governments have failed to act together in areas where solidarity and cooperation would have produced better outcomes. These failures include the unilateral imposition of travel and trade restrictions, the uncoordinated closure of borders, and in recent months threats to the production and distribution of vaccines as a result of the unilateral imposition of trade and other emergency measures in various countries. Nor have governments and stakeholders been able to agree, as yet, on proposals such as a waiver of intellectual property rights in the pandemic or on sharing intellectual property rights and know-how in WHO’s C-TAP. Above all, the biggest failure of global solidarity has been inequitable access to COVID-19 vaccines.
However, the pandemic has resulted in the creation of major institutional innovations designed to build and leverage international solidarity in fighting COVID-19. These are the ACT-A initiative and its component COVAX. Our analysis suggests that these have been widely welcomed as multi-stakeholder groups with the specific objectives of developing new tools to combat COVID-19 that also explicitly address the need to ensure equitable global access to these tools. But as new institutions, created at top speed in the midst of the pandemic, they have been hampered in fully achieving their goals, not least because many countries had already embarked on national initiatives, in particular in the development and acquisition of vaccines. They have also been criticized for being insufficiently inclusive in decision-making, particularly in relation to LMIC participation.
This mixed picture in respect of the demonstration of solidarity suggests that governments and other actors need to do better collectively in a spirit of solidarity to minimize or avoid some of the problems identified in this pandemic.
There is a need to put in place mechanisms that will help to institutionalize solidarity ready for the next global health crisis. For example, the Independent Panel recommends transforming the current ACT-A infrastructure into a permanent platform with representative governance and an equity-driven strategy. Such structures will require additional mechanisms to support operationalization and ensure accountability; otherwise they risk succumbing to the same political plays and power grabs that undermined ACT-A, and COVAX in particular, in the pandemic. There is a fundamental imbalance of power and knowledge in many existing governance structures, and this needs to be addressed and carefully reconstructed in the design of any new ones.
The principles of solidarity should be embedded in any new pandemic governance instrument, and parties should be convened regularly to review progress, encourage accountability and reinforce solidarity norms.
Solidarity cannot just be created overnight. There should be a focus after this pandemic on institutions and rules that encourage collective action. One way in which greater solidarity can be created is through countries agreeing to a set of rules about how they would prepare for and respond to a future pandemic. The IHR (2005) are the current agreed rules, but the Independent Panel in its second progress report declared the global pandemic alert system ‘not fit for purpose’ and described the IHR as an analogue system in a digital age. A Review Committee on the functioning of the IHR in the pandemic reported in April 2021, with a number of recommendations for improving the current arrangements. It did not recommend revising the IHR, as opposed to strengthening its implementation, but noted the need for a new and complementary mechanism such as a global convention.
Solidarity cannot just be created overnight, but there should be a focus after this pandemic on institutions and rules that encourage collective action.
On 30 March 2021, 25 heads of state endorsed a statement calling for a pandemic treaty. Dr Tedros stated: ‘This treaty would strengthen the implementation of the International Health Regulations, and critically, it would also provide a framework for international cooperation and solidarity.’ Yet the call for a treaty has not been endorsed by the US, China, Russia, India and many other countries whose support would be necessary for such a treaty to see the light of day. At the World Health Assembly in May 2021, member states could only agree on a further meeting in November 2021 to consider the benefits of a possible international instrument, whereas the Independent Panel had recommended actual agreement on a Framework Convention by that time. Moreover, there needs to be greater clarity on the potentially very wide scope of such a treaty, in particular the type of enforcement mechanisms available to prevent governments from rejecting solidarity norms in the next crisis. As highlighted by the International Law Impact and Infectious Disease Consortium, the process to establish or reform pandemic governance instruments presents ‘an opportunity to reinforce norms of global solidarity and compliance with international legal obligations’.
Solidarity within countries
Governments should improve the social and economic conditions of disadvantaged groups in line with their commitments to the SDGs, and through meaningful engagement with civil society and community representatives.
The COVID-19 pandemic has reinforced the body of research that relates poor health outcomes to social and economic inequalities. A major lesson from the experience of the pandemic is that an important measure of preparedness is to tackle these social and economic inequalities, which have grown in many countries in recent years for a number of reasons, including the consequences of the 2008 financial crisis. Such action will not only improve health, but also increase resilience to future pandemics. In 2015 world leaders endorsed the SDGs, the central undertaking of which is to ‘leave no one behind’. The objective of the SDGs, among other things, is to eradicate extreme poverty and provide social protection for all. In that context, a Global Fund for Social Protection, first proposed in 2012, might be a means to support countries in improving social protection and resilience for disadvantaged groups.
Governments should develop national solidarity plans to maximize protection for vulnerable groups through financial, social and healthcare measures during crises.
Governments could do little about existing inequalities when the pandemic struck: that requires long-term, multisectoral action. But there were numerous things that could have been done in solidarity with the disadvantaged and vulnerable to mitigate the impact of the pandemic on them, and consequently on the rest of the population. For example, in many countries the poor and vulnerable were often unable to self-isolate when infected, or in contact with the infected, because their livelihoods depended on their going out to work. Lockdowns also disproportionately affect the poor and vulnerable, particularly where there are inadequate or no social safety nets offered. In a great many countries, there was an absence of any planning for such groups, resulting in inadequate protection for residents of care homes, migrant workers, asylum seekers, prisoners, the homeless and many others particularly at risk because of their living and working conditions. Protecting such vulnerable groups can be challenging even with the best will in the world, but in too many countries there was a tendency to turn a blind eye to them.
The pandemic has also demonstrated that even countries with hitherto admired health systems have been overwhelmed by uncontrolled escalation of infections. In many countries, public health measures have been the poor relation of healthcare provision, but the pandemic has demonstrated their critical role as part of a holistic health system. Health systems must therefore adequately invest in the infrastructure and capacities that have enabled many countries to suppress or even eliminate the virus, not only saving lives but also mitigating the heavy economic and social costs of lockdowns. A unified health system should be able to prevent and control outbreaks and epidemics while also providing affordable and accessible health services. Health security must therefore be integrated into national health systems as part of universal health coverage (UHC). UHC was a policy endorsed by world leaders at the UN in a political declaration just four months before the onset of the pandemic, but planning and preparing for future epidemics are notably absent.
Governments, in collaboration with the leading scientific and public health communities, should provide clear and trustworthy communication to build public solidarity with crisis response efforts.
Although very important, solidarity with the poor and vulnerable is just one element in building solidarity in the whole population. The culture in many societies across Africa and Asia, and in Indigenous communities worldwide, for example, is far more community-minded than the societies in much of Europe and North America, with their prevailing individualistic climate. In some countries, particularly in these last two regions, there was a concern that the population would not countenance stringent measures. Yet, despite some well-publicized incidents and anti-lockdown demonstrations in a number of countries, this has mainly proved not to be the case. The key has been good communication from the political and public health leadership, and consistent messaging – including warning of the risks of inaction.
The quality of political leadership has proved to be a critical factor in tackling the pandemic. The ‘success’ stories, often in countries in East Asia and the Pacific region, have tended to occur where solidarity and mutual trust have prevailed between public health officials and the governing politicians, and where the public health recommendations have been well explained to the public and acted on expeditiously. In countries most badly affected by the pandemic there have often been tensions between public health officials and politicians, which then undermine public trust and willingness to comply with measures. In some countries, politicians openly disagreed with recommendations over, for example, lockdowns and mask-wearing. In others there was not so much open disagreement as a tendency to delay taking recommended measures, in particular because of concerns about their economic impact (for example with lockdowns). In some cases, a minority of public health professionals supported political and other voices that were opposed to measures such as lockdowns, mask-wearing, testing and even vaccination.
Political institutions and systems around the world need to absorb the central lessons of this pandemic, based on the experience of countries that have responded most successfully.
The pandemic has overturned commonly held assumptions about preparedness and the resilience of health systems and societies. High- and upper-middle-income countries feature prominently in the list of countries worst hit by the pandemic, measured by deaths per million to date, while many low- and lower-middle-income countries have suffered a fraction of the burden. What the pandemic has revealed is the importance of factors other than wealth – or even health systems – in effective responses. Successful countries have recognized that even the best health systems in the world will be overwhelmed if the disease is allowed to grow unchecked, and there is no alternative to the determined implementation of traditional public health measures – test, trace, isolate and physically distance. The key to doing that successfully is to support and demonstrate solidarity with the populations that are adversely affected by the public health measures necessary to address the pandemic. A central lesson is the importance of collaborative and coordinated leadership – between political leaders of different persuasions, between public health professionals and academics, and between national and subnational authorities.
