On the eve of the pandemic, in September 2019, global leaders appeared to understand the importance of solidarity and equity in tackling health issues.
Responding, in part, to a global report warning of the dangers of a potential pandemic of a new respiratory disease, all heads of government at the United Nations General Assembly that year gave their support to achieving universal health coverage. They agreed that everyone should receive the health services they need without suffering financial hardship.
In the case of infectious diseases, this would mean that everyone would benefit from public health services that detect and control epidemics, as well as benefiting from preventive services such as vaccines and treatments for those who fall sick.
Most importantly, universal health coverage requires that such services be allocated according to need, which requires a system of solidarity whereby wealthy people subsidize services for the poor and vulnerable.
Little did the leaders’ meeting at the General Assembly know how soon these principles would be tested.
A Chatham House Research Paper in July 2021 found that solidarity in tackling Covid-19 has been decidedly mixed. On the positive side, the immediate response from the global scientific community to share data and knowledge about the nature of the virus, how it was spreading and how to combat it, was impressive.
This led to a number of collaborative partnerships between public and private sector scientists in countries across the world. An amazing arsenal of effective vaccines began to be produced by the end of 2020. Scientific solidarity had given humanity the tools to see off the virus.
The task of ensuring these commodities were produced in sufficient quantities and allocated efficiently and equitably to those who needed them fell to national governments, multilateral agencies and pharmaceutical companies.
Here, solidarity is clearly failing.
As immediately as mass vaccine distributions began, global bodies like the UN began pointing out that wealthy nations had secured enormous supplies of vaccines, many times their own populations, and this was depriving poorer nations of these life-saving commodities.
Multilateral mechanisms, such as Covax, that were established to overcome this problem, by purchasing vaccines for developing nations using pooled aid financing, were undermined. Rich nations had sewn up contracts with suppliers for earlier deliveries.
In early 2021, as Britain, the United States, Canada and the European Union raced to vaccinate more and more of their people, it soon became obvious that healthy, young people in these countries who had less need of protection were being vaccinated before high-need groups in poorer countries.
From a whole-of-humanity perspective, the world was failing to fulfil its universal health commitments. This led Antonio Guterres, the UN secretary-general, to tweet as early as January 16 that ‘science is succeeding – but solidarity is failing’.
These early warnings about vaccine inequities were amplified in May 2021 when the Independent Panel for Pandemic Preparedness and Response – co-chaired by Helen Clark, the former prime minister of New Zealand, and Ellen Johnson Sirleaf, the former president of Liberia – published its review of the Covid-19 crisis.
As well as making long-term policy recommendations to avert future pandemics, the panel listed a series of urgent actions to tackle the current pandemic, prioritizing the need to tackle vaccine inequity. These involved clear recommendations concerning reallocating supplies from stockpiles in wealthy countries, increasing funding for multilateral funding mechanisms and accelerating the transfer of vaccine technologies to developing countries to increase and diversify the supply of vaccines.
The annual G7 summit the next month would have been the ideal forum for the governments of wealthy nations to act on these recommendations and even up the distribution of vaccines. But under the chairmanship of Boris Johnson, the British prime minister, the G7 did virtually nothing – only promising to reallocate 870 million vaccines over an ill-defined period.
After the failure of the G7 summit, there were encouraging signs in September that President Biden was going to fill the political vacuum on vaccines when he called a special summit before the General Assembly. This event agreed global targets to accelerate vaccine coverage – 40 per cent of the world population by the end of 2021, and 70 per cent by mid-2022 – but again firm commitments from countries as to how to meet these targets were largely lacking. The attention of the growing global vaccine campaign switched to the G20 summit in Rome. Again, multilateral agencies joined together to present the health and economic benefits of rapid universal vaccine coverage: five million lives saved in 2022 alone and $5.3 trillion additional economic output by 2026, most of it captured by wealthy nations. But again, the heads of government failed to act.
The year is therefore ending with wealthy countries such as Britain administering booster vaccines to their own vaccinated population faster than first vaccines are being given to the entire population of sub-Saharan Africa. The World Health Organization has warned that this will prolong the pandemic by at least a year and potentially a lot longer if new virus variants appear.
Yet history shows us that although the behaviour of richer nations may be damning, the outcome need not be. The crisis and the lack of solidarity from wealthier nations could lead to universal health reforms in some countries using domestic resources.
This may appear unlikely given the downward pressure on public spending caused by the economic shock of the pandemic. Yet many of the world’s great universal health systems have emerged out of crises. This includes in Britain, France and Japan after the Second World War despite their economies being in ruins; Thailand after the Asian financial crisis at the turn of the century; Sri Lanka after malaria epidemics in the 1940s; and Rwanda in the aftermath of the 1994 genocide.
Interestingly, China re-socialized its health financing system with billions of dollars of tax in the aftermath of the Sars epidemic of 2002/3, responding to political pressure from the population.
So might the Covid pandemic trigger a new generation of universal health reforms especially in middle-income countries with the fiscal space to cover their entire population. Politically this would appear a smart move for leaders keen to improve access to health services while improving the financial wellbeing of their people.
Indeed there are already signs of leaders adopting this strategy, with Cyril Ramaphosa, the president of South Africa, and Imran Khan, Pakistan’s prime minister, both announcing they will launch universal publicly financed health systems.
Even in high-income countries yet to adopt universal healthcare there are signs of political pressure building – for example in Ireland where the crisis has galvanized efforts to launch a universal health system called Slaintecare.
Maybe, at last, this crisis might persuade the American population to embrace publicly financed universal healthcare. Already wealthy states such as California and New York are contemplating this approach.
Failings in global solidarity might be prolonging the pandemic but it could yet be the spark that ignites universal health reforms around the world as more leaders appreciate the health, economic and political benefits of financing their own health systems.