After the pandemic

How will COVID-19 transform global health and development?

By Michael Igoe and Vince Chadwick 

The COVID-19 pandemic has created unprecedented disruption for the global health and development community. Organizations fighting infectious disease, supporting health workers, delivering social services, and protecting livelihoods have moved to the very centre of the world’s attention. But they find their work complicated by challenges of access, safety, supply chain logistics, and financial stress like never before.

The short-term implications of this global challenge are evident everywhere, but the long-term consequences of the pandemic — how it will reshape health and development institutions, occupations, and priorities — are still difficult to imagine. Here are insights and predictions from some global health and development thinkers and leaders.

Massive costs spark billions in investment

Ngozi Okonjo-Iweala is chair of the board at Gavi, the Vaccine Alliance, and Nigeria’s former minister of finance.

It is clear that the outcry in virtually every country about the lack of equipment and supplies to test for and protect against COVID-19 will lead countries to re-examine their supply chains for critical health and livelihood related products. This will lead to a surge of nationalism with respect to the need to produce pharmaceuticals, medical supplies, and equipment domestically. Even countries that traditionally had no capability in these areas will seek to develop the same.

The realisation that the economic costs of a pandemic can be huge, far surpassing investments in research and prevention, will lead to billions more dollars of investment in research, vaccines, therapeutics, and non-medical methods of prevention. This will mean that trillions of dollars in economic losses, loss of life, and loss of livelihoods for millions of poor people all over the world will be averted.

A new excuse for isolationism

Madhukar Pai is director at McGill Global Health Programs.

I am anxious that rich countries, having suffered huge economic losses, will use COVID-19 as the excuse to cut development assistance for health and reframe global health as a limited “national security” exercise. The pandemic could become the new excuse for nationalism, isolationism, anti-immigration policies, and institutionalized racism. We are already starting to see some of this. All of this could increase inequities that already plague global health, and further concentrate power among the elite in the global north.

A humanitarian access problem

Janez Lenarčič is European commissioner for crisis management.

The crisis, if not managed by a substantial and coordinated global response, will highlight and deepen the divide between North and South, challenging the multilateral system and global solidarity on an unprecedented scale.

Humanitarian action, too, is starting to be affected in numerous ways: Movement restrictions  and the suspension of commercial air transport routes risk having a severe impact on a basic prerequisite for any form of humanitarian action — access to affected people. If the pandemic starts affecting the functioning of global food markets, the impact will be most acutely felt by the most vulnerable.

A movement toward self-determination

Viwanou Gnassounou is assistant secretary-general for sustainable economic development and trade at the Organisation of African, Caribbean and Pacific States.

Like many other crises, the current health crisis will leave a trace on how we interact with our environment and with each other. But observing the initial reactions in different quarters, it seems that the COVID-19 and the ensuing economic temporary derailment are unlikely to bring substantial change to the conception and management of development cooperation policies, even in the health sector, from the development partners’ perspective.

It will, however, undoubtedly add to the factors which are bringing developing countries closer and closer to the self-determination of their development track and the choice of the most suitable policies and partners to accompany them. It will not be a drastic, but rather an evolving, change.

Now, each country has discovered further its fragility, reflected in the dependence on the rest of the world to satisfy the maintenance of the way of living, and at the same time, the isolation and loneliness when attempting to respond to a major exogenous shock. And it is just a beginning.

The state is back

San Bilal is head of trade, investment, and finance at the European Centre for Development Policy Management think tank.

The COVID-19 crisis has the potential to radically change development for the better. First, it shows how interconnected and interdependent our world has become: There is no way of tackling the COVID-19 crisis at national levels only; “helping you is helping me,” “solidarity is in my self-interest;” international cooperation and multilateralism are back!

Second, COVID-19 illustrates our common vulnerability, across borders, beyond North-South, East-West, public-private divides, and the limits of our segmented approach to development; a more holistic, comprehensive, and coordinated approach is back!

Third, strategic interventions by the state become central again, to address the health, social, economic, food impacts of COVID-19: with a major economic contraction, public budgets will have to become more strategic, more focused, more counter-cyclical and leverage more (private) finance for development; social policy matters, private sector is key, the state is back!

Fourth, COVID-19 stimulus and recovery packages are needed, and provide a golden opportunity to engage in ambitious sustainable transformation initiatives by all, including developing countries, based on systemic changes toward more sustainability, inclusivity, and equity; active transformative sustainable approaches and a “green deal” agenda are back!

Our world is fragile — let’s work together to preserve, enrich, and enlighten it.

Accelerating technology uptake

Amie Batson is executive director at WomenLift Health and Stanford Global Health.

The COVID-19 pandemic will transform the global health community’s acceptance and use of digital health technologies. As health systems around the world are overwhelmed responding to COVID-19 while continuing to provide health care services, leaders are adopting technologies that only three months ago were on the sidelines of most health care systems.

As doctors, patients and home care providers turn to telemedicine to reduce exposure to COVID-19, they are discovering these virtual consultations are effective for triaging care, sharing critical guidance, and providing emotional support.

“Each country has discovered further its fragility, reflected in the dependence on the rest of the world to satisfy the maintenance of the way of living, and at the same time, the isolation and loneliness when attempting to respond to a major exogenous shock” 

Dashboards for logistic management systems are improving the efficient deployment of essential resources — from hospital beds to PPE to, ultimately, vaccines. More advanced technologies including AI are being employed to provide insights into complex questions of how individual behaviours impact transmission and identifying which policies are effective for specific groups.

As the saying goes, “you can’t put the genie back in the bottle.” Once deployed, the use of these technologies will only expand as we revert back to solving the challenges problems that preoccupied us prior to COVID-19 — too few health personnel, inadequate budgets, and weak health systems. Maybe these technologies will be what helps us get closer to our shared goal of universal health coverage.

Digital connectivity finally delivers

Polly Dunford is president and CEO at Intrahealth.

Sometimes it takes a crisis to force us to adapt and adopt changes. For example, I have met very few of my new colleagues face to face, but we’re all more connected than ever.

We’re working out the kinks that have plagued teleconferencing and videoconferencing systems. We’re learning them and making them work seamlessly, because we have to. We’ve used digital learning and telemedicine to expand the reach of global health but haven’t seen ubiquitous uptake.

COVID-19 could be what makes us finally deliver on the promises of remote learning and support, impacts that will serve health workers — particularly in rural areas — long after this pandemic ends.

Less tolerance for wasted resources

Michael Eddy is senior adviser at GiveWell.

The COVID-19 pandemic demands rapid responses. We will be forced to learn quickly about what works. Some responses to the COVID-19 pandemic will be more effective than others. I’m hopeful we will learn which parts of our bureaucracy respond most effectively so we can lean on them in the future. We can also learn how to better use data, evidence, and technology to improve our ability to react to crises. In moving fast and learning fast, we’ll strengthen the muscles we as a community need to respond to the uncertain environments that are an inevitable part of our work going forward.

Even before the pandemic, the global health and development community has had to stretch its resources to meet global challenges and life-saving commodities have been underfunded. Now, resources are likely to be more constrained than ever. Inefficient and wasteful spending will be even more noticeable during this crisis. This pandemic will force us to articulate what matters most and to prioritize investments.

A focus on sustainable service delivery

Catherine Connor is vice president of policy and advocacy at the Elizabeth Glaser Paediatric AIDS Foundation.

This pandemic will force a re-examination of global health architecture to promote an approach to sustainability that significantly increases investment in emergency preparedness with an eye to how that investment supports, but does not supplant, “regular order” service delivery. COVID-19 has put greater value on data, research, and epidemiological surveillance — things regularly used in public health — now supercharged to inform a pandemic response.

It has to be seen if the crisis will have any promising effects on the spending patterns of affected countries in the global south. Most of them do not spend enough on health care. Will this change in the future? Will they invest more in prevention? Will they pay higher salaries to their medical staff so that they do not migrate to richer countries? Will they develop systems of health insurance?

COVID-19 could be what makes us finally deliver on the promises of remote learning and support, impacts that will serve health workers — particularly in rural areas — long after this pandemic ends 

There is reason for concern about the commitment of the richer countries to safeguard good health — and thus prevent pandemics — worldwide. It goes without saying that $5 of aid in health per African citizen is not enough to guarantee even basic health services. The Americas are devoting 6 percent of their official development assistance to health; Europe a meagre 2.3 percent. This will have to increase significantly if dramas are to be avoided.

More health spending

Patrick Develtere is principal adviser for European social policy at the European Political Strategy Centre.

It has to be seen if the crisis will have any promising effects on the spending patterns of affected countries in the global south. Most of them do not spend enough on health care. Will this change in the future? Will they invest more in prevention? Will they pay higher salaries to their medical staff so that they do not migrate to richer countries? Will they develop systems of health insurance?

There is reason for concern about the commitment of the richer countries to safeguard good health — and thus prevent pandemics — worldwide. It goes without saying that $5 of aid in health per African citizen is not enough to guarantee even basic health services. The Americas are devoting 6% of their official development assistance to health; Europe a meagre 2.3%. This will have to increase significantly if dramas are to be avoided. ( (Devex.com)