Covid19 has shown that a health response alone won’t solve our current crisis. We need to focus on the big picture: political, governance, financing, and civic space issues.
Covid has not only exposed many health and development challenges, it has also exposed political and governance failures.
The clearest evidence of these failures is that there are over 43 million recorded infections, in every single country in the world, and over one million deaths (1) that could have been prevented, many also in the most advanced economies and democracies.
Although the impact of these failures is currently most evident and debated in global health, the same failures are impacting many other global issues as well, including climate change.
In this article, I outline why we need to focus on the big picture to resolve our current crisis, and why politics, governance, financing, and civic space should be front and centre of our response.
The failure of politics
Over the past decade, we have seen a sharp rise nationalism, and in parallel also rising inequality – also in the most advanced economies and democracies.
For global health and development, nationalism and inequality has recently been most evident in erratic border closures, bilateral deals for and hoarding of Covid19 protective equipment (PPE), and advance vaccine purchases.
The UN just published data this week that rich countries have purchased 100 times more equipment for Covid19 than poor countries. (2)
The result is that those who need support most are being placed at the very end of the line.
Another sign of nationalism is that some key countries have stepped out of multilateralism and collaboration – most notably the US, which is leaving WHO.
These political trends of rising inequalities and nationalism have been there before Covid19, but Covid19 has laid bare where we’re are at when it’s not just about rhetoric, but making actual decisions on who gets limited resources.
The failure of governance
Covid19 has again raised the question whether institutions and collaboration across national borders are strong enough.
Do we have coherent and timely policies (e.g. to respond to a pandemic, which jumps across borders)? Are we focusing on where action is needed (e.g. countries with most cases and weakest health systems to contain and cope)?
The problem we face is that health is primarily still organised and funded nationally (public health), and the primary responsibility of states is towards their citizens.
But Covid19 has again shown how a disease doesn’t care about or work with borders, and our lives are not contained within the borders of nation states anymore either.
This means that every weak health system in ANY country is a threat to the health in OUR country.
Global responses can only be coordinated through global health, using multilateral institutions – which are, however, chronically underfunded. The WHO budget of around US$2.5 billion p.a. (US$ 4.84 billion for 2020-21) is less than the budget of Geneva’s university hospital (3), or around 3% of Disneyland’s annual budget (US$ 69.7 billion in 2019). (4)
Week support for multilateralism isn’t only a problem at the global level: it’s also a regional problem. The EU’s planned global health budget over seven years is EUR1.7 billion, that’s a pitiful EUR242 million p.a. (5)
The failure of financing
We clearly have a shortfall in budgets and also where funding goes: it’s not going to those countries that would need it most.
But we also need to look at what we are actually financing. Are we investing in prevention, or only in the response to crises? The Covid19 response has so cost US$11 trillion; preparedness would cost about $39 billion. (6) The response is therefore costing us more than 300 times what the cost would have been if we would have invested in prevention. Every week, the costs of the response rise exponentially. And these figure include just the financial costs, not including lives lost, human costs of losing jobs, education, and freedoms.
We face a similar challenge with social security systems, or most clearly climate change – and are left with the question: are we willing to finance prevention?
This question about prevention is ultimately one that is a political choice: are we willing to invest resources into the right areas, at the right time? Are we willing to change the way that we tax people and businesses, organise our economies and strengthen our social systems?
The failure of civic space
The Economist has over the past weeks published several articles on how Covid19 is being used to crush civic space in many countries, whereby e.g. ‘fake news’ restrictions on Covid19 are used to silence any political criticism.
But this response itself also shows a trend we’ve seen for several years (and highlighted by groups such as e.g. HRW and Civicus): many countries have been curtailing the voice and inclusion of civil society, including advanced democracies such as Australia and the US.
The result in Covid19 responses has been that they have been primarily medical responses, without civil society or community representation in the design and decision-making. And it’s not just civil society that’s missing, out of all Covid19 task forces, 85 percent have been composed of men. (7)
This means that aspects relating e.g. to minorities, women, stigma of patients, but also questions how to communicate and organise at community level being ignored, undermining buy-in and the entire response.
A very concrete example of why this matters is domestic violence. During the first wave of Covid19, “stay at home” campaigns spread around the world. These, however, fully neglected what happens is “home” is not a safe place, an issue raised with alarm by multiple advocacy and community organisations. The result was a huge spike in domestic violence, issues that could have been prevented with a more inclusive, comprehensive approach.
A comprehensive approach requires a focus on the big picture
The Covid19 response has shown that we can’t just focus on health, or development aid – we need to look at the big picture: this includes political, governance, financing, and civic space issues.
If we don’t address these broader challenges – and in many case outright failures – we will not be able to tackle this current Covid19 crisis, nor other ongoing and future crises, including climate change.
Covid19 has been an eye-opener and has laid bare many challenges that have been brewing over several years: nationalism, inequality, weak global governance, curtailing of civic space, lack of financing.
If we focus on health alone in this response, we will fail. We will also fail in our responsibility to address other ongoing crises, and to prevent many future crises.
***
The substance of this article was presented at the launch of The New Network on Health and Governance on 29 October 2020.
(1) WHO Covid19 Tracker: https://covid19.who.int/
(2) UNCTAD: https://unctad.org/news/global-trade-shows-frail-recovery-third-quarter-outlook-remains-uncertain
(3) Globalization and Health: https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-018-0436-8
(4) Disneyland Annual Report 2019: https://thewaltdisneycompany.com/app/uploads/2020/01/2019-Annual-Report.pdf
(5) Euronews: https://www.euronews.com/2020/10/20/eu-not-prepared-for-next-pandemic-according-to-meps
(6) GPMB: https://www.weforum.org/agenda/2020/10/economic-cost-covid-global-preparedness-monitoring-board/
(7) BMJ: https://www.weforum.org/agenda/2020/10/economic-cost-covid-global-preparedness-monitoring-board/
Katri Bertram 
I am greateful having this blog. keep writing like this article