Introduction by Croakey: The World Health Organization has released six policy briefs to support national and global efforts to end the COVID emergency worldwide. They include recommendations on testing, clinical management, community engagement and communications.
Releasing the briefs, WHO Director-General Dr Tedros Adhanom Ghebreyesus said they are an urgent call for governments to take a hard look at their policies, and strengthen them for COVID-19 and future pathogens with pandemic potential.
He said the number of weekly reported deaths from COVID-19 last week around the world was the lowest since March 2020. “We have never been in a better position to end the pandemic. We are not there yet, but the end is in sight,” he told a media briefing.
“A marathon runner does not stop when the finish line comes into view. She runs harder, with all the energy she has left. So must we. We can see the finish line. We’re in a winning position. But now is the worst time to stop running.
“Now is the time to run harder and make sure we cross the line and reap the rewards of all our hard work. If we don’t take this opportunity now, we run the risk of more variants, more deaths, more disruption and more uncertainty.”
Amongst other recommendations, the briefs urge governments to communicate clearly with communities about any changes to COVID policies – a timely prompt for Australian governments given ongoing concerns about lack of transparency around National Cabinet decisions – and to train health workers to identify and address misinformation.
Meanwhile, Croakey editor Dr Amy Coopes reports below on some related discussions about lessons from the “pandemicene”.
Amy Coopes writes:
Disinformation, political self-interest and social division have had a chilling effect on global efforts to tackle the COVID-19 pandemic, with evidence trumped by expedience in a cycle of “panic and neglect” at a time when climate-driven cascading disease outbreaks demand healthier policy making.
These were among the issues raised during a wide-ranging discussion between Pulitzer Prize-winning science journalist Ed Yong and renowned epidemiologist Professor Raina MacIntyre at the recent Antidote festival, held at the Sydney Opera House on Sunday.
The one-day event featured an array of eminent speakers including actors, musicians and politicians, with talks pondering the big questions as the world emerges from SARS-CoV-2 shutdown. The novel respiratory virus has surpassed 600 million infections globally, and claimed some 6.5 million lives.
In a session titled Welcome to the Pandemicene – a neologism Yong said he coined to capture what was shaping up to be a critical era in modern human history for new and resurgent infectious diseases – some of the pearls and pitfalls from the world’s COVID-19 response came under scrutiny.
Yong won journalism’s highest prize for his much-lauded coverage of the pandemic at The Atlantic, while MacIntyre, who is head of global biosecurity at the Kirby Institute, has been among the most outspoken critics of Australia’s COVID response, particularly on the importance of vaccines-plus strategies, including masking and ventilation.
The pair offered frank assessments of how the world had handled the pandemic, which is now in its third year, providing numerous timely insights on the social, longitudinal and political dimensions of a crisis Yong warned was just a taste of what was to come in the so-called ‘pandemicene’.
“it’s been clear for a while that we, the world, were going to be beset by new and re-emerging infectious diseases in a very regular drumbeat,” Yong told the audience Sunday, dialing into the event from Washington DC.
“We’ve seen Ebola, Zika, various strains of flu, COVID, monkeypox is now sweeping the world. This is a thing we can and should continue to expect, and it’s going to get worse, not better.”
Yong said climate change would accelerate this process by driving species into new ecological niches, and into contact with other species they had not previously crossed paths with, creating new viral mixing opportunities and more chances for human spillover events.
“This has already been going on for some time, we are sort of at the peak moment of this right now, these current decades that we are living through,” he added. “And it’s the case that even if we cease all greenhouse emissions tomorrow that process is going to continue steamrolling on into the future. So we do need to grapple with this new reality we are living in.”
While COVID had offered up plenty of lessons for future pandemics – many of which Yong described as things we already knew but had failed to heed – he said he was not optimistic about things being done differently next time around, given recent experiences.
The central problem when it came to the pandemic had been its framing, and the secondment of the science to values propositions and political imperatives, Yong said.
Disease outbreaks had long been understood as social phenomena, but scientific and technological advances had seen an ascendant biomedical paradigm focused on treatments and vaccines which – while obviously important – had obscured the role of upstream, population-level determinants likely poverty, education and insecure work, Yong said.
He pointed to the US as a textbook example, noting that despite being widely regarded as number one in the world in terms of preparedness prior to the outbreak of COVID-19, it had suffered “arguably the worst outbreak in the industrialised world” with more than one million deaths.
Yong attributed this to “incredibly weak” social infrastructure and low levels of trust, both between citizens and of government by the populace. He said COVID had exposed the US healthcare system as extremely vulnerable and “very easily overrun”, along with an ailing social safety net which left many with “no choice but to sacrifice their lives or risk their health in order to protect their livelihoods”.
“There is this constant underlying vulnerability that occurs when your social fabric is threadbare and frayed,” Yong said.
He described the pandemic response as paroxysmal, characterised by cycles of panic and neglect, driven in large measure by the media, who Yong said had a “complete wrong-headed approach” to coverage, which required grappling with longitudinal, cumulative costs and ethical considerations.
The media had failed to apprehend and convey that COVID was a long-term problem that would require protracted public health measures, and that the need for collective action greatly outstripped calculations of individual risk.
“The problem with the pandemic and many of these diseases is that the risk at the societal level is always considerably greater than the risk at the individual level,” Yong said.
“When you get infected and pass the virus on to other people you can create chains of infection that do things like slam the healthcare system, that lead to disability because people develop things like long COVID. Your individual risk is always going to be lower than your contribution to society as a whole, so we have to think about this collectively and we have to treat these as collective problems. And I think, in the main, we have not.”
Disinformation, profit and power
Disinformation and the co-opting of COVID-19 into broader social movements utilising “information warfare” had been a sobering lesson, MacIntyre told the audience, describing it as the latest chapter in a sorry history of the bastardisation of science for corporate and political gain, as with tobacco and fossil fuel interests.
MacIntyre, who has been subject to intense and targeted ad hominem attacks online for her advocacy and commentary regarding ‘vaccines-plus’ measures such as clean indoor air and the ongoing use of masks, said the pandemic had seen disinformation peddled at all levels, from social media punters through to scientists and world leaders.
“Often these are orchestrated attempts to create a narrative or achieve a political outcome without the use of force,” she told the audience. “That’s the difficult part, trying to separate out who is actually speaking truth about science versus people who are just selling themselves for profit and power.”
Both corporate and state interests were involved in such campaigns, MacIntyre said, adding that “there are a lot of profound social changes happening as a result of disinformation”. The coalescence of far-right extremist groups and alternative lifestyle communities over opposition to vaccines was one such example, she said.
Crisis of values
Yong said this illustrated a fundamental flaw in science and health communications, which is that it too often started from a deficit premise, seeing audiences as “empty vessels into which you pour knowledge, and that is how you change hearts and minds”.
“People process information according to their values, identities, cultural beliefs, and this is really important to understand,” he said. “To actually make progress you have to meet people where they are, you need to understand what’s at the root of their resistance to whatever you are trying to tell them.”
“You need to try and find shared cultural values, shared moments of identity.”
Rather than a crisis of facts, Yong said the pandemic had exposed a crisis of values, with individualistic framing of a collective problem “as much of a misinformation problem as a lot of the other things that typically fall under the banner”.
“And it’s a much harder thing to deal with because at its core it is not a science issue, it is an issue of our values and what we believe,” he said.
Yong went on:
Do we care about things like equality, do we care about the collective good? Do we care about protecting the vulnerable, the immunocompromised, the poor, people who are sick long-term?
Those are questions for society to grapple with ethically, and I think that is what we are sort of missing in this discussion.
Often the science is clear, but you could make very different decisions based on how you filter that science through the lens of your own values, and I think it’s the values piece that we need to get better at.”
The day after her Opera House appearance, MacIntyre tweeted that she had tested positive for COVID.
Overall, she gave Australia a 5/10 on its pandemic response, saying we had done well with shutting the borders and buying time to vaccinate the population to very high levels, but had dropped the ball on booster doses and health communication, particularly in culturally and linguistic communities where MacIntyre said disinformation had been allowed to take hold.
She said the pitfalls in Australia’s response included “the polarisation and politicisation of things that are just public health”.
MacIntyre said political and media messaging that the pandemic was over and it was back to business as usual had contributed to healthcare worker burnout when, “what they have to do and deal with is the opposite of the public narrative” and they faced “occupational hazards day in and day out.”
Yong echoed this, describing a mass exodus of generational knowledge and experience out of a “shredded” health care system that would reverberate for decades to come, with health care workers reeling from the trauma of three cumulative years of COVID surges interspersed with frantic efforts to address the mounting backlog of delayed and deferred care.
“We can’t do this business as usual thing as expect the health care system to pick up the slack,” he said.
“You’re not going to yoga your way out of the moral injury health care workers are facing,” added Yong. “The simple fact is a lot of them got into their job to help people, and the circumstances of the last three years – the political malfeasance, the poor responses from institutions, patients not getting vaccinated, patients being antagonistic – all of that means they cannot provide the level of care that they want to provide.”
Relying on doctors and nurses as the “frontline” to a pandemic was itself an admission of and pretext for failure, Yong said, calling for strengthening of community health, public health, prevention and the social safety net.
The pressure on healthcare workers and strain on a system that had been teetering on the brink before COVID-19 hit was explored at a separate Antidote session featuring Croakey editor Dr Amy Coopes, Fairfax alumnus-turned-psychiatry trainee Lisa Pryor, and physician-broadcaster Dr Norman Swan.
The crossover between journalism and medicine, particularly at the height of a global public health emergency, was in focus at the event titled A Higher Calling, with the trio reflecting on the tradeoff between a one to one conversation, and reaching the masses in abstract.
Coopes and Pryor shared insights from their respective journeys into medicine from the media, and debated the meaning of vocation, place of ideals and activism in the often conservative world of medical practice, and how far a doctor’s duty extended to advocate for their patients.
They also extolled the value of narrative and bearing witness across the two professions, as an act of solidarity, respect, and healing.
You can watch playback of the livestream of both talks, and the full Antidote program, via the Sydney Opera House. (Link to streaming Festival Pass: Antidote 2022 – Stream – Sydney Opera House).
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