Introduction by Croakey: Global health specialists have been warning for decades that we were at risk of a devastating global pandemic and would likely fail to manage it.
Now here we are living through the deadliest, most economically challenging year in recent history, writes Meera Senthilingam, a London-based journalist, editor and consultant specialising in global health and infectious disease, who had written countless articles sounding those pandemic warnings.
Senthilingam, who has joined the Croakey team to write on global health issues, was formerly international health editor for CNN. She has also worked with media outlets including the BBC and the New York Times and research institutions including the LSHTM and the Wellcome Trust.
She was working on her now published book — Outbreaks and Epidemics: Battling infection from measles to coronavirus, as the first cases of COVID-19 emerged late last year.
Now nearly 12 months on, Senthilingam asks why the world has not yet got a handle on this disease, and where lie the ongoing risks — health, economic and political.
Her article comes ahead of the 3 November US presidential election and amid this week’s warning from World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus for the world to stop the politics around COVID-19.
Tedros said:
“When leaders act quickly and deliberately, the virus can be suppressed. But, where there has been political division at the national level; where there has been blatant disrespect for science and health professionals, confusion has spread and cases and deaths have mounted. This is why I have said repeatedly: stop the politicisation of COVID-19.”
Meera Senthilingam writes:
Last year I interviewed Mike Ryan and Sylvie Briand from the World Health Organization – two names that were known mostly to global health experts and specialist reporters like myself at that point in time, but have since become household names as they lead the health agency’s battle against Covid-19.
These were phone interviews slotted neatly into specific time slots that worked not only for the extremely busy UN experts but for me, as I was simultaneously looking after a 6-month old and had managed to get childcare for just a few hours that week. (Even on maternity leave you never stop being a journalist).
Back then, the two health emergency experts outlined the struggles they face in containing infectious diseases in an increasingly globalised world.
They highlighted a large-scale yellow fever outbreak in Angola that had spread to China and thankfully fizzled out there, and what they went through to eventually control Ebola in West Africa back in 2014-15.
But, importantly, they stressed ongoing concerns over the inevitability of something more damaging. A new, unknown infection going on to infect large proportions of the world, causing extensive damage in its wake — the long feared pandemic — and the fact that we still weren’t really in a place to stop one.
Fair warning
As a global health journalist, I’ve lost count of the number of articles I’ve written over the years that listed the various reasons a global pandemic was inevitable.
It was either that or pondering if the world was in fact ready for a global pandemic – the answer to which was always no, as Ryan, Briand and many other experts before them corroborated.
Cities were crowded, living conditions often undesirable, people were living closer to animals, and health care services were strained across the globe. Either that or people simply didn’t have access to health care, either due to proximity or cost.
The combination was just right for a new infection to not only emerge but also thrive.
SARS had set a precedent in 2003 but was thankfully contained fairly quickly (in terms of a pandemic) despite reaching 26 countries. It infected 8000 people globally and caused 774 deaths.
Then H1N1 arrived in 2009 and while it had a marked impact it on the world, it ended more smoothly than people had predicted.
It wasn’t as fatal as experts had first thought and it turned out the virus resembled previous strains enough that many older people showed some form of immunity to it.
I covered the pandemic for a science radio show I worked on back then, the Naked Scientists, and remember that although our coverage was regular and extensive, it was nothing compared to COVID-19.
My flatmate in London at the time had symptoms and was prescribed antiviral treatment, but again this didn’t feel like a particularly big deal. Living with her, I didn’t feel a need to hide in my room.
Throughout these years since I’ve explored the topic of pandemics and the challenges of controlling infectious diseases in general for various media outlets, including CNN, the BBC and New Scientist, and even ran workshops and courses on reporting on them for journalists across Africa.
As a journalist with training in the control of infectious diseases, this was my patch. I knew a pandemic could happen.
Despite reminding editors there were in fact many infections already causing a great deal of damage out there, tuberculosis and malaria being two examples, the elusive pandemic is what would spark people’s curiosity.
Something new and unknown that anyone and everyone was susceptible to, something that evened the playing field when most infections predominantly infect the poor, marginalised communities of the world.
It fascinated them, this enigma that people long feared but didn’t quite think would happen.
And then it came. COVID-19. A coronavirus infection that snuck in and spread far before anyone took it seriously enough.
Now here we are, living through the deadliest, most economically challenging year in recent history.
And while I knew something like this was inevitable, what I didn’t know was how quickly it would bring the world to a standstill, effectively shutting it down.
The World Health Organization (WHO) knew this though, as Ryan and Briand pointed out in their interviews.
I interviewed them for my book, Outbreaks and Epidemics: Battling Infection from measles to coronavirus, which published worldwide earlier this year. The book explores a wide range of infections we see in the world today and the challenges we face in eradicating them, but it also contains various moments of prescience, with Ryan stating that an airborne infection that’s more transmissible than SARS “would bring society to a halt”.
Less than one year after that interview, his prediction came true.
Spotlight on inequity
When it did hit, countries such as South Korea, Taiwan and New Zealand that acted fast helped mitigate the damage. Ones that delayed, like the US and the UK, are still paying the price.
Because they dragged their feet on prevention and management, the greatest vaccine race in history is now underway to provide the world with some form of protection in a tenth of the time normally taken for such an endeavour.
COVID-19 has also put a spotlight on the world’s many other problems.
Obesity (and everything that stems from it), racial disparities, economic inequalities, political incompetence and global inequality are just the first on a list of injustices lit up in the wake of the pandemic.
For example, we watched the global obesity problem burgeon this past decade or two and cases of diabetes, heart disease, and stroke rise alongside it to leave a vast pool of people at risk of severe COVID disease, or worse death.
In almost every country, ethnic minority groups have been the worst affected in terms of infections but also severe disease and death.
Infectious diseases often affect minorities the most, but governments are finally being held to account over this due to the sheer number of deaths being reported.
In countries like the UK, reports show how disproportionate these numbers are when you look at the percentage minority groups make up of the national population.
For example, data from the Intensive Care National Audit and Research Centre in the UK revealed that 34 per cent of critically ill coronavirus patients in England and Wales towards the start of the pandemic were from Black, Middle Eastern or Minority Ethnic backgrounds, despite representing just 14 per cent of the population in England and Wales in the 2011 census.
Whether highlighting this imbalance will truly change anything is a separate question.
In addition, low and middle-income countries lack the services to truly enforce lockdowns and keep their economies going, in turn helping the virus to flourish.
Many also lack the provisions to treat large numbers of severe cases adequately. For some countries, for example across sub-Saharan Africa, demographics have served as some form of saving grace, with predominantly younger populations meaning severe cases have stayed proportionally low.
Then you have the countries like the US using political power and wealth under the Trump administration to stockpile drugs and tentative vaccines, leaving little for everyone else, and others like China and Russia keeping what they discover and develop largely to themselves — all of this further highlighting the unequal standing of populations worldwide.
The pandemic has in many ways spurred unprecedented collaboration across the world, but unsurprisingly it has also brought with it extreme division. It’s every country for themselves, as much as the WHO and other public health bodies, like Gavi, try to promote unity.
So where do we go next?
Global stakes
It’s a contentious year. Next week, the US election will determine a lot, not only for the US but the entire world and the UN bodies that represent it. So far, each day has brought a new, unprecedented twist.
As a global health journalist I have long known and reported on the power the US has over the rest of the world — the impact of it being the largest funder in almost every field and the devastation caused whenever it’s taken away by a change in administration.
A prime example of this is the constant removal and reinstatement of the ‘global gag rule’, giving and then removing funding for sexual health services in multiple countries that are reliant on it not only for good sexual health but improving gender equality.
But this year has shown the country’s own vulnerability as it struggles with multiple national challenges at once.
So again I wonder, where will things go next?
Old problems continue to persist and in fact surge in the wake of coronavirus as all attention is diverted away from them. TB, HIV and malaria programs have suffered and been set back by years, as have cancer screenings and treatments and care for chronic conditions like diabetes and heart disease to name a few.
Routine immunisations are also only now catching up with the millions unreached during national lockdowns, so will we now see measles outbreaks?
Public health services in all respects have declined.
But what concerns me most is that the world still doesn’t have a handle on things — almost one year in.
By this point in the pandemic, SARS was over and H1N1 under control. With the coronavirus, however, studies suggest it may be mutating to become more contagious and multiple countries are about to endure a flu season with this virus still at large.
On top of that countries like the UK, France and Spain are seeing second waves and don’t seem to have learned enough from the first one — the UK’s track and trace system is not functioning as it should, for example, in fact far from it.
Each day will continue to bring a new twist and in the meantime all you can do is take the right steps to protect yourself and those around you. Then comes hope that the world’s leaders will finally listen to public health experts and have effective test and trace programs in place.
It’s quite remarkable just how many countries did not prioritise this basic principle of epidemiology, because knowing where the virus is circulating is the key to stopping a virus and hoping that a vaccine will come along and save everyone is not.
A vaccine will play a role in ending the pandemic, don’t get me wrong, but it won’t be this magical elixir that gives everyone protection for all of eternity.
At best it will provide some protection and it’s likely there will be multiple forms made available to cover the almost 8 billion people living on this planet.
At first, it will also be given to those at most risk, so if we want to end this situation sooner rather than later, it’s about effectively tracking down infections and cutting them off in their tracks – something the experts have stressed since day one.
