Following thousands of deaths and infections in the world’s most developed countries, the coronavirus is beginning to reach developing countries with their fragile health systems – and with terrible consequences predicted. Today is World Health Day and we remember the massive need for a global effort to create and strengthen public and universal health systems around the world.
Having left more than 70,000 dead along with nearly 1.5 million identified cases and causing health systems to collapse in developed countries in Asia, Europe and the Americas, the Covid-19 pandemic is beginning to reach a number of regions in the developing world. Its unstoppable progress and high rates of transmission lead us to fear – greatly – the potential consequences for the African continent, which has countries with the world’s weakest health systems, as well as low-income countries in Central Asia and Latin America, where there are enormous inequalities in terms of access to health.
In many countries in these regions, there are additional social conditions that make the crisis worse: inadequate primary care networks, enormous deficiencies in regard to infrastructure, equipment and healthcare staff, rights over access to health being violated, and overcrowding. There are too many areas where even the most basic prevention tasks – such as handwashing – are difficult. In sub-Saharan Africa, for example, only 15 per cent of people have regular access to soap and water.
Furthermore, coronavirus places and will continue to place an enormous additional burden on weak healthcare systems and economies that have been struggling with disease for decades without much success. Epidemics such as tuberculosis – the world’s most deadly respiratory disease, killing 1.5 million people a year – malaria, dengue fever and HIV/AIDS. The collapse of healthcare systems will mean that medical care will not be available for these and many other diseases. Basic treatment and vaccination services as well as medicine supply chains will also be disrupted.
There is a huge fear that Covid-19 will reverse the progress made in dealing with these pandemics over recent decades. The virus will strike hardest at vulnerable populations in those countries affected by respiratory diseases, such as tuberculosis, and immunosuppressive diseases, such as HIV. And especially those who live with one of these diseases without knowing it due to a lack of diagnostic tools in under-resourced health systems. WHO, for example, estimates that 40% of the world’s tuberculosis cases go undetected.
Universal Health Coverage – a priority
In view of this, the international community and world’s governments must ramp up their efforts to finance and strengthen the healthcare systems in all countries, especially those that are least developed. And they need to understand that only by doing so will it be possible to combat globally and effectively a pandemic such as this or others that are sure to come in the future.
Effort and investment, moreover, that match the commitments made under the United Nations’ Sustainable Development Goals – namely, to achieve universal health coverage. That is, to ensure that all people around the world receive the quality healthcare services they need, with access to safe, effective and affordable medicines and vaccines, without economic or administrative discrimination. And leaving no one behind.
In the specific case of this pandemic – where a vaccine does not yet exist and treatments are still in the clinical trial phase – effort is needed to accelerate the availability of all knowledge and technologies resulting from research as global public goods, without monopolies and at affordable prices, to ensure that they are accessible to all who need them, including people living in countries with fewer resources.
And it should not stop there. Given that most research is being conducted in high-income countries, it is unlikely to respond to the needs and requirements of developing countries. But it should. As warned by DNDi – which is already running a project in this area – preventive approaches and tools designed for cities like Bangkok and Berlin will not be valid for Lubumbashi or Lilongwe.
A clear example of the importance of healthcare for all
The importance of strong, universal healthcare systems, even in the most developed countries, can be seen in the USA, where there are now more than 350,000 diagnosed cases and 10,000 people have died. The lack of public healthcare for all, along with tardy political reaction, also raises fears about the terrible consequences that coronavirus will have there.
This is not news: millions of Americans avoid visiting the doctor due to fear of the costs involved. On top of that, every year more than half a million people file for bankruptcy because they cannot afford the high medical costs associated with their illnesses. This is a country where nearly 28 million of its citizens currently have no health insurance, in addition to 11 million undocumented migrants.
Although the coronavirus test has so far been free for the entire population, recent analysis warns that an uninsured US citizen hospitalised with coronavirus may have to pay bills of up to $75,000. For those who are insured, and depending on their policy, those costs could be up to $40,000.
Many in the US are calling for the creation of a universal healthcare system. As advocated by a team of epidemiologists from Yale in a study recently published in The Lancet, this policy, if implemented in the United States, could save 68,000 lives a year along with $450 billion in taxpayer dollars.
Global pandemic, global solution
Maybe the developed world will now understand what it takes for a single disease to bring about the collapse of the healthcare system (something that impoverished countries face every day) and understand the need for a global and coordinated response.
The World Health Organisation (WHO) is leading a global effort and has created the Solidarity Response Fund so that individuals, corporations, foundations and other organisations around the world can support the WHO’s work to help the most vulnerable countries prevent, detect and respond to the Covid-19 pandemic, including accelerating efforts to develop vaccines and treatments. But this is no more than a patch that also highlights the lack of sufficient financial support from member states that the WHO has suffered from over the years.
The global response must not be a one-off, nor limited to this crisis. Today, on World Health Day, faced with a health crisis that is unprecedented in decades, the international community and the world’s governments must remember the need to step up their efforts to increase funding and strengthen healthcare systems in all countries, making them strong, solvent and universal, and capable of providing quality and affordable services to all. And leaving no one behind.