This article was originally published by The Lancet.
A historic and calamitous milestone was reached this week. WHO reported more than 10 million cases of COVID-19 and over 500000 COVID-19 deaths. The world’s political leaders have been tested and they have been found wanting. It’s hard to recall a more lamentable response to a global emergency. Even the climate crisis had its Kyoto and Paris agreements. But despite the urgency of this continuing human catastrophe, despite the immediacy of the economic collapse we are witnessing, there has still been no moment when nations have been convened to reflect on lessons to be learned, to coordinate actions to protect citizens, and to plan for future spikes or waves of infection. COVID-19 is the greatest threat to peace and security since World War 2. Since 1948, there have been ten Emergency Special Sessions of the UN General Assembly—beginning with the Suez Crisis in 1956, and including the Six-Day War (1967) and the Soviet invasion of Afghanistan (1980). Surely this pandemic is serious enough to warrant similar political attention. An Emergency UNGASS can be convened within 24 h when international peace and security are threatened. It has the power to make “appropriate recommendations to Members for collective measures”. All it takes are seven members of the 15-member Security Council or a majority of the members of the UN to call an Emergency UNGASS. A meeting under the auspices of the UN is the only means available to construct a global response to this pandemic. It’s hard to understand why such a global gathering has not yet taken place. It must take place. And soon.*
For those of us working in global health, COVID-19 has been devastating, and not only because of the toll of avoidable human loss. This pandemic is dismantling the foundations for protecting and advancing health. The right to health, health equity, and social justice form a trinity of values that animates the daily practice of global health. These values, underpinning first the Millennium Development Goals and, since 2016, the Sustainable Development Goals, have accelerated progress in women’s and children’s health, the control of epidemic diseases, and health system strengthening. But these achievements are now threatened by COVID-19, a pandemic that has still not reached its peak worldwide. Global health has entered a period of rapid reversal. De-development is the new norm. Yet no plan is in place, or even being proposed, to address this global regression in human health.
This coronavirus has accentuated inequalities on all continents, across all societies. The direct effects of the pandemic have been horrifying. The extreme age gradient in risk of death has highlighted the fact, hardly discussed, that the right to health should not diminish with age. And yet governments have abandoned protections for older people. Black, Indigenous, and People of Colour have been similarly deserted. Their extreme vulnerability to COVID-19 is not fully understood. But what is clear is that racial injustice is at the heart of understanding the effects of this pandemic. Similar vulnerabilities affect migrants, refugees, and health workers. The indirect consequences of the pandemic will take longer to manifest. The Global Fund to Fight AIDS, Tuberculosis and Malaria has calculated that COVID-19 will dislocate health systems to such an extent that an additional 1·4 million deaths from these three diseases will follow. The Global Fund needs an additional US$5 billion over the next 12 months to mitigate the effects of COVID-19 on AIDS, tuberculosis, and malaria programmes and to assist countries in responding directly to the pandemic (mainly through the provision of diagnostics). It’s difficult to believe that this money will be easily forthcoming given the economic predicaments facing The Global Fund’s traditional donors. Worse, the World Bank has revised its estimates upwards of those likely to be tipped into extreme poverty by COVID-19. That figure now stands at an additional 71–100 million people living on less than $1·90 per day. And consider the “shadow pandemic” of violence against women and children that has intensified during the past 5 months or the 1·2 billion young people who have had their education abruptly interrupted through national lockdowns. The multiple and deep wounds to humanity from this pandemic deserve historically unrivalled global political leadership. And yet all we have is silence. How have we fallen so low?