Lessons from our 9/11 moment of global public health

By the time this column is published, the second wave of covid in India is likely to have peaked. Some months later, a third wave may come and go. Further in the future, we will no doubt see the end of this pandemic, and a return to some form of normalcy. But after all this is behind us, what lessons would we have learnt about our public health system, globally?

Considering the context of human progress over millennia, our achievements in the field of medicine and public health occupy centre-stage. Today we live nearly twice as long as we used to 50 years ago. We have invested heavily in healthcare infrastructure and insurance. Access to healthcare has improved dramatically. Today, there is one doctor for every 650 or so people across the world, a ratio which exceeds the threshold recommended by the World Health Organization (WHO). We have found cures for most life-threatening ailments, and continue to make dramatic progress against diseases like cancer. In fact, we seem to have such a good handle on basic public health issues that the “health impact of climate and environmental change” has emerged as a global priority in this field.

Enter the novel coronavirus. In much the same way that a handful of terrorists in 2001 brought the world’s mightiest and most sophisticated defence infrastructure in the world to its knees, this virus has caught our public health system by surprise. We have fallen short of finding a reliable cure, developing and rolling out effective vaccinations, containing the spread, and even providing adequate life support care such as oxygen. As with most crises, this presents an opportunity for us to learn and emerge stronger.

First, we would do well to strengthen global cooperation in the field of public health. While some regions may at times do better than others, the global nature of this pandemic leaves no doubt that none of us is safe until all of us are safe. Institutions of cooperation such as WHO need to be strengthened and empowered.

This is true even at the national level. In India, for example, states have a number of decision-making layers. While local lockdown and containment strategies may well be determined at the state level, issues such as the roll-out of vaccinations needs a centralized view. Overcoming vaccine hesitancy through public outreach and education, securing the availability of adequate number of doses, determining payment policy and other such aspects are better handled centrally, with the cooperation of states.

Second, as the science about the disease continues to evolve, we need to develop transparent and credible media for communicating to and transparently sharing verified information with the public. This is a particular challenge in the post-truth world we arguably live in, where suspicion of vested interests tends to creep into the public psyche.

Third, we must re-imagine our drug approval processes. During the pandemic, we pushed through trials and approval processes that usually take several years within just a few months. Yet, we are assured by doctors and regulators that these vaccines are completely safe. Why then must we take years to approve cures and vaccines for other diseases? The answer may not be black or white, but a review of our drug approval processes is certainly called for.

Fourth, the pandemic has thrown up questions about health economics and bio-ethics that we have not previously thought about with adequate rigour. For example, can life-saving drugs be differentially-priced for developed and developing countries? What should be the pecking order for a vaccine roll-out? And in a country with more than a billion mobile subscriptions, why is health insurance, which costs ₹500 per month, not more prevalent?

Fifth, going back to the analogy between public health and defence, an infinitesimal fraction of any country’s military forces are actually engaged in combat. Yet, most countries maintain large active militaries and reserve forces. There is merit in considering the possibility of developing a core and reserve force of paramedics, nurses and even doctors, far in excess of ‘peacetime’ needs. For the record, India spends eight times more on defence than healthcare. Moreover, the US’s spend on healthcare as a proportion of gross domestic product is around 50 times that of India’s. We have some catching up to do.

It’s not just the number of doctors or other medical personnel that is relevant. In the days of digital healthcare, our training processes for medical personnel need to be modernized. Medical devices and databases store copious patient information, using which artificial intelligence engines detect patterns and provide diagnoses and suggestions for treatment. Medical personnel need to be trained to effectively utilize these technologies, enabling them to attend to a far greater number of patients, far more effectively.

Finally, and most importantly, we must have the humility to know that nature can bring us to our knees. We did have early warning signs such as the Sars and Ebola breakouts, but fell short of imagining that one such a disease could escalate into a global pandemic, affecting developed and developing countries alike.

Once we get past the widespread suffering caused by the covid pandemic, we must learn and emerge stronger with a public health system that can withstand future shocks of any kind.

Kapil Viswanathan and Preetha Reddy are, respectively, chairman of Krea University, and executive vice-chairperson of Apollo Hospitals. These are the authors’ personal views