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On May 5, 2023, the WHO declared the end of COVID-19 as a public health emergency. While this is an important milestone, the scientific community argues the aftermath of COVID has exposed significant issues within how countries try to address global diseases. For instance, the World Bank and the WHO demonstrate that COVID-19 has stopped “two decades of global progress toward Universal Health Coverage.” In light of these concerns, it is essential to consider how the global community has tried to address the international transmission of disease and how it might respond to the ongoing impacts of COVID-19.
The current organization responsible for coordinating international responses to global health crises is the World Health Organization (WHO). Established in 1948, the WHO is a UN Specialized Agency with 194 member states who collectively advocate for universal healthcare, monitor health risks, and take action against health emergencies. The WHO took the lead in coordinating efforts to manage COVID-19 by developing Access to COVID-19 Tools (ACT). Although, some argue that the WHO frequently makes under-resourced commands or fails to enforce international health regulations within member states.
These criticisms have not lessened for other international organizations as well. Historically, political leaders have tried to combine their knowledge, resources and time in the International Sanitary Conference (1851-1938) or The League of Nations Health Organization (1923-1946). With the WHO, there have undoubtedly been advances in multilateral cooperation and scientific capacity to tackle global diseases. However, many countries remain unable to adapt to new global health threats. Some attribute this to the increasing spread of outbreaks or international travel, but others argue that ineffective political leadership may be the cause.
The Reversal Problem
The Global Preparedness Monitoring Board (GPMG) is one of the organizations that made such a discovery. A recent report measured the ability of 195 countries to detect and respond to global health crises. They reported an overall score of 40.2/100. As a solution, this report called for stronger domestic leadership and increased funding for research, development, and international cooperation.
Political leaders frequently overlook the root causes of infectious diseases, such as extreme poverty or access to clean water and sanitation. The impact of COVID-19 has shown us infection in low and middle-income countries is associated with and worsened by extreme poverty. A UN Report in 2020 found that COVID-19 pushed over 71 million people back into extreme poverty.
Infectious diseases have disproportionately impacted those with lost incomes or limited access to healthcare facilities and women and children. For instance, 1.57 billion children across the globe faced disruptions to their learning and in-person instruction. These effects were felt heavily by children without access to technology or safe at-home learning environments. The World Bank calls this the Reversal Problem. After two decades of advancements in poverty and inequality reduction, the emergence of COVID-19 hindered this progress. From 2013-2015, global poverty levels dropped by 1% annually. In 2020 they increased by 0.9%. Consequently, low and middle-income countries have faced harsh effects, particularly people living in inner-city poverty and women and girls.
Finding a Solution to Global Health Inequity
If this is the case, what is the solution? The international community will have to wait and see the future implications brought by COVID-19. However, one attempt political leaders have taken to address global health inequity is the Global Fund in 2002 — a partnership between government, civil society, the private sector and individuals who have lived experience with infectious disease. Since its creation, the Global Fund has put more than $55.4 billion into preventing the outbreak of HIV/AIDS, TB and Malaria and in developing culturally and locally appropriate treatment programs. It is a significant move of “global solidarity and leadership” and demonstrations of political will to end infectious diseases.
Through the collective billions of investments from participatory states, the Global Fund has saved 50 million lives and treated 5.3 million individuals diagnosed with TB. The Global Fund is successful because it places the needs of countries affected by HIV/AIDS, TB, or malaria at the core of decision-making. They determine where the funding should go — allowing political leaders to invest the money appropriately to their “political, cultural and epidemiological context.” Secondly, the supply of funding is strict, as countries that need it most are of immediate priority. Finally, the Global Fund has an accountability tool to ensure that the money achieves its intended purpose instead of being pooled into the rich or for corrupt reasons. This idea is great, but political leaders should ensure this idea of “accountability” is reflected in feedback from recipient countries. The current model of foreign aid is too economic-focused and top-down in how Western countries distribute money to the Global South.
One of the most compelling reasons for the Global Fund’s effectiveness is how it uses a poverty reduction approach. A few of the ways they have tried to do this is by addressing gaps in national strategies and strengthening the healthcare structure in affected states. However, Michael Messenger, current President and CEO of World Vision Canada, says that investments in programs such as the Global Fund are only one small step to ending global poverty. To truly help the most vulnerable, Messenger says other foreign aid investment programs should mirror the Global Fund’s focus on the local community and affected populations.
Many aid programs now adopt a liberal model — focusing on integration into the global economy and ignoring how infectious diseases have disproportionately impacted women and girls. Ignoring the lived experiences of such affected communities only reinforces the problem. For example, in Somalia, women and girls are seven times more likely to contract tuberculosis. To address this, Messenger proposes actively consulting individuals personally affected by the disease. It also involves working with local grassroots organizations with specialized knowledge about the community’s needs.
Ending global disease must consider poverty reduction and development in its approach. While the Global Fund has demonstrated its effectiveness, political leaders must continue investing in this program for years to come. To combat infectious disease requires not merely financial resources and material infrastructure but a focus on the community and affected populations. The lived experiences of people with these real diseases cannot be an afterthought. Otherwise, foreign aid will become inappropriately invested in the hands of corrupt actors and insensitive to the people affected by these conditions.
Edited by Zander Chila