Fit-For-Purpose Priorities for a Pandemic-Threatened Future

Dr. Lydiah Kemunto Bosire
25 May 2020
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African Expert Network (Washington, DC)
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In January 2000, the UN Security Council held its first ever debate on the security threat posed by a health issue. The topic was the impact of HIV/AIDS on peace and security in Africa. The debate was presided over by US Vice President Al Gore, who called upon the world to "forge and follow a new agenda for world security", which required due consideration of environmental and pandemic threats.

Unfortunately, it was not until COVID-19 began spreading that the relevance of this statement became abundantly clear to all citizens of the world. The crisis has swiftly revealed that almost without exception, all states were catastrophically underprepared for these new security threats.

Our best hope has come from our global human capital, in collaboration across borders. To be fit for purpose in this new reality, we must imbue new ambition into sustainable development, with a special focus on investing in the systems and people that can prevent and respond to future health crises, as well as the climate change ones that lie just beyond.

Over the last five years, the Sustainable Development Goals (SDGs) have become the organizing framework against which stakeholders measures their progress and contribution towards shared prosperity. With 17 goals and 169 targets, there is something in there for everyone. However, some goals and targets are more important than others. Commitment to global health targets is critical for our survival as a species and underscores all of the SDG goals (there are no sustainable cities without pandemic preparedness, no ending poverty if crises initiate economy-wide job losses).

COVID-19 must fundamentally reorder our objectives as a global community; it is not just something we get over and return to business as usual. Everything else depends on our response. As President Akufo-Addo of Ghana said on Twitter recently, "we know how to bring the economy back to life. What we do not know is how to bring people back to life."

Substantive focus on health issues cannot wait until global prosperity is achieved. Rather, it is the equivalent of the world putting on its seatbelt. The same is true of climate change.

We need to identify the system-level investments in health infrastructure that every country must make to be prepared for the next outbreak. This means moving away from working in the reductionist, vertical, issue-specific manner we have become accustomed to: maternal health in this corner, HIV/AIDS in that one, Non-Communicable Diseases in yet another one - all measuring different indicators of success, and unaccountable to the people in whose name they are undertaken.

The present approach is more about interests and lobbies than about the ways in which people experience health. We must return to the 'Health for All' framework of Alma-Ata, and the goals to which we once aspired before primary health care was considered too ambitious.

To be sure, the SDG agenda already contains some important targets on universal health coverage, global health emergency preparedness, and research and development for affordable access to vaccines and medicines. These must be broadened to include the under-investments in public health plumbing that this crisis has laid bare, such as beds and ventilators, masks and test kits, sutures and blood banks.

To make these investments yield outcomes, we need people, on two fronts. First, in line with Bill Gates' famous TED talk, health risk preparedness must take on the seriousness of military preparedness. We must think of training our technical health workforce the same way we think of reservists.

We therefore must invest in a deep bench of expertise, including epidemiologists and engineers who can model the next crisis, and data analysts and AI engineers who can help us turn all encounters with health systems into predictive intelligence shared with the world at large. This need is particularly acute in lower- and middle-income countries whose next health incident may well precipitate new consequences for advanced economies.

Second, we also need health-and-climate competent policymakers. Policy is steered by people.

No doubt our response to the current crisis would have been swifter and more confident if the highest level of policy was (wo)manned not just by those who valorize West Point, Wharton, and Sandhurst, but also those who have an appreciation of the Johns Hopkins Bloomberg School of Public Health. Let's find or found the climate equivalent of these institutions and elevate their strategic importance.

In 2020, twenty years after the world was urged to forge a new global security agenda, we have bridged one decade to the next with a staggeringly complex health crisis that will affect most of humanity, in unknowable ways, for years to come. This time around, the headlines suggest that everyone is overwhelmed.

The urgent question of our moment is this: How do we rise up to meet the coming, potentially more challenging global crises? Whatever else we do, we need to revamp focus on our prevention and response capacities: make the pivotal, proven investments that can strengthen the health system of every last country and territory in the world, and complement them with a strategy to mobilize the best minds from all corners of our world.

Dr. Lydiah Bosire is the founder of 8B Education Investments. Previously she worked at the United Nations and the World Bank on issues including peace and security, global health, transitional justice and development finance. She holds a DPhil from the University of Oxford. Follow her at @DrLydiahKBosire

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