As the Omicron surge overwhelms the world, it is clear to people everywhere that the actions which leaders so far have taken in response to the Covid-19 crisis have not been sufficient to overcome it.
We are not beating Covid. It looks rather like Covid is beating us. What is to be done?
Crucially, they are two key dimensions to what is needed now which, though related, are distinct. The first dimension is what policies are required to get us out of the crisis. The second dimension is how to get those policies put into place.
In other words, the first key question is “what do leaders need to do?”, and the second key question is “how do we make them do it?”
On the first question, the world is fortunate that we are not short of excellent public health expertise. Whilst there are no quick fixes, the contours of the policies required are not a mystery, and have been set out, to leaders and to media, repeatedly, by the World Health Organisation, by leading academics, and by health practitioners.
They come down essentially to this: in a pandemic emergency, leaders need to deploy the whole range of tools that have been shown to help. The key here is the whole range.
Importantly, in terms of how these approaches can be realized, this requires that they are realized for the whole world. Until they do, none of us will get out of the crisis. When Desmond Tutu said that “I am because you are, I am because we are”, that was not only true ethically, but, it turns out, true epidemiologically too.
The approaches required include vaccines, treatments, and also, as the WHO’s Peter Singer has noted, “public health measures that encourage spending time outdoors, physical distancing, wearing masks, rapid testing, limiting gatherings and staying home when sick”.
None of these alone is enough. Any approach that only does one of these, however well, would fail – all of them are needed, together.
It requires the application of the whole range of policy tools. For example, rich countries, and Foundations based in rich countries, have emphasized the importance of sharing doses as a solution (even whilst they havecomprehensively failed to deliver on their promises to do so).
In contrast, developing countries, the World Health Organisation and civil society have all highlighted that sharing doses alone cannot ensure enough for everyone, and that it is essential also to share the technology so that multiple producers across the world can simultaneously manufacture enough to vaccinate the world.
This requires rapid agreement and implementation of the TRIPS Waiver proposed by South Africa and India at the WTO, and it also requires that rich country governments use their huge leverage (as procurers, investors and regulators) over the companies they host to make them share knowledge, know-how and material. Furthermore, this requirement to share Covid technologies needs to apply to vaccines, medicines and diagnostics.
As public health professors Madhukar Pai of McGill and Manu Prakash of Stanford have noted, “Science has delivered many tools that work against Covid-19. But equitable distribution of these tools is where we are failing.
If we can find a way to share effective tools equitably and increase their production across the world, then we have a real shot at ending this pandemic.
If we hoard these tools, block TRIPS waiver, and think we can boost our way out of this pandemic in the global North, we will begin 2023 by playing whack-a-mole with the rho, sigma, tau or Omega variants.”
The challenge then, is not that we don’t know what leaders need to do. The challenge is that they are not doing it. We like to believe that our leaders are led by the evidence. But evidence alone is not enough.
The brilliant and essential reports of scientists will not be enough to shift the much harsher world of political interests. Getting leaders to do what is needed to overcome the Covid-19 crisis – in particular getting leaders to force the big pharmaceutical companies to share the rights and recipes for the vaccines, therapeutics and diagnostics so the world can produce the billions needed – will depend on pressure from ordinary people.
This is not a new lesson. We saw it in the late 1990s and early 2000s with antiretrovirals for HIV. Then, as now, a monopoly hold on production was preventing people in developing countries from accessing life-saving help.
Then, as now, the big pharmaceutical companies worked aggressively to block other producers from manufacturing what would save millions of lives. Then, as now, rich country governments sided with the big pharmaceutical companies. Twelve million people died. Finally, massive global public pressure, together with assertive action by developing countries, ensured that production was opened up and lives could be saved.
It was not a coincidence that when the Covid-19 crisis erupted the first groups to call for the sharing of medical technologies, and to start to organise for it, were groups of people living with HIV. They are the heart of the movement for a People’s Vaccine because, from painful experience, they know what it takes. Health, like justice, is never given; it is only ever won.
Some people are inspired by activism. Others, understandably, just want to get on with their lives. Activism feels like another burden. They’re ready to do their part by wearing a mask when available and getting vaccinated when offered. But they want to leave the leadership to our leaders.
The thing is, that’s not enough. Our leaders are not leading. They are not doing all they can to end the crisis. They are not forcing the big pharmaceutical companies to share technologies so that enough can be produced. They are not ensuring access to health care as right. They are not protecting the vulnerable from the shock of the crisis.
The past two years can best be summed up like this: the science is working, but the politics is failing.
It is only through bold action by political leaders that the Covid-19 crisis will be ended. It is only through people’s organising that we’ll make leaders take that bold action. As the great novelist Alice Walker once put it so powerfully, “activism is the rent we pay for living on the planet”.
The writer is an advisor to the United Nations, governments and civil society organisations (CSOs).
BY BEN PHILLIPS