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Equitable access should be a key consideration when public health systems are rebuilt in the wake of COVID-19, said Michael Ryan, MD, executive director of the Health Emergencies Programme at the World Health Organization (WHO), who called this “a critical point in the pandemic.”
“We cannot become distracted by retrospection and finger pointing,” said the former trauma surgeon. “We can choose to see this as an opportunity to learn and grow instead of casting blame or putting our heads in the sand. This could turn out to be the greatest era of change there has ever been, or it could be our greatest missed opportunity.”
But critical issues will need to be addressed, he said during his presentation at the Virtual COVID-19 Conference 2020. “How will building back be better? And how will it be feasible at a time when every single sector of society is looking for resources to rebuild?”
Ryan is not alone in calling for equity as a crucial component of COVID-19 recovery. World leaders at the meeting, organized by the International AIDS Society, echoed his call.
“If we just let drugs and vaccines go to the highest bidder instead of to the people and the places where they are most needed, we’ll have a longer, more unjust, deadlier pandemic,” said Bill Gates, cochair of the Bill and Melinda Gates Foundation.
And António Guterres, secretary-general of the United Nations, called for effective treatments and “a people’s vaccine” to be available for “everyone, everywhere as a global public good.”
This could turn out to be the greatest era of change there has ever been, or it could be our greatest missed opportunity.
For equity to happen, structural factors must be considered just as important as COVID-19 drug development, said Tedros Adhanom Ghebreyesus, PhD, MSc, director-general of WHO.
“There’s a real risk that more people will die from lack of access to healthcare than from COVID-19,” he said.
In the United States, this means providers, patients, and policymakers have to confront and dismantle the interlocking institutional, structural, interpersonal, and internalized pieces of antiblack racism, said LaRon Nelson, PhD, RN, associate dean for global health and equity at the Yale School of Nursing in Orange, Connecticut. These systems are what “predispose black communities to disability and to death,” he told Medscape Medical News.
To build back better after the COVID-19 pandemic, “we need to be clear that we’re fighting on two fronts, and we have to be fighting on these fronts simultaneously,” he explained. We are fighting on the ground and in hospitals against the SARS-CoV-2 virus — to contain and cure it — and we are fighting antiblack racism in our institutions, policies, and healthcare systems.
Nelson suggested, among other things, that medical schools, nursing schools, and professional associations all institute courses on structural racism, and that there be a requirement for ongoing education on the topic for providers already in the field.
“At this point, for providers and for clinicians to call out racism as a public health issue is the exact right approach,” said Monica Gandhi, MD, from the University of California, San Francisco, who is cochair of both the COVID-19 conference and the International AIDS Conference 2020.
“We have a platform at this moment, just as we had a platform at the beginning of the HIV movement, to talk about how all these structural determinants are completely determining outcomes. We don’t need to be where we are,” she said.
Learning From the HIV Response
In fact, world leaders are borrowing ideas from global HIV prevention and treatment frameworks — like the President’s Emergency Plan For AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria — which have consolidated money and know-how to ensure that necessary medicines get to those who need them.
“One of the best lessons in the fight against HIV/AIDS is the importance of building this large, fair, global distribution system to get the drugs out to everyone,” said Ryan.
In that vein, WHO has launched the Access to COVID-19 Tools Accelerator and the COVID-19 Supply Chain System, which streamlines the worldwide response to the pandemic by facilitating the transfer of supplies from countries and organizations that have them to those that need them.
And Ambassador Deborah Birx, MD, a member of the White House COVID-19 Task Force, said she is drawing on her many years of work as head of PEPFAR to address the COVID-19 pandemic.
Perhaps most important, she said, is that the government is working to deploy interagency teams to communities that have pending or current COVID-19 outbreaks to increase testing at large and within households to identify asymptomatic people and support necessary quarantine actions.
This approach — finding “asymptomatic individuals to stop community spread” — is similar to the way the United States is working to end the country’s HIV epidemic, said Birx. “It’s the same principle in this respiratory disease.”
But “we really need to increase our footprint indirectly into the communities,” she added.
Virtual COVID-19 Conference 2020. Presented July 10, 2020.
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