The world as we know it has changed, forever. The Covid-19 pandemic has achieved what a few outspoken voices had predicted. The emergence of the SARS-Cov-2 virus has affected every person in a multitude of ways, from restricting movement and changing interaction with others, to many losing their livelihoods and large numbers becoming infected and many of those infected, dying – more than 800,000 deaths have already been ascribed to the virus and evidence suggests that this is a substantial underestimation (in South Africa, the current level of excess deaths is three times higher than the number of deaths that can be ascribed to Covid-19).
It is, therefore, obvious that this pandemic is not just like any influenza epidemic (the 2009-2010 swine flu pandemic caused 300,000 deaths). On the other hand, fortunately, the lethality of this virus is modest when compared with the Spanish influenza pandemic of a century ago that cost between 20 million and 50 million lives and the more recent West African Ebola outbreak, where 11,000 deaths occurred among the 28,000 infected (a 40% case-fatality rate).
What is patently clear, is that such events, whether they are caused by natural evolution of an infective agent or are human-made, will recur. During this week’s virtual symposium organised by the Africa Centres for Disease Control and Prevention, Columbia University and the University of the Witwatersrand, titled Meeting the Challenge of Covid-19 in Africa, the key messages were:
Mechanisms to prevent and manage pandemics are, therefore, essential. This requires that all countries have an effective public health system that is well run, and is adequately and consistently resourced. These entities must be in the position to rapidly deploy, using the most up-to-date, evidence-based health interventions and technologies. Their ability to advise the decision-makers and the populace must be unrestrained and protected from political interference. Importantly, the most effective tool available to these agencies is their communication about preventive public health measures, the importance of societal solidarity and the value of vaccination. Such messaging must be trusted by everyone in society and it is mandatory that this has political ownership in the highest office.
This requires that governance at all levels of society is ethical, strong, thoughtful and accountable. Such servant leadership is not only essential to ensure the level of international collaboration needed to allow for an effective global response, but more importantly is the quintessential element in implementing the local interventions, which at times may be harsh and unpopular. Trusted management, based on transparent decision-making, using the best scientific evidence available at the time and subsequent quality trustworthy communications are much more likely to reduce the rate of spread of the virus. Without trust, no measure will be implementable, no matter how effective the local enforcement agencies are, particularly in societies that are deprived or under threat.
That trusted leadership works in reducing the number of SARS-Cov-2 infections and minimises Covid-19 mortality has been clearly demonstrated in a number of countries. On the other hand, where trust in leadership is patchy or does not exist, high infection rates occur. Similarly, when political leadership has been in solidarity with neighbouring nations, regional outcomes appear to be better. As the Covid-19 pandemic has again shown, the biosphere has no borders. This also means that with the possibility of Covid-19 vaccines being available in the near future, immunisation equity will be central to global health security. In contrast, vaccine “nationalism” will impede the development of global immunity and global distributive justice.
As we have seen, human tragedy from rapidly spreading infectious outbreaks is profound, with extensive health, economic and social consequences causing monumental human suffering. The painful statistic of lives lost is only the first measure of impact. Covid-19, like the 1918 Spanish flu, has underscored how vulnerable the world is. Therefore, investing in health security research, preparedness and responsiveness, nationally, regionally and globally, is critical, even when no imminent crisis is apparent. So what does this boil down to? That the management of any pandemic, which arguably is the biggest threat to the wellbeing and survival of humanity, requires effective, credible, altruistic political leadership at all levels of society. Above all, this leadership must be worthy of the trust placed in it. Anything less is paid for with lives, mostly by those who carry the burden of inequity and disadvantage. DM
Martin Veller is the dean of the Faculty of Health Sciences at the University of the Witwatersrand and Ames Dhai a Visiting Professor of Bioethics at the WITS School of Clinical Medicine and Specialist Ethicist at the Office of the President and CEO of the South African Medical Research Council.
The programming language Python is named after Monty Python.
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