Samantha Amerasinghe eyes a transformation of the global healthcare sphere

The COVID-19 pandemic has created unprecedented disruption in the global healthcare and development sphere. Organisations have had to change how they operate, and are finding work complicated by challenges of access, safety, supply chain logistics and financial stress like never before.

Indeed, the short-term implications of this global challenge are evident everywhere but the long-term consequences of the pandemic – and how it will reshape healthcare and development institutions in particular – remain to be seen.

Global health looks set to become a major component of national security, and a concern that all governments and economies should take seriously. However, rich countries – having suffered huge economic losses – may use COVID-19 as an excuse to cut development assistance for healthcare and reframe global health as a limited ‘national security’ exercise.

The pandemic could become the new excuse for nationalism, isolationism and anti-immigration policies. All of this could increase inequities that already confront global health and further concentrate power among the elite.

Development assistance will likely be reprioritised in the aftermath of the pandemic and world recession. Traditional development assistance will be needed to combat poverty and respond to health emergencies, strengthen national healthcare systems, train medical staff, create vaccines and combat malnutrition.

However, economies worldwide will be substantially weakened so the evolution of low to middle income country status will slow down or reverse and even while more is needed, broader development assistance will be at risk.

The lack of a coordinated global response will highlight and deepen the divide between the haves and have-nots, challenging the multilateral system and global solidarity on an unprecedented scale. If the pandemic affects the functioning of global food markets, the impact will be most acutely felt by the most vulnerable in society.

COVID-19 illustrates our common vulnerability across borders – beyond North-South, East-West and public-private divides – and the limits of a segmented approach to development; a more holistic, comprehensive and coordinated approach is required.

Strategic interventions by the state become central again to address the health, social, economic and food impacts of COVID-19: with a major economic contraction, public budgets will have to become more strategic and focussed, and leverage on more private finance for development; social policy will come to the fore; and the private sector will need to step up and play a more critical role.

The COVID-19 pandemic will transform the global healthcare community’s acceptance and use of digital technologies. Dashboards for logistics management systems are improving the efficient deployment of essential resources – from hospital beds and personal protective equipment (PPE) to ultimately, vaccines.

More advanced technologies including AI are being employed to provide insights into complex questions of how individual behaviours impact transmission and identifying which policies are effective for specific groups. These technologies may help developing countries move closer to the shared goal of universal health coverage.

Globally, more than 1.5 billion children were impacted by school closures, most of them in low and lower middle income countries. There is a risk that the poorest and most marginalised girls will never return to school. Early marriage, teen pregnancy and child labour rates will likely rise – and hard-won development gains will be lost.

In a worst case scenario, teachers left unpaid during the closures may be lost to the profession, and schools in poor and rural areas – closed during the pandemic or repurposed as healthcare facilities – may not reopen. To avoid such adverse outcomes, it’s imperative that international assistance is mobilised through COVID-19 government funding.

Another factor to consider is healthcare expenditure. Many developing countries do not spend enough on healthcare. Will this change in the future, and will they invest more in prevention and develop systems of health insurance?

There is also cause for concern regarding the commitment of richer countries to safeguard good health and thereby prevent pandemics. It goes without saying that US$ 5 of aid for every African citizen is not sufficient to guarantee even basic healthcare services. The Americas are devoting six percent of their official development assistance to healthcare; Europe a meagre 2.3 percent. This will have to increase substantially if pandemics are to be averted in the future.

The COVID-19 pandemic has reminded world leaders that underinvestment in the public health of one country is a threat to global health security everywhere.

More familiar disease control priorities (e.g. HIV/AIDS, tuberculosis, malaria and polio) that have been part of the global health effort to date may suffer a fall in attention as it shifts to infectious disease threats that affect high income countries.

The COVID-19 crisis has the potential to radically change global health and development for the better. Every country has further discovered its fragility, reflected in the dependence on the rest of the world and at the same time, the isolation when attempting to respond to a major exogenous shock.

This pandemic has demonstrated how interconnected and interdependent our world has become. There needs to be a paradigm shift in global health governance and multilateral cooperation to achieve worldwide health security for the future.