Dr Justin Parkhurst reflects on the past year in global health and looks ahead to what 2022 might offer in the way of global health issues.
This is the first blog in the Blogmas 2021 series.
This is the second year in which the LSE Global Health Initiative is producing a set of end-of-year blogs under a ‘Blogmas’ banner. It’s my privilege as the current Chair of the Initiative to produce this first instalment of the series which allows members of our Initiative to write about a range of issues – from recent research, to policy and practice efforts, or to focus on more personal reflections in relation to global health topics.
At the end of the previous series a year ago I attempted to look ahead to what 2021 might offer in the way of Global Health issues. I noted that Joe Biden’s arrival to the US Presidency would likely change the direction and policies seen under his predecessor – and indeed within the first few weeks of the Biden administration, the United States cancelled its plans to leave the World Health Organization (WHO) and repealed its ‘global gag rule’ – a policy implemented by Republican Presidents since Ronald Reagan which prohibits US funding to agencies providing abortion related services or counselling. The policy is regularly repealed by Democratic presidents, re-instated by Republican ones, and repealed again in what must now at least be a predictable pattern – if frustrating to funded agencies affected.
Another issue I discussed was the international race for an effective COVID vaccine, and the fear that historical global power imbalances would lead to an unequal benefit arising from them. Unfortunately, this too has played out as anticipated. Higher income countries have achieved adult vaccination rates of 70, 80 or even 90% and higher in many cases. In these countries, debates rage over the right time to offer vaccines to youth, or to provide booster doses to already vaccinated individuals whose immunity may be waning. Similarly, there are important academic insights to be had about the social and political influence of ‘anti-vax’ movements – for example how they proliferate through social media, and how politicians in some settings may feel a need to accommodate their views even if they personally disagree with them.
But these debates may seem like an unaffordable luxury in lower-income settings where fewer than 5% of the population have obtained a COVID vaccine. Indeed, Africa particularly stands out on the global map of COVID vaccine distribution – where, according to According to Our World in Data, some countries have seen less than 1% of populations vaccinated.
The stark reality of this means that health workers in many of these settings are dealing with incredibly high rates of COVID related illness and death, and doing so without only around 10% of them having had any vaccine protection themselves. Indeed, earlier in the year the WHO estimated between 80,000 – 180,000 healthcare worker deaths from COVID between January and May 2021.
Despite these challenges, it has been South Africa – a leading nation in terms of health research – that identified the new omicron variant of COVID just a short time ago. Yet rather than the global community rewarding the researchers and scientists for their world-aiding efforts and data sharing, countries slapped travel bans on the country – and others from the region showing any number of cases – even when European countries had shown a number of cases too. Language and imagery seen in the press of higher income countries at times demonstrated colonial and racist elements which just shows how global pandemics – no matter how ‘exceptional’ – still play out through existing systems of inequality, ideology, and historical political economy.
COVID thus remains dominant on the global health landscape at the end of 2021, and into 2022. The year ahead for COVID may be harder to predict in some ways, however. The data are still out on the impact of Omicron – it clearly appears to spread faster than Delta where it has been seen, but it will take a few more weeks to know how much this will translate to serious illness and death. And while we might have argued a year ago that much of society (anti-vaccination campaigners aside) would be united in their desire to achieve an effective vaccine, divisions can now be seen on how societies should proceed in the ‘new normal’ of ongoing COVID waves. In recent weeks, renewed restrictions in Europe have seen a wave of protests, with scenes of violence on the streets of Holland providing a stark reminder that divisions can run deep in societies around the world. The polarisation of American politics is perhaps no better seen in how vaccination itself has become a political issue, with vaccine hesitancy in US states strongly associated with the proportion of votes cast for Donald Trump in the previous election (despite Trump himself claiming credit for vaccine successes at times).
COVID is transforming from an immediate crisis response to requiring longer term shifts in social practices – and is social change that has always been at the heart of politics and political division. Thus, we are likely to see ongoing debate, protests, advocacy, and party politics play out in countries around the world over how to continue to respond to the virus.
And yet, if the challenges of COVID are not sobering enough a recent global climate change conference and the release of a WHO Health and Climate Change Survey Report have reminded us that a potentially even greater threat to global population health lies in the effects of climate change. The WHO has called it “the biggest health threat facing humanity” – yet its survey report found large gaps in national plans and actions to address climate change and health. In terms of global action, climate change mitigation presents a classic collective action problem. High income countries have strong domestic political influence from corporate actors that have historically caused climate harm. Middle income countries are concerned their potential to rapidly grown and achieve benefits of higher incomes will be slowed or stopped. While lower income settings are most vulnerable to the impacts of climate change, yet have limited influence and power in global negotiations.
But there may be signs of hope as well. Advocacy groups have proliferated to apply political pressure to national governments for climate action – and increasing numbers of countries are considering if they can pass major climate legislation under the ‘green new deal’ banner. But perhaps most optimistic is the rise in environmental concern by youth around the world – described as a new social movement with the potential to help drive forward global action.
If nothing else, the state of Global Health shows us the fundamental importance of social and political science insights into the health sector. It is no longer a challenge to make a case that responding to heath threats is only a concern for clinical and epidemiological science alone. Health threats do not exist in a vacuum. Rather they affect societies – and societies respond in ways shaped by ideology, psychology, culture, and politics. Global health equity and climate concerns provide arenas for coalition building, priority setting, and political action that will be essential to overcome historical inability to achieve coordinated international cooperation. These are no small tasks, yet it is clear that insights and guidance from the social will continue to be required for societies – local, national and international – to respond to current and future global health threats.
The views expressed in this post are those of the author(s) and in no way reflect those of the Global Health at LSE Blog or the London School of Economics and Political Science.