Intended for healthcare professionals

Editorials Christmas 2020: M*A*S*H

A new year’s resolution for health workers

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4602 (Published 15 December 2020) Cite this as: BMJ 2020;371:m4602
  1. Martin McKee, professor of European public health1,
  2. May C I van Schalkwyk, NIHR doctoral research fellow1,
  3. Nason Maani, assistant professor in public health evaluation12,
  4. Sandro Galea, dean2
  1. 1Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
  2. 2School of Public Health, Boston University, Boston, MA, USA
  1. Correspondence to: M McKee martin.mckee{at}lshtm.ac.uk

Having faced the full force of the covid-19 storm, they must now set out a vision for the future

Few health workers will be sad to see the end of 2020. There is, however, a light at the end of the tunnel, with several vaccines against SARS-CoV-2 coming on stream1 and advances in treatment reducing deaths among those infected.2 The prospect of a return to normality seems within reach. But what will that normality look like? We believe that health workers, who have been at the frontline of the pandemic, must offer a vision of a healthier future. We must not let the terrible events of this year recast the pre-pandemic world in a glowing light. The normality we departed from at the onset of the pandemic was unjust, unsustainable, and shaped the evolution of, and responses to, the pandemic with devastating consequences, particularly for the most deprived and vulnerable.

The start of a new year offers an opportunity to question old ways of working and to ask how we can create a better future for everyone. It is a cliché to say that you should never waste a crisis. Just as in wartime and in the global financial crisis,3 many have profited greatly from the pandemic, whether as providers of online services4 or by taking advantage of the rush to procure essential goods such as personal protective equipment.5

But many were far less fortunate, living in circumstances that rendered them vulnerable to an infection that spread especially rapidly through communities where successive generations had been living ever more precarious lives. As the recovery begins, the powerful groups who benefited from the social and economic systems that created those conditions6 will, once again, seek to shape the world to their advantage. Health workers cannot remain silent. They must offer a compelling vision of how we should reconfigure the world so that it produces and sustains health for all, resilient in the face of future threats.

Lessons to take on board

This vision must learn the lessons from the pandemic.7 There were many successes. The virus was identified within days, and its genome was decoded within weeks. Knowledge of its effects on the body and on communities, and their responses to it, grew rapidly. Some countries acted on this knowledge but others did not. There were too many political failures, with catastrophic consequences.

A country navigating the pandemic is like a ship navigating treacherous and unpredictable waters in a storm. If the ship, its crew, and its passengers are to come through the experience unscathed it needs three things. First, it needs an experienced captain who understands the ship and commands the trust of the crew. Unfortunately, in some of the countries worst affected, captains were either away from the bridge, denied there was a storm, or had lost the trust of those on whom they depended.8

Second, it needs a crew that is adequate for the size of the ship, that is well trained, and that is working as a team to achieve the same goal. Yet in too many countries, skeleton crews were working in health systems that were highly fragmented. Dissenting voices who raise the alarm about the integrity of the ship, the working of the team, or its leadership must not be silenced or lives can be lost.9 It also needs passengers who are as seaworthy as possible so that they can withstand the storm. One of the sentinel challenges of covid-19 was finding large segments of the population weighted by a disproportionate burden of preventable disease that predisposed them to severe covid-19 once infected.10

Third, we need a ship that is securely constructed. Yet in many of the countries that have fared worst, we have been working in vessels that are full of holes.11 Social safety nets have been ripped asunder, allowing too many people to fall though the holes. We have made many demands on our people—to stay at home, to face loss of income—and we have added greater uncertainty to what were already difficult situations, particularly for certain racially and economically marginalised groups. The disproportionate exposure to covid-19 of many in these groups—a consequence of precarious jobs and social circumstances that denied them the luxury of social distancing—drove, in large part, the high burden of covid-19 among minority and marginalised groups worldwide.

A covid secure future?

As we look to the prospect of a covid-19 secure future, with effective vaccines, new treatments, and continued countermeasures as necessary, we must ask how we can strengthen the foundations of our societies, coming together to repair the torn safety nets. We must never be afraid to challenge our political leaders when they are going in the wrong direction, and we must insist that they really are guided by the science, and not just those bits that support their beliefs. And we must ensure that our fellow citizens are as healthy as possible so they can withstand the inevitable storms that lie ahead. We must insist that our health systems and other public systems are adequately staffed, with the tools needed to do the job, with teams that are working together, pulling in the same direction.12 If we do all this, then we, and the populations we serve, can be confident that we can weather any future storms.

Footnotes

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following: MM is a member of Independent SAGE.

  • Provenance and peer review: Commissioned, not externally peer reviewed.

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References

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