Intended for healthcare professionals

Feature Essay

Covid-19: a disaster five years in the making

BMJ 2021; 373 doi: (Published 09 April 2021) Cite this as: BMJ 2021;373:n657

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  1. Peter Hotez, professor of paediatrics and molecular virology and microbiology
  1. Texas Children’s Center for Vaccine Development, Department of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
  1. hotez{at}

The covid-19 pandemic is not a one-off extraordinary event but the culmination of a five year unravelling of progress in global health, writes Peter Hotez

We live in extraordinary times in global health. Through two decades of the United Nations’ millennium and sustainable development goals, the number of childhood deaths from measles and some other vaccine preventable infections has fallen by as much as 87%.1 The launch and support of global vaccination programmes through Gavi, the Vaccine Alliance, and mass treatment programmes for HIV-AIDS, malaria, tuberculosis, and neglected tropical diseases have produced enormous global health gains.1 We are also moving towards the elimination of neglected tropical diseases including onchocerciasis, lymphatic filariasis, scabies, yaws, and trachoma, with major falls in the incidence of AIDS in Africa and elsewhere.

The benefits of these successes go beyond public health to reduced poverty through improvements in productivity, child development, and maternal-fetal outcomes. Global security has also been strengthened. Over the past 5-6 years, however, we have seen abrupt reversals in these developments leading to the emergence or re-emergence of both vaccine preventable diseases and neglected infections in multiple areas of the world. And that’s before the onset of covid-19.

Humanity is able to make tremendous gains against global disease like never before—but we have allowed those gains to unravel. The novel coronavirus has shown us the consequences of this.

Political instability and social collapse

Between 2015 and 2020 a group of new social determinants, sometimes working synergistically with climate change, accelerated to halt or collapse health systems and bring back illness globally.1

Among the most potent of these were political instability and conflict. In Venezuela, failed policies of the Maduro regime together with dropping oil prices in 2015 precipitated a total socioeconomic collapse that began under former president Hugo Chavez. Interruption to childhood vaccination programmes contributed …

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