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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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Broader approaches are necessary for containing Covid-19 type pandemics

Dear Editor
In a wide ranging editorial1, Peter Hotez rightly emphasized the importance of scientific approaches for stemming the Covid-19 pandemic via policies such as mass vaccinations, social distancing, and avoidance of political meddling. However, the analysis might have fleshed out the complex interactions between scientific, socioeconomic, and demographic variables for the formulation of evidence-based policies. First, while it seems reasonable to mention possible Russian misinformation campaign concerning SARS-CoV-2 , it is odd to omit the unhelpful role of the Chinese government in delaying the information that could provide insights into the phylogeny of the virus. This is especially important in view of the unsubstantiated claim by the former Centers for Disease Control director Robert Redfield that SARS-CoV-2 originated in a Wuhan laboratory. Perhaps more importantly, it seems risky if not premature to conduct “gain-of-function” research altering viral genomes in laboratories if there is even a miniscule chance that deadly pathogens can escape into the population.
Second, although Figure 1 in the article attempted to capture socioeconomic, public health and climate change dimensions, the role of population growth especially in developing countries was not recognized and is fueling migration in the wake of globalization and climate change. For example, United Nations Sustainable Development Goals 2 are largely unattainable and ignore the role played by population growth that in turn affects the demand for healthcare services, and children’s schooling and skill acquisition3. Moreover, the SDG’s appear to inspire overly optimistic projections by biomedical researchers such as the claim that “food systems can provide healthy diets for an estimated global population of about 10 billion people by 2050” 4. Such claims undermine the credibility of scientists partly because factors such as nutrition-infection interactions, poor sanitation, helminth infections, and low non-heme iron absorption rates are responsible for iron deficiencies among 3 billion people5.
Third, while Dr. Hotez underscored vaccinations against SARS-CoV-2, practical difficulties in vaccinating in rural and remote areas of poor countries remain an impediment for attaining herd immunity. Moreover, there is evidence from countries such as India that children born at high birth orders, often regarded by their mothers as being “unwanted”, have significantly lower vaccination uptake 6. Thus, without an emphasis on small family size, future pandemics are likely to be difficult to control.
Lastly, poor waste disposable methods especially in low-income countries are potentially a breeding ground for future pathogens. The problems are compounded by increases in global temperatures, groundwater depletion, and rises in sea levels that can lower agricultural productivity and increase congestion in higher grounds. Although the development of vaccines against SARS-CoV-2 has been relatively straightforward due to attachment of its S-protein to ACE-2 receptors, vaccinations against future viruses may be more difficult, as is evidently the case for HIV. Thus, reductions in population growth, and greater utilization of recyclable products and generation of clean energy, are essential components of evidence-based policies for combatting future pandemics.

1 Peter Hotez, ‘Covid-19: a disaster five years in the making’, BMJ 2021; 373 doi: (Published 09 April 2021)
2 United Nations, 2015. The Sustainable Development Goals 2015-2030. .
3 Bhargava, A. “Climate change, demographic pressures and global sustainability”, Economics and Human Biology, 2019, 33, 149-154.
4 Willett, W., Rockstrom, J., Laken, B., et al. Food in the Anthropocene: The EAT-Lancet Commission on healthy diets from sustainable food systems. The Lancet, 393:447-492, 2019.
5 Bhargava A, Bouis HE, Scrimshaw NS. Dietary intakes and socioeconomic factors are associated with the hemoglobin concentration of Bangladeshi women. Journal of Nutrition 2001;131(3):758-64.
6 Bhargava, A., Guntupalli, A.M., Lokshin, M., and Howard, L. Modeling the effects of immunizations timing on child health outcomes in India”, Health Economics, 2014, 23, 606-620.

Competing interests: No competing interests

14 April 2021
Alok Bhargava
Professor of Public Policy
University of Maryland
College Park, MD 20742, USA