Intended for healthcare professionals

Letters Covid-19: a disaster five years in the making

Broader approaches are necessary for containing pandemics like covid-19

BMJ 2021; 374 doi: (Published 01 September 2021) Cite this as: BMJ 2021;374:n2107
  1. Alok Bhargava, professor of public policy
  1. University of Maryland, College Park, MD 20742, USA
  1. bhargava{at}

Hotez rightly emphasises the importance of scientific approaches for stemming the covid-19 pandemic through policies such as mass vaccinations, social distancing, and avoidance of political meddling.1 But the analysis could have fleshed out the complex interactions between scientific, socioeconomic, and demographic variables for the formulation of evidence based policies. Although it seems reasonable to mention a 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 Robert Redfield, former director of the Centers for Disease Control and Prevention, 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 when there is even a minuscule chance that deadly pathogens can escape into the population.

Figure 1 in the article attempted to capture socioeconomic, public health, and climate change dimensions, but the role of population growth, especially in developing countries, was not recognised and is fuelling migration in the wake of globalisation and climate change. The United Nations Sustainable Development Goals,2 for example, are largely unattainable and ignore the role played by population growth that in turn affects the demand for healthcare services, as well as children’s schooling and skill acquisition.3 They also seem 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-haem iron absorption rates are responsible for iron deficiencies among three billion people.5

Hotez emphasises the importance of vaccinations against SARS-CoV-2, but 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 higher birth orders, often regarded by their mothers as being “unwanted,” have significantly lower vaccination uptake.6 Thus, without emphasis on small family size, future pandemics are likely to be difficult to control.

Poor waste disposable methods, especially in low income countries, are a potential 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, owing to attachment of its S protein to ACE-2 receptors, vaccination against future viruses might be more difficult, as is evidently the case for HIV. Thus, reductions in population growth, and greater use of recyclable products and generation of clean energy, are essential components of evidence based policies for combatting future pandemics.


  • Competing interests: None declared.

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