Covid-19: Commission describes “massive global failures” of pandemic responseBMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o2237 (Published 14 September 2022) Cite this as: BMJ 2022;378:o2237
The global response to the first two years of the covid-19 outbreak failed to control a pandemic that has led to an estimated 17.7 million deaths to date, a major review has concluded.1
The Lancet Commission on lessons for the future from the covid-19 pandemic, produced by 28 world leading experts and 100 contributors, cites widespread failures regarding prevention, transparency, rationality, standard public health practice, operational coordination, and global solidarity. It concludes that multilateral cooperation must improve to end the pandemic and manage future global health threats effectively.
The commission’s chair, Jeffrey Sachs, who is a professor at Columbia University and president of the Sustainable Development Solutions Network, said, “The staggering human toll of the first two years of the covid-19 pandemic is a profound tragedy and a massive societal failure at multiple levels.”
In its report, which used data from the first two years of the pandemic and new epidemiological and financial analyses, the commission concludes that government responses lacked preparedness, were too slow, paid too little attention to vulnerable groups, and were hampered by misinformation.
Sachs said, “We must face hard truths: too many governments have failed to adhere to basic norms of institutional rationality and transparency; too many people have protested [against] basic public health precautions, often influenced by misinformation; and too many nations have failed to promote global collaboration to control the pandemic.”
The report cites some positive examples of international cooperation, including public-private partnerships to develop vaccines in record time. But it highlights inequalities in vaccination rates, with three in four people fully vaccinated in high income countries but just one in seven in low income countries.
Maria Fernanda Espinosa, commission coauthor and former president of the UN General Assembly, said, “All countries remain increasingly vulnerable to new covid-19 outbreaks and future pandemics if we do not share vaccine patents and technology with vaccine manufacturers in less wealthy countries and strengthen multilateral initiatives that aim to boost global vaccine equity.”
The report notes that the distribution of covid-19 death rates internationally was almost the inverse of what was expected before the pandemic. The US and the UK were respectively ranked first and second in terms of pandemic and epidemic preparedness by the 2019 Global Health Security Index, while the Western Pacific region scored much lower.
But the commission said that the index had failed to predict the disappointingly poor public policy response of Europe and the Americas. The experience of the SARS epidemic of 2002 meant that the Western Pacific adopted relatively successful suppression strategies for covid-19, resulting in lower cumulative deaths of around 300 per million people, while failures in Europe and the Americas led to the highest levels of cumulative deaths among World Health Organization regions, at around 4000 per million.
The commission identifies prevention, containment, health services, equity, and global innovation and diffusion as the five essential pillars of a successful fight against emerging infectious diseases. The authors said, “Accomplishing [them] requires an ethical framework of prosociality—the orientation of individuals and government regulations to the needs of society as a whole, rather than to narrow individual interests.”
Among the commission’s key recommendations include:
A “vaccination plus” strategy, combining widespread vaccination, appropriate public health precautions, and financial measures to slow the emergence of new variants and reduce the risk from new waves of infection;
A strengthening of national health systems, adoption of national pandemic preparedness plans, and wider universal health coverage; and
A strengthened multilateralism focusing on a reformed and bolstered WHO, integrating the global response to future pandemic risks with actions to tackle the climate crisis and reversals in sustainable development.
The commission concludes, “The covid-19 crisis has exposed major weaknesses in the UN-based multilateral system, resulting from excessive nationalism, tensions among the major powers, chronic underfinancing of global public goods including the UN system itself, lack of flexibility of intellectual property regimes to ensure that global public goods are available to all, lack of adequate sustainable development financing for LMICs [low and middle income countries], and the erosion of political support for multilateral solutions by the major powers.”
Sachs commented, “Now is the time to take collective action that promotes public health and sustainable development to bring an end to the pandemic, addresses global health inequities, protects the world against future pandemics, identifies the origins of this pandemic, and builds resilience for communities around the world.
“We have the scientific capabilities and economic resources to do this, but a resilient and sustainable recovery depends on strengthened multilateral cooperation, financing, biosafety, and international solidarity with the most vulnerable countries and people.”
An accompanying editorial2 notes that the commission’s original work on the origins of the pandemic was abandoned because of divisive public discussion about the source of SARS-CoV-2, becoming mired in controversy at an early stage.3 It says that commissioners came under “unprecedented attack and pressure as a result.”
The report nevertheless recommends intensifying the search for the pandemic’s source.
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