Across the US, the country with the most reported cases of COVID-19 in the world, an unfamiliar feeling is emerging: hope.
Although catastrophic infection rates and death tolls continue, cautious optimism is growing as the country’s besieged health workers and others who are most at risk receive their first dose of the vaccine, with 2 vaccines now approved and additional ones soon to come.
A vaccine roll-out, however haphazard, is not the only reason to be hopeful.
After pandemics, societies transform. Each of the devastating pandemics throughout history have fundamentally reshaped the way humans view and approach science, government, and society. From the horrors of the 1918 influenza pandemic emerged the early foundations of multilateral cooperation on science and health, the public’s demand for universal health coverage, newfound support for the scientific method, and a more robust social safety net.
The COVID-19 pandemic is another opportunity for transformation. With a new administration in Washington, DC, the months ahead will be pivotal in determining just how society can be transformed. As veterans of the global health and human rights movement, we offer 6 guiding principles to the Biden-Harris administration on how to ensure the coming paradigm shift results in a more healthy, equitable, and just society.
Make no mistake: We are in for a grueling period before this transformation. Recent models from the Institute for Health Metrics and Evaluation project that the US will reach 500,000 COVID-19 deaths by the end of February. Many hospitals are at or beyond capacity around the country, and health workers have been pushed to the brink.
But of course, the deaths and severe illness from COVID-19—appalling as they are—represent only part of the story.
We don’t just face a pandemic; we face a syndemic: a synthesis of multiple epidemics. The coronavirus itself has combined with the epidemic of noncommunicable diseases such as hypertension and diabetes that disproportionately afflict those affected by deeply rooted social and economic inequalities and injustices. It has combined with longstanding human rights violations stemming from structural racism and a broken social safety net that could have protected many who instead face exposure to the coronavirus and increased vulnerability to its most dangerous effects. If we focus on the virus alone, we will fail. We must address the virus, but also confront the underlying inequalities and inequities that have fueled this global crisis.
In just one year, we have gone from failing to appreciate the scope of COVID-19’s deadly potential to delivering multiple highly effective, safe vaccines to millions of people—clearly one of the greatest scientific accomplishments in our time. But vaccines alone are not enough. The trust between the public and government around science has been frayed. Anti-vaccination movements are mobilizing in the US and elsewhere. They’re powerful, they’re insidious, they’re propagandists, and too often, they’re winning. These movements, fed by misinformation and rejection of science, also risk further alienating communities of color in the US, whose mistrust of medical institutions is an understandable response to longstanding discriminatory care and a legacy of abusive research.
The crucial task of remedying these barriers to widespread vaccination and preparing the public for what is to come will fall not just on the new presidential administration, but on everyone.
To counter the syndemic and lay the foundation for positive, equitable post-pandemic transformation, we call for the Biden administration to focus on these 6 key strategies:
REBUILD TRUST: First and foremost, President Biden must rebuild trust with the American people. He must be a communicator-in-chief, set positive examples, let science lead, and partner with key trusted community leaders to help develop and spread effective messages. Biden has assembled an excellent COVID-19 team with enormous experience in global health and equity, so he must harness their knowledge and convey both science and empathy with the public regularly. The team’s national strategy for COVID-19 is a positive first step.
CALL ON ALL OF SOCIETY: Neither the US, nor any government, can solve a syndemic alone. We need a “whole of society” response; leaders everywhere must answer the call. Business, the private sector, academia, entertainment, faith and community organizations, philanthropy, sports—every organization must be part of the solution.
MOBILIZE COMMUNITIES: Communities across the country need to step up to confront this syndemic. Responses to the syndemic cannot succeed without local community networks and organizations being actively engaged and empowered to respond to the pandemic in their localities. This includes the need for robust government and philanthropic funding of the nonprofit and civil society groups that know their own communities best and have earned their trust. We need to build a culture of mutual trust and respect.
ENHANCE THE TATTERED PUBLIC HEALTH SYSTEM: The Biden administration also needs to rebuild what has been one of the most shocking failures in the US: its public health infrastructure. COVID-19 has made it painstakingly clear how much the US suffers without strong primary care systems, universal health coverage, and well-funded and strong public health departments. The legacy of structural racism begins in medical school training and is embedded in every aspect of the delivery of care. In addition, this year has exposed the failures of an “America First” global health strategy, and the Biden administration must double down on contributions of resources and expertise toward global health. We need to strengthen the global health infrastructure to get through COVID-19, but also to protect from the epidemics and pandemics to come.
PROTECT AND ENHANCE SUPPORT FOR HEALTH CARE WORKERS: The pandemic has also demonstrated the pressing need to increase workplace protections and supports for frontline health care workers, together with all essential workers who have bravely held the country together throughout the pandemic. This includes implementing workplace safety and whistleblower protections that to-date are inadequate. It also requires ensuring adequate funding and coordination so that health systems are well-stocked with personal protective equipment, have necessary resources to ensure adequate staffing—with necessary benefits and manageable working hours—and have implemented appropriate protocols and contingency plans to address future catastrophic health emergencies. Funds need to be directed toward increasing the numbers of BIPOC healthcare workers and addressing racist practices and structures throughout health care systems, which the pandemic has revealed.
RESTORE HOPE: And finally, the Biden administration needs to spread a unifying message of hope and shared common cause. His inaugural address last week was an important step in this direction. We need to look to the future and unite all sectors to develop and implement a plan for national regeneration, not just in the health sector but in our economy, our politics, and our culture. Approaching COVID-19 as a syndemic rather than a pandemic allows for this larger vision—one of equity and social justice. It is time to embrace the transformative opportunity ahead of us, informed by the lessons of history.
One reason to hope: In our decades of work in global health and human rights, the kind of cooperation, solidarity, and unity of purpose that we have seen amongst our colleagues in health and science this year is unprecedented. The collaboration across disciplines, across communities, across borders in the past year has been astonishing and gives us a sense of what’s possible in the future.
COVID- 19 has divided and challenged us, but it has also shown the best of who we are and the best of who we can be. This is a moment to rewrite a different future for ourselves, for our families, and for our communities. We must and can do it.
Richard Horton, FRCP, FMedSci, is editor-in-chief of The Lancet, a position he has held since 1995. Horton was the first president of the World Association of Medical Editors and he is a past president of the US Council of Science Editors. He is a member of the Physicians for Human Rights board of directors.
Donna McKay, MS joined PHR as executive director in February 2012. Before PHR, McKay served for nearly a decade as the director of institutional advancement and special projects at the American Civil Liberties Union.