Member states of the World Health Organization (WHO) are gathering next week at the World Health Assembly in Geneva to discuss a global pandemic treaty, aimed at strengthening future pandemic prevention, preparedness and response. This is an opportunity for high level commitment and a governance framework to address future disease threats. To be effective, however, it must be recognised how far epidemics are social and political phenomena, and that effective mechanisms need to balance global health concerns with people’s diverse social, political and economic realities.
Over the past two years our research on the impacts of Covid-19, with partners around the world, overwhelmingly found that from urban North-West London to rural Zimbabwe, disjunctures emerged between global pandemic imaginaries and procedures and people’s lived experiences and contexts. In many settings centralised, surge-style, measures were favoured by international agencies and national governments. However, one-size-fits-all models were found wanting not only on the grounds of effectiveness, but also of social justice.
Dominant framings and processes of response too often underplayed the importance of localised contexts and on the ground knowledge, missing opportunities to attune sensitively to people’s needs and possibilities. At the same time, underappreciation of diverse experiences and vulnerabilities undermined ability to protect those marginalised by poverty, geography, religion, ethnicity and gender. As the work of the 59 partners involved in the Covid Collective showed, not only disease but also public health measures had devastating social and economic effects.
Pandemic preparedness for the real world
IDS research, brought together in Pandemic Preparedness for the Real World, highlights how people navigate disease outbreaks in the context of marginalisation, often-intersecting acute and chronic challenges, and precarious livelihoods, amid multiple uncertainties. It also highlights the vital role of social sciences within health research and the need to better understand and address entrenched inequalities, deepening political polarisation, unhealthy populations and structural long-term development in order to improve future pandemic outcomes.
For example, the rapid advances made in the development of vaccines during the Covid-19 pandemic were to be applauded, but their application was beset by structural challenges related to distribution systems and public anxieties rooted in people’s health, social and political understandings. Internationally, the inequity of vaccine distribution across lower income countries will persist unless we acknowledge, understand and rectify the political and structural power imbalances that exist in innovation systems and financing for vaccine development and sharing.
Covid-19 policies often became heavily politicised as parties in power were accused of mixing public health decisions with narrow political imperatives. In India, for example, Muslims were blamed by the ruling Bharatiya Janata Party (BJP) for ‘spreading’ the virus during a gathering. Such ‘politicisation’ fed into increasing polarisation and crises of confidence in governments around the world. In Brazil, divisive discourse in national politics heightened during the pandemic and posed a significant challenge to public confidence in institutions.
Learning from the lessons of Covid-19, and to better protect those who are marginalised and at greater risk from future pandemics, we believe a Global Pandemic Treaty for pandemic prevention, preparedness and response should centrally address the following three points:
- Support community centred approaches that build on the existing resources, relationships and forms of authority that people have long used to respond to threats to health and life. These exist in many places. However, the efforts need resourcing and cannot rely on assumptions of ‘community resilience’ in contexts of deprivation. Better connections need to be built between such ‘preparedness from below’ and formal responses, with mechanisms that enable better adaption of global directives to local epidemiological and social contexts.
- Include diverse knowledge, experience, expertise and perspectives. Local solutions often originate from within local communities and need to be heard. Including diverse knowledge helps address human rights, power inequities and exclusionary politics and challenging entrenched interests, short-term thinking and policymaking that marginalises population groups. Mechanisms such as citizens’ panels to ensure diverse knowledge, expertise and perspectives should be prioritised and integrated.
- Renew people’s trust in politics and state institutions, understanding state-society relationships, history and context. Complex political dynamics play out in outbreak situations and factors such as levels of public trust need to be improved if the mistakes of the Covid-19 pandemic are not to be repeated. IDS research shows that for future pandemics authorities should decentralise decision making and resources and empower local authorities to enable contextualised, flexible and timely responses to local disease ‘spikes’. Accountable and inclusive decision-making also builds trust between citizen and state and reduces polarisation.
New framework for action
These three points along with our new framework for action in the Pandemic preparedness for the Real World report need to be centred within the global pandemic treaty,
On 5 May 2023, Dr Tedros Adhanom Ghebreyesus announced that Covid-19 was now an established and ongoing health issue which no longer constitutes a public health emergency of international concern (PHEIC). As we officially move to the next stage of Covid-19, our attentions must turn even more to preventing and preparing better for the next global pandemic. At multi-lateral fora and among national governments and local authorities, addressing social, economic and political issues, must be core to this urgent agenda for effective pandemic prevention, preparedness and response as biological, medical and technological ones.