The Lancet Commission called for a major overhaul to the World Health Organization (WHO) and global health policy following the estimated deaths of more than 17 million people worldwide as a result of the COVID-19 pandemic.
“This staggering death toll is both a profound tragedy and a massive global failure at multiple levels,” according to their 58-page report published in The Lancet — a result of 2 years of collaboration between 11 global task forces, 100 consultants, and 28 world-leading experts in public policy, international governance, epidemiology, vaccinology, economics, international finance, sustainability, and mental health.
The Commission recommended that the WHO “be transformed and bolstered by a substantial increase in funding,” as well as “increased and more effective investment for both pandemic preparedness and health systems in developing countries, with a focus on primary care, achieving universal health coverage, and disease control more generally.”
Additionally, heads of state from each region need to be called on for decision making, and a new global pandemic agreement must be drawn up, the Commission 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 basic public health precautions, often influenced by misinformation; and too many nations have failed to promote global collaboration to control the pandemic,” said Commission Chair Jeffrey Sachs, PhD, of Columbia University in New York City.
To address the COVID-19 pandemic, a global vaccine-plus strategy needs to be established, combined with public health and financial measures to control infection, the report noted. Moreover, the origin of SARS-CoV-2 needs to be found, which will require “unbiased, independent, transparent, and rigorous work by international teams in virology, epidemiology, bioinformatics, and other related fields.”
“The faster the world can act to vaccinate everybody, and provide social and economic support, the better the prospects for exiting the pandemic emergency and achieving long-lasting economic recovery,” said Salim S. Abdool Karim, PhD, of the Mailman School of Public Health at Columbia University, in the press release.
Co-author María Fernanda Espinosa, MA, of Robert Bosch Academy in Berlin, noted that “over a year and a half since the first COVID-19 vaccine was administered, global vaccine equity has not been achieved.”
In high-income countries, three out of four people have been fully vaccinated, but in low-income countries, it’s only one in seven, she 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.”
Disjointed public health systems and poor-quality public policy response in the U.S. and Europe led to cumulative deaths of around 4,000 per million, “the highest of all WHO regions,” the Commission wrote, adding that these are the countries with the highest rankings in the 2019 Global Health Security Index — accolades that “turned out to be poor predictors of the actual outcomes of the pandemic.”
Some failures in national responses included:
- Lack of public policies to address inequitable impacts on vulnerable communities, including women, children, and workers in low- and middle-income countries
- Misinformation on social media that exacerbated inequities
- Substantial public opposition to routine public health and social measures
- Failure to draw on behavioral and social science to encourage changes in behavior
On the other hand, Western Pacific countries, including in East Asia and Oceania, did much better. These countries had about 300 cumulative deaths per million, the result of “relatively successful suppression strategies,” the report noted.
The Commission further pointed out that “the COVID-19 response has shown several aspects of international cooperation at its best: public-private partnerships to develop multiple vaccines in record time; actions of high-income countries to financially support households and businesses; and emergency financing from the International Monetary Fund (IMF) and World Bank.”
According to Sachs, “we have the scientific capabilities and economic resources” to meet the Commission’s goals, “but a resilient and sustainable recovery depends on strengthened multilateral cooperation, financing, biosafety, and international solidarity with the most vulnerable countries and people.”
Sachs reported no conflicts of interest.
Karim reported grants paid to the Centre for the AIDS Programme of Research in South Africa from the National Institute of Allergy and Infectious Diseases, the South African Medical Research Council, the National Research Foundation, and the European and Developing Countries Clinical Trials Partnership. He is a vice-president of the International Science Council; a commissioner of the African Commission on COVID-19; and a member of the WHO Science Council, the Advisory Council of the Physicians for Human Rights, the Global Medical Advisory Board on COVID-19 for Sanofi Pasteur, and the Scientific Advisory Committee of the Bill & Melinda Gates Foundation.
Espinosa reported no conflicts of interest.
Other co-authors reported multiple relationships with pharmaceutical companies, academic institutions, and government entities.