I heard the sound of a thunder that roared out a warning
I heard the roar of a wave that could drown the whole world.
Bob Dylan, A Hard Rain’s a-Gonna-Fall
If a rising tide is said to float all boats, the opposite may be the case with COVID-19. The pandemic of this novel coronavirus, which first made its silent appearance in China sometime in 2019, was, in the jargon of health emergency planning, a ‘Rising Tide’, a tide that has sunk any boat that was holed below the water line. In gathering momentum and circumnavigating the world in record time, the virus found the cracks in flawed public health systems at each level from the global WHO down to the frontline in local communities. In so doing, it has threatened the lives of millions and the economies of even the stronger countries. As of August, it had been responsible for approaching 15 million cases and 600,000 deaths worldwide.
As the virus spread, it tested every weakness of biosecurity and public health in its path. Although primarily airborne in its transmission, through droplet and aerosol spray, but also via environmental contamination of hard surfaces, it challenged governments and public health authorities to mobilise their citizens in a concerted effort to stop it in its tracks. While some were able to demonstrate a good initial measure of success, notably South Korea, Hong Kong, Taiwan, Australia, New Zealand and most of Scandinavia, others, including the United States and the UK, were found wanting. Poorer countries and those with less developed public health systems, especially in the Southern Hemisphere, struggled to protect their citizens but even those better prepared were interrogated ruthlessly by the simplest of life forms, an RNA virus. Once again, as with Ebola in 2014, the WHO failed to declare a Public Health emergency of global concern in a timely way.
Fundamental to the biosecurity and protection of the health and wellbeing of the world’s 8 billion population was the ability of the WHO to galvanise the organised efforts of its 194 member states. At a time when effective international health diplomacy was paramount, the prerequisite of collaboration in sharing epidemiological data was an early casualty. Accusations of bad faith were levelled against China with the weakness of the arrangements for world health governance being cruelly exposed.
The combination of China’s lack of initial collaboration together with WHO’s vacillation played into the hands of a hostile President Trump who cut off essential funding to this vital vehicle for health protection. WHO, as currently constituted, is neither fish nor fowl, carrying global status as a United Nations body charged with protecting world health but lacking neither authority nor teeth and powers to act promptly and decisively to protect the world from 21st-century threats. It is riven with crippling politics and makes the bureaucracy of the European Union look light-footed. It is crying out for reform and strengthening but we can’t do without it.
As the emergency developed, other rifts in solidarity emerged as individual countries staked out their national claims to be first in the queue for effective treatments and vaccines, irrespective of relative need. In the UK, the narrow and chauvinistic Brexit dogma spilled over in a truculent refusal to engage with collective procurement of essential testing equipment, personal protective equipment and ventilators, to the detriment of the home population. This contributed to thousands of unnecessary deaths and the dysfunctional organisational aftermath of the Lansley health reforms of 2013, including the disastrously centralising Public Health England, set the country up to fail. The Prime Minister’s lazy approach to leadership was the straw that broke the camel’s back.
Also domestically, as the waves of the rising tide grew into a tsunami of damage, the weaknesses in many areas of national life were identified and penetrated with forensic ruthlessness. These included the dire state of social care and the poor state of health and safety in the slaughterhouses and textile sweat shops hidden in plain sight in the nation’s towns and cities, creating ideal conditions for further outbreaks of the pandemic.
In the Bible, the book of Galatians VI tells us that ‘Whatsoever a man soweth, that shall he also reap’, an instruction also to be found in traditional North American culture as ‘looking after the things that look after you’, or in the practice of public health as the ‘Precautionary Principle’, so often disparaged by free marketeers. If the COVID-19 pandemic teaches us nothing else, it should be that a rising tide may sink all ships.
Declarations
Competing Interests
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Guarantor
JA.
Contributorship
Sole authorship.
Acknowledgements
None.
Provenance
Not commissioned; editorial review.