The Lancet Commission on lessons for the future from the COVID-19 pandemic, published on Sept 15, lays bare what has been nothing less than a massive global failure—a failure of rationality, transparency, norms of public health practice, operational coordination, and international solidarity. The Commission shows that national governments were too slow and too cautious in their response to the outbreak of SARS-CoV-2. They paid too little attention to the most vulnerable groups in society. Their responses were hampered by low public trust and an epidemic of misinformation and disinformation. The result was millions of preventable deaths and a reversal in progress towards sustainable development for many countries. A multilateral system developed after the World War 2 did not hold up to a modern pandemic. Global collaboration and solidarity were good in business and science but poor in politics and international relations. The Commission proposes five pillars that are essential in fighting emerging infectious diseases: prevention, containment, health services, equity, and global innovation and diffusion. To achieve these pillars the Commission argues that governments, regulators, and institutions must be reoriented toward society as a whole, rather than the interests of individuals—a concept the Commissioners call prosocialty. Without this shift, the world is vulnerable and unable to tackle effectively any global threat.
The Commission gives recommendations in three main areas. First, practical steps to finally control and understand the COVID-19 pandemic, such as a vaccination strategy that is sustainable and not just reactive, with the goal of protecting populations. Second, realistic, feasible, and necessary investments to improve the first line of defense in countries by strengthening health systems and widening universal health coverage. Third, ambitious proposals to ignite a renaissance in multilateralism, integrating the global response to the risk of future pandemics with actions to address the climate crisis and reversals in sustainable development. In this way, the Commission boldly sets out a vision of a different future, defined by a properly financed and better-prepared global architecture that is driven by cooperation and shared responsibility rather than globalised profit-seeking.
The Commission began with a task force on the origins of the pandemic. But, regrettably, the divisive public discussion about the source of SARS-CoV-2 damaged the trust needed for the task force to complete its work. This Commission therefore has no additional new evidence to contribute to the ongoing investigation of the pandemic's origins. The recommendation to intensify the search for the source of the pandemic is an urgent plea for countries to strengthen cooperation to elucidate the causes of this catastrophe. This will aid the prevention of future pandemics. Some Commissioners have come under unprecedented attack and pressure as a result of their work. The Lancet thanks them for their time and dedication to scientific enquiry.
There have been an estimated 17·7 million excess deaths due to COVID-19 globally, and this number is likely to be an underestimate. The number of reported new weekly cases decreased or remained stable across all six WHO regions. However, many countries have reduced their surveillance, causing uncertainty about the true number. Surveillance and testing capacity must be safeguarded and rescaled to prepare for potentially increasing numbers during winter in the northern hemisphere. Japan, South Korea, Australia, Chile, and parts of Europe such as Greece continue to have very high numbers of new cases. The risk of new variants remains elevated and there are uncertainties around the strength and duration of immunity from vaccination. But perhaps most importantly, as many countries and institutions try to find a path out of the pandemic, many questions about what went wrong and how future pandemics can be prevented remain unanswered.
The war in Ukraine and climate and economic instability have diverted attention away from COVID-19. But as the Commission demonstrates, reassessing and strengthening global institutions and multilateralism will not only benefit the response to COVID-19 and future pandemics but also to any crisis that has global ramifications. The release of The Lancet Commission on COVID-19 offers the best opportunity to insist that the failures and lessons from the past 3 years are not wasted but are constructively used to build more resilient health systems and stronger political systems that support the health and wellbeing of people and planet during the 21st century.
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