For a global pandemic response, we can do better

August 12th, 2021   |   Global Health, India, SIT Graduate Institute, SIT Study Abroad

Dr. Azim Khan

'As a student, researcher, and professor of public health, I see exciting opportunities to learn more, research more, share more; to do a better job when humans are struck by the next pandemic.'

About 30 percent of the world’s population have so far received at least one dose of a COVID-19 vaccine. The vast majority of those have been among people in wealthier nations. In fact, only about 1.2 percent of people in low-income countries have received at least one dose of a vaccine.

Addressing this discrepancy at the G-7 summit in Belgium in June, wealthy nations pledged to provide 870 million doses for the World Health Organization’s COVAX initiative, including a pledge of half a billion doses from the United States and 100 million from the UK.

To talk about these pledges and the larger question of a global response to the pandemic, we spoke with Dr. Azim Khan, who brings a broad and multi-disciplinary background as a leader of SIT’s master’s and undergraduate health programs in India. Azim has a PhD in health, gender, and human rights from Aligarh Muslim University; an MA in human rights from the University of London; a master of laws from Aligarh Muslim University; and a bachelor of laws with distinction in constitutional law from the University of Lucknow.

Why do we need a global response to this crisis? 

We have learned that no country, no community can isolate itself from a pandemic, thinking ‘We will be fine if we cut ourselves off from the rest of the world’. Today, that’s almost impossible. COVID-19 comes 100 years after the Spanish Flu of 1918 that went on for two years and caused human catastrophe, but 1918 was very different. The world was not as connected and mobility was not so high, so it took a long time to spread. Look at how quickly COVID-19 spread and caused havoc all over the world. With this kind of pandemic—at this level of magnitude—we can only come out of this when there is a coordinated global response.  

What have wealthy nations done right, and what should the be doing differently? 

It's really important for developed countries that have more resources to invest more. There are countries around the world that are barely able to meet basic needs of food and shelter. We can only successfully fight the pandemic when there is a coordinated global response where higher-income countries support those that do not have similar levels of resources. This is not like the Ebola outbreak, which was an epidemic but was concentrated in a specific geographical location. There seems to be no country that COVID has not reached. 

Even if countries that have resources think they can vaccinate their entire population and try to contain the pandemic within their territory, they need to understand that the pandemic won’t go away unless we are able to successfully defeat the virus all over the world.

Even if countries that have resources think they can vaccinate their entire population and try to contain the pandemic within their territory, they need to understand that the pandemic won’t go away unless we are able to successfully defeat the virus all over the world. If we had been able to put $60 billion into vaccinations along with what has been spent on health care around the world, we could have insured that every human that qualifies around the world would be vaccinated. 

Countries, especially those that have resources, have been pretty self-centered, which is understandable. For any country, protecting the life and well-being of their citizens is a priority. But we need to be sure that in doing so, these countries don’t jeopardize other countries’ interests.  

We have seen a sort of vaccine nationalism, which is against what we have been preaching and practicing in the post-globalization era. The scientific community, political leaders, economic resources and collective leadership should come together to create a roadmap. This is the way we’ll fight the virus more effectively. 

I understand the Biden administration’s priority is to vaccinate as many people as possible as soon as possible. But we also need to look at how this affects the world. The US invested a lot of money to advance vaccine research and production. It was a very good move. This is the reason that the US does not have a lack of vaccines today. But the United States also ordered more than 50 million doses of the AstaZeneca vaccines, which have not yet gotten emergency-use authorization from the FDA. I wish that these doses were sent to the global alliance for vaccination, the COVAX initiative for smaller countries, where 50 million doses would have at least helped in vaccinating healthcare and other frontline workers. Better late than never, the White House has realized this and is now working on distribution of these vaccine doses through COVAX. 

But it’s not just about the US; European countries have been fighting against themselves. All these things sidetracked the job that was expected from world leaders, especially a group like G7. World politics are shaped by these countries. 

The scientific community, political leaders, economic resources and collective leadership should come together to create a roadmap. This is the way we’ll fight the virus more effectively. 

We need to understand that we cannot be safe until all people are safe. This an old struggle. Infectious disease has always been a ‘Third World problem.’ Countries with limited resources struggle with all kinds of infections at different times while health systems and policymakers in high-income countries thought, ‘Epidemics are not our problem’.  

Unfortunately,in the last few years the CDC had considerably cut the funding for various centers across the globe, and we saw how badly prepared the American healthcare system was in their response to the COVID-19 pandemic. In the US and the UK, doctors and healthcare workers didn’t have the capacity to deal with patients in these volumes. So, it was a huge challenge to effectively respond to the pandemic and we lost so many lives in the US, UK, Brazil, and India that could have been saved if we had had good, coordinated planning, vaccine policy and acknowledged that infectious diseases aren’t just a problem for the developing world or poor countries.

Now we must learn from these mistakes, from poor or lack of leadership that we saw around the world. We had a US president who didn’t take it seriously and we saw that although the US has a robust, advanced health system with good doctors and advanced hospitals, if there is a lack of political leadership things can still get messed up. That happened in the EU, in UK, Brazil, and in India. It happened in so many countries.

And we saw that where leadership was collaborative, transparent, science driven, and understood the importance of saving lives, those countries have done better. New Zealand, Scandinavian countries, South Korea all have done pretty well. We don’t know much about China because there is a lack of transparency in terms of data. But the worst scenarios were in places like the US, Brazil, India—all cases marked by populist politics and leaders who ignored the science and worked according to their whims and fancies. They caused a lot of misery to their countries.

... where leadership was collaborative, transparent, science driven, and understood the importance of saving lives, those countries have done better. 

I really appreciate the Biden Administration’s initiative to share vaccine doses with other countries, but this could have been done in a more organized way and a few months earlier. I hope that Europe, the US, the UK, Japan, India, and Russia all join this global initiative. This is a pandemic. It can only be defeated when we work together. 

What are some other factors that point to the need for a more global approach? 

So many things are interconnected. The total GDP for the world was about $110 trillion before the pandemic. What happened in 2020-21 is a significant erosion of wealth; we are losing upwards of 27 percent of wealth.  

Businesses are not going to function as normal unless there is control over this pandemic. How can American industry do business with industries in countries that are still fighting the virus and business activities are almost shut? 

We need to understand that unless and until we defeat this pandemic, the economic situation won’t improve, even for developed countries. They have been able to support their citizens and small businesses, but you can’t boost export if other countries are not importing. 

We need to understand that unless and until we defeat this pandemic, the economic situation won’t improve, even for developed countries. They have been able to support their citizens and small businesses, but you can’t boost export if other countries are not importing. So, it’s in the interest of the globe, the business community, people, and organizations to have a global initiative to defeat this pandemic. 

What are some of the lessons in this pandemic for your field of public health? 

Public health will be an even more interesting field, especially in the next few years as we study COVID from all angles—policy, gender, labor, economics, social impact, impact on children. A huge focus of public health is going to be understanding and studying infectious diseases in general and COVID in particular, epidemiologically, socially, economically, and clinically. So, there will be much more focus on public health. We often think of health in terms of doctors and hospitals. But we’ve seen that a pandemic requires people across disciplines, people who can insure clean water supplies and food, good governance, communication. 

A huge focus of public health is going to be understanding and studying infectious diseases in general and COVID in particular, epidemiologically, socially, economically, and clinically.

For example, we know that in many places, even if technically they are free, available and affordable, accessibility to vaccines is not there. Somebody who can read English, who can get online and find a vaccine dose, someone who is technically savvy has a higher chance of accessing this vaccine than somebody who doesn’t have access to technology. 

A country like India should facilitate walk-in appointments. There are clinics but if 300 people walk in, their system and resources can get overwhelmed. What happens if somebody has gone to a vaccine center thinking that he or she will get vaccinated and this person is sitting all day and then told, ‘Sorry, we’re out of stock for today. Please come tomorrow’? This person gets discouraged and, in many cases, may not turn up the next day. 

So, we have done a lot of advocacy work with the government in Delhi and in other states to ensure that the vaccines are accessible and the process is user-friendly to encourage more people to get vaccinated. I’ve worked with the committees leading the campaign against COVID to support community volunteers and share the feedback with government officials to help them understand the realities and challenges on the ground.  

It’s not enough to build fancy hospitals and create a good health infrastructure and say you’re doing well. Viruses have been with us; this won’t be the last pandemic. So, there is a lot of learning ahead for us. There has been a lot of misery, challenges, emotional trauma, but as a student, researcher, and professor of public health, I also see exciting opportunities to learn more, research more, share more; to do a better job when humans are struck by the next pandemic. We need to organize better and deliver better. We need to learn from each other and work together.  

Dr. Azim Khan is academic director of three SIT Study Abroad programs in India: Public Health, Gender & Community Action; Traditional Medicine and Healthcare Practices; and Virtual Internship in Public Health, Community Action & Response to COVID-19 Pandemic. He is associate professor and co-chair for SIT Graduate Institute’s master’s degree in Global Health. Follow him on Twitter @azimsherwani.