Widespread, global failures at multiple levels in the COVID-19 response led to millions of preventable deaths and reversed progress made towards the UN Sustainable Development Goals (SDGs) in many countries, according to a new Lancet COVID-19 Commission report.

The Lancet Commission reports on lessons for the future from the COVID-19 pandemic and outlines recommendations that will help hasten the end of the ongoing COVID-19 pandemic emergency, lessen the impact of future health threats, and achieve long-term sustainable development.

The report warns that achieving these goals hinges upon a strengthened multilateralism that must centre around a reformed and bolstered World Health Organisation (WHO), as well as investments and refined planning for national pandemic preparedness and health system strengthening, with special attention to populations experiencing vulnerability.

Crucial investments also include improved technology and knowledge transfers for health commodities and improved international health financing for resource limited countries and regions.

The Commission is the result of two years of work from 28 of the world’s leading experts in public policy, international governance, epidemiology, vaccinology, economics, international finance, sustainability, and mental health, and consultations with over 100 other contributors to 11 global task forces.

Professor Jeffrey Sachs is Chair of the Commission, University Professor at Columbia University (USA), and President of the Sustainable Development Solutions Network. He explained:

“The staggering human toll of the first two years of the COVID-19 pandemic is a profound tragedy and a massive societal failure at multiple levels.

“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.

“Now is the time to take collective action that promotes public health and sustainable development to bring an end to the pandemic, addresses global health inequities, protects the world against future pandemics, identifies the origins of this pandemic, and builds resilience for communities around the world.

“We have the scientific capabilities and economic resources to do this, but a resilient and sustainable recovery depends on strengthened multilateral cooperation, financing, biosafety, and international solidarity with the most vulnerable countries and people.”

What went right

• public-private partnerships to develop multiple vaccines in record time
• actions of high-income countries to financially support households and businesses
• emergency financing from the International Monetary Fund (IMF) and World Bank.

What are the multiple failures

• Costly delays by WHO to declare a “public health emergency of international concern” and to recognise the airborne transmission of SARS-CoV-2
• national governments’ failure to cooperate and coordinate on travel protocols, testing strategies, commodity supply chains, data reporting systems
• lack of cooperation among governments for the financing and distribution of key health commodities—including vaccines, personal protective equipment, and resources for vaccine development and production in low-income countries

Pre-COVID-19 rankings of country preparedness for pandemics, such as the 2019 Global Health Security Index, ranking the USA and many European countries among the strongest for their epidemic response capabilities, turned out to be poor predictors of the actual outcomes of the pandemic.

The Commission found that the Western Pacific region, including East Asia and Oceania, primed by previous experience with the SARS epidemic of 2002, adopted relatively successful suppression strategies resulting in cumulative deaths per million around 300, much lower than in other parts of the world. Disjointed public health systems and poor-quality public policy response to COVID-19 in Europe and the Americas resulted in cumulative deaths around 4,000 deaths per million, the highest of all WHO regions.

Maria Fernanda Espinosa, former President of the UN General Assembly and former Minister of Foreign Affairs and Defence, Ecuador. is a Commission co-author said:

“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 in four people have been fully vaccinated, but in low-income countries, only one in seven

“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.”

The report is also critical of national responses to COVID-19, which often featured inconsistent public health advice and poor implementation of public health and social measures, such as wearing face masks and vaccination. Many public policies did not properly address the profoundly inequitable impacts of the pandemic on vulnerable communities, including women, children, and workers in low- and middle-income countries.

These inequities were exacerbated by extensive misinformation campaigns on social media, low social trust, and a failure to draw on the behavioural and social sciences to encourage behaviour change and counter the significant public opposition to routine public health measures seen in many countries.

To finally control the pandemic, the Commission proposes that all countries adopt a vaccination-plus strategy, combining widespread vaccination with appropriate public health precautions and financial measures.

Preparing for the Future

 The Commission recommends:

• strengthening national health systems
• the adoption of national pandemic preparedness plans
• actions to improve coordinated surveillance and monitoring for new variants
• investing in ventilation and filtration to protect groups experiencing vulnerability, and create safer school and workplace environments

The Commission calls for WHO to be transformed and bolstered by a substantial increase in funding and greater involvement from heads of state representing each region to better support decision-making and actions, especially on urgent and controversial matters. The Commission supports calls from other panels for a new global pandemic agreement and an update of the International Health Regulations.

The Commission recommends a 10-year effort by G20 countries to bolster research and development and investments in infrastructure and manufacturing capacity for all critical pandemic control tools including testing, diagnostics, vaccines, treatments, and PPE, alongside support and training for health workers in low- and middle-income countries.

Other recommendations made include:

• the call for an expansion of the WHO Science Council to apply urgent scientific evidence for global health priorities, including future emerging infectious diseases
• strengthening of WHO through the establishment of a WHO Global Health Board with representation of all six WHO regions
• strengthening of national health systems on the foundations of public health and universal health coverage, grounded in human rights and gender equality.

The Commission also recognises the need for an independent, transparent investigation into the origins of SARS-CoV-2, alongside robust regulations, to help prevent future pandemics that may result from both natural and research-related activities, and to strengthen public trust in science and public authorities.

Click on this link to access to report : The Lancet COVID-19 Commission published 14th September 2022