3 Global Health Design Questions for a Post-COVID-19 World
As we ease travel restrictions and lockdown measures there will be a strong desire to return to the way things were. We must resist that. Contrary to what you may have been told, it will probably be very easy to return to the way things were — it will be the less painful, and seemingly less costly thing to do. We must resist that, we must deliberately seek to carefully process what realities of our response to this pandemic mean for international development and global health and we must be willing to confront bold fundamental design decisions not transitions like the digitization of trainings and workshops, (digitization of current non-digital processes are not necessary pedestrian and can be hard to design, navigate and implement).
These are still early days in the brave new world born of a global pandemic. But we need to start keeping our notes on how we must restructure our world for greater resilience. In this piece, I briefly take an overview of 3 things we should take a careful look at post-COVID-19.
How the International Health Regulations (2005) works. We need to redesign the IHR (2005) and the tools it provides the WHO and state parties (and their NPHIs). Contrary to what you will hear from credible sounding sources in the coming weeks, the WHO’s response to the COVID-19 Pandemic isn’t terrible. In fact, given the tools it had, WHO has done a stellar job. It is arguable that it did miss a few calls and was behind on a number of key decisions by a few days. But it was largely working according to design, within the constraints of its own rules. We need to look at how WHO collects evidence for its decisions, how binding these decisions should be on state parties (during a Pandemic, at other times etc). One thing we need to redesign and test aggressively is how the WHO triggers work and what they mean for NPHIs and for coordinating mechanisms/platforms within state parties and the regions in which they operate. We need to ensure that the WHO triggers are very sensitive and that the measures they trigger are effective. One quick example of a decision-making paradigm that we need to redesign is the WHO’s strong aversion to recommending travel restrictions. In the majority of cases, advising against travel restriction is the right thing to do. But a one-week lag in the decision to impose travel restrictions can be the difference between a controllable situation and a catastrophic pandemic.
How Science is Communicated. There is a need to close the appalling gap in the public’s understanding of how science works (or just how the world works). We need a critical mass of people who will be able to spot bullshit from a distance at the first try. Public Health measures will be so much more effective if our risk communication works as designed and if dangerous voices are seen as such. To be clear, I am quite impressed by the quality (and the effectiveness) of Risk Communication for CoViD-19 globally (and in Nigeria). But the ease with which people questioning public health measures using totally bogus logic easily gain traction is rather alarming. Things like the 5G-COVID-19 conspiracy theory should exist only in the fringe of society. And when people with big media platforms question public health measures and authorities a critical mass of the public should be able to follow the conversation and separate nonsense from valid alternative opinions, regardless of where that nonsense is coming from.
Funding Priorities and Frameworks for Global Health. We need to completely rethink and redesign how global health for developing countries is being funded. There’s a need to focus on the hard problems of development rather than the short-term numbers-driven targets. I know we really need to eradicate polio urgently but we also need to ask ourselves questions about the value of the polio eradication scaffolding (and so many non-system optimizations) we have built. We should move away from programming that wants trophies after a couple of years of work. We have to become more willing to invest in programs that yield results fifteen to twenty years down the line. In designing and mapping funding priorities, we need to be bold and show a willingness to back ideas that have a real chance of failing but whose upside has the potential fundamentally change/transform our systems. It is a terrible legacy that after decades of Global Health funding in Nigeria we can neither design and produce test kits and it took us as long as it did to activate the network of laboratories needed for a near-national coverage of testing for COVID-19.