Shawview Consulting’s Brendan Shaw makes a compelling case for why the ongoing coronavirus pandemic should lead to a rethinking of how healthcare works across the globe.
Global crises can trigger major reform and Covid19 should trigger a reform of our health systems.
9/11 and the GFC
When two jet airliners hit the twin towers of New York’s World Trade Centre on 11 September 2001 the world changed.
The events of 9/11 showed that terrorism had gone global, extremists could strike anywhere, and existing national security structures were not fit for purpose for an internationally connected 21st-century threat that knew no borders.
The 9/11 terrorist attacks resulted in massive changes in security systems worldwide, an expansion of new and existing security agencies, investment in defence and security technologies and a major stepping up of international cooperation to fight global terror.
It was not that we were not fighting terrorism before 9/11, just that we realised from that point on that our security services, our investments in technology and our policy and regulatory systems were not sufficiently funded, internationally coordinated or prioritised to deal with a globalised world.
Similarly, when Lehmann Brothers investment bank collapsed on 15 September 2008 the world changed again.
What started as the crash of the sub-prime mortgage market in the United States quickly escalated into the Global Financial Crisis that spread financial contagion around the world and brought the world’s financial system to the brink of collapse.
In the aftermath of the GFC, countries around the world came together again to improve the capacity and resilience of their financial systems through investments in financial system strengthening, regulatory reform and introducing new levels of international cooperation to manage the global financial system.
Again, it was not that we were not managing our financial systems before the GFC, just that it demonstrated that our existing financial systems did not have enough capacity and resilience to deal with the realities of an interconnected 21st-century global society.
Covid19
Today, the Covid19 pandemic is demonstrating that our health systems are not enough for an interconnected global society in the 21st century.
We are rapidly discovering in real-time that our health systems are not sufficiently funded, coordinated or prioritised to deal with a global society in the 21st century where people and diseases move around the world with relative ease.
In the space of three months, a highly infectious coronavirus coming out of one Chinese city has overcome health systems in many countries and almost brought global society and the economy to a standstill.
Again, it is not that we were not dealing with pandemics before Covid19, just that our current health systems are not structured to deal with the 21st century.
We are rapidly discovering in real-time that our health systems are not sufficiently funded, coordinated or prioritised to deal with a global society in the 21st century where people and diseases move around the world with relative ease
For example, we have known for years that pandemics were a possibility.
There have been preparatory war games, international health regulations, pandemic preparedness plans, international agencies created, and we have had previous outbreaks to learn from like SARS in 2003, H1N1 in 2009 and Ebola in 2014.
The World Health Organization had previously listed pandemics as a major top 10 threat to human health and we have even known that SARS-coronaviruses were a potential threat.
And yet, just as in the past when terrorists and sub-prime mortgage lenders revealed flaws in the global architecture of our security and financial systems, many countries’ health systems have not been able to cope with an infectious virus that can fly around the world undetected in a matter of hours.
That much of the world’s population is today in lockdown is a graphic demonstration of this as is the unseemly competitive panic buying by governments of medical equipment and medicines that rivals any panic buying of toilet paper by consumers.
Just as we did in the aftermath of 9/11 and the GFC, we will need to look for the lessons for our health systems in the aftermath of Covid19.
Global health reform
While it might be too early to speculate on exactly what needs to be reformed in health systems around the world, a few ideas are already starting to emerge out of the current Covid19 crisis.
Funding
If we can spend trillions of dollars on new security agencies and capital injections for financial systems, we must be able to find a way to marshal enough capital to invest in modern health systems for the 21st century. We already have a series of global health targets under the UN Sustainable Development Goals, but the World Health Organization, the World Bank and others have said we are not on track to achieve those goals due to a lack of finance. There needs to be conversation about having enough finance to fund health systems around the world.
Value and prioritisation of health systems
The Covid19 pandemic in the last couple of months has shown the catastrophic economic impact for society of not investing sufficiently in protecting our health. In the global fight for finance, health systems have not always won out ahead of defence budgets and financial sector investments. As well as the obvious social benefit of saving people’s lives, investing sufficiently in healthcare makes good economic sense. But the health sector has not been particularly good at making this case for many reasons.
Use of technology and better efficiency
Health systems have not always dealt with new technology well. Legacy systems, traditional frameworks and a cost-containment mindset influenced by imposed budget caps have made systems wary of new technology. Many technology changes are affecting healthcare, but we need to be sure our systems can adapt and utilise these effectively. Equally there also needs to be a discussion of what is the efficient uses of our resources, with efficiency being broadly defined to include long-term societal benefit as opposed to cost saving in any one budget year.
International coordination
The ability of our health systems to coordinate and cooperate internationally needs to be reviewed. The fact the World Health Organization is so poorly funded and that a patchwork of other international agencies have sprung up in the last decade or two to fill gaps suggests that getting greater clarity on how our health systems interact and coordinate their activities at the national and international level is vital.
Cross-sectoral collaboration
The way that different stakeholders and sectors engage in health care needs to deepen. If the Covid19 outbreak has shown us anything it is that when real crisis happens different sectors can work together. Governments are working in extraordinary ways right now with private sector companies, health care professionals, research scientists and the broader community to fight the Covid19 outbreak. We should learn the lessons from this experience about how different sectors of the economy and society can come together to collaborate better than they have before.
Never waste a good crisis
Calamitous world events can sometimes be the warning bell for us that our governance systems need reform.
They can be the exogenous shock that forces us to face the new reality.
Like 9/11 and the GFC, Covid19 may prove to be one of those shocks that again shows that our ways of working together have not caught up with our ways of living together in the global society of the 21st century.
This reform and new thinking is likely to be a difficult challenge for all stakeholders in global health, be they governments, funders, regulators, health experts, patients, health care professionals and private sector companies.
While we are still in the midst of the Covid19 crisis, we should be starting to think now about how we can build a better global architecture for our health systems for the sort of world we want in the future.
Brendan Shaw is Principal of Shawview Consulting, Adjunct Senior Lecturer in pharmaceutical medicine and global health at the University of New South Wales and a former Assistant Director General of the International Federation of Pharmaceutical Manufacturers and Associations.
