It is humbling to work on global health and humanitarian communications in this moment. The vastness and vulnerability of the human race are breathtaking in equal measure. Talking with people in Nairobi, Geneva or Bangkok on how Covid19 could quickly collapse a fragile health system in a conflict zone or disrupt a medical supply chain on one continent causing a deadly drug shortage on another. Consulting on strategies for incentivising rebellious European teens to stay at home or to help impoverished children in low income countries stay safe without soap and water. Even the uncertainty of where we are heading. We are all vulnerable, in different, but equal ways. There is no ‘us and them’ this time.
People in Liverpool, Lagos and Laos are all social distancing and uber- handwashing as the virus wafts right across isolationist and nativist barriers. The nationalist orientations of just yesterday seem small and redundant today. We are on a war footing with a deadly enemy, but Covid19 is not an ethnic or ideological foe. Like all living things it simply wants to reproduce. We cannot counter it with an alternative ideology. We need the two things that populism seeks to diminish: science and international collaboration. A solution found in one country or more, will become a solution for all countries everywhere.
I have been lucky to work alongside epidemiologists in large scale humanitarian responses, but never on this scale. Public health, along with universal education and social protection, are amongst the UN’s basic international human rights tenets. In disaster and war, maintaining public health is a recognised humanitarian principle. Good public health is when societies improve health outcomes for all: reduced child mortality, non-communicable disease and longer life expectancy. It is also our first line of defence against a deadly enemy like Covid19.
The global child survival revolution of previous WHO/UNICEF and public health generations dramatically reduced child mortality by attacking disease transmission. For the first time in history, major childhood diseases were stopped in their tracks. This occurred through herd immunity via mass immunisation and access to clean water and sanitation. Vaccines, clean water and Sanitation transformed our world beyond recognition and still stop more deaths than any invention since. This is the reality that many of our societies have come to take for granted for the past few decades. Until now.
Pandemics recede when the basic reproduction rate drops way below one. This is the average number of people someone with the disease will infect. The current basic reproduction rate for Covid19 is estimated at between 2 and 2.5. It is much more infectious than regular flu which has a reproduction rate of 1.3, but much less infectious than measles with a rate of up to 18.
Without vaccines or herd immunity for Covid 19, we need other means of reducing transmission. Mass testing and then isolating and caring for cases is our primary form of attack. Social distancing and rigorous hand washing are the best defensive assets we have. Often these public measures are challenging as recent politics has shrunk space and trust for public intervention. We need to rebuild it to defeat Covid19. In doing so we can build a more cohesive society, as many places did after the second world war. This is up to us.
I have seen children die in countries where herd immunity and vaccine confidence has dipped following a concerted anti-vaccination campaign . The Covid19 crisis is only a very moderate version of where they would take us. The anti-vaxxers and their friends would unravel decades of progress on the major childhood diseases and leave our children exposed to something much worse than Covid19. Deadly diseases, including measles, with a basic reproduction rate of between 5 and 18.
One example is Polio. Only two generations ago Polio was every parents worst fear. The paralysing, life changing and often deadly disease has a reproduction rate of between 5 and 7. In 1955 Jonas Salk, a virologist from a working class, Jewish migrant family in the Bronx became a global hero when he found a Polio vaccine.
Just 60 days into Covid19, we already have a vaccine being trialled. This is unprecedented and would never have happened if countries had not put the genetic sequences out in public. It will probably be a multi-national team of Jonas Salks who will deliver the final vaccine to defeat Covid19.
Mostly now we are seeing the best of ourselves. We can see that the values that have recently stripped employment rights, public services, science and international collaboration to the bare bones are flimsy and reckless. We can see that wealth makes you no less dependent on the at-risk front-line health worker or low-paid food delivery person. It is a humbling time indeed. Maybe that humility will help us regroup, rethink and defeat Covid 19. And then build a better tomorrow.