The pandemic has exposed the fragilities of health systems in many countries around the world, from the highest income nations to developing ones, across all kinds of different healthcare models, from universal to private, single-payer to multi-payer, National Health Insurance to out-of- pocket and other systems. It has also clearly revealed the inadequacies around a lack of international coordination in response to the crisis, with many countries treating the outbreak as national issues to address alone and going their own ways with different approaches rather than forging a coherent global strategy. There has been mismanagement across the board from communication and the supply of PPE, to managing lockdowns to testing, tracing and more. Even those nations held up as model examples and the gold standard, have struggled immensely. The effects of a historical lack of political will and effective measures to ensure proper investment into health systems has been laid bare. We can and must be better and never again should we allow governments to be so inadequately prepared. The systemic weaknesses in healthcare systems that in most economies have been little changed since the Second World War have been highlighted for all to see as well as the huge vulnerabilities in the global community’s poor ability both to prevent and react to this pandemic. We have to learn from the mistakes and not allow them to be repeated, and countries need to strengthen the resilience of their healthcare systems with root and branch public health reform to counter years of underfunding and insufficient focus. 

We need to address the chronic ills plaguing health sectors globally including a sclerotic bureaucracy and poor centralised monitoring and coordination which has led to a lack of awareness around where supplies are most needed, insufficient healthcare infrastructure and reserves of key equipment, inefficient supply chains and a lack of contingency facilities to produce critical equipment and an overall approach that is too short term and does not focus enough on prevention. These problems have been left untreated for years and we have uncomfortably tried to manage the symptoms but the severity of the current pandemic is a loud wake-up call. In spite of other outbreaks that should have acted as warnings, countries have been derelict in investing the money needed to prepare for such pandemics. By nature, governments tend not to ignore major threats but overreact to immediate problems facing them and underreact to longer-term ones that build in a slower manner. As an analogy, taking measures to treat heart attacks is important of course, but so is addressing root causes in order to prevent them from happening in the first place. We do not need cosmetic minor adjustments that have palliative effects and lull us into a false sense of security but systemic reforms and investment in infrastructure and research to act as a defense against pathogens that appear in the future. Quick wins would include reversing cuts to disease control surveillance programs that track nascent outbreaks globally and help governments anticipate future crises. Beyond that, more unified governance and coordination around monitoring and measurement would help us understand at any time where supplies are most needed and where outbreaks are at their worst. This would be a powerful tool in any health crisis and assist governments in reacting in a rational, collective, and rapid manner that these situations demand. Nothing can completely prevent a novel virus but we can prepare, respond, and recover better. Such reforms won’t just pay off when the next pandemic appears, making it much less terrifying and more manageable but will also benefit us in non-pandemic periods.

It has been great to see truly inspiring philanthropic donations and efforts to raise money for charities supporting healthcare systems as well organisations and initiatives focussing on sourcing PPE and critical equipment but we should not normalise the public having to step in to plug the gap. They should not have to. It is the role of governments and we must ensure they perform it sufficiently moving forward. Sadly, after years of chronic underfunding and cuts, health systems have been stretched to the limits, and the advice, complaints, and feedback of many healthcare professionals have been ignored by governments. This neglect has helped lead to and manifested itself in the current fragilities in healthcare systems globally. We must recognise the peravise, integrative nature of healthcare and that a strong health sector is crucial for all other parts of an economy. One silver lining from the pandemic is the lessening resistance to viewing medical care as a basic right. Governments need to recognise this and work to eliminate health disparities and ensure nobody is left behind. It is evident from this crisis that we are only as strong as our weakest link and the health and lives of the most affluent in society are entwined with those less fortunate. All our lives depend on the resilience of the collective so our personal health alone is not just important but also that of others. 

New light has been shone on the importance of mental health services due to the toll the pandemic has been taking on people’s mental health, as a hidden cost of the crisis. The suffering, uncertainty, and fear that people have been experiencing have been compounded by the tragic reminders of systemic injustices and decades of underinvestment and neglect in addressing people’s mental health needs. With depression, suicides, and drug and alcohol abuse on the rise across the planet, mental health needs must be put at the heart of governments’ pandemic response and recovery plans. Mental health services were already stretched before the pandemic and we face a major mental wellbeing crisis whose scars could last years unless investment in mental health services is increased urgently and interruptions that have occurred to such services are reversed, with coverage being expanded. Huge swathes of populations have been impacted from frontline workers, the elderly, children and adolescents to people who have lost their loved ones as well as their livelihoods and homes, to those who are most at risk with pre-existing mental and physical health conditions, those who are shielding or self-isolating and refugees or people caught up in conflict zones. For the vast majority, these are unique, unprecedented circumstances where so many have been put under extraordinary pressure faced immense personal trauma and dealt with further fear, loss, and social distancing/isolation due to pandemic response efforts. Funerals have even had to change and the trauma for many of those facing bereavements has been worsened by not being able to properly grieve or say goodbye to their loved ones. 

Governments must step up with immediate expansion in mental health provisions so they have adequate resources to cope and long term they have to build a better future where mental and physical health is put on a par. Research has shown the strong relationship between mental and physical wellbeing, unemployment, and living conditions and those who have been hardest hit in this crisis are the poorest and most vulnerable in societies whose pre-existing hardships have been amplified. It is clear that mental health is a spectrum where people’s wellbeing can change and it is not something only relevant for those with clinically significant psychiatric conditions. Countries across the globe must use this opportunity to scale up, reorganise, and build mental health services that are fit for the future, as a failure to take this seriously will undoubtedly lead to long term social and economic costs as well as further damage to people’s emotional wellbeing. It has been great to see a newfound global interest in mental health which is finally getting the attention it deserves but it is important to ensure this is not short-lived as a ‘hot topic’ or ‘box to tick’ on policy agendas but leads to enduring reforms and greater investment. The WHO has called for ambitious commitments from countries and to quote Dévora Kestel, Director of the Department of Mental Health and Substance Use at the WHO, “This means developing and funding national plans that shift care away from institutions to community services, ensuring coverage for mental health conditions in health insurance packages and building the human resource capacity to deliver quality mental health and social care in the community.”

This crisis has left no room for doubt around who some of the most essential workers in society are and many of them have been undervalued/overlooked for far too long and treated as sacrificial workers (in particular low paid immigrant staff who prop up healthcare systems). In addition to appreciation, we are determined to advocate for better working conditions and appropriate pay for essential workers and champion their rights moving beyond this crisis. We should not merely pay lip service to how much we value them but instead need to show it in reality. This is the best form of appreciation anyone can show them and is more tangible and longer-lasting. Many on the frontline have spoken about how grateful they are for the heartwarming public support that has been displayed but also about how what they want most is to be able to do their job with better resources and adequate protection and equipment, in a safer working environment where they are listened to and with appropriate remuneration. We cannot allow it to be a sentimental distraction from the significant issues they face and can help them in practical ways. They should not have to stand alone and be public activists, clamoring for better protection for their patients and fellow health workers, in the face of sluggish government responses that put lives at risk. If they remained silent they would be shirking their duty and oath to protect their communities and do no harm. Whilst those on the frontline help protect us in fighting this crisis, we all have the ability to make even a small but practical contribution by lobbying for them so they can do their jobs in a safe manner and also have a safety net if they do become sick. They deserve better and governments can help improve things in the long run in response to calls for improvements from members of the public. In many countries across the world, these workers have been chronically undervalued and poorly paid despite being such important members of society and the workforce. Let us not forget them quickly and allow them to be neglected once more. Countless key workers are anxious, overworked, and exhausted, but are still bravely doing their jobs in the face of great adversity. We must repay our collective debt to them, show our support, and ensure that they have better conditions and are treated as a priority as they deserve to be.