Combating COVID-19 Without Sacrificing Sustainable Development Goals
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Combating COVID-19 Without Sacrificing Sustainable Development Goals

We must not stop investing in long-term health projects—even under significant resource constraints in times of pandemic

Picture shows James smartly dressed in a well-appointed purple suit with a matching mask. In the background are striking blue and orange and green suits hanging on the wall.
The author argues for pandemic responses that do not sacrifice long-term health projects—just as Kenyan fashionista James Maina Mwangi, on July 30, 2020, blends 160 stylish suits with sensible masks. REUTERS/Thomas Mukoya

The coronavirus pandemic has started to hit developing countries, and all forty-seven countries of the World Health Organization (WHO) African Region are now affected, with the cumulative number of cases in Africa exceeding 784,800 as of July 30, 2020. The landscape of the battle against COVID-19 in low- and middle-income countries is different from that of high-income countries. Due to the lack of adequate health systems, the same approaches could have unintended consequences making them less effective in these countries.

56,700

The reduction in the coverage of maternal health-care service of 45 percent would result in 56,700 maternal deaths

In developed countries, the battle against COVID-19 has essentially become a virus-centric or so-called “vertical” approach, with a primary focus on enhancing capacity for testing and treatment. But such virus-centric approaches will be problematic in developing countries because they will require resource reallocation from other projects that are themselves designed to cover unmet medical needs in these countries. One modeling study highlights that the reduction in the coverage of maternal health-care service of 45 percent would result in 56,700 maternal deaths. Another study estimates that in the worst scenario, the annual mortality due to malaria in sub-Saharan Africa this year could be twice as high as the number of deaths in 2018, should the intense resource reallocation occur.

The picture shows a charred kapok tree, home to hundreds of bats that may have been hosting the deadly virus.
Etienne Ouamouno, father of Ebola patient zero, stands by the kapok tree where scientists say his two-year-old son might have contracted Ebola from bats in Meliandou, Guinea, on February 4, 2015. REUTERS/Misha Hussain

Second, these unintended consequences could undermine the credibility of external medical assistance. One of the biggest lessons we learned from the 2014–2016 Ebola outbreak in West Africa was that control of communicable diseases requires the acceptance and understanding of the local people.

It showed how preparedness and response activities should be synergized with a long-term development agenda. Emergency responses to emerging infections should not only focus on safeguarding and distributing technical solutions to contain the outbreak—they should be human-centric, aiming to enhance the local people’s acceptance and understanding of Ebola projects. The way to do this is by carefully considering the wide range of the needs of the local community.

Picture shows the boy with a bandage wrapped vertically around his jaws to the top of his head sitting next to his mother. They are looking at each other.
Other infections indeed persist: 3-year-old Allay Ngandema, who has measles, eats with his mother Maboa Alpha in a hospital isolation ward in northern Democratic Republic of Congo on Feb. 29, 2020. REUTERS/Hereward Holland

The Convergence and Divergence of Health Security and Development Agendas

The difficulty in applying a simple virus-centric approach is why the battle against COVID-19 is a more Herculean task in developing countries. Given the lack of adequate health systems, how do we simultaneously pursue the goal of containing outbreaks while also strengthening health systems in developing countries under significant resource constraints? Pursuing such a human-centric approach first requires an understanding of the commonalities and differences between the health security and development agenda. A simultaneous pursuit of these two goals is difficult because they are fundamentally different in their purposes and approaches. But there should also be commonalities between the two agenda: We can leverage them to craft an effective resource allocation strategy during the pandemic.

‘Why the battle against COVID-19 is a more Herculean task in developing countries’

The reduction of health, economic, and political risks is the key conceptual similarity between the health security and development agenda. Some have argued that pursuing the global health security agenda and promoting universal health coverage, both example of “horizontal” approaches, are similar in that they aim to reduce the health, economic, and political risks of the local people. The security agenda focuses on reducing the risk of infection, while the universal health coverage focuses on securing the access to routine and emergency medicine broadly, including reducing the risk of other diseases and ameliorating their economic consequences. The same conceptual convergence can be observed in global health security and the sustainable development goals, as evidenced by the fact that the United Nation’s 2030 agenda emphasized the importance of freedom from poverty, hunger, disease, want, fear, and violence.

The photo shows a row of graves with mounds of dirt piled beside them.
Health security seeks to address immediate risks—like not filling these freshly dug graves prepared for COVID-19 victims at the Honingnestkrans cemetery, outside Pretoria, South Africa July 14, 2020. REUTERS/Siphiwe Sibeko

On the other hand, pursuing health security and the sustainable development goals diverge in conceptual and practical ways. First, while the health security agenda’s main focus is on the short term—protecting people from the immediate risks of an emerging infection or some other health crisis—the development agenda aims to achieve long-term health goals by empowering local people with access to care and good health information. Second, global health security is focused on the containment of a pandemic at a global level, across borders, but sustainable development projects could be more narrowly zeroed in on the needs of the local communities.

‘Freedom from poverty, hunger, disease, want, fear, and violence’

That's the crux of the problem. In a global health crisis, with limited available resources, the re-allocation of resources from long-term development programs to crisis responses is the easiest expedient. Since the majority of funding for long-term programs comes from developed countries or agencies within developed countries anyway, those resources could be redirected from development projects to health security ones. Who would argue with the wisdom of prioritizing protecting human lives in the immediate health crisis over spending on more long-term programs?

I, for one, would.

The photo shows a man wearing a mask with his sleeve rolled up taking an injection in the upper arm.
A volunteer receives an injection during South Africa's first human clinical trial for a potential vaccine against the novel coronavirus, at the Baragwanath hospital in Soweto on June 24, 2020. REUTERS/Siphiwe Sibeko

Particularly in developing countries, health security and achieving sustainable development goals are the two wheels of a cart even during the pandemic: take off either wheel, and you will be left dragging a box. An effective containment requires both protection and empowerment of the local people—both short-term emergency responses as well as long-term spending on improving health systems.

‘Take off either wheel, and you will be left dragging a box’

Given the broad scope of the sustainable development goals and the ongoing resource constraints, an effective prioritization of limited financial, human, and health resources should be permitted during the pandemic, but not in a zero sum way. The key to effective prioritization is to focus on the convergence of health security and development agenda, and to invest in the projects that contribute to the reduction of health, economic, and political risks of the local people. Even during the pandemic and under significant resource constraints, we must not stop investing in the development agenda, as the long-term investment to meet the local needs is the key to effective containment operations.

This is a striking photo of a man in a green shirt pushing a cart past wooden shuttered shops painted green and beige and red and yellow.
Health security and sustainable development goals are like two wheels of a cart, the author said. Here a man pushes a cart by closed shops during COVID-19 in Addis Ababa, Ethiopia, on July 1, 2020. REUTERS/Maheder Haileselassie

EDITOR'S NOTE: The author acknowledges Joy Li for her thoughtful comments on the earlier version of this article—as well as the Future of Diplomacy Project at Harvard Kennedy School and the Ito Foundation for International Education Exchange. All views expressed in this article belong solely to the author and do not represent the opinions of the author’s affiliations.

Mitsuru Mukaigawara is a master in public policy student and Belfer International and Global Affairs Student Fellow at Harvard Kennedy School.

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