Expertise, Coronavirus, and the New Normal

Expertise, Coronavirus, and the New Normal

North–south divide in the time of coronavirus may be a preview of what will emerge on other side of the pandemic

The photo is an original movie poster of the movie with the words across the bottom, "Not that it matters, but most of it is true."
“Nobody knows anything,” said Hollywood screenwriter William Goldman, who wrote the 1969 classic Butch Cassidy and the Sundance Kid," starring Paul Newman, Robert Redford, and Katharine Ross. GETTY Images/Movie Poster Image Art

“Nobody knows anything” the Hollywood screenwriter William Goldman once proclaimed —illuminating those in his own industry of the uncomfortable truth that expertise is in the eye of the beholder. This is the closest analogy we find to the global COVID-19 pandemic and how it is dealing with notions of expertise. Among the myriad of things this pandemic is bringing to light is how we must re-evaluate the old tropes of scientific expertise—particularly in global health. The novel coronavirus is a precursor to disastrous days ahead as governments and populations make decisions in order to prevent thousands of potential deaths and buffer societies to the economic dominoes that are currently falling one by one.

Decisions to prevent thousands of deaths and buffer societies to the economic dominoes that are currently falling one by one

Speaking at the government's daily coronavirus briefing on the 26th March, the United Kingdom’s deputy Chief Medical Officer, Jenny Harries, when asked why the Britain was not following the World Health Organization’s (WHO) recommendations for combatting the pandemic virus, said “We need to realize that the clue with the WHO is in its title—it’s a World Health Organization. And it is addressing all countries across the world, with entirely different health infrastructures … We have an extremely well developed public health system in this country.”

The image shows the medical officer at a podium speaking into a microphone.
Jenny Harries, U.K. deputy chief medical officer, at a daily news conference on coronavirus at 10 Downing Street in London on April 19, 2020. REUTERS/Pippa Fowles/10 Downing Street Handout

To suggest the WHO’s recommendations were, essentially, for “other” countries by invoking the United Kingdom’s developed country status is to assert a sort of health-care exceptionalism—and a dangerous one. Ignoring a global pool of expertise that has already shown to be effective at saving people's lives around the globe—not just for this pandemic, but previous epidemics over the years—may be putting British lives at risk.

Ignoring a global pool of expertise that has already shown to be effective at saving people's lives around the globe

One common thread in each national response is decision-making based on the best available evidence wherever it may be found. The World Health Organization, often the easy target of chagrin when global health events of this magnitude hit, has largely risen to the challenge, ensuring that the lessons learnt from one country are at least available for the next country to learn from, and hopefully avoid untold numbers of cases and deaths. Their daily press briefings since the start of the outbreak have been a master class in public health communications messaging—being technically exact and using precise urgent language. This is a unique role only the WHO can fill.

 The photo shows the building on a clear day.
A logo is pictured outside a building of the World Health Organization (WHO) during an executive board meeting on update on the coronavirus outbreak, in Geneva, Switzerland, February 6, 2020. REUTERS/Denis Balibouse

Countries that once prided themselves on being cathedrals to scientific expertise have been shown to struggle to stem the tide of the virus transmission. At the time of writing, the United Kingdom and United States stand apart from other countries in not only their unique approaches to responding to the virus, but also in cases and resulting deaths from the virus.

Global decisions get made in Geneva, Seattle, Washington DC, and London by global health actors whose financial resources outmatch local expertise

Global health expertise in the global north has always been an abundant commodity that was exported—writ large—to the rest of the world, those “other” countries. Global decisions get made in Geneva, Seattle, Washington DC, and London by global health actors whose financial resources easily outmatch local expertise. I too am guilty of this being based in a research institution in the global north. A recent New York Times opinion piece has called for a “brain trust” of the developed world to focus on a coronavirus strategy for the developing world—a brain trust of the same think tanks, news media, universities, and nongovernmental organizations that have shaped the imbalanced global health debate up until this point. The Times article largely ignores, either knowingly or unintentionally, the work that has already gone on within African borders. In February, only Senegal and South Africa had the capacity to test for the virus. By the middle of March that number was already at forty countries—due, in large part to the efforts of Africa CDC and WHO.

The photo shows a woman wearing a mask sitting amid an abundance of fruit in a tiny stand.
A woman buys fruit in Dakar, Senegal, on March 18, 2020. Senegal was one of two African countries equipped to test for coronavirus in February, but a month later, more than forty countries were. REUTERS/Zohra Bensemra

This false dichotomy in global health expertise is nothing new. This has been a recurring trend, with the “decolonise global health” movement among others. But this pandemic is putting it in a spotlight and making it impossible to ignore. And no doubt the discussion will continue. What is needed now is a way to reorient what we traditionally considered global health expertise and institutionalise this reorientation. Expertise is never unassailable and should not be held secure from scrutiny.


Expertise is never unassailable and should not be held secure from scrutiny

Recently, researchers from the London School of Hygiene and Tropical Medicine writing in The Lancet recommended that to combat the pandemic, the United Kingdom will need to implement a national program of community health workers for COVID-19 response. A distinctly global south approach. Evidence that a coordinated community workforce can provide effective health and social care support at scale can be gleaned from Brazil, Pakistan, Ethiopia, and many other nations. If there were ever a time to be more community minded, it is now.

The picture shows a crowded scene with a man washing his hands
A man washes his hands at a public hand washing station before boarding a bus as a cautionary measure against the coronavirus at Nyabugogo Bus Park in Kigali, Rwanda on March 11, 2020. REUTERS/Maggie Andresen

There are many more lessons to be learnt from a truly global pool of expertise. As British Prime Minister Boris Johnson was telling its elderly population not to worry and not to go on any cruises, Uganda, for example, had already implemented airport screening for incoming travellers a month earlier—all in the absence of detected cases within its borders. While videos of handwashing stations at bus stations in Rwanda had gone viral.

The lessons are there to be learnt from other countries for those willing to learn them. In a post-COVID-19 world, this will change, for no other reason than it needs to. The virus is also a precursor for a new world to emerge on the other side.

The photo shows a row of workers wearing protective blue suits and bright green facemasks working in a factory.
Workers are seen at a production line making personal protective equipment as a measure to stem the coronavirus disease (COVID-19) outbreak, in Athi River near Nairobi, Kenya, on April 14, 2020. REUTERS/Njeri Mwangi

Charles Ebikeme is a writer and researcher at the London School of Economics and Political Sciences.

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