The Covid-19 pandemic is a global health and economic crisis, and a global response is needed - especially to exit from the many nationwide lockdowns now in place. Otherwise, chains of transmission will recur.
Covid-19 is a global crisis. Yet the international responses thus far have been mostly at the country or city level, in part because pandemic preparedness planning and implementation have largely been the responsibility of individual governments.
This has to change if the world is to emerge from the coronavirus pandemic stronger. A good time to start is now as the International Monetary Fund and World Bank begin virtual conferences of leaders this week.
Some headway is being made with the Group of 20 (G-20) finance ministers and central bankers expected to offer a freeze on bilateral government loan repayments for six or nine months when they meet today. This is a positive move and more such coordination is needed.
PERVASIVE LOCKDOWNS, LIMITED GLOBAL IMPACT
The current state of the world is abnormal as the global economy slows to a crawl. Last month, countries from six continents unilaterally implemented either a partial lockdown through border closures, or a complete lockdown that restricted intra-city movement of people, goods and services, ranging from closing down parts of the manufacturing sector to the closing of small businesses and schools.
Countries such as Italy, Spain and the United Kingdom in Europe, to China, India and the Philippines in Asia, effectively declared a state of emergency that halted all non-essential industries and businesses, as well as enforced strict movement restrictions that required people to essentially stay within their primary residences and limit commutes within the country.
Some of these national closures were announced and executed with little prior warning and planning, resulting in the sudden implementation of curfews as well as the suspension of supply chains, which raised the spectre of food shortages. These have resulted in job losses, widespread anxiety and decline in the quality of life for millions of people.
Countries and territories such as South Korea, Hong Kong and Taiwan prioritised different strategies, relying on rigorous contact tracing, widespread testing and early quarantining of all high-risk cases to contain the outbreak without locking down the country or territory, although all have implemented varying degrees of border controls that suspended entry to visitors who have been to regions experiencing widespread community transmission.
Border closures aim to minimise importations and exportations that can lead to further transmission, whereas a complete lockdown aims to disrupt uncontrollable local transmissions.
When timed and executed well, both measures together can contain even large local outbreaks of the coronavirus Sars-CoV-2 that causes the disease Covid-19, as exemplified by reports from mainland China and specifically Wuhan, the first epicentre of the pandemic.
Controlling its local transmission has allowed China to gradually lift its curbs on its manufacturing and small business sectors, schools and local and international travel; but as it reopens borders, the risk of importations contributing to a potential second wave of widespread community transmission is very real. For the past three weeks, China has vastly more imported infections than indigenous ones.
There are many problems with country lockdowns. They work better in well-resourced countries that are able to provide compensatory resources to tide their citizens through a prolonged period of scarcity and isolation. Countries with insufficient planning and resourcing would inevitably have to rescind the lockdown prematurely to allow imports of essential food and medicine supplies, or to provide for the vulnerable communities to avert a different humanitarian crisis.
National responses have amplified current inequities as some nations and communities have turned to fending for themselves, by hoarding dwindling resources and restricting the export of medical and personal protective equipment (PPE) necessary for the management of the epidemic.
This exacerbates the shortage of vital PPE, such as surgical masks, face shields and gowns, in low-and middle-income countries that lack the financial capacity to engage in price negotiation to guarantee supply.
Apart from inequitable outcomes, country lockdowns that are individually executed have limited effect. They can reduce transmission and death rates in individual cities or countries for a short period, until movements of people and goods resume, increasing infection risks again. Thus they can at best achieve a temporary local containment, but will fail to slow the Covid-19 pandemic if one adopts a global outlook.
Most crucially, the subsequent opening up of economies and "unlocking" of these measures, if not coordinated globally, will unleash second, third and subsequent waves of infections. "Unlocking" in this case refers to countries electing to ease internal curbs on various sectors and international movement.
Of course what would have worked better is a globally coordinated lockdown that would dramatically reduce most commercial activities around the world for a pre-determined period to break the chain of transmission of the virus. This would deliver a sharp but short shock to the world economy, after which activities can resume.
But this did not happen. What is thus crucial now, since a coordinated lockdown has not occurred, is how the world coordinates to end the national lockdowns.
First, there has to be benchmarks to help governments decide when transmission is at a level that would permit the unlocking of various internal sectors and local and international travel without raising the risk of imported re-infections from travellers.
Without a coordinated approach, staggering or prematurely ending the national lockdowns could compromise any gains made and the proverbial weakest link in the chain aptly applies when the inability of every country to contain Covid-19 invariably would increase the risk to other countries.
Hence, clarity is needed on when the curbs can be eased, and the World Health Organisation must provide technical guidance on the appropriate measures to assess risks and manage the global pandemic as unlocking occurs.
Second, a risk assessment approach, sector by sector, is needed to exit from lockdown, rather than a blanket rule to ease or keep lockdown measures.
For example, activities involving specific population strata that are deemed to have low infection risks could be allowed to resume first, such as allowing school children to resume classes if transmission had been shown to be low in school settings. Next, perhaps a graduated approach to permit partial intra-city people movement and resumption of manufacturing and trade, but continuing with restrictions on international travel.
Risk assessment at present, however, is hampered by the lack of validated serological tests, which are needed to understand transmission in various sectors during the past few months. And a lack of current understanding of the immunity provided by previous infection hampers confidence in permitting those with a positive serological test to safely re-enter the workforce.
Third, engage businesses. Despite the above uncertainties, the business sector can be tapped to contribute more to the planning for unlocking the sector, be it aviation, manufacturing or small businesses. Business leaders, perhaps coordinated through an organisation like the World Economic Forum or World Trade Organisation, can work with governments to develop a gradual plan to resume operations, and ensure compensation mechanisms that were put in place during lockdown are fully honoured and new ones established if deemed necessary.
Fourth, tap overseas development assistance. One specific change needed is for the definition of overseas development assistance to be expanded, so that help given under many such programmes globally encompass all goods and services necessary for weaker nations, including conflict zones and failed states, to exit from the lockdown. This would require international organisations, such as the World Bank and other abled countries, to redistribute resources, as coordinated by the United Nations, and necessarily invoke any moratorium on sanctions.
The execution of international aid needs to be better targeted, including establishing coordinated systems that deliver aid to the needy and vulnerable, and in the long term help ensure that all countries have the capacity to respond to public health emergencies in the future as has been recommended by the G-20 in its recent declaration.
Fifth, make use of existing multilateral set-ups, including the global meetings of leaders this week, to conceptualise and coordinate plans for exits. There are many other international issues pertinent to coordinated exits, such as restarting port activities and trade, control of borders and travellers, cautious resumption of flights and aviation, and ability to honour stimulus or assistance packages promised.
The question now remains: Do leaders of nations have the will to come together and achieve this goal?
• Teo Yik Ying is dean and professor of the Saw Swee Hock School of Public Health at the National University of Singapore. David L. Heymann is professor at the London School of Hygiene and Tropical Medicine, and chairs the World Health Organisation Strategic and Technical Advisory Group for Infectious Hazards.
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