In this new piece, former Medact Director and Professor of Global Public Health David McCoy discusses the need for a much broader, whole-societal response to COVID-19. The piece is also available on BMJ Blogs

Across the world, scientists and public health experts are producing new ideas, knowledge and technologies to combat COVID-19. The degree of cross-border sharing of data, research methods and evidence has been heartwarming, and underlines the vital role played by trans-national communities of scientists and experts.

However, the story of every epidemic is a story of the interplay between knowledge, ideology and politics. And within each of these stories, the role of government is crucial in determining how epidemics play out in populations. Not only do governments decide on how science and evidence informs policies and plans; they are central to how policies and plans are implemented.

Having spent ten years as a clinician and public health doctor in South Africa, I saw this play out first hand with HIV/AIDS. First, Nelson Mandela’s government struggled to prioritise HIV/AIDS as it faced the complex challenge of healing the wounds of apartheid and building a new country; then Thabo Mbeki’s government produced confusion and despair by denying HIV, a position that is estimated to have cost 300,000 lives. And across the world, government positions on sex, sexuality and intravenous drug addiction resulted in many tragic preventable deaths.

More recently, heavy-handed government action, coupled with a lack of trust between officials and citizens, inadvertently hindered Ebola control measures in west Africa. And with COVID-19, we see multiple examples of governments determining both the trajectory of the epidemic curve, and the way that the costs and benefits of control measures are distributed across society. It has even been suggested that COVID-19 has delivered a verdict in favour of authoritarianism and dictatorship when compared to the faltering performance of liberal democracies.

Given that it affects all aspects of social, political and economic life, a case can be made for governments producing an explicit COVID-19 manifesto that outlines their principles and aims for dealing with the epidemic. What might such a manifesto look like? Here’s a suggestion for one built around seven key commitments.

A seven point COVID-19 manifesto for the UK

We will address COVID-19 comprehensively and fairly. We will recognise the social, political and economic dimensions of this virus, and ensure that it doesn’t worsen pre-existing social and economic inequalities. We will guard against the propensity for crises to produce opportunities for unethical exploitation and egregious profiteering. We will be guided not just by infectious disease experts, but also by economists, social scientists, ethicists, lawyers and philosophers, so that we produce a holistic response to this complex challenge. We will act urgently to save lives; but avoid any unintended consequences from being hasty and short termist.

We will not sacrifice liberty and we will protect democracy. While some enforcement of disease control measures, including the suspension of some freedoms and rights to privacy, we will respect the principle of proportionality and be alert to the danger that the current crisis could lead to a permanent shift in the direction of authoritarianism and intrusive surveillance. And while the crisis requires clear and decisive executive coordination, we will be transparent, encourage scrutiny and ensure the preservation of appropriate checks and balances to current and future systems of government.

We will not talk down to people. The complex nature of COVID-19, including our gaps in knowledge, requires the delivery of information and instruction to the general public to be clear and concise. But we will avoid platitudes and clichés; commit to being sincere and straight; and respect the fact that public participation is central to managing the epidemic. We will also explicitly reject populist attacks on experts and scientists, and restore faith in public service journalism, broadcasting and media.

We will strengthen local systems. All epidemics are local and geographic, shaped by their social, cultural, economic and topographical contexts. Susceptibility and vulnerability to the disease; as well as the effectiveness of different disease control measures will vary from one place to another. Local government public health teams provides an obvious building block for developing and implementing local action plans, and we commit to providing them with the required resources and mandate. At the same time, we will work to remove the obstacles to more effective coordination and integration of NHS, social care, public health and the community and voluntary sector systems and services.

We will strengthen multilateral institutions. The COVID-19 crisis clearly requires a coordinated international response. We will therefore promote enlightened multilateralism and call for the World Health Organisation to be properly funded and protected from unfair criticism, so that it can carry out its vital mandate to act in the interests of all people, in all countries. And we will call for changes in the way the global economy is governed to ensure that all countries have an opportunity to develop robust and properly resourced health systems as a requirement of achieving global health security for all.

We will look after those who look after us. We will never take the commitment and dedication of our health and social care workers for granted. We will remember that a health system that can be relied upon in moments of crisis is built on a public service ethos, cooperation and professionalism; and that there are risks attached to health systems that are fragmented and market driven. We will ensure that our key workers – in the NHS and beyond – are properly valued with decent pay, and we will say sorry when we let them down. We will end the rising levels of profiteering in our health and social care systems and ensure that public funds for the NHS and social care system are focused on frontline providers and services.

We will turn crisis into an opportunity for all. We will hang onto the silver linings of the COVID-19 cloud to make society better and safer for all in the future. We will treasure the return of birdsong and clear skies to our lives, and commit to the permanent reduction of consumption, waste, pollution and GHGs. We will remember the necessity of state intervention and ensure that the cost of COVID-19 does not result in even greater levels of inequality in wealth and power, but is an opportunity to ensure a redistribution of wealth.

David McCoy
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