By Javed Iqbal*
New York governor Andrew Cuomo has become the articulate, compassionate political face of government competence in fighting a pandemic.
That’s quite an achievement for a man who as late as early March 2020 trumpeted: “Excuse our arrogance as New Yorkers… We think we have the best healthcare system on the planet right here in New York. So, when you’re saying what happened in other countries versus what happened here, we don’t even think it’s going to be as bad as it was in other countries. We are fully coordinated; we are fully mobilized.”
New York was neither fully coordinated, nor was it fully mobilized.
In fact, it became the pandemic’s prime hotspot in the United States, accounting for the highest number of infection cases and the highest mortality rate. Its hospitals were overwhelmed, its stockpiles depleted, its frontline workers perilously exposed to risk of contagion. Many of the deaths could have been prevented had Mr. Cuomo opted to lock down the Big Apple earlier.
For now, that recent history has largely been forgotten. Mr. Cuomo thrives in his element, a rising star on America’s political ferment. His sober but empathetic, fact-based daily briefings project him as a man in command with a mission to ensure the health, safety, and wellbeing of his state.
If Mr. Cuomo, a veteran of dealing with the aftermaths of disasters like Hurricane Sandy, learnt anything from his delayed response to the coronavirus pandemic, it was that “an outbreak anywhere is an outbreak everywhere.”
Unlike other epidemics in recent years such as the Severe Acute Respiratory Syndrome or SARS in the early 2000s, the Middle East Respiratory Syndrome (MERS) in 2012 or the eruption of Ebola in West Africa in 2014, the coronavirus, dubbed COVID-19, left no corner of the globe untouched.
It is a lesson that goes to the heart of all that is wrong with global, regional, and national healthcare governance. It is a lesson that calls into question social and economic policies that have shaped the world for decades irrespective of political system.
It is also a lesson that goes to the core of the relationship between government and the people. It positions social trust as a pillar of an effective healthcare policy in a time of crisis.
In an era of defiance and dissent as a result of a breakdown in confidence in political systems and political leadership that kicked off with Occupy Wall Street and the 2011 Arab popular revolts and led to the rise of populists, mass anti-government demonstrations and in 2019 the toppling of leaders in Algeria, Sudan, Lebanon and Iraq, lack of trust complicated government efforts to counter the virus.
Distrust persuaded many Iranians to initially refuse to heed public health warnings to maintain social distancing, stay at home and install an Android app designed to help people self-diagnose and avoid rushing to hospital.
Pakistanis put their faith in religious leaders who rejected government demands for a halt to congregational prayers. So did many Russians as bans on mass gatherings split the clergy and threatened to undermine the Russian Orthodox Church’s key support for President Vladimir Putin.
Post-mortems of governments’ handling of the crisis once the coronavirus has been contained could increase the trust deficit.
Moreover, in an indication of pent-up anger and frustration that could explode, the imposition of curfews and stay-at-home orders failed to prevent incidental outbursts, including protests in mid-American states, quarantined Egyptian villages and poorer Tunisian and Moroccan hamlets.
In an echo of the Tunisian vendor who sparked the 2011 Arab revolts, 32-year-old unemployed and physically disabled Hammadi Chalbi set himself alight in a town 160 kilometres southwest of Tunis after authorities’ refused to license him as a fruit seller. In Lebanon, a taxi driver set his vehicle on fire while fruit vendors dumped their goods in the streets in expressions of mounting discontent. The protests suggest a universal corollary with the pandemic: an outbreak anywhere is an outbreak everywhere.
Protesters in 2019 went beyond demanding the fall of a leader. They sought the fall of political elites and radical overhaul of failed political systems. The pandemic called an abrupt halt to the protests. Protesters like the rest of the population went into temporary hibernation.
When they re-emerge, they are likely to put government leaders who prioritized political advantage above their health and economical well-being at a cost that surpasses that of the 1929 Great Depression on par with crimes committed against humanity during times of war.
Social, economic, ethnic, and sectarian fault lines are likely to be hardened in countries like Pakistan and Iraq where militants stepped in with healthcare and other social services to fill voids created by lack of government capacity.
The pandemic further painfully illustrated the economic cost of not only failing to confront a health crisis in a timely fashion but also the risk inherent in policies that do not ensure proper healthcare infrastructure in every corner of the globe, guarantee equal access to healthcare, make sure that people irrespective of income have proper housing and nutrition, turn a blind eye to the destruction of healthcare facilities in conflict situations like Syria, Yemen, Libya, Ukraine, Nagorno-Karabakh, Myanmar, and the Democratic Republic of Congo, tolerate millions of refugees existing in sub-standard living and hygiene conditions, and disregard environmental degradation and climate change.
The pandemic casts a spotlight on the deprivation of populations of proper healthcare as a result of politically motivated discriminatory social and economic policies.
The non-discriminatory nature of the coronavirus forced the Israeli government to ramp up testing in communities of Israeli Palestinians which had been described by public health experts as a ticking time bomb.
The experts warned that Israeli Palestinians, who figured prominently among frontline doctors and nurses treating Jews and Palestinians alike, were an at-risk group, many of whom suffer from chronic diseases, live in crowded conditions, and are socially and economically disadvantaged.
Ramping up testing to prevent the spread of COVID-19 constitutes an immediate effort to stem the tide but does little to structurally prepare Israeli and Palestinian society for the next pandemic.
Pre-dominantly Palestinian “East Jerusalem is gravely neglected in every possible way in terms of the infrastructure. Most neighbourhoods of East Jerusalem don’t have sewage systems. Just about every possible public service you can think of is underbudgeted and lacking in East Jerusalem. The only thing they get a lot of is parking fines and (punitive) housing demolition orders, said” left-wing member of the Jerusalem municipal council Laura Wharton.
A Monopoly board centred on Jerusalem given to her by Moshe Lion, the city’s mayor and a former economic advisor and director general of prime minister Benyamin Netanyahu’s office, illustrates the political calculus that potentially puts not only Jews and Palestinians but populations elsewhere at risk in a future pandemic.
“You have here the City of David, the Mount of Olives, the Knesset (the Israeli parliament), the Montefiore windmill, the markets, (the ultra-orthodox Jewish neighbourhood of) Mea She’arim. Al Aqsa (the third holiest Muslim site) is not here, the Church of the Holy Sepulchre is not here. Basically what you have is a bunch of Jewish sites and various illusions to other things. It’s not a very balanced picture of Jerusalem,” Ms. Wharton noted pointing at various landmarks on the board.
African Americans, Hispanics and native Americans tell the story, They have fallen disproportionately victim in the United States to the coronavirus.
US surgeon general Dr. Jerome Adams, a 45-year old African American vice admiral in the U.S. Public Health Service Commissioned Corps, one of America’s eight uniformed services, pulled out his inhaler at a White House press briefing in April 2020, saying he’s carried it around for 40 years, “out of fear of having a fatal asthma attack.”
Looking fit and trim in his dark uniform, Mr. Adams said he also had a heart condition and high blood pressure. “I represent that legacy of growing up poor and black in America. And I, and many black Americans, are at higher risk for COVID.”
The surgeon general said that “its alarming but not surprising that people of colour have a greater burden of chronic health conditions. African Americans and native Americans develop high blood pressure at much younger ages… and (the virus) does greater harm to their organs. Puerto Ricans have higher rates of asthma and black boys are three times (more) likely to die of asthma than their white counterparts…. People of colour are more likely to live in densely packed areas and multi-generational housing, situations which create higher risk for the spread of a highly contagious disease like COVID-19. We tell people to wash their hands, but a study shows that 30 percent of homes of the Navajo nation don’t have running water, so how are they going to do that?”
What goes for one of the wealthiest nations on earth goes for the rest of the world too, particularly with the last two decades suggesting that pandemics occur more frequently and are likely to do so going forward.
What started in Wuhan in China in December 2019 had by April 2020 brought the world to a virtual standstill. Millions across the globe were infected, tens of thousands did not survive, economies shut down and the prospects for recovery and return to what was normal seemed a mere hope in a distant future.
Andrew Cuomo may be the exception that confirms the rule. There is little in the response of leaders from China’s Xi Jingping to Russia’s Vladimir Putin, Turkey’s Recep Tayyip Erdogan and US President Donald J. Trump that suggests that the lesson that an outbreak anywhere is an outbreak everywhere has persuaded them to think in terms of structural change.
If the first six months of the coronavirus are anything to go by, the name of the game has been jockeying for political positions, ideology trumps science, and everyone for him or herself in a race to the bottom rather than apolitical banding together globally, regionally and nationally to fight a dangerous and debilitating common enemy.
The response to the pandemic reflected the crumbling of the post-World War Two international order that is in the grips of a struggle by big and medium-sized powers to shape global governance in the 21st century.
The struggle has already crippled the United Nations and politicization of the coronavirus and healthcare threatens to undermine the World Health Organization, the one, albeit flawed, structure capable of coordinating a global response.
Complicating the response, was the rise of civilizationalists like Mr. Xi, Indian prime minister Narendra Modi, Hungarian prime minister Victor Orban and Mr. Trump who think in civilizational rather than national terms.
They conceive of their nations as civilizations in which Hans, Hindus or Christians rule supreme and there is no equal place for minorities rather than nation states defined by legally recognized borders, population, and language.
Theirs is a world of neglect for international law, increased conflict, political violence, and mass migration that promises to be even less prepared for the next pandemic. It is also a world in which early warning systems are weakened by muzzling of a free press.
Former US president Barak Obama, in his opening blast against Trump in the run-up to the November presidential election, put his finger on the pulse.
“What we are fighting against is these long-term trends in which being selfish, being tribal, being divided and seeing others an enemy, that that has become a stronger impulse in American life. And by the way, you know, we are seeing that internationally as well. And it’s part of the reason why the response to this global crisis has been so anaemic and spotty… It has been an absolute chaotic disaster when that mindset of what’s in it for me and to heck with everybody else – when that mindset is operationalized in our government,” Mr. Obama told a virtual gathering of his former staffers.
The pandemic demonstrates the need for coordinated policies ranging from global, regional, and national stock piling, international cooperation in medical research and development, conflict mediation, protection of minority rights, environment, absorption of refugees and robust but diversified supply chains.
It also highlights the importance to healthcare of eradication of poverty and proper social security nets, housing, hygiene, and access to water in a world in which an outbreak anywhere is an outbreak everywhere.
The pandemic positions an approach towards healthcare that is integrated into sustainable social and economic policies as a matter of global and national security on par with regional and national defense and security policies and investments.
It also raises the question of what role major non-governmental institutions like the Clinton Initiative, George Soros and the Gates Foundation can play.