We are all going to be affected by Covid-19, and we must work together across the world if we are going to come out of the next year peacefully and coherently. The world in a year’s time will be fundamentally different from how it is now; now is the time to start planning for that future. The countries that will be most adversely affected by Covid-19 are not the rich and powerful, but those that are the weakest and that have the least developed healthcare systems. Across the world, many well-intentioned people are struggling to do what they can to make a difference in the short-term, but many of these initiatives will fail; most of them are duplicating ongoing activity elsewhere; many of them will do more harm than good.
This is a plea for us all to learn from our past mistakes, and work collaboratively in the interests of the world’s poorest and most marginalised rather than competitively and selfishly for ourselves.
Bilateral donors and international organisations are always eager to use their resources at times of crisis both to try to do good, but also to be seen to be trying to do good. Companies and civil society organisations also often try to use such crises to generate revenue and raise their own profiles. As a result many crises tend to benefit the companies and NGOs more than they do the purportedly intended beneficiaries.
This was classically, and sadly, demonstrated in the Ebola outbreak in West Africa in 2014, especially with the funding of numerous Internet-based initiatives – at a time when only a small fraction of the population in the infected countries was actually connected to the Internet. At that time, I wrote a short piece that highlighted the many initiatives ongoing in the continent. Amongst other things this noted that:
- “A real challenge now, though, is that so many initiatives are trying to develop digital resources to support the response to Ebola that there is a danger of massive duplication of effort, overlap, and simply overload on the already stretched infrastructure, and indeed people, in the affected countries”, and
- “Many, many poor people will die of Ebola before we get it under control collectively. We must never make the same mistakes again”.
I have not subsequently found any rigorous monitoring and evaluation reports about the efficacy of most of the initiatives that I then listed, nor of the countless other digital technology projects that were funded and implemented at the time. However, many such projects hadn’t produced anything of value before the crisis ended, and most failed to many any significant impact on mortality rates or on the lives of those people affected.
In the hope of trying not to make these same mistakes again, might I suggest the following short-term and longer-term things to bear in mind as we seek to reduce the deaths and disruption caused by Covid-19.
The following five short-term issues strike me as being particularly important for governments and donors to bear in mind, especially in the context of the use of digital technologies:
- Support and use existing technologies. In most (but not all) instances the development and production of new technological solutions will take longer than the immediate outbreak that they are designed to respond to. Only fund initiatives that will still be relevant after the immediate crisis is over, or that will enable better responses to be made to similar crises in the future. Support solutions that are already proven to work.
- Co-ordinate and collaborate rather than compete. Countless initiatives are being developed to try to resolves certain aspects of the Covid-19 crisis, such as lack of ventilators or the development of effective testing kits (see below). This is often because of factors such as national pride and the competitive advantage that many companies (and NGOs) are seeking to achieve. As a result, there is wasteful duplication of effort, insufficient sharing of good practice, and the poor and marginalised usually do not receive the optimal treatment. It is essential for international organisations to share widely accepted good practices and technological designs that can be used across the world in the interests of the least powerful.
- Ensure that what you fund does more good than harm. Many initiatives are rushed onto the market without having been sufficiently tried and tested in clinical contexts. Already, we have seen a plethora of false information being published about Covid-19, some out of ignorance and some deliberate falsification. It is essential that governments and donors support reliable initiatives, and that possible unintended consequences are thorouighly considered.
- Remember that science is a contested field. Value-free science does not exisit. Scientists are generally as interested in their own careers as anyone else. There is also little universal scientific agreement on anything. Hence, it is important for politicians and decision makers carefully to evaluate different ideas and proposed solutions, and never to resort to claiming that they are acting on scientific advice. If you are a leader you have to make some tough decisions.
- Ensure that funding goes to where it is most needed. In many such crises funding that is made available is inappropriately used, and it is therefore essential for governments and donors to put in place effective and robus measures to ensure transparency and probity in funding. A recent letter from Transparency International to the US Congress, for example, recommends 25 anti-corruption measures that it believes are necessary to ” help protect against self-interested parties taking advantage of this emergency for their own benefit and thereby undermining the safety of our communities”.
In the medium term…
Immediate action on Covid-19 is urgent, but a well thought-through and rigorous medium-term response by governments and donors is even more important, especially in the context of the use of digital technologies:
- We must start planning now for what the world will be like in 18 months time. Two things about Covid-19 are certain: many people will die, and it will change the world forever. Already it is clear that one outcome will be vastly greater global use of digital technologies. This, for example, is likely dramatically to change the ways in which people shop: as they get used to buying more of their requirements online, traditional suppliers will have to adapt their practices very much more rapipdly than they have been able to do to date. Those with access to digital technologies will become even more advantaged compared with those who cannot afford them, do not know how to use them, or do not have access to them.
- Planning for fundamental changes to infrastructure and government services: education and health. The impact of Covid-19 on the provision of basic government services is likely to be dramatic, and particularly so in countries with weak infrastructures and limited provision of fundamental services. Large numbers of teachers, doctors and nurses are likely to die across the world, and we need to find ways to help ensure that education and health services can be not only restored but also revitalised. Indeed, we should see this as an opportunity to introduce new and better systems to enable people to live healthier and more fulfilled lives. The development of carefully thought through recommendations on these issues, involving widespread representative consultation, in the months ahead will be very important if governments, especially in the poorest countries, are to be able to make wise use of the opportunities that Covid-19 is creating. There is a very significant role for all donors in supporting such initiatives.
- Communities, collaboration and co-operation. Covid-19 offers an opportunity for fundamentally different types of economy and society to be shaped. New forms of communal activity are already emerging in countries that have been hardest hit by Covid-19. Already, there are numerous reports of the dramatic impact of self-isolation and reduction of transport pollution on air quality and weather in different parts of the world (see The Independent, NPR, CarbonBrief). Challenges with obtaining food and other resources are also forcing many people to lead more frugal lives. However, those who wish to see more communal and collaborative social formations in the future will need to work hard to ensure that the individualistic, profit-oriented, greedy and selfish societies in which we live today do not become ever more entrenched. We need to grasp this opportunity together to help build a better future, especially in the interests of the poor and marginalised.
Examples of wasteful duplication of effort
Already a plethora of wasteful (in terms of both time and money), competitive and duplicative initiatives to tackle various aspects of the Covid-19 pandemic have been set in motion. These reflect not only commercial interests, but also national pride – and in some instances quite blatant racism. Many are also very ambitious, planning to deliver products in only a few weeks. Of course critical care ventilators, test kits, vaccines and ways of identifying antibodies are incredibly important, but greater global collaboration and sharing would help to guarantee both quantity and quality of recommended solutions. International Organisations have a key role to play in establishing appropriate standards for such resources, and for sharing Open Source (or other forms of communal) templates and designs. Just a very few of the vast number of ongoing initiatives are given in the reports below:
Critical care ventilators
- Why Ventilators are key to fighting the coronavirus battle
- Bengaluru based Skanray starts work on new ventilator design that would speed up production locally
- How India can combat the ventilator shortage? Bangalore-based Skanray Technologies plans to make 1 lakh locally sourced ventilators in 2-3 months to battle coronavirus. Shereen Bhan speaks to Vishwaprasad Alva of Skanray Tech
Despite criticisms of the replicative and wasteful nature of many such initiatives, there are a few initiatives at a global scale that do offer hope. Prime among these must be Jack Ma’s donation of 20,000 testing kits to each of 54 African countries, which will go some way to reducing the need for these to be domestically produced across the continent. But this is sadly only a small shower of rain on an otherwise parched continent. Working together, we have much more to be achieved, both now and in the months ahead.