Governance and the Social Contract within a Changing International Context.
“COVID-19 has laid bare the structures which condemn millions of people in Africa to lives of what Frantz Fanon called many years ago ‘wretchedness’. “
This is how Sello Hatang, Chief Executive of the Nelson Mandela Foundation, opened yesterday’s panel discussion titled Governance and the Social Contract within a Changing International Context: Making Universal Healthcare, Universal, with the support of ABSA and the Hanns Seidel Foundation. This is the first in a series of discussions in response to the 18th Nelson Mandela Annual Lecture, Tackling the Inequality Pandemic, delivered by the United Nations Secretary-General, António Guterres.
“It has become trite to describe the injustices and devastation experienced across the world and yet it is vitally important that we engage with the condition the world is in if we are to heal better,” as Secretary-General Guterres argued in his address. COVID-19 presents a global crisis unprecedented in recent times but it also brings with it the opportunity to begin the work of refashioning towards equity and social justice. The discussion sought to provide a space in which experts could offer solutions to rethink the healthcare systems at a global level and question how resources are mobilised to reach those in need.
The discussion was chaired by Umunyana Rugege, the Executive Director at SECTION27. Rugege’s work focuses on access to healthcare services in the public and private sectors. The panel was composed of the Executive Director of the Wits Reproductive Health and HIV Institute, Professor Helen Rees, World Health Organization Regional Director for Africa, Dr Matshidiso Moeti and Director-General of the World Health Organisation, Dr Tedros Ghebreyesus, who gave the keynote input.
“Healthcare is a political choice”, noted Dr Ghebreyesus. The current COVID-19 pandemic has thrived partly because of global vulnerabilities presented by inequalities in our societies and the gaps in our health systems. It is a “profound test of the bonds of trust between communities and governments”. The world has witnessed how good governance can work to combat the pandemic in countries both rich and poor, both in Vietnam and in New Zealand. Our connected societies mean that a vulnerability in one quarter is a risk the world over.
Dr Ghebreyesus went further to state that what is clear is that the effects of this pandemic will be felt for many years after the virus itself is overcome. This is true not only for those who have lost their sources of income and homes from retrenchments and evictions because of the lockdowns and contracting economies, but “in many countries, lockdown measures have had unintended consequences for lives and livelihoods, deepening hunger for millions. Up to 270 million people may face acute food insecurity before the end of the year. An estimated 10 thousand children may die from hunger every month.” Many will come from populations in Africa and other vulnerable regions in the global South.
“We must address the fundamental inequalities that leave us so fragile. We must learn the lesson that this crisis is teaching us, that health cannot only be a privilege for those that can afford it”, continued Dr Ghebreyesus.
For the global community to overcome this pandemic and secure universal access to healthcare, Dr Ghebreyesus unpacked three areas of priority:
- Political leadership must be united across partisan lines and between countries. There is no room for a fragmented response.
- Equity must be our guiding principle. Treatments, therapeutics and vaccines must be distributed equitably and go to the populations that need them the most.
- We have to build and rebuild the trust in public institutions. Civil society and communities are critical voices that must be heard. Trust must be earned by the state to have people’s buy-in as partners in efforts to foster global equity.
During the discussion it was evident that a driving factor in global vulnerability that has contributed to the virus thriving has been a lack of investment in well-equipped and efficient health systems. As Dr Moeti stated: “We need to invest in healthcare before an outbreak. Investment in health systems, respecting the principles of accountability, efficiency - it can build you a resilient health system that can resist an outbreak when one strikes.”
On the issue of criticism and critique of the World Health Organisation, Dr Moeti described the decade-long debate within the organisation around funding models, the role of the private sector, philanthropic organisations, big donor countries and non-governmental representation in decision-making. Dr Moeti insisted on the need for communities, through their forums and organisations, to be directly represented in the multilateral decision-making platforms of the World Health Organization. Furthermore, Dr Moeti unpacked the need for civil society organisations to represent the voices and needs of the people they claim to represent, especially those who are vulnerable and live in poverty.
Prof Rees’ main line of enquiry was that Africa is a vital player in the production of vaccines, and she argued that “we have a right to be able to give towards scientific and social good globally. We have a right to contribute to solving this pandemic.” Africa’s role in the combatting of the current pandemic is crucial. We must continue to put up our hand, participate in the process to discover vaccines and treatments and demand, on the World Health Organisation’s founding principles of global equity and in terms of global health, that we are entitled to participate and contribute to global health and have a share in global health equity. This sentiment was echoed by Dr Moeti. Responding to the critique of vaccines being trialed in Africa, Prof Rees argued that the benefit of vaccines trialed in Africa is that there is a greater chance that they will work well in Africa, given the broad genetic variance in Africa amongst other sociocultural factors unique to the continent. Further, there is the argument that by having produced and trialed vaccines in Africa, Africa gains the ethical right to reciprocity when a working vaccine is produced.
In closing, Prof Rees described the ideological world in which the virus has thrived, one where nationalisms compete with ‘globalism’. Some regions and countries are marked by closing borders and looking inwards towards national interests whereas others have recognized that a vulnerability in one part of the world is a risk for the world over. Our strongest position in combatting the next global calamity will be one in which we have invested in health systems, created space for communities to use their voice in the global community, and one in which the principles of good governance, global equity and universal healthcare are followed by all.