Reading The Covid-19 Catastrophe in 2023

The Covid-19 Catastrophe is a book by Richard Horton, Editor-in-Chief of The Lancet. It is written between April-May 2020 and is very short, only 133 pages including the reference. I found it by chance when I search for another book in the Altstadt library. My campus adopts a quite uncommon way to organize its massive collection. Rather than ordered by subject, it is stacked according to the year the book was purchased by the university library. I find the system quite strange but later found that it has its own advantage. When I see the book purchased from 2020 onwards, all the books are still so new it feels like it comes straight from the bookstore but you can have it for free, which is amazing.

Reading The Covid-19 Catastrophe in 2023 surely feels different. Just one day before 2022 end, Jokowi announce that all restrictions on crowds and mobility in Indonesia have been lifted, stating that people can resume activities normally like pre-pandemic. In Germany, life pretty much has returned to normal, with the exception of mandatory mask usage in public transportation. It is easy to forget about the pandemic and continue with our own life.

But the horror that we face back in 2020 shall never be forgotten. As I flip through the pages, memories of early Covid-19 come into my mind. In Indonesia, the government only start mobility restrictions in mid-March. The uncertainty and confusion were so real. I remember that time I was the only person in my class who have some background in health. The instructor asked me about the importance of the general public to wear a medical mask. I answered quite confidently, following what most health professionals believed at that moment, that medical mask is not necessary for general setting and we can proceed with cloth mask which is more reusable. Context-wise, it's also when PPE become so scarce even for people who work in direct contact with patients, leaving them very vulnerable to infection. But, the situation change, evidence grows, and recommendation follows. Later we know that medical mask usage is important to prevent the spread. One can not be so sure in the middle of a pandemic.

One insight I find so interesting from this book is how clear the message actually was from Chinese scientists at the beginning of Covid-19. From December 2019, reports about the Novel Covid-19 in Wuhan start coming and were published in The Lancet on January 2020. “The Chinese scientist warned their government, their government warned WHO, and WHO warned the world”. At the end of January, WHO already announced Public Health Emergencies of International Concern (PHEIC) which notifies all countries about the seriousness of this new infection. However, most government, especially in the West as Horton argues, seem confident enough that the problem will not cause a substantial impact on their country. Many delayed taking action in February only to find out in March that their health system start collapsing.

Seeing from a Global Health perspective, Covid-19 also possesses a unique landscape. Before Covid, most of the recent outbreaks are localized in developing countries, think of SARS, MERS, Ebola, and Zika. Even a study on global health security in 2019 which placed the US and UK on top of the list shows a different reality in the Covid-19 situation. This is a hard truth that we must accept. No one is protected until everyone is. The virus knows no border and no politics. It didn't care even if it breaks the myth of developed countries' health system immunity to pandemic threats.

The US, or Trump, sentiment toward WHO was also utterly unhelpful. His request to halt US funding to WHO until further investigation into China is jeopardizing the organization. The US is one of the big contributors to WHO. This budget freeze means WHO needs to find other funding or cut spending to cover the financial gaps.

WHO, although a global governance body of world health, basically is a multilateral organization that relies on its members. During our health policy class, we discuss the structure of WHO funding and why it lefts WHO can not be completely independent. Only 20% of the WHO budget comes from member states' contributions. The rest 80% comes in voluntary funding which usually ties to certain causes according to the donor. Although member states in World Health Assembly theoretically decide WHO priorities, in practice, it is driven more by its additional funding source.

Horton concludes this book with a quest to rethink our moral obligations to prevent the next pandemic. “I worry that we will forget the facts and lessons of Covid-19, just as we forgot the facts and lessons of SARS in 2002-3”, he continues “Do we as a global community have an obligation to remember -not only as an aggregate of individual memories but also as a shared memories? I believe we do, partly because this shared memory is what we owe to those who died and partly because we need to remind ourselves what we must do to prevent this avoidable tragedy from repeating itself”.

Reading the book now, we can feel relieved that the vaccine strategy works and we slowly return to normal. But Horton reminds us that this pandemic certainly is not the last, and the next pandemic may come sooner than we expected. This sound very gloomy and pessimistic. But, “Optimism can also blind us, imbue us with a sense of power and overconfidence, and mask real dangers that need to be embraced, understood, and addresses with humility and care”. Let us embrace the world post-Covid-19 with this in mind.

Im Neuenheimer Feld, 03.01.2023