'Massive Global Failures' In Response To Covid-19 Led To Millions Of Preventable Deaths: Lancet Report

According to the Lancet report, the IHME estimates that there were around 417 million infections and 1.6 million deaths from Covid-19 in India between April 1 and July 1, 2021.

'Massive global failures' in response to Covid-19 in the first two years of the pandemic led to millions of preventable deaths worldwide, according to a new Lancet Covid-19 Commision report. These resulted in an estimated 17.2 million deaths, including those not reported. 

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'Massive global failures' in response to Covid-19 in the first two years of the pandemic led to millions of preventable deaths worldwide, according to a new Lancet Covid-19 Commision report. The failure in the response also reversed progress made towards the United Nations Sustainable Development Goals (SDGs) in many countries. The report, titled 'The Lancet Commission on lessons for the future from the Covid-19 pandemic', outlines recommendations that will help hasten the end of the ongoing Covid-19 pandemic emergency, through the synthesis of evidence from the first two years of the pandemic with new epidemiological and financial analyses. 

This evidence will also help achieve long-term sustainable development, and lessen the impact of future health threats. The report cites widespread failures of prevention, transparency, operational cooperation, rationality, international solidarity, and basic health practice that resulted in an estimated 17.2 million deaths, including those not reported.  

The Lancet report is based on the estimates of Covid-19 infections and deaths made by the Institute for Health Metrics and Evaluation (IHME). According to the IHME, there were 6.9 reported deaths and 17.2 million estimated deaths as of May 31, 2022. 

The Indian government had previously dismissed earlier reports that the number of Covid deaths in the country was being underreported.

Earlier this year, the New York Times reported that WHO had estimated that by the end of 2021, India could have had more than 3 million deaths in excess of the number actually reported. The Lancet, meanwhile, had put India's death Count at 4 million. On both occasions, the government responded with a statement, disputing the numbers and questioning the methodology used.

Underreporting Of Deaths Was Most Notable In India During Delta Wave, Report Says

The new Lancet report too references previous studies that concluded India's count was being underreported.

According to the Lancet report, the underreporting of deaths was perhaps most notable in India during the delta wave from March to July, 2021. India was among the first countries to impose travel restrictions, suspend international flights, and implement a strict lockdown early in the pandemic, the report says. India had 654 cumulative confirmed cases of Covid-19 in March 2020. The adopted restrictions aimed to prevent community transmission.

The lockdown was relaxed at the end of May, 2020. During June and July, India saw a surge of Covid-19 cases. The Indian government relaxed most controls early in 2021 because case counts had decreased by the end of the year. 

Which Factors Led To Increased Covid-19 Infections In India In March 2021?

In March 2021, two factors combined to markedly increase the number of infections, the report says. The first factor is that the highly infectious delta variant emerged, and other variants of concern arrived from other countries. The second factor is that several events in the country, including election, religious festivals, and public protests, brought large groups of people together. Moreover, most participants in the events did not wear face masks. 

The combination of new variants and crowds had a devastating impact on India, the report states. The delta surge gathered momentum in March 2021. Within weeks, hospitals were overwhelmed. Due to breakdowns in the medical supply chain, there was a severe shortage of oxygen, hospital beds, and pharmaceuticals, the report says. Large numbers of patients were untreated in smaller towns and rural areas. 

Between January 1 and June 30, 2021, India reported roughly 20 million Covid-19 infections and 2,50,000 deaths attributed to the novel coronavirus. But the actual numbers are estimated to be vastly higher, the report states. In December, 2020, and January, 2021, the seroprevalence of Covid-19 IgG antibodies in non-vaccinated individuals older than six years was 24 per cent. The value increased to 62 per cent in June and July, 2021. This confirmed that millions of people were infected during the delta wave.

IHME Estimates Of Covid-19 Infections And Deaths In India

According to the Lancet report, the IHME estimates that there were around 417 million infections and 1.6 million deaths from Covid-19 in India between April 1 and July 1, 2021, compared with just 18 million reported cases and 2,52,997 reported deaths. 

According to another study, between 3.1 million and 3.4 million deaths from Covid-19 are estimated to have occurred in India between the start of the pandemic and September 1, 2021. Meanwhile, 4,40,000 deaths from Covid-19 have been reported as of September 1, 2021. The figures suggest that the reported death count was roughly 14 per cent of the actual value, the report states. 

Covid-19 cases decreased markedly and vaccination efforts accelerated after the delta surge. As of September 1, 2022, more than 76 per cent of the eligible population of India had been vaccinated with a single dose and more than 70 per cent were fully vaccinated. Despite the surge of the Omicron variant in January, 2022, hospitalisation rates and deaths remained low, the report says. 

What Suggestions Does The Commission Make To End The Covid-19 Pandemic?

Goals such as long-term sustainable development can be achieved through a strengthened multilateralism, the report says. This means that the alliance of multiple countries pursuing a common goal should be strengthened. The multilateralism must centre around a reformed and bolstered World Health Organization (WHO), the report suggests. Moreover, investments and refined planning for national pandemic preparations and health system strengthening, with special attention to populations experiencing vulnerability, are important to ensure that the impact of future health threats is lessened, the end of the ongoing Covid-19 pandemic emergency is hastened. 

Improved technology and knowledge transfers for health commodities and improved international health financing for resource-limited countries and regions will ensure that the goals are achieved. 

The Lancet report is the result of two years of work from 28 of the world's leading experts in public policy, epidemiology, economics, international governance, vaccinology, sustainability, international finance, and mental health, and consultations with more than 100 other contributors to 11 global task forces. 

WHO Acted Too Slowly On Important Matters, Report Says

The report states the WHO acted too cautiously and too slowly on several important matters. It states that the UN health agency acted too slowly to warn about human transmissibility of SARS-CoV-2, to declare a Public Health Emergency of International Concern, to support international travel protocols designed to slow the spread of the virus, to endorse the public use of face masks as protective gear, and to recognise the airborne transmission of the virus. 

Commission Says Most Governments Were Too Slow To Act With Urgency In Response To Covid-19

The report says that as the outbreak became known globally in early January, 2020, most governments around the world were too slow to acknowledge its importance and act with urgency in response. According to the report, it was mainly the countries in WHO's Western Pacific region that reacted with urgency to the Covid-19 outbreak, primed by their experience with severe acute respiratory syndrome. This led to low cumulative mortality in WHO's Western Pacific region. However, the Omicron variant had been undoing some of the gains. 

According to the report, coordination among governments was inadequate on policies to contain the pandemic, including travel protocols to slow the global transmission of the virus, commodity supply chains, testing strategies, data standards and reporting systems, public health and social measures, and advice to the public. 

The high-income countries with strong and resilient national health systems, including public health systems that complement clinical health care, have generally fared better at addressing Covid-19 and maintaining non-pandemic-related health services, the report states. In low- and middle-income countries, health systems tend to be under-resourced and fragmented.

Better outcomes were seen in these countries when previous experiences with outbreaks and epidemics were built upon, and when community-based resources were used to support screening and contact-tracing capacity. 

Inequality Between Countries, Failures Of Global Cooperation 

The different aspects of international cooperation which the Covid-19 response has shown include public-private partnerships to develop multiple vaccines in record time, emergency financing from the International Monetary Fund (IMF) and World Bank, and actions of high-income countries to financially support households and businesses. 

According to the report, the events of the past two years have exposed multiple failures of global cooperation. These include delays by the WHO to declare a "public health emergency of international concern" and to recognise the airborne transmission of SARS-CoV-2, the report says. The lack of cooperation among governments for the financing and distribution of key health commodities has come at dire costs, according to the report. These health commodities include vaccines, personal protective equipment, and resources for vaccine development and production in low-income countries. 

The 2019 Global Health Security Index, a pre-Covid-19 ranking of country preparedness for pandemics, ranked the United States and many European countries among the strongest for their epidemic response capabilities. These rankings turned out to be poor predictors of the actual outcomes of the pandemic. According to the Lancet Commission, the Western Pacific region, including East Asia and Oceania, adopted relatively successful suppression strategies. They were primed by previous experience with the SARS epidemic of 2002. Hence, their strategies resulted in around 300 cumulative deaths per million, a value much lower than in other parts of the world. 

Europe and the Americas had disjointed public health systems and showed poor-quality public response to Covid-19. This resulted in around 4,000 deaths per million, the highest of all WHO regions, the report says. 

Isolated National Responses Had Devastating Effects

The report states that national responses to Covid-19 often featured inconsistent public health advice and poor implementation of public health and social measures, including wearing face masks and vaccination. Moreover, many public policies did not properly address the profoundly inequitable impacts of the Covid-19 pandemic on vulnerable communities, including women, children, and workers in low- and middle-income countries. Extensive misinformation campaigns on social media, and low social trust exacerbated these inequities in many countries. 

Vaccination-plus strategy is essential to end the pandemic emergency, the Lancet Commission states.

What Recommendations Does The Lancet Commission Make?

The 2030 SDG agenda is jeopardised due to the deepening of socioeconomic inequities, public and economic health setbacks, and growing social and political tensions. The report states two timelines for pandemic response and preparedness. First, immediate actions in the short-term should be taken to end the Covid-19 emergency. Second, longer-term policy recommendations for a new era of multilateral cooperation are necessary to achieve long-term sustainable development, the report says.

The Commission proposes that all countries adopt a vaccination-plus strategy to finally control the pandemic. All countries should combine widespread vaccination with appropriate public health precautions and financial measures, the report suggests. 

The Commission recommends that countries should prepare for future pandemic health threats by strengthening national health systems and adopting national pandemic preparedness plans. Also, actions should be taken to improve coordinated surveillance and monitor new variants. It is important to protect groups experiencing vulnerability, and create safer school and workplace environments by investing in filtration and ventilation, the report says.

The Lancet Commission has also called for an expansion of the WHO Science Council to apply urgent scientific evidence for global health priorities. These priorities include preparedness for future emerging infectious diseases, strengthening of WHO through the establishment of a WHO Global Health Board with representation in all six WHO regions, and strengthening of national health systems. 

According to the report, there is a need for an independent, transparent investigation into the origins of SARS-CoV-2, and robust regulations, to help prevent future pandemics. 

The Commission recommends that a new Global Health Fund should be created that is closely aligned with the WHO, and must combine and expand the operations of several existing health funds, and add new funding for three windows of financing. These windows are commodities for disease control, pandemic preparedness and response, and primary health system strengthening in low- and middle-income countries. 

The Commission proposes that the Global Health Fund should have its headquarters in Geneva, Switzerland, but have strong regional offices in each of the six WHO regions. 

The Lancet Commission also recommends that the UN member states, with particular responsibility of the G20 (Group of Twenty) countries, should adopt a new financial architecture to scale up financing for low- and middle-income countries. This will help the countries meet the urgent challenges of pandemic preparedness, Sustainable Development Goals, and the Paris Climate Agreement. The report suggests that the new financial architecture should include increased sustainable development funding from all sectors, including official institutions, the private sector foundations, and civil society.