Mr. S. Ananthakrishnan has over 37 years of experience in international development work, including over 15 years of work with the UN in Nairobi Kenya (UNEP and UN Habitat) engaged in urban youth empowerment initiatives, policy and research, advocacy, program management and development and implementation of projects. Currently, engaged as the co-chair of Urban Economy Forum, looking at the ways and means to strengthen the economies of cities and towns to deliver services including in the health sector. Completed a number of assignments and initiatives for international organisations (e.g. World Bank) and national governments (e.g. Nigeria, China, Norway) on Crisis Recovery Assessment, Youth Entrepreneurship Award, Clean and Safe Energy, Urban Basic Services and so on. He is also the editor of the Chinese/English bilingual magazine UNITY (UN Initiative and Technology for the Youth).
Coronavirus has spread in many countries, infecting millions of people all over the world. The World Health Organisation (WHO) initially assigned it the temporary designation of 2019-nCoV, and now officially it is called COVID-19 (Coronavirus Disease 2019), which I think is being adopted internationally.
WHO emphasizes that “The right to health must be enjoyed without discrimination on the grounds of race, age, ethnicity or any other status. Non-discrimination and equality requires states to take steps to redress any discriminatory law, practice or policy.””。When COVID-19 has been declared by WHO, it has been reported in the media that “the outbreak of the virus in December 2019, which originated in the city of Wuhan has led to increased prejudice, xenophobia, and racism against Chinese and other people of East Asian descent”. So it is important to understand that the consequences are not only related to health, but also can trigger prejudice against certain people or countries.
A Commission on Social Determinants of Health (CSDH) was established by WHO in March 2005 to support countries and global health partners to help address the social factors leading to illness and health inequality. The major social determinants that make countries vulnerable to infectious disease epidemics include poverty, illiteracy, gender inequality, and rapid urbanization. Reducing discrimination and stigmatization with regard to the infectious diseases and focusing on the most vulnerable groups especially women and children are of crucial importance and can be instrumental in minimizing and preventing further spread of communicable diseases including Ebola, Zika, SARS and COVID-19.
A Public Health Emergency of International Concern (PHEIC) is a formal declaration by the WHO of “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”. The declaration is publicized by an Emergency Committee (EC) of WHO made up of international experts operating under the International Health Regulations (IHR) 2005, which was developed following the SARS outbreak of 2002/2003.
The implications of the PHEIC are: a) at the governmental level, the health ministers of the countries will have to strengthen coordination and cooperation among WHO Member States, b) to enhance surveillance measures at points of entry, increase public awareness efforts, and c) to develop a regional preparedness plan.
As we know, WHO has dispatched experts to countries believed to be at higher risk of an outbreak of coronavirus to assist in areas including case management, surveillance and early detection. WHO is also working to increase the capacity of national laboratories to detect COVID-19 by supplying reagents, testing equipment and training for staff. Essential personal protective equipment has also been dispatched by WHO to various countries. As COVID-19 has affected over 90000 people globally, only sustained international efforts can check this pandemic.
The Sustainable Development Goals (SDG) 3: “Ensure healthy lives and promote wellbeing for all at all ages”. Under this goal, target 3.d mentions the strengthening of the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks. UN can assist in coordinating international relief and treatment efforts as well in securing cooperation among counties in research against virus to find cures such as vaccinations and medicines.
As the Director of WHO Tedros Adhanom Ghebreyesus recently said, “While China was taking ‘strong measures’ to stop the outbreak from spreading, the rest of the world should work on preventing a further spread and controlling it”. Fear and misinformation can be more harmful than COVID-19 that we are fighting against— it’s important to focus on the facts about the virus and the risk to the public. Engaging and informing the public is important and the UN can play a key role internationally.
Just like in any humanitarian crisis, public health disasters should be addressed in a seamless manner by tackling the immediate situation arising out of the crisis as well by beginning the process of early recovery. Early Recovery is both an “approach to disaster response which, through enhanced coordination, focuses on strengthening resilience, re-building or strengthening capacity, and contributing to solving rather than exacerbating long standing problems”; for example health systems and public hygiene are in bad shape in many countries, and new public health crisis emerges also because of this.
Hence, we have to contribute to a set of specific programmatic actions, for example training the health sector personnel, make the health sector robust, as well as awareness raising among the public by engaging the communities that are important in every recovery response. In short, while we are addressing the crisis immediately, we should also prepare for preventing a relapse or an occurrence of future crisis by creating a robust system in the communities and the health system itself.
Health systems and the economy in many countries will be affected, and we already see that they have been affected. With the virus now detected in more than 50 countries, economists are lowering their forecasts for global economic growth.
According to Overseas Development Institute (ODI) in UK, the immediate impact on the health of the population and connectivity are most visible in confirmed coronavirus spread, as well as through direct flight cancellations and travel bans resulting in flight cancellations. From the beginning as epidemic and now coronavirus become pandemic, meaning that it has reached beyond the borders of many countries. Countries need to take urgent and large-scale action mainly in the health sector given the impact of a pandemic health shock to all individuals and sectors. Countries, especially with low access to health services need to implement a range of health-related policies and information campaigns to contain the spread of the virus. In the long run, countries in Europe and North America, the expected shortages in health personnel will have to be addressed through liberal immigration policies and higher wages. 。
As pointed out by WHO, in order to mitigate the impact of epidemics, protect the health workforce and ensure continuity of health services during and after them, stronger health systems are needed. It is also important to maintain staff, efforts, and medical supplies to others not affected by the crisis. As we have seen, all efforts shift to respond to the emergency. This often leads to the neglect of basic and regular essential health services. Ironically, mortality rates of other diseases for which people could not get treatment may rise. Hence a balanced approach to emergency care and normal health services in cities will be useful.。
Countries must also examine the potential economic fall-out and spill-overs effects. ODI’s vulnerability index can examine a country’s direct exposure to the virus through trade, investment, and movement of people. Countries with constrained fiscal resources and weak health systems are less resilient and more vulnerable. Strong urban economy and funding of health services to look after the crisis and recovery will be necessary. 。Emergency relief funds that are provided by many donor counties should be channeled to address the spread of COVID-19. ODI should also focus more on health and prevention of the spread of Coronavirus.
There are challenges and opportunities when it comes to cities and infectious diseases. Urbanisation drives up the emergence and spreading of infectious diseases due to various reasons. New infectious diseases can emerge from nature, for example from birds, independent of the urban context and then will spill over to urban centres from where the spread becomes speedy. These zoonotic diseases from wildlife can spread quickly due to human population density in cities. Avian flu and coronavirus are among the examples. In poorer countries many of the large cities also have unhygienic living conditions such as in slums. People are more susceptible to diseases in slums with very little access to clean water and sanitation and crowded living conditions. Studies based on statistical data say that “the greatest risk of infectious disease emergence is in the rapidly urbanising developing nations, in particular India, eastern China and southern Africa.”
Of course, traveling from one city to another can easily “globalize” such diseases. An example is the SARS outbreak in Hong Kong in the early 2000s was blamed not only on density but also on the high rate of people traveling into and out of the city. Hence the measures put in place for travellers in connection with COVID-19 is quite understandable. We should also keep in mind that the variety and complex nature of diseases and methods of transmission “mean that even the best prepared city with the cleanest infrastructure can still be vulnerable to outbreaks”.
On the other hand, cities also offer possibilities for quick delivery of health services to many people at the same time, detection of infections, monitoring and treating of affected people, and prevention of the spread of the diseases. City planning with the engagement of the population, and continuous monitoring can be powerful tools to improve the health of the urban populations as well as decrease the burden of communicable diseases. Economy of scale will be possible due to agglomeration. Research findings indicate that countries and cities with low population densities face higher burdens to achieve coverage of facilities like health services. They also require more resources per capita to achieve the SDG targets. For example, maternal health or HIV care, more resources will be required in reaching people living apart or in a less dense manner. Urban density can be good because resources are more easily shared.
There needs to be an emphasis on good urban governance through which urban populations can play a greater role in the formulation and implementation of policies at the national and global levels. A top down approach where by citizens are treated as passive recipients of cures or measures considered as harsh, intended to prevent the spread of diseases will make people resist even well intended measures. Openness and engagement of the community will create acceptance. There is no need to panic. It is pointed out by experts that of contracting COVID-19, the respiratory illness caused by the coronavirus remains low. However, there is a need for being prepared for the worst case scenario and hence the raising the awareness of the urban populations about the disease as well about simple and practical measures like washing one’s hands as often as possible.
In Sierra Leone, the community-based strategy of social mobilization and community engagement was effective in case detection and reducing the extent of Ebola transmission in a country with weak health system. This is described in a study funded by China, a practical community-based response strategy to interrupt Ebola transmission in Sierra Leone, the study was conducted during 2014–2015.
Field-operational workflow of EVD case detection, investigation and management in three pilot communities
Please found details：https://www.ncbi.nlm.nih.gov/pmc/articles/PMC49747…
The measures taken so far to halt the virus epidemic are very impressive and amazed – from what I gather, The commendable volunteering work happening in the cities in China is also to be noted. It would be important for the world to know how the communities and city dwellers are being actively engaged in addressing this situation. If there is no further spread of the infection beyond Wuhan, it will be an indicator itself and gives room of optimism and recovery.
The local authorities and the medical community must address the real sense of suspicion, distrust, and cynicism that are probably embedded in the community. The health system should not be seen as a “control and punish” instrument. That’s why earning a patient’s trust is a very difficult task given the fact that how the medical practitioners and authorities are perceived . But medical education systems, hospitals, and physicians themselves can take steps to address this issue of fear and distrust. Even in a situation of quarantine, or an intrusive action, there is greater need for robust evidence for what is being proposed is likely to achieve its desired aim. When specific evidence is not available, decisions should be based on reasoned, substantive arguments and informed by evidence from analogous situations, to the extent possible. Any restrictions must be based on scientific evidence and not imposed in an arbitrary, unreasonable, or discriminatory manner.In this context, one can mention, WHO’s Guidance for Managing Ethical Issues in Infectious Disease Outbreaks (2016). We are dealing with people, not machines, so it’s a question of people being able to communicate with medical and health systems, and the authorities must work closely with people to prevent the spread of the disease.
My immediate recommendation will be for the audience to have a comparative understanding of how disease like this has been tackled in different countries. Like students in your university can be able to reach out for different student communities across the world, so that there could be a better communication among communities in exchanging practices, experience and ideas. We should use electronic media to communicate with each other, to find out what steps have been taken and what are useful, and how it can be done further. Creating an international virtual network of students and young people to exchange success stories and good examples as well as about the difficulties can build global solidarity in fighting this pandemic.。
In the longer run, I would feel that we should think of doing international research to find out lessons learned from this disease and how the world can address and prevent such epidemics in the future. It will also be important to look from the gender, age and social status dimensions, how the disease affects people, is certain population (elderly people, woman) more vulnerable in facing the disease, and why so? Therefore, we should look into the specificity of how we can fix certain population. And this is what I think we should be able to study, research, understand, at the same time analyse and inform each other.
“We should have optimistic approach to fight the disease and we can end well with optimism just like what we have done with other diseases in the past.”