Sound the alarm: people left behind in decision-making on COVID-19

As COVID-19 infiltrates the physical, mental, social, economic and geographical landscapes we all inhabit, citizens around the world are forced to obey new national laws and policies on social isolation, lockdowns, and movement restrictions.

For some groups of particularly vulnerable people - the elderly, disabled, those suffering from physical and mental ill-health or those at risk of violence and abuse - the restrictive measures have a significant and negative effect. These people’s health and wellbeing, in all senses, are being corroded. In some cases, people are in extremely threatening and deadly situations.

So who is making these decisions on isolation and lockdowns? How do their judgments take into consideration the wider impact on the population and the secondary effects of these restrictions, especially on vulnerable people? We, a group of colleagues working on universal health coverage, decided to do a rapid analysis of 24 national COVID-19 Taskforces to identify their composition and investigate their decision-making processes. What we found out was shocking.

Composition of COVID-19 Taskforces

Analysis of 24 national COVID-19 Taskforces (from all regions) showed overwhelmingly that their members were mainly male politicians, virologists and epidemiologists. The poor female representation is alarming. So is the fact that very few non-health experts were included in the taskforces; for example, no social workers, no mental health experts, no child health and development specialists, no experts on chronic diseases or preventative medicine, no human rights lawyers. If these types of experts were consulted at all, it was mainly as an afterthought.

Civil society organizations are hardly involved in COVID-19 decision-making at all, except in a few countries. About 175 civil society organisations, which responded to a survey conducted through the UHC2030 Civil Society Engagement Mechanism, said that their COVID-19 work was independent of their government.

Furthermore, there is very little transparency about whom these Taskforces are consulting in their decisions. Evidence on which decisions are made seems to be scientific and research-based from academic institutions, rather than drawing on the lived realities of those groups most negatively affected by isolation and restrictive measures.

In some countries, Taskforces comprise only government members and in these instances a cross-sectoral approach involving education, interior and finance ministries is more likely.

Transparent decisions and multi-sectoral action

We, as a team, scanned a broad variety of websites, newspapers, and government documents in several languages to find the information we needed for this analysis. Often, we found it difficult to get enough information on who is making the decisions, how decision-makers reach their conclusions, and what position advisors had.

Transparency is of the utmost importance in these weeks and months of national crises around the globe. Transparency is needed in who makes the decisions and who influences those decisions. Now, more than ever, the voices of those who are most left behind, the most vulnerable in our societies, must be listened to. The mantra of the Sustainable Development Goals – to leave no one behind – needs to be shouted loud and clear during this pandemic.

For national COVID-19 responses to be genuinely effective, and reduce the harm that can potentially occur to the world’s most vulnerable people, the prefix ‘multi’ needs to be applied to all efforts. The response must be multi-dimensional, multi-disciplinary, multi-sectoral, multi-stakeholder.

Governments must consult and engage more broadly across all disciplines and sectors, both within and beyond health. They must engage meaningfully their national civil society organisations which often speak for the poorest and most vulnerable sections of society. The universal health coverage (UHC) movement argues in one of its six key asks that stakeholders must ‘move together’ in order to achieve UHC. We must listen hard to this and ‘move together’ now, in this era of COVID-19.

Conclusion

In conclusion, the societal consequences of COVID-19 isolation and lockdown measures are woefully being overlooked in government decision-making. The people, professions and organisations which have meaningful contributions to make to each and every national response to COVID-19 are simply not involved in the government decision-making process and response. This should ring alarm bells for everyone. If there is one thing we learnt from another virus-based crisis (HIV), it is that the population, communities, and civil society are an integral part of the crisis solution.

BMJ Commentary

This blog is based on a commentary published in the British Medical Journal: Governance of the Covid-19 response: a call for more inclusive and transparent decision-making. Authors: Dheepa Rajan  (1) Kira Koch (1) Katja Rohrer (1) , Csongor Bajnoczki (1)  Anna Socha (2) Maike Voss  (3) Marjolaine Nicod (2) Valery Ridde (4) Justin Koonin (5) 

Affiliation

1. UHC2030 Partnership and Health Systems Governance Collaborative, World Health Organization, Geneva, Switzerland
2. UHC2030 Partnership, Geneva, Switzerland
3. German Institute for International and Security Affairs (SWP), Berlin, Germany
4. CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Paris, France
5. AIDS Council of New South Wales (ACON), Surry Hills, New South Wales, Australia

Photo © WHO / Tom Pietrasik

Categories: Ensure political leadership beyond health, Regulate and legislate, Civil society and communities, Government