Lancet Commission on COVID-19 response: 'Massive global failure'

A stinging new Lancet Commission report on the international COVID-19 pandemic response calls it "a massive global failure on multiple levels" and spares no one the responsibility—including the public—for millions of preventable deaths and a backslide in progress made toward sustainable development goals in many countries.

Noting an estimated 17.2 million COVID-19 deaths worldwide through May 31, the commission said, "This staggering death toll is both a profound tragedy and a massive global failure at multiple levels. Too many governments have failed to adhere to basic norms of institutional rationality and transparency, too many people—often influenced by misinformation—have disrespected and protested against basic public health precautions, and the world's major powers have failed to collaborate to control the pandemic."

Published yesterday in The Lancet, the report is aimed at United Nations (UN) member states and agencies and intergovernmental groups such as the G20 and G7. The commission included 28 experts from around the world.

It details national negligence in prevention, rationality, public health practices, and international cooperation, as well as "excessive nationalism" that led to unequal access to resources such as personal protective equipment (PPE), vaccines, and treatments. The report also acknowledges that many members of the public openly flouted government efforts to control the pandemic.

What went wrong

Specifically, the report details 10 failures:

  • A lack of timely notification of the initial outbreak of COVID-19
  • Delays in acknowledging that SARS-CoV-2 spreads by aerosols and to implement appropriate public health mitigation measures at national and international levels
  • An absence of coordination among countries to suppress viral transmission
  • Government failures to examine evidence and adopt best practices for controlling the pandemic and managing economic and social spillovers from other countries
  • A lack of global funding for low- and middle-income countries (LMICs)
  • A failure to ensure adequate supplies and equitable distribution of key resources such as PPE, diagnostic tests, drugs, medical devices, and vaccines—particularly for LMICs
  • A dearth of timely, accurate, systematic data on infections, deaths, viral variants, health system responses, and indirect health consequences
  • Poor enforcement of appropriate levels of biosafety regulations leading up to the pandemic, raising the possibility of a lab leak
  • A failure to combat systematic disinformation
  • The lack of global and national safety nets to protect vulnerable populations

The report proposes the five pillars of fighting infectious diseases, including prevention strategies such as vaccination, containment, health services, equity, and global innovation and diffusion. But the underpinning of success, the commission proposed, is "prosociality," or the reorientation of governments, regulators, and institutions toward society as a whole.

The commission said it aims to promote a new era of global cooperation to decrease the dangers of COVID-19, proactively address global emergencies such as pandemics, and enable sustainable development, human rights, and peace through UN institutions such as the World Health Organization (WHO).

The report provides a framework for understanding pandemics, a timeline of the COVID-19 pandemic, thematic findings, and policy recommendations, including investments in preparedness for future health crises through strong national health systems, international financing, and technological cooperation with LMICs. About $60 billion, or about 0.1% of the gross domestic product of high-income countries, would be needed each year to fund these efforts, it said.

In a Lancet news release, report coauthor Maria Fernanda Espinosa, MA, of the Robert Bosch Academy in Germany, said that while COVID-19 vaccines have been available for more than 18 months, "Global vaccine equity has not been achieved. In high-income countries, three in four people have been fully vaccinated, but in low-income countries, only one in seven."

Coauthor Salim Abdool Karim, MBChB, PhD, of Columbia University, said that a strategy of high vaccine coverage plus other public health measures will slow the emergence of new variants and reduce the risk of future pandemic waves. "The faster the world can act to vaccinate everybody, and provide social and economic support, the better the prospects for exiting the pandemic emergency and achieving long-lasting economic recovery," he said.

WHO: Key omissions, problems in report

In its response today, the WHO said the commission's recommendations align with its goals but called out "several key omissions and misinterpretations in the report, not least regarding the public health emergency of international concern (PHEIC) and the speed and scope of WHO's actions."

Since Day 1, the agency said, "WHO, together with our global expert networks and guideline development groups, regularly updates our guidance and strategies with the latest knowledge about the virus, including updates to the SPRP [COVID-19 Strategic Preparedness and Response Plan] and the COVID-19 global vaccination strategy, and to the 11th version of WHO's living guideline on COVID-19 therapeutics, which was published in July 2022."

The WHO also highlighted the many calls to action from Director-General Tedros Adhanom Ghebreyesus, PhD, to world leaders to protect people and share disease-mitigation tools.

The WHO also said it continues its search for the origins of SARS-CoV-2 with the July 2021 establishment of the permanent International Scientific Advisory Group for Origins of Novel Pathogens (SAGO) for both COVID-19 and emerging pathogens.

A chance to rebuild

In a related editorial, Lancet editors said that international systems developed after World War II didn't hold up to a modern pandemic. "Global collaboration and solidarity were good in business and science but poor in politics and international relations," they wrote.

They added that while the war in Ukraine and climate and economic instability have siphoned attention away from COVID-19, surveillance and testing capacity must be safeguarded and broadened to prepare for a possible winter surge in the Northern Hemisphere.

"The risk of new variants remains elevated and there are uncertainties around the strength and duration of immunity from vaccination," the editors wrote. "But perhaps most importantly, as many countries and institutions try to find a path out of the pandemic, many questions about what went wrong and how future pandemics can be prevented remain unanswered."

The best hope of regrouping the response to COVID-19 and gird for future pandemics lies in the release of the Lancet Commission's report, they concluded. The report, they said, "offers the best opportunity to insist that the failures and lessons from the past 3 years are not wasted but are constructively used to build more resilient health systems and stronger political systems that support the health and wellbeing of people and planet during the 21st century."

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