The world's poor response to the Covid-19 pandemic led to 17.7 million unnecessary deaths, a death toll that is "both a profound tragedy and a massive global failure at multiple levels," according to a report published by the Lancet Covid-19 Commission.

Covid-19 tested national health systems—and they responded largely as designed

What went wrong

The report—which is the result of two years-worth of collaboration between 11 task forces, 100 consultants, and 28 experts in a variety of topics including epidemiology, vaccinology, and public policy—lists flaws in the global response to the pandemic that led to so many unnecessary deaths.

According to the Washington Post, the report carries no legal authority, but represents "one of the highest-profile attempts to identify lessons from covid-19 and how to better prepare for the next pandemic."

One main finding in the report was a lack of coordination between governments, especially as countries locked down and reopened.

"We saw seesaw swings across countries, which gave the virus and the variants a superhighway for transmission into areas where previously it had not entered," said Srinath Reddy, president of the Public Health foundation of India and a co-author on the report.

"What we saw—rather than a cooperative global strategy—was basically each country on its own," said Jeffrey Sachs, an economist at Columbia University and chair of the commission. "National leaders deciding … the strategy and the fates of their countries in an incredibly haphazard way."

The report also found that vaccine inequity contributed to the failed response, as many countries rapidly developed Covid-19 vaccines but didn't share them more widely throughout the world.

"While immunity is the splendid armor that protects us against the virus, inequity is the wicked accomplice of the virus," Reddy said.

The report also blamed widespread resistance to prevention and safety measures, in part due to confusing and conflicting messages from government officials, but also due to misinformation and disinformation campaigns on social media.

"We must actually ensure that people's confidence in science grows, and we counter the anti-science movements that post a serious public health threat all across the world," Reddy said. "And the political compulsions that sometimes drive policymakers to perpetuate such movements must also be called out."

The commission also criticized the World Health Organization's (WHO) response to the pandemic, saying it "acted too cautiously and too slowly" on many urgent matters, like recognizing the virus was spreading through airborne transmission.

"We must face hard truths—too many governments have failed to adhere to basic norms of institutional rationality and transparency; too many people have protested basic public health precautions, often influenced by misinformation; and too many nations have failed to promote global collaboration to control the pandemic," Sachs said.

What to do going forward

The report outlined a few ways the world can address the failures outlined by the commission going forward—one of which is better collaboration among different countries.

"New variants, hugely uneven vaccine coverage, and quite possibly serious surprises [are] still to come" in the pandemic, Sachs said. "In other words, we are not prepared for ending this pandemic."

Vaccine inequity around the world should also be addressed, members of the commission said. Maria Fernanda Espinosa, a co-author of the report, noted that "over a year and a half since the first Covid-19 vaccine was administered, global vaccine equity has not been achieved."

While around 75% of people have been fully vaccinated in high-income countries, just one in seven have been fully vaccinated in low-income countries, she added. "All countries remain increasingly vulnerable to new COVID-19 outbreaks and future pandemics if we do not share vaccine patents and technology with vaccine manufacturers in less wealthy countries and strengthen multilateral initiatives that aim to boost global vaccine equity."

A global vaccine-plus strategy that includes testing, treatment for new infections and long Covid, the installation of public health measures, and financial and social supports to ease isolation and quarantine periods should also be developed, the report said. "We have to be prepared and make sure that we will leave no one behind in the future," Gabriela Cuevas Barrón, a member of the commission, said.

"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," said Salim Abdool Karim, from the Mailman School of Public Health at Columbia University.

Finally, the report recommends expanding WHO and its Science Council, which consults with the director-general about "high-priority scientific issues and advances in science and technology that could directly impact global health."

According to the report, WHO should "be transformed and bolstered by a substantial increase in funding," as well as "increased and more effective investment for both pandemic preparedness and health systems in developing countries, with a focus on primary care, achieving universal health coverage, and disease control more generally."

"Global health might have derived its initial impetus from a sense of shared vulnerability, but now it must draw momentum from a sense of shared values," Reddy said. "We must actually stand and work together."

According to Sachs, "we have the scientific capabilities and economic resources" to meet these goals, "but a resilient and sustainable recovery depends on strengthened multilateral cooperation, financing, biosafety, and international solidarity with the most vulnerable countries and people." (Hein, MedPage Today, 9/14; Daniel, "Goats and Soda," NPR, 9/14; Diamond, Washington Post, 9/14)