Since being declared a public health emergency in January 2020, the worldwide response to Covid-19 has been one of extreme measures (lockdowns, school closures, travel restrictions, …) which has caused significant collateral damage to the health of some of the most vulnerable in our society.[1] Worldwide, the bulk of the Covid-19 response has been targeted on virus containment and vaccine development, with little attention for health promotion,[2] treatments and health systems.[3]

Especially in the beginning of the Covid-19 outbreak, governments around the world relied on virologists, epidemiologists and biostatisticians for advice on the Covid-19 response. Although important, the resulting biosecurity-focused approach led a group of global health experts to launch a call for “reclaiming comprehensive public health”.[4] Other scholars also called for making a paradigm shift from a reactive, virus-focused response to a systemic approach with a focus on health promotion and health system strengthening.[5] But how would such a global health-inspired Covid-19 response look like?

The objective of this webinar was to bring in the competencies in complexity science, systems approach and health policies of the members of the Belgian Network of Researchers in Global Health – Health Policy and Systems (BNR-GH-HPS)[6] and their partners, to discuss how the Covid-19 response policies (in Belgium and beyond, at the international level) can benefit from a more global health/health systems perspective. The key take-home messages from the webinar have been synthetized here and will be disseminated widely.

Key messages

The context: where is global health in Covid-19 management?

• An observation of the Covid-19 response policies across the globe shows that they are quite similar despite very important contextual differences. However, our knowledge in global health policies and systems definitely indicates that they should be context-specific.
• The choice of the mix of Covid-19 strategies is not merely a technical, but most of all a political choice. Therefore, competences beyond virology, epidemiology and biomedical sciences are necessary to analyse possible options and the wide range of their effects. Political aspects of this pandemic need to be discussed more explicitly and policymaking processes need to be more transparent.
• Global health, which is interdisciplinary by nature, can support such improvement of the policy processes. The question to be answered is: as a global health community, do we have a strong enough identity and clear enough skills set to the outside world in order to claim our place around the table?

Key messages regarding health policies:

• It has to be reminded that health is a personal, dynamic, complex, and adaptive state. It is influenced by context(s) in which individuals are living.
• The pandemic revealed that everything is connected to everything. A complex system means that the properties of the parts (of health/health system) do not equal the properties of the whole system. Therefore, such complexity needs to be taken into account for policymaking.
• The Covid-19 response could have been far better by if it had relied on trust and engagement instead of fear and resentment. Moreover, the drivers of health policies should be health, and not disease.
• Response policies should also be targeted on the (well-known) populations at risk, and not one-size-fits-all.
• Some governments have put forward a necessity to trade off economy against health? This is a false trade-off, because health and the economy go hand in hand. There are trade-offs to be made in the choice of policies, but they cannot be solved from a positivist point of view. Indeed, they relate to societal values – and politics.
• To get policies take account of complexity, be implemented and successful, our experience in global health shows that it is essential to build on local competences and “decolonize health policies”. This requires:
  • A shared vision of what health is all about;
  • Clear communication towards populations;
  • Transparent and inclusive policy processes
  • To stop the illusion of control: if science is important to guide epidemic management, epidemics cannot be solved through “command-and-control” measures, but through community involvement.

Key messages regarding health systems:

• The pandemic revealed the need to strengthen health systems and their resilience.
• Health security goes beyond biological aspects and encompasses health systems and policies, as well as intersectoral actions.
• Responsiveness to populations’ expectations remain important. Therefore, health policies and systems are closely interlinked.

As a conclusion, we, experts in global health policies and systems, definitely have the necessary competences to improve the Covid-19 response policies, especially in view of its foreseen transition to endemicity. These competences should be better exploited to support policymaking.

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[1] COVID-19: an ‘extraterrestrial’ disease? – ScienceDirect

[2] When the worldwide response to the COVID-19 pandemic is done without health promotion – Linda Cambon, Henri Bergeron, Patrick Castel, Valéry Ridde, François Alla, 2021 (sagepub.com)

[3] Playing vaccine roulette: Why the current strategy of staking everything on Covid-19 vaccines is a high-stakes wager – ScienceDirect

[4] Reclaiming comprehensive public health | BMJ Global Health

[5] COVID-19: time for paradigm shift in the nexus between local, national and global health | BMJ Global Health

[6] The BNR-GH-HPS is a working group of the Belgian Platform for International Health (be-causehealth). It is comprised of scholars and practitioners with various disciplinary backgrounds who are interested in health policy and systems research.