IHP news 613 : Preparing for the next pandemic ( 19 March 2021) The weekly International Health Policies (IHP) newsletter is an initiative of the Health Policy unit at the Institute of Tropical Medicine in Antwerp, Belgium. Dear Colleagues, Last time I checked, the pandemic wasn’t exactly over yet, but nevertheless, the special issues, analyses and reflections on “preparing for the next pandemic” (any takers?) are already popping up like a thousand flowers blossoming in Spring. I do agree with their assessment, though: “The COVID- 19 pandemic has opened a window of opportunity for rethinking the way countries prepare for public-health crises. This window must not be wasted.” Let’s hope we define ‘public health crises’ not just as global health security, but broad enough. I can think of a few more wicked Anthropocene challenges coming in our direction. Last weekend, the world learnt for the first time about “The Quad”, which sounds like a somewhat dumb superhero team from a Marvel movie. This time, apparently, with Mr Modi in the role of Ironman, while, sadly, Wonder Woman was nowhere to be seen (Unlike in the new WHO Council on the Economics of Health for All, from what we hear). Anyway, this sort of geopolitical “vaccine diplomacy” - this week even edging a bit closer to a “vaccine war” - should not distract us from the real challenge. On Monday, Tony Blair, of all people, displayed some yogi wisdom when he called for relaxing IP rules for vaccines - pointing out, lest you might have missed it, that we’re in the midst of a pandemic. On social media, Tony hadn’t been this popular for a while. But Tony is right, with his version of ‘If not now, when?’ Even if Rachel Silverman made some valid points in a Washington Post op-ed, this week, some others call this debate a ‘red herring’, and we agree scaling up vaccine production is complicated, in essence there are no good arguments left against the Trips waiver proposal. Paraphrasing a former US president: “It’s a pandemic, stupid”, so if pharmaceutical companies don’t want to share their technology “voluntarily”, governments should make them do so (In China, CEOs go to jail for less ). And if they really do need some “compensation” for that, let’s go for a billionaire tax. Citizens are increasingly going berserk in countries, waiting for vaccines slowly ‘trickling down’, while seeing the US largely “lead from behind” so far on global vaccine equity, behaving like a chicken sitting on her nest. Let’s hope for some breakthrough in the weeks and months ahead. Also, a Trips waiver would be hugely important, symbolically, to show that we’re really all in this together. If not, expect more ugly populism in the years ahead, in addition to many more lives needlessly spilled. At his weekly media briefing last week, John Nkengasong announced that a campaign (Vaccinate Africa 2022) will be launched in the coming weeks, to vaccinate at least 60 % of African citizens by the end of 2022. It would be good if by then, WTO, the US and many others get their act together. #PeoplesVaccine Enjoy your reading. Kristof Decoster 1 Featured Article Towards post-pandemic protest preparedness Okikiolu Badejo (PhD Student at the University of Antwerp and ITM Antwerp & Emerging Voice 2018 Fellow) Large-scale anti-government protests and collective aggression against leadership and government systems have increased in almost every region of the world since the start of the COVID-19 pandemic. With more than 30 significant demonstrations in 26 countries targeting COVID-19 restrictions, the year 2020 was aptly described as “the year of protests”. A protest is a familiar manifestation of social behaviour that reflects (degrees of) a gap between the government and the governed. Carothers and Press (2020) distinguished four main groups of anti- government COVID-19 related protests: anti-authority lockdown protests, economic hardship lockdown protests, protests against the use of force in COVID-19 responses, and health-worker protests. The anti-authority lockdown protests, which were the most common, occurred in response to perceived tension between individual freedom ideas vs restrictive public health measures. This type of protest is often, though not solely, driven by misinformation and conspiracy theories and may reflect political polarisation trends and scepticism of science and authority. See for example the thousands who protested in London in September 2020 against the second wave of lockdown restrictions. Economic hardship lockdown protests made up the second type of protests. They were more common in low and middle income countries (LMICs), and reflected concerns about the impact of lockdown on livelihoods. The third category of protests concerned the use of force in COVID-19 responses, focusing on how restrictions were implemented (in terms of harshness, arbitrariness, and misuse of rules for repressive ends). Finally, health-care workers protested against government responses that left them vulnerable to COVID-19 risks in various countries. In Africa, between March and August 2020 there were 288 COVID-19-related protests by health-care workers calling for better provision of personal protective equipment and better remuneration for extra work done. While the pandemic is anything but over yet, and various forms of COVID-19 related protests are continuing, there is every reason to believe that mass protests may even increase post-COVID-19 due to economic scarcity and resource competition. Even in settings with low cases or where government responses may have been adequate. Studies on the 2014-16 Ebola epidemic in West Africa and five cholera waves in the 19th century found more rebellions post-epidemic than before and argue that epidemics are incubators of more social disorder (to come). During an active epidemic, epidemic- related protests are very likely to crowd out other concerns. But unresolved pre-epidemic grievances can give rise to stronger post-epidemic protests, especially when there are additional grievances related to the epidemic itself. The current global fixation on the COVID-19 vaccine assumes that the vaccine will allow a “return to normal” while underestimating the underlying social grievances that may pose a risk to post-pandemic social stability. We have already seen early signs of how wrong this assumption can be from massive 2 protests like the EndSARS protest in Nigeria and Senegal's recent protests. This highlights the need to look beyond vaccines and engage in more proactive policy action to forestall the worst impact of coming protests. In short, we better soon get our act together on post-pandemic protest preparedness (PPPP). That obviously requires tackling some of the root causes, even if macro-economic circumstances are anything but easy now. Highlights of the week Global report on Ageism WHO - Global report on ageism https://www.who.int/publications/i/item/9789240016866 “The Global report on ageism outlines a framework for action to reduce ageism including specific recommendations for different actors (e.g. government, UN agencies, civil society organizations, private sector). It brings together the best available evidence on the nature and magnitude of ageism, its determinants and its impact. It outlines what strategies work to prevent and counter ageism, identifies gaps and proposes future lines of research to improve our understanding of ageism.” WHO (press release) - Ageism is a global challenge: UN https://www.who.int/news/item/18-03-2021-ageism-is-a-global-challenge-un “Ageism leads to poorer health, social isolation, earlier deaths and cost economies billions: report calls for swift action to implement effective anti-ageism strategies…” “Every second person in the world is believed to hold ageist attitudes – leading to poorer physical and mental health and reduced quality of life for older persons, costing societies billions of dollars each year, according to a new United Nations report on ageism…..” Lancet Comment - Ageism: a social determinant of health that has come of age C Mikton, E Krug et al ; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00524- 9/fulltext “… Combating ageism is one of the four action areas of the Decade of Healthy Ageing (2021– 2030). … Consensus on the meaning of ageism has remained elusive and there is insufficient evidence on the topic. The Global Report on Ageism, to which we all contributed, offers a clear and widely supported definition of ageism as the stereotypes, prejudice, and discrimination directed towards people on the basis of their age. The report highlights that ageism can be institutional, 3 interpersonal, or self-directed and summarises the best evidence on the scale, impacts, and determinants of ageism against both older and younger people and the most effective strategies to address ageism. Ageism is an important social determinant of health that has been largely neglected until now. …” “… The evidence reviewed in the report shows that three strategies are effective to reduce ageism: policy and law, education, and intergenerational contact interventions. Policy and law can address discrimination and inequality on the basis of age and protect human rights. Educational interventions across all levels of education can correct misconceptions, provide accurate information, and counter stereotypes. Intergenerational contact interventions are among the interventions that work best to reduce ageism against older people and could also have a role in combating ageism against younger people. …. The Global