Pandemics change business-as-usual overnight. Governments mobilise huge resources to tackle the problem and compensate for its impacts. At the same time, people depend on the civil and public domains for advice, protection, health services and the whole infrastructure of response. Expectations around how we travel, work and entertain ourselves shift and we quickly learn to behave in ways that minimise risks of transmission.
Flying to attend a conference, for example, might swiftly be replaced by holding an event online. In the midst of the coronavirus alert, airlines internationally experience significant falls in passenger bookings that are set to drop still further as people opt not to fly. Reactions to the novel coronavirus, COVID-19, in China have led to emissions reductions in different industrial sectors ranging from 15% – 40%. What if plummeting levels of air pollution gave the public a lasting taste for cleaner air? Could it shift expectations and open up new possibilities for change?
Comparing pandemic responses to action on climate is more than a simply theoretical exercise. Both require communicating the urgency of action and simple advice on what to do. With pandemics, public health bodies have learned the importance of providing quick, clear information across multiple platforms from text messages to newspapers, online and broadcast media. The spread of diseases too is strongly linked to global heating. One difference that argues for even more vigorous action on the climate emergency is that, whilst health authorities are constantly on alert for new pandemics, they cannot know in advance the precise nature of the threat and must race each time to develop a vaccine, the climate crisis and its solutions have been well known for a long time. Inadequate action on the climate could even be described as something like knowing the cure to COVID-19, and failing to manufacture, distribute and treat people with it.
Some of the latest climate research points to a growing gap between action commitments on the climate emergency and what the science says is needed. With a much shorter time in which to act, three lessons on rapid transition stand out from global pandemic responses:
- A clear understanding of risk can lead to much faster, coordinated responses to an emergency
- Rapid, physical mobilisation of resources can happen alongside behaviour change. People can change their daily habits very quickly, and adapt to new social norms
- Where adaptations and behaviour changes reveal possibilities for more sustainable behaviour – such as avoiding unnecessary travel – they should be encouraged to become the new norm, and part of the broader climate emergency response.
On May 8, 1980, the 33rd World Health Assembly officially declared the world free of smallpox, which killed between 300-500 million people during its 12,000 year existence. Granted, this was almost two centuries after Edward Jenner published his hope that vaccination could annihilate the disease, but it was due specifically to public health programs carried out in a relatively short period from 1959 – 1977. This is still considered the biggest achievement in international public health. In recent years, the global community faced the new threat of HIV, which has killed 36 million people to date. Today, in most countries, the HIV virus can be controlled using a cocktail of drugs to prevent AIDS developing, thanks to cooperation between governments, health agencies and companies enabling the production of generic drugs. The issue now is ensuring that poorer people have access to the medical help that can save them. Since 1995, death rates from HIV have dropped by 80%.
The novel coronavirus COVID-19 marched inexorably into peoples’ lives from late 2019 when they started to notice sniffles, coughs and spluttering as a potential threat rather than a seasonal nuisance. What can we take from this and earlier pandemic responses that might prove useful for the even bigger, systemic climate challenge? The STEPS Centre recently pointed out that big social-environmental problems perhaps need more plural, locally-sensitive approaches that do not necessarily sit comfortably within an ‘emergency’ mindset. Yet in many emergency situations, local communities are often ‘first responders’ and their responses are diverse. Managing pandemics and the climate emergency both require an enabling large-scale framework for effective local action. And, there is still much to learn from the collaborative global approach to public health that is seen in sharp focus at times of pandemics. From analysing the actual dangers versus hype, and calculating the risk of taking any particular strategy, to encouraging the wider population on board to take preventative action without creating panic, there is much to discover.
We have coped with pandemics in the past and are better equipped than ever to cope with similar future events. In 1918, the “Spanish Flu” pandemic infected over a third of the world’s population and killed 20–50 million; life expectancy for the average American plummeted by a dozen years in a single year. There were no vaccines or anti-viral drugs – the first licensed flu vaccine did not appear until the 1940s. But by the 1950s, vaccine manufacturers were routinely producing vaccines that would help control and prevent future pandemics. Flu vaccines are now produced quickly in response to new strains. This has been made possible thanks to international cooperation coordinated through the World Health Organisation (WHO), bringing together research, funding and feet on the ground to carry out the necessary programmes of work.
Similar coordination on rapid transition could be mobilised on the ground through a range of international agencies; instead, countries have been left to come up with their own ways of reaching the aims of the Paris Agreement. The rhetoric of international cooperation heard at global summits can be contradicted by the reality on the ground where inefficiencies arise in sharply competitive markets, with companies struggling for space in the market. Policy on climate change is being done via ad-hoc approaches involving elements of international cooperation, voluntary compliance, and faith in positive outcomes. In the absence of a body having jurisdiction over the global environment with corresponding legal enforcement authority, the international community has abdicated management of the world’s environment to a system of pledges based on trust in well-meaning states.
Pandemics cause governments to prioritise and decide what is most important – economic growth or human life, fulfilling a dream to travel or looking after our most vulnerable people. With the current viral threat, governments have sought to delay the spread even as we accept we cannot stop it entirely, in order to protect older people, who are more likely to die from its effects. When facing illness, we understand instantly how important it is to protect and prioritise life; yet we do not have steps with similar urgency in the face of our climate crisis. Heatwaves for example, like the one that hit Europe in 2003 causing more than 30,000 deaths, disproportionately among older people, are set to become more common.
A debate over adjusting societal aims by, for example, including well being in GDP calculations, has grown from the realisation that the measure of growth (widely relied on by decision makers) is a poor measure of human and ecological health and well-being. Many other measures have been proposed including a combination of ‘happy life years’ – an indicator that links well being and life expectancy – and ecological footprint, to provide a measure of the ecological efficiency with which people enjoy relatively long and happy lives. Separately, a strong correlation between inequality, poor health and well being has a substantial evidence base. Well-being as a concrete metric to influence policy has only been taken up by Bhutan and New Zealand to date and in neither case was this in response to immediate, temporary crises. We could learn from our approach to pandemics to rethink the priorities that underpin our current development model and appreciate that a sustainable development path might be easier to achieve if we placed more fundamental human values at its centre.
Context and background
Until the 19th Century, smallpox was a terrifying and devastating disease that ravaged the world. Some three out of every ten people infected died and those who survived were often left with disfiguring scars. One of the first methods for controlling the spread of smallpox was the use of variolation (after the smallpox virus ‘variola’) – using material from smallpox sores to infect people who had never had the disease, by scratching the material into the arm or inhaling it through the nose. This reduced the number of deaths from the disease, but not the symptoms. In 1796, an English doctor called Edward Jenner discovered that inoculating people with the lesser but related disease of cowpox stopped them from developing smallpox. In 1801, Jenner published “On the Origin of the Vaccine Inoculation,” in which he expressed hope that “the annihilation of the smallpox, the most dreadful scourge of the human species, must be the final result of this practice.” Vaccination became widely accepted and a major method of countering infectious and contagious diseases was born.
But it wasn’t until the post-war era, and a time of global collaboration on an unprecedented scale, that steps were taken to eradicate the disease. In 1959, the World Health Organization (WHO) initiated a plan to rid the world of smallpox, but the campaign suffered from lack of financial commitment from countries, as well as a shortage of vaccine donations. By 1966, smallpox had been successfully eliminated in North America (1952) and Europe (1953), but still saw regular outbreaks across South America, Africa, and Asia. A second wave of efforts, called the Intensified Eradication Program, began in 1967 and this time, laboratories in many countries where smallpox occurred regularly (endemic countries) were able to produce more, higher quality freeze-dried vaccines.
A number of other factors also played a role in the success of the intensified efforts, including the development of the bifurcated needle, establishment of a surveillance system to detect and investigate cases, cash payments for successful identification, and mass vaccination campaigns. By 1974, smallpox was eradicated from South America, followed by Asia (1975) and Africa (1977). Three-year-old Rahima Banu, in Bangladesh, was the last known person to have had naturally acquired smallpox.
First identified in Democratic Republic of the Congo in 1976, HIV/AIDS has killed more than 32 million people and remains a lead cause of death globally, although medical advances now allow people to live with it.
Around 38 million people were living with HIV at the end of 2018 the vast majority of those are in Sub-Saharan Africa. New treatments have been developed that make HIV far more manageable and many of those infected go on to lead productive lives. Between 2005 and 2012 the annual global deaths from HIV/AIDS dropped from 2.2 million to 1.6 million. By 2018 deaths globally fell further to 770,000. Infection with the HIV virus originally carried a major stigma, because it was sexually transmitted and hit marginalised communities such as homosexual men and intravenous drug users.This changed over time with social norms, although in many countries those who are infected still hide their status for fear of prejudice and ill treatment.
Pandemics fast track advances in technical innovations and in the sharing of that knowledge. This is particularly effective if there are systems and structures in place to enable their diffusion. In multiple countries people annually visit their doctors to obtain a preventative flu shot, which itself is the result of remarkable collaboration. All year round, the WHO oversees a programme in which 142 national influenza centres in 113 different countries collect data on the flu viruses impacting the world’s population. This body of information is collated at five main centres in the US, Australia, Europe and Asia, where scientists analyze the data together to identify new flu strains and to determine which strains of the virus are most likely to spread and cause illness in the upcoming flu season. Consultants from each centre then meet twice each year. They meet in February to determine the recommended composition for the yearly flu vaccine to be produced in the northern hemisphere for the upcoming flu season, and they also meet in September to make the same decision for future patients in the southern hemisphere. Seasonal influenza is still estimated to cause between 290 000 to 650 000 deaths just from respiratory causes, but this fast, continuous, collaborative method saves millions of lives every year.
The example of the global response to HIV is particularly interesting, because it required not only a medical intervention but a societal change – or at least a willingness to try to change. Key to reversing the disease was a comprehensive approach of identifying vulnerable population groups, developing antiretroviral treatments (ART), demystifying and tackling prejudices surrounding the condition, and developing accessible services for those at risk and those infected.
In the 1980s, when the disease first emerged in the US, it was heavily stigmatised and publicly associated with the male gay community, hampering effective responses. During the COVID-19 outbreak, a similar hostility towards people of East Asian appearance has also been reported.
Despite a steady rise in cases in the US, Europe and in Africa, and a high death rate, little was done at first to combat this disease. Fear in the wider community was great and people suffering from the disease faced considerable hostility and lack of empathy. Looking back, it is easy to see milestones such as the first famous victim, Rock Hudson, who left funds to research into the virus, and Princess Diana, who famously shook hands with an AIDS victim to prove it was not contagious. The WHO had stepped in during the mid 1980s, but UNAIDS was not formed until the mid 1990s; throughout this period, campaigners continued to push for resources and a change of attitude. However, by 1999, the WHO announced that AIDS was the fourth biggest cause of death worldwide and number one killer in Africa. Today, numbers of new infections are falling but many people with HIV still face huge discrimination. Nevertheless, the global picture shows clearly how attitudes can change with powerful empathetic leaders and strong advocacy from civil society.
One important area to tackle was the price of drugs; although no vaccine had been found (and still remains elusive), individual and combinations of drugs were proving effective at holding the virus at bay, but were out of reach of most sufferers. In 2002, UNAIDS negotiated with five pharmaceutical companies to reduce antiretroviral drug prices for developing countries – a key step in prioritising the fight against this disease above profit. But it was only after generic drug manufacturers, such as Cipla in India, began producing discounted generic forms of HIV medicines for developing countries, that several major pharmaceutical manufacturers agreed to further reduce drug prices. Making technology open to all is a vital part of rapid transition and governments need to support global agencies to enable this to happen. According to the World Health Organisation (WHO), new HIV infections fell by 37% and HIV-related deaths fell by 45% between 2000 and 2018.
Scope and evidence
- In 1918, the “Spanish Flu” pandemic infected over a third of the world’s population and killed 20–50 million; life expectancy for the average American plummeted by a dozen years in a single year. There were no vaccines or antiviral drugs – the first licensed flu vaccine did not appear until the 1940s.
- The WHO oversees a programme in which 142 national influenza centres in 113 different countries collect data on the flu viruses impacting the world’s population.
- By 1966, smallpox was successfully eliminated in North America (1952) and Europe (1953).
- On May 8 1980, the 33rd World Health Assembly officially declared the world free of smallpox, which killed between 300-500 million people during its 12,000 year existence.
- First identified in Democratic Republic of the Congo in 1976, HIV/AIDS has killed more than 32 million people. Since 1995, death rates from HIV have dropped by 80%.
- The WHO estimates that there were around 37.9 million people living with HIV at the end of 2018, the vast majority of those are in Sub-Saharan Africa.
- In 2002, UNAIDS negotiated with five pharmaceutical companies to reduce antiretroviral drug prices for developing countries – a key step in placing combatting this disease as a priority higher than profit.
- Between 2000 and 2018, new HIV infections fell by 37% and HIV-related deaths fell by 45%.
- Changes in attitude were vital in mounting an effective response. Milestones include the first famous victim, Rock Hudson, who left funds to research into the virus, and Princess Diana, who famously shook hands with an AIDS victim to prove it was not contagious.
- Between 2005 and 2012 the annual global deaths from HIV/AIDS dropped from 2.2 million to 1.6 million, and dropped again by 2018 to 770,000.
Lessons for rapid transition
- Pandemics reveal the ability of governments to respond at speed and scale and change economic priorities in the public interest. A clear understanding of risk can lead to much faster, coordinated responses to an emergency. When communicated to the public it can explain and justify policy changes that otherwise might not gain support.
- Rapid, physical mobilisation of resources can happen alongside behaviour change. People can change their daily habits very quickly, and adapt to new social norms.
- Where adaptations and behaviour changes reveal possibilities for more sustainable behaviour – such as avoiding unnecessary travel – they could be encouraged to become the new norm, and made part of the broader response to the climate emergency.
- Avert (last updated Jan, 2020) History of HIV & AIDS overview https://www.avert.org/professionals/history-hiv-aids/overview
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- Center for Disease Control (2016) History of Smallpox https://www.cdc.gov/smallpox/history/history.html
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- Vox, G (2015) The Reagan administration’s unbelievable response to the HIV/AIDs epidemic. https://www.vox.com/2015/12/1/9828348/ronald-reagan-hiv-aids
- Murrell, D. (2018) The History of HIV and AIDS in the United States. https://www.healthline.com/health/hiv-aids/history#prep
- www.mphonline.org. (2020) Outbreak: 10 of the worst pandemics in history. https://www.mphonline.org/worst-pandemics-in-history/
- Oxley, N. (2020) STEPS. Should we treat the climate crisis like corona virus. https://steps-centre.org/blog/should-we-treat-the-climate-crisis-like-coronavirus/
- Stierwalt, S. (2016) Scientific American. How are seasonal flu vaccines made?https://www.scientificamerican.com/article/how-are-seasonal-flu-vaccines-made/
- World Health Organisation (2018) HIV/AIDS Key Facts http://www.who.int/news-room/fact-sheets/detail/hiv-aids