Diplomacy, disadvantage, and dealing with Delta

Science diplomacy has played a vital role in global health equity during the coronavirus crisis. Australia needs to build on that success, Misha Schubert writes.

The COVID-19 pandemic has laid bare the fault lines of inequity and disadvantage around the world.

It has highlighted vast disparities between countries – and within countries.

And despite the valiant efforts of many dedicated, hardworking and very skilled people, like all pandemics, it has exacerbated inequity and disadvantage around the world.

We have seen this in the numbers and patterns of deaths and severe illness.

We have seen it in global access to vaccines, and in access to vaccines within countries.

We have seen it economically, in the numbers and patterns on job losses, economic damage, and the early impact of recessions.

We have even seen it in the equity and diversity toll of COVID-19 on the scientific workforce.

But it could have been even worse for equity had it not been for the efforts of science and public health diplomacy.

Right now, Australia is fighting the worst outbreak we have yet seen of cases running unchecked through the community in its most populous state.

It has hit especially hard in two regions over recent weeks.

The first was the south-west suburbs of Sydney.

Home to large migrant and multiculturally diverse communities, the region is the engine room of Australia’s supply chains.

It ensures the rest of the nation has food in the supermarkets, supplies and goods in stores, and is the backbone of the trades, building, and cleaning workforce in Australia’s largest city.

Many locals speak a language other than English in the home and live in multi-generation households. The lack of a comprehensive communications strategy for these diverse communities from the very start of this outbreak is attributed by local experts as a factor in the spread of misinformation and vaccine hesitancy in parts of the region.

For the first 16 months of this pandemic, Australia had suppressed infections to zero cases across the country through lockdowns to restore enviable freedoms.

Now that is no more.

The Delta variant is on the run, especially through economically disadvantaged communities.

The virus has also jumped containment lines in the north-west of New South Wales, home to large First Nations populations.

A massive local community effort is underway to stop it spreading further into Aboriginal and Torres Strait Islander communities.

These are Indigenous communities with disadvantage-driven and complex underlying health conditions that make COVID-19 especially terrifying.

A grassroots push led by locals is underway to encourage vulnerable Elders and the whole community to get vaccinated in an urgent race against time.

In each region, we have seen grassroots science diplomacy.

Trusted local leadership figures have pushed for vaccine supply, translated public health messages, ran clinics in mosques and Aboriginal Medical Services, and got jabs in arms.

Without local grassroots leadership – or grassroots science diplomacy – countless more lives would have been lost.

Around the world, fault lines of disadvantage and inequity can be seen everywhere.

Globally, there have now been 4.5 million deaths and 217 million infections from this virus.

And we can look at the pattern in the nations with the largest numbers of deaths – the United States, Brazil, India, Mexico, Peru, Russia.

They are either developed nations – where the early evidence suggests deaths hit hardest in the most disadvantaged regions and populations.

Or they are developing nations where – for differing reasons in the contrasting cases of Brazil and Peru – pre-existing poverty has been a potent factor.

On the global stage, we’ve seen how science diplomacy makes a difference.

At the outset of the pandemic, public health and science diplomats saw the huge risk of vaccine nationalism and inequity.

And a group of global leaders including Australia’s Jane Halton, Chair of the Bill and Melinda Gates Foundation-backed Coalition for Epidemic Preparedness Innovations (CEPI) and former chair of the board of the World Health Organization (WHO), set to work.

CEPI was created two and a half years ago to work on priority pathogens. In its first year, it raised $800 million to start responding to pathogens like coronaviruses.

And from a vast number of conversations through that network and beyond, the COVAX facility was established last year.

It’s an international collaboration to work on vaccines, diagnostics, and therapies.

The COVAX vaccine pillar of this work was jointly chaired by Jane Halton and Nigerian-American economist Dr Ngozi Okonjo-Iweala – now the World Trade Organization Director-General – to deliver vaccines to low- and middle-income countries.

Working with the WHO, they identified that every country needed to first target vulnerable groups – around 20 per cent of their population – in the first rollout of vaccines.

The idea was to create a facility through which richer nations would place orders and place down-payments on vaccines, which could then be shared globally.

Even with this new approach, there have been criticisms of how some nations have ring-fenced vaccine supplies for their own populations.

But COVAX sought to have enough countries lined up together to get into a supply chain and its equitable access policy required countries to sign on to a shared distribution.

It created a mechanism for more transparency and equity than would have been the case without it.

So, what is there to learn from this?

Science diplomacy and public health diplomacy matter.

Well-connected, passionate, and skilled individuals with strong scientific literacy can drive changes to deliver more equity more often.

And that drive needs to be supported by governments. In Australia, one way to do this is to expand the role and recognition of science diplomacy in foreign relations as a powerful economic, diplomatic, and soft power asset.

Doing so would enhance international collaboration, bringing the best research and researchers from around the world together to repair the fault lines exposed by the pandemic.

As British-based public health researcher Clare Bambra and colleagues note:

“COVID-19 has laid bare our longstanding social, economic and political inequalities… the right public policy responses are (vital) so the COVID-19 pandemic does not increase health inequalities for future generations. Public health must ‘win the peace’ as well as the ‘war’.”

Each of us – community members, scientists, and policymakers – can play a powerful role in this task. The world needs us all to do our part.