Today marks a new chapter in the fight against COVID-19, as the Public Health Emergency (PHE) expires in the United States. Similarly, on May 5, 2023, the World Health Organization (WHO) announced the end of the Public Health Emergency of International Concern, downgrading COVID-19 from an emergency to an “ongoing health issue” with a need to focus on longterm management.
While we may be moving out of an acute, emergency phase of the pandemic, people are still dying from COVID-19 in staggeringly large numbers (more than 1000 deaths in the U.S. alone each week). As we can expect to see more incidents of infectious diseases in the future, we must not be complacent, especially when it comes to protecting vulnerable communities.
These transitions also represent a new chapter for Physicians for Human Rights (PHR). For the past year, I have helped lead PHR’s work around the COVID-19 pandemic. As the PHE comes to an end, I want to reflect on our engagement with the emergency over the last three years, to describe PHR’s hopes to continue its work going forward, and to highlight lessons to take forward in preparation for the inevitable next pandemic.
1. Vaccines saved lives. Vaccine equity would have saved even more.
The global bio-pharmacological response to COVID-19 was extraordinary, with tests, treatments and vaccines made at record speeds. International scientific information-sharing and collaboration among scientists, researchers, and health experts were likewise unprecedented. However, nationalism and vaccine hoarding led to many preventable deaths, widened inequities, and prolonged the pandemic.
PHR underscores the importance of centering human rights and equity in both pandemic response and any public health emergency. At the heart of vaccine inequity lies decades of underinvestment in global health and health infrastructure and a general lack of available or affordable access to pharmacotherapies and technologies.
PHR has continuously worked to highlight vaccine equity through various forms of advocacy including letters, data, webinars, press releases, and calls for accountability, as well as working to ensure that marginalized communities – such as those in immigration detention – are included in vaccine allocation and rollout. We joined other organizations calling for waiving intellectual property rules and urging the World Trade Organization to ease patents for COVID-19 tests and treatments. PHR has closely followed the Pandemic Accord (WHO CA+) negotiations and welcomes the inclusion and ongoing discussion of intellectual property, publicly funded goods, and the human rights responsibilities of governments and institutions. At the 77th World Health Assembly in May 2024 we hope to see an accord that has been strengthened rather than weakened, and one that creates a mechanism that protects the right to life for everyone, everywhere.
2. Protecting communities begins with protecting health workers.
In the early days of the pandemic, health workers throughout the world faced enormous challenges responding to the pandemic in clinical settings and at home. Health workers have faced verbal and physical abuse, stigmatization, the scourge of pervasive dis-misinformation, all while struggling to protect themselves both physically and mentally. From lacking adequate personal protective equipment, to needing greater support to combat burnout and increase their resilience, health workers have been tested like never before. PHR has advocated to support and uplift the voices of health workers through research, collaboration, resources, toolkits, and guidance both in the United States and internationally.
Protecting health workers and public health officials must be a core feature of preparing health systems for future emergencies. It is clear that if we cannot protect health workers and uplift their expertise, no one is safe.
3. Health and social impacts fall disproportionately on historically marginalized communities.
Throughout the world, the COVID-19 pandemic spotlighted and worsened existing inequities in access to health and demonstrated persistent threats to international human rights, including the right to equality and non-discrimination, the right to life, and the right to free movement. Understanding the unequal burdens and violations of human rights that have disproportionately impacted certain groups is vital and necessary.
Fear around COVID-19 helped fuel racism, discrimination and xenophobia globally. People of color, immigrants and undocumented workers – all of whom are often overrepresented in public-facing, “essential” jobs – were more likely to be exposed to COVID-19. Similarly, they were disproportionately impacted by inadequate safety net services, poor access to paid sick leave, and unaffordable or inaccessible health. We have seen how governments can weaponize health emergencies against ethnic minorities, refugees and asylum seekers, and impose unnecessary and disproportional limits on travel and border crossing.
In the United States, under the guise of public health, an order known as Title 42 allowed the government to expel children and adults seeking refuge in the US, despite the lack of scientific evidence to support it. PHR has advocated against this rule since it’s implementation and has filed several amicus briefs in federal courts. PHR also studied the impact of expulsions on health and human rights, rallied thousands of medical professionals, repeatedly called for an end to border expulsions, and continuously condemned the ongoing use of Title 42 expulsions. As Title 42 expires today, along with the Public Health Emergency, PHR will continue to monitor the impact of new Biden Administration policies on those seeking asylum. Public health cannot be weaponized to serve political agendas.
4. Misinformation and disinformation is deadly.
The world experienced a flood of constant COVID-19 mis- and disinformation, leading to health harms, erosion of public trust in science, and political battles over public health For example, areas of the United States exposed to television programming that downplayed the severity of the pandemic saw greater numbers of cases and deaths, likely because people ignored or dismissed public health recommendations. A recent analysis found that across the United States, and between January 2021 and April 2022, there were at least 318,000 vaccine-preventable COVID-19 deaths.
Scientists and health workers are important and trustworthy voices; they must be protected whenever navigating any pandemic or public health emergency. Mis- and disinformation attacked the integrity of health workers. In response, PHR has worked to empower physicians and health workers to fight back against health conspiracies. We have publicly supported empowering state medical boards to take action and discipline physicians who undermine public health and endanger their communities.
5. Civil society remains underrepresented at decision making tables.
Civil society organizations (CSOs) are crucial voices for representing the needs of communities and ensuring inclusion and accountability; they also have some of the most experience in advancing social protection and the application of public health measures. These valuable voices were underrepresented during the world’s COVID-19 response and continue to be inadequately engaged in preparedness and prevention discussions.
PHR has called for ongoing and additional inclusion of CSOs in the WHO Pandemic Accord. PHR has advocated for voices of civil society through open letters on participation and key priorities, engagement in high-level meetings, and a more holistic lens centering human rights at the United Nations General Assembly, with partners at the People’s Vaccine Alliance and The Civil Society Alliance.
6. COVID-19 fueled a “parallel pandemic” of gender-based violence.
Sheltering in place came with a rise of domestic and intimate partner violence globally, especially affecting women and children. The United Nations estimated that “6 months of lockdowns could result in an additional 31 million cases of gender-based violence.”
PHR has explored the impact of COVID-19 on clinical care and services for sexual and gender-based violence in the United Kingdom and Kenya and called for health worker education, health system responsibility, and multisectoral collaboration. We have likewise explored the unique challenges of navigating women’s health services during the pandemic, and how particular communities are impacted, including refugee communities and those living in conflict zones.
Future pandemic and public health emergency responses need to adopt a more robust gender lens. Sexual and gender-based violence services must be deemed essential, alongside comprehensive family planning and reproductive services.
7. Accountability is vital to address future pandemics.
To genuinely participate in adequate preparedness, prevention and response, governments, institutions, and organizations must critically review and evaluate decisions made during COVID-19 and be transparent about their findings.
PHR has sought to improve state accountability for inadequate COVID-19 responses by joining partner organizations in calling on global leaders to pledge that the mistakes of this pandemic not be repeated. To that end, PHR has supported the strategic litigation of the Open Society Justice Initiative, which recently filed a complaint before the European Committee of Social Rights (ECSR) against Bulgaria for failing to prohibit discrimination and failing to protect health during their COVID-19 vaccination rollout.
Governments, global health organizations and health-related funders have a duty and moral imperative to engage wholeheartedly in prevention and preparedness, and to uphold human rights in the process.