In this heartfelt letter on World Health Day, Varun Deshpande, the son of an Indian cancer surgeon, writes passionately about the lack of access to healthcare and the devastating knock-on effect for millions in his own country of India and across the world, even in the “best of times” when there is no pandemic.
Today, April 7 2020, is #WorldHealthDay. It’s also my birthday – and, as you can imagine, a particularly surreal one. This is an unprecedented ‘crucible’ moment, one for which the world was ill-prepared. We’re all reeling, trying to make sense of a shock to our collective sense of security, an evisceration of our hopes and worldview by an invisible threat which many of us would have considered unfathomable mere weeks ago.
For many around the world, though, this uncertainty about their health and economic prospects, the lack of a security blanket – this is reality even at the best of times. The UN estimates that 69m children will die, 167m children will live in poverty, and 750m women will be married as children between 2016-2030. Malaria, the third biggest killer of children globally, is 100% treatable and preventable. Other neglected tropical diseases like tuberculosis and filariasis kill millions every year. A third of children under 5 suffer from malnutrition, including debilitating but preventable conditions such as iron-deficiency anemia and neural tube defects.
It doesn’t have to be this way, but it is.
At the best of times, these statistics are just that – numbers with limited emotional resonance for those of us who are privileged, because we’re abstracted away from their effects, desensitized to their devastating consequences for billions.
This is one of those rare moments when that isn’t true. The last few weeks have made us – all of us – painfully, palpably aware of the fragility of our security blankets. Invisible, unidentifiable victims have turned into recognizable ones – when we look in the mirror, and when we turn on the news. In India, the fragility of our institutions and safety nets has been laid bare with the current lockdown, and devastatingly, heartbreakingly so for millions of stranded migrant labourers who will no doubt suffer immensely from lack of work and food for several months.
As the ‘slow moving tsunami’ of Covid-19 cases hits hospitals in countries all over the world, entire health systems will be overwhelmed. Italy offers a scary glimpse into what that looks like – “..hallways with patients, the doctors are struggling to figure out where to put them..older people who are mostly hooked up to ventilators, who are still conscious but they’re struggling to breathe. And doctors that are completely overwhelmed. And also, there used to be 11 of them in the unit, and now there’s five of them, because six of the nurses and doctors have all fallen ill, or are currently being tested because they have fevers and symptoms”.
Those overwhelmed doctors are performing what’s known as ‘triage’ – deciding which patients get scarce resources, and which don’t. Much has been made of this, and rightfully so. In resource-constrained countries like India, this is the reality every single day. My father is a cancer surgeon in Mumbai, India. He practices in hospitals widely considered to be among the best in the country. He and his colleagues are always doing triage. “There are roughly 2000 ICU beds in Mumbai,” he says, “and not all of them have modern ventilators with in-built automation and fail-safes.” He and his peers regularly need to choose which among their patients get those good ventilators.
Bill Gates wrote in 2015 – “Perhaps the only good news from the tragic Ebola epidemic… is that it may serve as a wake-up call: we must prepare for future epidemics of diseases that may spread more effectively than Ebola.” It didn’t, and we didn’t. Gates has been one of a painfully small number of vocal advocates for pandemic preparedness over the last few years, and public health and philanthropic spending for a slew of related areas – improving healthcare and public health capacity and infrastructure; developing diagnostics, therapeutics, and vaccines; moving away from industrial animal agriculture, a major source of zoonotic diseases like Covid19 – has remained woefully low relative to the size of the challenge.
Covid19 is another wake-up call. And – ill-prepared and under-resourced as we may have been, and devastating as the next years may prove to be – we’re living at the best time in history to turn the tide of suffering. Civil society is proving this to be true as we speak – faced with tremendous uncertainty and resource constraints, nonprofits and the private sector are already showing their willingness to cooperate, pool resources, and aim their collective ingenuity at an invisible enemy.
As we grapple with that slow but inexorable tsunami of patients, the tragic human cost, and the distressing economic fallout over the next months and years, we can’t afford to let another wake-up call pass by. While mitigating the fallout of what is already a collective nightmare, we need to take the opportunity to recognize that health security and economic security are inextricably linked; to strengthen our public health apparatus, especially for those most vulnerable among us; to consider that – at this time in history more than ever – we can eradicate the invisible killers of millions.
If we do heed this call, we may yet have some good news emerge from this crucible moment. Stay safe, and happy #WorldHealthDay.
Want to help? Here are some starting points:
- Find out how to apply your talent to the world’s most pressing problems: 80000hours.org
- Discover a framework for thinking about those problems, and how to do better triage: effectivealtruism.org
- Get involved in high-impact opportunities for giving, particularly in global health and poverty: givewell.org
- Learn more about pandemic preparedness and health security: centerforhealthsecurity.org
Varun Deshpande is on a mission to bring about a healthier, more sustainable, and more just global food system in India. As the Managing Director for India at the Good Food Institute, he is focused on building the future of food in the world’s largest democracy by working with scientists, foundations, governments, entrepreneurs, and corporations to advance the plant-based and cell-based protein sector.
Lead image courtesy of Himanshu Bhatt / Nurphoto via Getty Images.