Morning Update: How COVID shaped and shattered public health
Good morning. It is, somehow, the fifth anniversary of the COVID pandemic – more on that below, along with new violence in Syria and Loblaw’s label for tariff price hikes. But first:
Today’s headlines
A relic from early pandemic days.Melissa Tait/The Globe and Mail
Health
The lingering pandemic
Five years ago today, three separate events persuaded much of the planet to take the novel coronavirus seriously. Tom Hanks announced on Instagram that he had tested positive. The NBA cancelled a game just before tipoff, then suspended the whole season. And the World Health Organization declared COVID-19 a global pandemic. All of a sudden, we were hosing down our packages and keeping a strict two metres apart.
Since then, public health has been a bit of a mixed bag. On the one hand, scientists rolled out an effective vaccine in an astonishing nine months, shattering the previous record of four years. (Take that, mumps.) On the other: Widespread health misinformation – and RFK Jr. – are conspiring to make measles great again. So where do we go from here, and how ready are we for the next public health crisis? To find out, I spoke with Ross Upshur, a professor at the University of Toronto’s Dalla Lana School of Public Health who co-chaired the WHO’s working group on ethics and COVID-19.
When we spoke in early April of 2020, you told me that developing a safe, effective COVID vaccine in 18 or 24 months “would be breaking land-speed records.” How come?
It’s nice to have been completely wrong about that one. But it was because, usually, vaccine development takes nine to 15 years.
We can look back on the first Trump administration and be grateful for Operation Warp Speed, which devoted tens of billions of dollars to vaccine research, including messenger RNA. People say, oh, mRNA is some sort of alien technology. No, it’s not. It had been kicking around for a long time. But researchers developed these lipid capsules that you could tuck the mRNA into, so it didn’t get degraded by the human immune system, which meant it could enter the cell and stimulate an antibody response. I didn’t expect how quickly we could pivot to new kinds of vaccine delivery, then get clinical trials up and running. So I’m happy to eat my words from April 2020.
Now, whether this enthusiasm for vaccine research will continue, I don’t know. But we have set a precedent where it’s possible to develop vaccines rapidly, safely and effectively.
Provided we throw a bunch of money at the problem. But the U.S. plans to withdraw from the WHO. It just cancelled the vast majority of USAID programs. What will the consequences be?
Pretty much all negative. The U.S. has been the major funder of global health initiatives for decades. The EU doesn’t even come close to their investment. So with the closing of USAID, the delicate partnerships and infrastructure built for research and services in low- and middle-income countries vanished. It’s gone. As a result, we can expect to see increases in malaria and malaria deaths, particularly affecting children, in tuberculosis and, of course, in HIV AIDS. The progress made over the past 20 years is being systematically dialled back, and the rest of the globe just can’t make up the shortfall – except for China. This is a prime opportunity for them to gain the kind of soft-power influence that the U.S. had traditionally earned through their support of health programs globally.
A worker removes the USAID sign from their headquarters in D.C. last month.Kayla Bartkowski/Getty Images
It now basically seems a given that COVID broke American faith in public health and its institutions. What about in Canada?
To a lesser extent here, I think, although there are still some legacy effects. I mean, the size of the current measles outbreak in Canada is about the size of the one in the U.S., and it’s in the same populations of undervaccinated or unvaccinated children. I’m not sure which century Make America Healthy Again wants to bring us back to, but we need to appreciate that public health regulation and legislation has led to a sustained improvement in life expectancy and self-perceived health, which is a really good thing.
I think what’s at play now is that progressive cohorts of Canadians and Americans are entering late life with a greater chronic disease burden, particularly associated with the dramatic increase in people who are overweight or obese. MAHA is focusing on this chronic disease epidemic but pointing the finger in the wrong direction, because a lot of this is avertible. From a prevention standpoint, it’s powerful to set good health behaviours earlier in life on nutrition, physical activity, and social connection. But those require systemic solutions, not focusing on individual behaviour.
The past five years have been a huge experiment in human behaviour, and I feel we’re still untangling what COVID demanded of us. How did we measure up?
I mostly stopped doing media around June 2020, and one of the reasons is that I didn’t think we had the resolve to do the sorts of things necessary to contain the pandemic, because they were going to interfere too much in our daily comforts. It was a significant challenge. And I think we’ve found there’s a limit of tolerance to people’s commitment to the public good. By 2022, when the trucker blockade started, people said, yeah, enough is enough, as if you can somehow will away the biological realities of a very difficult virus.
So we need to think really carefully about how we balance our response whenever we next need to take public health action, because we will have another situation where there’s an unknown pathogen circulating that causes a lot of illness and death and threatens to overwhelm health services. In the absence of medical countermeasures, the only thing we have are interventions like isolation and quarantine – but we’ve seen the impact, for example, on children and their education. It’s profound.
I don’t want you to scare the bejeezus out of me, but how equipped are we to tackle bird flu?
It’s a really good question. Influenza viruses are far more prone to rapid mutation than coronaviruses, which is why the public health world is very concerned about the H5N1 virus again. In my mind, our biggest threat is that we have a health care work force that’s been thoroughly exhausted, not to mention demoralized, by their experience with COVID. We don’t have deep bench strength in public health – it’s a very lean system that’s looking at further cuts. We need to invest heavily in our work force, so we can build the resilience, confidence, and stamina to go through another health challenge.
This interview has been edited for clarity and length.
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The Shot
‘People are scared. We feel like hostages.’
A member of Syria’s new security forces at a checkpoint in Homs.Asmaa Waguih/The Globe and Mail
After three months of relative peace, Syria appears to be sliding toward new sectarian conflict. At least 1,000 civilians are believed to have been killed over the past five days in clashes between government security forces and gunmen loyal to Bashar al-Assad’s fallen regime. Read more here from The Globe’s Mark MacKinnon on the ground in Homs.
The Wrap
What else we’re following
At home: Donald Trump’s energy secretary said the U.S. could remove its tariffs on Canadian oil and gas – though Ontario just slapped a 25-per-cent surcharge on all electricity exports to the U.S., which Premier Doug Ford said will stay in place until Trump retracts his tariff threats for good.
Abroad: Fears are growing in Ukraine that Elon Musk may cut off access to his Starlink satellite service, which has played a crucial role in the country’s defence.
On shelves soon: Cheaper, generic versions of Ozempic could be available in Canada as early as next year.
On shelves even sooner: Loblaw created a symbol – a “T” inside a triangle – to indicate which products have gone up in price as a result of U.S. tariffs.