Not Everyone Can Afford to ‘Learn to Live With’ COVID-19
For most of human history, the majority of people died of infectious disease. Scourges like tuberculosis, typhoid, plague, smallpox, and (in some places) malaria carried most people to their graves, many as infants or children. As public health and biomedicine advanced, cancers and organ diseases replaced microbes as the main causes of mortality. The control of infectious disease, and consequent doubling of average life expectancy, helped to bring the modern world as we know it into being. But paradoxically, the control of infectious disease also helped to widen health inequities, both within and between societies.
COVID-19 now appears to be falling along these familiar lines. The effort to bring the coronavirus pandemic under control has really become two distinct battles. Within America’s borders, where vaccine doses are abundant, it’s a fight against misinformation and hesitancy. Globally, it is a race between vaccine delivery and virus transmission.
These two sides of the effort are dangerously interconnected. The untrammeled spread of COVID-19 through large, vulnerable populations worldwide increases the risk that new variants will emerge and then roar through pockets of undervaccinated groups in the U.S. The harm done by a now-preventable disease throughout the world is a humanitarian crisis in its own right. But we are also creating an enormous risk. Every new variant carries with it the possibility of a devastating turn in the pandemic‚ a mutation that further weakens the efficacy of the vaccines, or that causes the disease to be more severe in children and young adults.
It is tempting to push such fears aside and to insist that we “learn to live with” the virus. But adapting to a world where COVID-19 is endemic should not mean complacency about the global inequities that are already stark and only getting starker. In the words of the International Monetary Fund, “The world is facing a worsening two-track recovery, driven by dramatic differences in vaccine availability, infection rates, and the ability to provide policy support.” As these gaps widen, success in managing the pandemic is starting to correlate more clearly (if still imperfectly) with national income. In the United States, more than 60 percent of the adult population is fully vaccinated. In Indonesia, that number is only 11 percent. In India, it’s 9 percent. In countries such as Vietnam, Tanzania, and Nigeria (as well as many others), it is still below 2 percent. This two-track recovery, where protection against the disease mirrors wealth and power, unfortunately reflects a historical pattern that is several centuries old. The world’s only hope lies in breaking it.
The pattern began in earnest with the start of the Industrial Revolution. Social elites were able to take advantage of new ideas and new technologies, while the working classes were crowded into factories and tenements. This widening of health disparities within societies is familiar enough. Inequities between societies are less appreciated, even though plagues and pandemics played a decisive role in the massive and enduring global gaps that formed in the century before World War I.
The emergence of new infectious diseases is an externality of modernization. Explosive population growth, rapid urbanization, mechanized transportation, the exploitation of natural ecosystems, industrial agriculture, and ever-more-global networks of trade and migration all intensified the threat of infectious diseases. Outbreaks of cholera, influenza, polio, and AIDS are only the most notable precursors of the current crisis.