Editorial 2: The pandemic — looking back, looking forward

Context

Despite valuable lessons in public health, innovation, and global equity, much critical work remains incomplete.

Introduction

“The only possible answer to the question of how we can survive the plague is by living.” — José Saramago. Last month marked five years since the COVID-19 pandemic began. We've had countless events, editorials, and policy debates, yet many still reflect on Saramago’s words. Have we truly learned enough to build a more inclusive, healthy, and innovative world. The pandemic forced a deep rethink on trust, technology, care for the vulnerable, and the structure of health systemsacross the Global South and North.

Some of the critical lessons

1. Fragility of Trust in Health Systems

• The pandemic exposed the fragility of public trust in health-care institutions and public health messaging.
• Low trust and confidence in health-care services hindered the uptake of:
  • Non-pharmaceutical interventions (e.g., masking, social distancing)
  • Pharmaceutical interventions (e.g., testing, vaccination)

Global Impact of Trust Deficit

2. The Indian Experience

• In India, early heterogeneity in reported COVID-19 cases reflected uneven confidence in the health sector.
• Reports later published in Science indicated underreporting of excess mortality.
• These findings highlighted:
  • Variations in data transparency
  • The urgent need for public confidence-building in health surveillance

3. The Crucial Role of Government

• Public health success relies on public trust.
• Governments must play an active role in:
  • Communicating effectively
  • Building confidence in preventive health measures
• Without trust, even the most well-designed interventions may fail.

4. Technology: A Double-Edged Sword

5. Rise of AI in Pharma Innovation

• The pandemic accelerated AI adoption in health R&D:
  • Research at the University of Sussex showed a sharp rise in AI keywords in pharmaceutical patents post-2020.
• Supported by milestones like:
  • Nobel Prize to Demis Hassabis and John Jumper (DeepMind)
  • Breakthroughs in AI-led drug discovery

6. Telemedicine & Digital Health

• Telemedicine revived as a vital alternative during mobility restrictions.
• Though digital health tools expanded globally, they revealed:
  • A glaring gap in access, especially in developing countries
  • The need for inclusive digital infrastructure

Vulnerabilities were amplified

1. Existing Vulnerabilities Got Worse

• The pandemic exposed and worsened inequalities, especially in poor and vulnerable economies.
• Many now fear that the 2030 Sustainable Development Goals (SDGs) are at risk.
• Women were affected more, especially in areas like:
  • Childcare responsibilities
  • Workplace participation
  • Mental health

2. Struggles in Accessing Health Services

• Basic health services became hard to access, especially for the poor.
• This showed the need for:
  • Better investment in public health
  • Policies focused on vulnerable groups

3. Global Mental Health & Work Crisis

4. Health System Weaknesses

• COVID-19 revealed major gaps in health systems, especially in the Global South.
• Problems included:
  • Lack of resources
  • Weak institutional capacity
  • Insufficient public health funding

Suggested Solutions

5. Equity vs. Profits: The Vaccine Debate

• The pandemic reignited global debates on profit vs. access.
• Key issues included:
  • IP waivers on COVID-19 vaccines, tests, and treatments
  • Tension between innovation protection and global health equity
• Africa suffered due to vaccine nationalism, where wealthier countries hoarded doses.

6. South-South Cooperation: A Way Forward

• There’s a growing call for South-South partnerships (collaboration between developing nations) to:
  • Share resources and research
  • Ensure fairer access to vaccines and health tools in future pandemics
  • Reduce dependence on wealthier countries in health crises

Conclusion: In perspective

Five years since the COVID-19 pandemic, we seem to have flattened the curve in health, innovation, and the economy, yet much unfinished work remains. Whether we move towards ‘One World, One Health’ or stay trapped in protectionist, national security-driven approaches is still unclear. As we live beyond the pandemic, echoing Saramago, are we truly learning and building inclusive, resilient health systems for tomorrow?