The Global Pandemic is a Dress Rehearsal for the Wicked Problems of the 21st Century

If you thought COVID-19 would be coming to an end next year, think again. In a powerful conversation with Fred Swaniker, founder of The Room, Peter Drobac shared his insights on the multiple structural crises that have been unleashed with the pandemic, revealing the fault lines of an unjust world. Peter, who is the Director of the Skoll Centre for Social Entrepreneurship, played a key role in the transformation of Rwanda’s health system. As a leader in the fields of public health and social innovation, he spoke of the need for a radical reimagining of global governance and an end to colonial mentalities. The messy, wicked problems of the 21st century will affect us all — perhaps it’s time we realised that the most innovative solutions to these crises may lie in the Global South.

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“The hubris of the West was the blindfold that caused wealthy countries to sleepwalk into a catastrophe. I hope that’s cause for humility and a recognition of the talent and expertise and leadership that exists in Africa and elsewhere in the world that’s been neglected for far too long.”

What inspired your journey into public health and shaped your life’s mission?

The animating principle for my life’s work has been the idea that every child, woman and man on the planet deserves access to healthcare as a human right; to take that a step further, every person deserves access to education and economic opportunity. This core belief was crystalised during a formative period in my life, when I had the chance to live in Tanzania. I was there at the height of the AIDS pandemic in the late 1990s, a period when it was ravaging the African continent. Effective treatments had been approved and were coming into widespread use in wealthy countries but were deemed too expensive or too complicated to deliver in poor countries. Entire generations were being wiped out because the drugs weren’t being made available to them. I became overwhelmed by a sense of outrage at the injustice; it put me in a deep funk.

When I went back to the US, I couldn’t understand how people were going about their lives, watching movies and visiting the mall, while kids were dying of a treatable disease. I felt helpless. Eventually, people got sick of me talking about it, so I just shut up and went to medical school. I needed a tangible set of skills or tools to respond to it.

Given your extensive experience with infectious diseases, did the catastrophic crisis of COVID-19 come as a surprise to you?

We always said that the big one would be a matter of when, not if. We didn’t know it would be COVID-19 and we didn’t know it would be in 2020, but it’s not surprising to me that we are where we are right now. Pathogens — be it HIV or COVID-19 — exploit our social fault lines; they thrive in the spaces created by inequality, racism and other structural forces that pull us apart. The pandemic has exposed some of these fault lines, which were invisible to many.

The multiple systemic crises that have been unleashed with the pandemic — from the racial justice crisis to unemployment and a severe economic crisis, not to mention the climate crisis lurking in the background — serve as a dress rehearsal for 21st century problems. These are wicked problems. They are messy and complex, and they transcend borders. It’s going to require global cooperation to solve them, with a long-term focus in bringing people together around a common vision. If we get this right, we’ll be much better positioned to confront all the problems that will emerge in the future. It’s said that you never let a crisis go to waste, because radical change rarely happens outside the context of a crisis. We are in one of those rare moments of upheaval; our actions today will have implications for our children, our children’s children and for generations to come.

Bill Gates has predicted that the pandemic will come to an end by the close of 2021. Do you agree?

I hate to disagree with Bill Gates, but I don’t believe it’ll be over by then. The virus is endemic, meaning it’s in circulation around the world and in our society. It’s worth emphasising that even for those not in high-risk categories, we’ve seen really troubling consequences of infection, where people don’t fully recover. They continue to suffer chronic fatigue, heart inflammation, neurological problems, anxiety and all kinds of issues that we don’t fully understand yet. It can be significant and debilitating even for those who are young and healthy.

With regards to how it ends, there’s no endgame without a vaccine. We should take hope from the unprecedented scientific cooperation that’s taking place around the world for this. One of the most promising vaccines was developed at Oxford by some of my colleagues who have been working around the clock. We’re hopeful, but I should caution that even if it’s successful, the vaccine won’t be a magic bullet. It’s likely that it will only provide partial protection and we don’t know how long immunity will last. There’s a lot we still don’t know, and that’s cause for real humility.

I think realistically, our lives are going to be turned upside down by this virus for at least another two or three years. I wouldn’t see us going back to a significant level of normality before then. To be honest, I hope we don’t we go back to normal if normal means going back to the way the world was. I hope that we use this crisis as an opportunity to rebuild in a more equitable and sustainable way for long-term prosperity.

The task of vaccinating billions of people around the world is mammoth. What will determine our success with this?

The one factor that’s best determined which countries have done a good job in responding to the pandemic has nothing to do with GDP or concentration of scientific expertise, or even the number of hospital beds. It’s down to leadership. We need to think of a different kind of leadership and to reimagine global governance. The idea of nationalism is something we have to fight against — it’s a common enemy in a global crisis, and we have to remember that none of us will be safe until all of us are safe. We’re an interconnected world, so it’s in all of our best interests to make sure that it’s not only a select few who get vaccinated.

COVAX is an important global mechanism, allowing for equitable distribution of vaccines. It’s premised on the understanding that we’ll need to work together as a global community to distribute vaccines based on need rather than wealth, with the goal being that 20% of the population would get vaccinated by the end of 2021. Rich countries have signed on but are still making their own deals in addition to COVAX. The US is a notable exception. Under Trump, it’s an America-first strategy and we’ve abandoned any sense of responsibility to our brothers and sisters in other countries.

When the virus started spreading, many people seemed to assume that it would hit the African continent the hardest — yet the opposite has been true. Why is this?

Most African countries took it very seriously. We all saw the risk, but there was more humility and early aggressive action in how they responded. Epidemic disease and emerging infective diseases are not new to the African continent, so they didn’t waste time. In the US and the UK, there was a sense of exceptionalism, hubris and overconfidence, to the point where they didn’t see the need to follow WHO advice, even when an extraordinary number of preventable deaths were happening. This colonial mindset — that they were the ones who dispensed expertise and that WHO guidelines were only for poor countries — was the blindfold that caused wealthy countries to sleepwalk into a catastrophe. In Rwanda, where I lived and worked for a dozen years, they’ve had 16 deaths. In the UK, we’ve had almost 60,000. I hope that’s cause for some humility in the West and a recognition of the talent and expertise and leadership that exists in Africa and elsewhere in the world that’s been neglected for far too long.

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