Call to action: A people-centred approach to disease prevention in the era of Covid-19

For some policymakers, Covid-19 has raised the tension between life and livelihood, for many civil society activists it has raised human rights issues, inequities and the need to focus on global solidarity – as opposed to global security. For those working in health systems, it has also confirmed the inadequacy of investments in public health.

Many of these issues (and tensions) are raised in the Call to Action – Reclaiming Comprehensive Public Health which has its genesis in the recent paper of the same title by Loewenson et al in the British Medical Journal Global Health.

In their critique, they note that there are broadly two approaches to public health. One is the biomedical top-down technical approach – which largely focuses on paternalistically invoking measures to protect communities from pathogens. This approach is broadly promoted by the World Health Organisation and illustrated by the use of terms such as “command and control”. The other approach to public health focuses on people’s sense of agency with rights with whom governments should engage in determining how to respond to a pandemic. 

These authors cite the importance of the 1984 Siracusa Principles of the United Nations Economic and Social Council to guide actions of governments to restrict the freedoms of individuals as is the case with the lockdowns that many governments around the world have implemented and continue to implement to limit the transmission of the SARS Covid-19 virus.

These principles include: actions must have a clear public health rationale; be based on scientific evidence; be targeted and the least restrictive intervention for the desired goal; engage the public for as long as the intervention is necessary to enable community involvement in the interventions; not discriminate unlawfully and respect human dignity; and be time-limited and subjected to reviews.

Countries not following the principles have left themselves open to contestation of restrictions.

The mass protests in the US and Europe are largely led by right-wing organisations and political parties who argue that their individual civil liberties are being violated. Some of the mass protests against lockdowns are supported and organised by institutions that advocate for an unfettered free market such as the American Institute for Economic Research which was behind the Great Barrington Declaration, as suggested by Greenhalgh and others. Or those that seek unrestricted civil liberties such as the Querdenker movement in Germany which has become increasingly violent during its protests.

Not surprisingly, individuals belonging to such organisations also propagate conspiracy theories about the spread of the virus. These expound, for example, that the Chinese government created the virus or that Bill Gates created the virus and will use a coronavirus vaccine to monitor people through a microchip.

Civil society organisations have made significant contributions to the Covid-19 responses in their countries. Civicus published a number of case studies outlining these contributions noting that: “Much of civil society’s responses focused on mitigating the impacts of state policies that imposed lockdowns and halted many aspects of daily life, which affected vulnerable and excluded groups first and worst.”