Alicia Ely Yamin

Covid-19 is showcasing the good, the bad and the ugly of human nature and social ingenuity. What are the lessons that we as ESC rights advocates should take away from this pandemic and how might we use this time to prepare a transformative agenda for health rights, democracy, and global governance?

1. This virus is NOT “a great equalizer.” 
Far from being an equalizer, Covid-19 is, in reality, a social x-ray that illuminates the fragmentation and social inequalities within and between our societies. That mendacious bit of propaganda which politicians, pundits and celebrities are fond of spouting shows repulsive indifference to the depths of suffering tens of millions are and will suffer because of the pandemic.

Think for example of the millions who have lost their jobs and have no benefits, the women who find themselves confined with their abusers; and the homeless people, prisoners and those in any form of overcrowded housing conditions; and think of the vast swathes of people across the global South who have no stable employment whatsoever and don’t even have regular access to soap and water.  

It doesn’t matter how many wealthy people get sick or that some data suggests that men may be at higher risk for complications than women. Discrimination that means poor and otherwise marginalized persons (with intersectional identities that affects people in varied ways across contexts) have less control over their lives and life choices in “normal” times now places those same people at greater risk for contracting the virus and often the likelihood of getting access to appropriate care if infected. We must learn from false discourse--and from the blunt measures governments have put in place as “equalizing” responses-- that pretending we are all the same is a massive lie that serves to entrench the status quo. We desperately need to join other social movements to advocate truly universal health and social protection systems that depend upon social solidarity and do not exclude on the basis of cost. But the navigation of difference is both the greatest challenge and strength of plural democracies and human rights has demonstrated the importance of taking heterogeneity as a starting point.

2. Philanthro-capitalists, donors and corporations will NOT save us.
The fact that we so desperately need corporate donations and collaboration, and philanthropic largesse in the midst of this crisis—even in the wealthiest country in the world-- is part of the problem.  Over decades we have embraced neoliberal policies in national economies and across global governance that systematically hollowed out fiscal space and capacity in governmental institutions to meet the health and other rights we were increasingly articulating.  Let’s have Gates, Bezos and the rest of the Davos crowd pay all the taxes they should have been paying all along; let’s re-regulate financial sectors and make anti-trust laws mean something again, with regard to Big Tech and beyond.

The narrative of infinite economic growth has been abruptly shattered, not just in one country but around the world. We now need to reject the idea of getting the global economy back to normal, when ‘normal’ was a very obviously sick state.  The decades of various iterations of adjustment make this even more imperative for countries without the options of fiscal stimulus and monetary adjustments. For the global South, where donors and development backs have literally left governments shackled as their countries go underwater from this virus.  This crisis provides a window for pushing through substantial redistribution (and support for health, social protection, education, housing and other ESC rights) at the national level in many countries—and substantial reimagination of global economic governance. We must seize that window.

3. The solution to future pandemics is NOT just “modernizing” health systems.
First, this pandemic is not just a health problem; it is a social calamity and a crisis of democratic institutions, as well as of international cooperation in the world order that has existed since World War II. Moreover, health systems are not just delivery systems for health goods and services, as crucial as we have seen that role is in this pandemic.  

Indeed, this crisis provides an opportunity for human rights advocates and the general public to understand that health (just like education, e.g.) is a matter of democracy. Health systems function as core social institutions—just as justice systems do—often to marginalize and exacerbate patterns of discrimination in the overall society, along with race and class and gender, e.g.  Take market-based allocation of care, which in the US has become so absurd as to have governors now bidding against one another for scarce equipment. But there is another possibility: health systems alternatively can function to mitigate exclusion and reaffirm normative principles of equal concern and respect—from financing to priority-setting to organization and delivery of care. In countries where that is more the case, this pandemic is playing out very differently in terms of its material and symbolic impacts. In moving toward the world we want to construct, we will need to do everything possible to highlight the connections between health, health systems as fundamental social institutions that play normative roles and democratic legitimacy of decisions regarding health, and social determinants of health.

In short, the way specific countries and the world reacts to this global pandemic will change the structures of our economies and societies, and global governance, for years to come. It will be critical for the ESC rights community to resist going back to the usual claims and ways of working we have in the past, and instead to mobilize for a transformative agenda.

Alicia Ely Yamin is a Senior Fellow at the Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics at Harvard Law School. She also works with the Centre on Law and Social Transformation and the Bergen Center on Ethics and Priority Setting in Norway. Yamin’s career at the intersection of global health and human rights has bridged academia and activism, as well as law and global health/development. She has lived half of her professional life outside the United States and collaborated with local advocacy organizations across Latin America and East Africa. Twitter: @AE_Yamin