Global Health, Pandemics, and Geopolitics

Cha-Hsuan and Helen:
Global health is what we are experiencing and practising to improve health and achieve health equity for all people worldwide. Yet, the contemporary concept of global health is Western-oriented. In the roundtable ‘Global Health and Asia Pacific’ at International Convention of Asian Scholars (ICAS) 2021, scholars and care practitioners shared their experiences and views on global health issues. Topics raised in the conversation included geopolitical relations, the relations among nations when it comes to handling pandemics, their impact on the economy and wellbeing of populations, marginalized groups within a country and the nation, disparities or inequalities of access to treatment, and access to health care services or vaccines.

Ciptasari:
While we talk about global health, we probably need to keep in mind that identifying global health issues itself is already a global health issue.

ZhiPeng:
Two components are involved in the concept of Global Health. First, it concerns a global issue, such as global warming or climate change. Second, it concerns a health issue – for example, infectious diseases. Such infectious diseases are spread globally, like HIV and COVID-19. Power also plays a role in Global Health. Therefore, it is important to have a better understanding of its structures/institutions. There is an overlap between global health and public health. While public health may put the main focus on intervention and prevention, global health also concerns treatments, care systems, political power, inequality, and inequity.

Cha-Hsuan:
Take HIV as an example. It's like a prelude to this pandemic of COVID-19. HIV started getting attention from global health in the 20th century. Then it came to SARS. And now we have COVID-19. While we are concerned with the effectiveness of containment, we have to take care of the vulnerable groups’ needs as well.

Ciptasari:
Since the Covid pandemic was put as the priority to be tackled on the national agenda, the unremitting needs of other epidemics in a country can be overlooked/ignored. Due to the mobility restrictions, many preventions or care practices are not able to perform during this time. Furthermore, many vulnerable groups cannot access the health care that they need.

Helen:
The kind of help that we need and the kind of research that we need on global health, especially on COVID-19, is to find ways a means to get over the economic emergencies while we are going through the health emergencies and the education emergencies. Furthermore, there are two phases of handling the pandemic. The first part is handling the pandemic under lockdown, et cetera. And now we're going into the second stage: the vaccination, which is not equally distributed.

Cha-Hsuan:
When we have put the focus of our ideas on COVID 19, Helen just reminded us that our approach is probably very medically centred – mainly about the containment of this disease. We seem to put less consideration on well-being. Well, the discussions about the economy are already there. But how about the quality of life during this very moment? I am glad to see that researchers have already started to investigate the mental health of the youth at the time of lockdowns. We need to have a more holistic view to look at the impact of a pandemic.

We shouldn’t overlook the justice of health measures as well. We know it is an emergent situation. But, has the government explained well the necessity of lockdowns and what we can expect from the outcome? In Asia, most citizens follow government measures. People stayed at home and put on masks in public spaces. On the contrary, there are a lot of protests against COVID measures going on in Europe and other Western countries. I wonder what makes the differences in people's attitudes towards COVID between groups and cultures.

Fatima:
In the Philippines, COVID results in further marginalization of marginalized sectors. For example, some sex workers are abused by the police during the lockdown. And some indigenous people cannot access the vaccines because they are not registered as residents of the local government where they live. And there's also an increasing trend of domestic violence again among women during the lockdown. The registration of online sex exploitation among children suddenly increased. Another problem is the Philippine government’s very militaristic rule, where the wanderers are penalised by the military, which is very inhumane. I think it's also important to look into the social organisations that are helping marginalised groups to be recognized in the time of the pandemic.

As we know, there is actually discrimination in the distribution of vaccines and the usage of vaccines. For example, some territorial issues are arising. For example, if you're vaccinated with Sinovac, you cannot travel to Europe or the US. We should look into the fact that containing COVID-19 is a shared responsibility across nations. Global health has become a shared responsibility and should not just be dominated by western practices and concepts. There are already a lot of localised practices (worldwide), and a lot of practices are in place in Asia. There are different studies and operations on medications and vaccines by Asian countries and Asian scientists. The positive thing about the COVID pandemic is that there's a higher appreciation and integration of medical practices across nations.

Cha-Hsuan:
Yes. These efforts on global health and practices worldwide should be equally recognized. The integration, interrelations, interrelationships between nations and the shared responsibility on health issues should be taken on a global scale.

Ciptasari:
COVID-19 and HIV attract international attention because they become global health problems. Therefore, the provision of medicine for patients is one of the most important issues and becomes the global agenda.   Fortunately, the Ministry of Health has committed to providing antiretroviral (ARV drugs for free in Indonesia. Also, for COVID-19, the Government of Indonesia has tried to make the treatment as affordable as possible. There should be strong coordination and collaborations to make it happen. When we talk about global health, traditionally, it has always been a Western-oriented approach. However, nowadays global health cannot be dependent on the Western world only, especially when it should be adapted to the geographical setting and local context. There will be local wisdom. Again, for the pandemic, we help each other not only from West to East anymore. We [Asia] also contribute to global health care via interrelations.

Zhipeng:
When we talk about global health, it's not a centralization idea that can be imposed onto the globe and different territories. Because of the differences between cultures and how things can be done at the local level, it is also important to get feedback from all. The local and the global institutes can work together.

Cha-Hsuan:
There are also other global issues, including health diplomacy. We have addressed the uneven distribution of vaccines and medicines. Let’s take it as an example. The global distribution plan is not just based on geographical differences but also concerns the economic and political power of a country. Sometimes, nations use health resources as power in diplomacy to gain recognition or gain international support from other nations.

Helen:
Now it seems the economy could decline sharply. This is very difficult for the local government to overcome the situation. Sometimes you can see that the stakeholders can be good at implementing plans for the long term. But at the same time, they feel hesitant to face the economic consequences. What can global health stakeholders do to tackle such issues? WHO does have a very big role, especially when it comes to the vaccine. There have been problems in the economy and education. But stakeholders have to volunteer to do something with the vaccine. However, there should be a mechanism to make sure that stakeholders do it with benefit. They have to benefit from the help that they give.