What COVID-19 has taught us about investing in public health

COVID-19 continues to pose novel challenges to health systems around the world. With the rapid depletion of stockpiles of personal protective equipment (PPE) and severe shortages of physical space in which to care for those affected by this perplexing and terrible disease, even well-resourced surgical health systems have been pushed to the brink of their capacity.

But in many low- and middle-income countries, the virus that emerged in late 2019 has exacerbated a problem that remains anything but novel in 2021. In places that lack the infrastructure, funding, and healthcare workforce able to cope with the pre-pandemic needs of its citizens, COVID-19 has further limited the ability of public health systems to provide essential surgical care to people who need it.

A study published in the British Journal of Surgery estimates that over a twelve-week period during the initial surge of COVID cases last spring, hospitals in low- and middle-income countries were forced to cancel more than 15.5 million surgical procedures as they prioritized patients infected with the virus. The ripple effect caused by these cancellations has had costly consequences in terms of avoidable human suffering. People who need surgery for trauma, cancer, burns, or congenital conditions such as cleft lip and cleft palate have been forced to wait and grapple with the debilitating effects of their conditions. Lives have been lost.

On a personal level, the coronavirus pandemic has brought back memories of my experience in Liberia leading Africare's response to the 2014-15 Ebola epidemic. During that emergency, all essential and emergency public health services were suspended as the healthcare system struggled to respond to the surge in Ebola cases. As a result of insufficient investment over many years, the country was ill prepared to address the highly infectious nature of the disease, and its response was further weakened by the dearth of critical medical equipment, testing and diagnostic capabilities, healthcare workers with the training needed to respond to the disease, and adequate PPE.

We see many of the same factors at work today, with predictable results, including an erosion of trust and confidence in health workers' capacity to provide adequate care and in patients' ability to receive care without risking their lives. As reported in a Journal of Public Health paper, patients in need of surgery are not seeking care for fear of contracting COVID while in hospital or a clinic. And this is in addition to preexisting structural, financial, and socioeconomic barriers that prevent tens of millions of people from accessing safe surgery.

We must and can do better.

If we are to care for the countless number of people in need of surgery while remaining responsive and resilient when faced with outbreaks of diseases such as COVID-19, the global health and international development communities must step up their capacity-building investments in both surgical ecosystems and public health systems.

Early on in the pandemic, Operation Smile made the difficult decision to put all its medical programs on pause. We knew hospitals and frontline health workers would soon be overwhelmed by an influx of desperately sick patients and that we needed to protect the people who turn to us for help, their families, and our staff and volunteers by suspending international travel indefinitely.

These measures resulted in surgery and dental care being delayed for thousands of Operation Smile patients. At the same time, we decided to increase our investment in public health systems in the countries where we work, both in response to the virus and to improve the quality of locally available care after the pandemic was over. To that end, we leveraged our longstanding relationships with various ministries of health and NGO partners to procure and donate PPE, respiratory equipment, COVID-19 test kits, and food and hygiene supplies to hospitals and communities hard hit by the virus.

What has been especially impressive about the global surgery community's response to COVID-19, however, has been its unity. Despite all the challenges posed by international travel restrictions, NGOs have turned to one another for help in overcoming their logistics and implementation hurdles. We experienced this firsthand in our work with organizations like the World Children Initiative, African Medical and Research Foundation, Kids Operating Room, Lifebox, and Medical Aid International, all of which have been instrumental in helping us procure and distribute PPE and medical supplies and equipment across Africa.

And the response extends beyond physical donations. Academic institutions, surgical societies, NGOs, and corporations have also come together to provide virtual training and education opportunities to frontline healthcare providers in resource-constrained settings. Operation Smile today partners with the United Nations Institute for Training and Research, the College of Surgeons of East Central and Southern Africa, and ministries of health in a number of countries to help thousands of health workers upgrade their skills and address the unique challenges they face.

At the end of the day, investments in public health systems help build confidence among patients, who can see that they will receive care that is safe and effective, as well as health workers, who are empowered with the knowledge, supplies, and skills they need to deliver relevant care safely and in a timely fashion. Indeed, World Health Organization chief Tedros Adhanom Ghebreyesus recently affirmed that the time for such investments is now: "Public health is more than medicine and science and it is bigger than any individual and there is hope that if we invest in health systems…we can bring this virus under control and go forward together to tackle other challenges of our times."

In the same essay, however, Tedros warned that the response to COVID-19 is not enough to "address the global under-investment in essential public health functions and resilient health systems, nor the urgent need for a 'One Health' approach that encompasses the health of humans, animals, and the planet we share. There is no vaccine for poverty, hunger, climate change or inequality."

At Operation Smile, we've learned that the time is always right to invest in systems with the aim of making them more resilient and responsive to the needs of the people they are intended to serve. But only a global response will yield the kind of impact we desperately need to stop COVID in its tracks and end the pandemic.

As the old saying goes, "to whom much is given much is required." Today, more than ever, global health stakeholders and international development actors must step up and provide the financial and human capital needed to build public health systems that can respond to emerging health needs efficiently and effectively. There's a not a moment to waste.

(Photo credit: Operation Smile)

Ernest Gaie serves as senior advisor for global business operations at Operation Smile.