Covid-19: a disaster five years in the making

• Dr Peter Hotez, professor of paediatrics and molecular virology and microbiology at Baylor College of Medicine, argues the problems we are facing in the COVID-19 pandemic are not a one-off extraordinary event but the culmination of a five year unravelling of progress in global health. The factors in play involve:
• 'Political instability and social collapse' between 2015 and 2020:  Venezuela saw socioeconomic collapse leading to spill over childhood vaccination programmes that drove the 2017 and 2018 Latin American measles epidemic. Human migration and displacement led to a rise in disease as viruses travelled. Unemployment led to work in illegal gold mining in mosquito infested areas in Venezuela leading to widespread malaria.
• Illegal drug trafficking shifted from Colombia to the northern triangle of El Salvador, Guatemala and Honduras, leading to economic declines slowing down disease vector control promoting infection from Chagas disease, Zika and Leishmaniasis. The Arabian Peninsula saw civil war in Syria and the Islamic State bringing back measles, polio and other vaccine resistant disease, spreading across the continent with the proxy war in Yemen.
• Boko Haram in northern Nigeria and places like South Sudan, DRC and Central African Republic are seeing the return of epidemics of leishmaniasis and sleeping sickness.
• 'Climate Change Impacts heating up existing problems' In 2015, unprecedented temperatures that exceeded 50 degrees centigrade, combined with drought, causing the abandonment of ancient agricultural lands in the Middle East, as did prolonged drought in Venezuela, on the back of 50-65% declines in rainfall between 2013 and 2016.
• Rapid Urbanisation and the creation of megacities of 10 million people or more. Caracas in Venezuela, Kinshasa in DR Congo, Lagos in Nigeria and Aleppo in Syria, have become the foci of disease and poverty, with urban transmission of vectorborne disease widespread. In some places, urbanisation combined with deforestation has created new opportunities for catastrophic viral infections transmitted from bats, including Ebola and Nipah virus infections.
• Shifting Poverty - with more than 700 million people still living in extreme poverty (and the COVID-19 pandemic pushing more people into it still) the pre-pandemic levels of 700 million people in extreme poverty will be rising with almost all affected by one severely negelected disease.
• G20 investment most of the world's nuclear powers probably devote more reseources to the research and stockpiling of weapons than to research and development of vaccines for neglected diseases. Thus, war, political collapse, internal displacements, climate change, urbanisation and shifting poverty combine in unique and interesting ways to promote widespread emergence of infectious and tropical diseases.
• Anti-science movement - taking off from the sharp rise in sentiment that paralled the Donald Trump election campaign from 2015, as measles expanded across the USA, outbreaks occurred in Samoa and American Samoa in the South Pacific which can be possibly attributed to antivaccine groups. 
• Weaponised health communication - Russia has become a leading source of anti-science disinformation. Putin has launched programme of weaponised health communication that fill the internet with COVID-19 conspiracies and anti-vaccine messages.
• A vulnerable plant versus COVID-19 - these factors above established the conditions for the pandemic to spread rapidly across continents. Although climate change and conflict have no obvious role in driving COVID-19, there is an association between factors linked to the ascendency of the coronavirus to those that destabilise global health more generally and the return of vaccine preventable or neglected diseases
• Poverty has figured in the disproportionate number of low-income families associated with hospital admissions and deaths from COVID-19. Global urbanisation creates perfect transmission zones in large cities and crowded urban slums. And more than 100 million extra people have been thrown back into extreme pverty as a result of the economic collapse from the pandemic and the measures to control it.
• Political instability from populism and political extremism has loomed large in countries where autocratic heads of states have exaggerated efforts to control the pandemic while downplaying its severity. They've also promote spectacular cures with uncertain or little medicinal benefit like hydroxychloroquine. They've also been breeding grounds for anti-science messaging attacking face masks and social distancing.
• How to solve it - by developing next generation vaccines and other biotechnologies essential for suppressing COVID-19, but technology is not the only tool needed. We need to protect cities from urban environmental degradation which leads to vectorborne disease. We need greater cooperation between the wealthy G20 nations to fight poverty and related illness within their own borders while working together to support new biotechnologies.
• We must reset and reframe international cooperation around science to promote vaccine diplomacy, particularly for the next generation COVID-19 vaccines which we'll need for the new variants. We need a pathway to tackle the dramatic rise in anti-science rhetoric and to halt Russia's systematic programme of weaponised health communication.