The word ‘Lancet’ has a confusing meaning to the non-medical experts like many of us. In the ordinary two-fold dictionary meaning, a lancet as a medical term is ‘a small surgical instrument, usually sharp-pointed and two-edged, for making small incisions, opening abscesses, etc’, or simply ‘a pointed surgical knife with two sharp edges’. Secondly, as an architectural concept, a lancet is a ‘high, narrow, pointed arch or window’. An ‘arch’ is a curved structure supporting the weight of what is above it’. In the medical field, lancet is an ubiquitous term as the name of one of the oldest and prestigious international medical journal called The Lancet.
The Lancet is an independent, international weekly general medical journal founded in 1823 by Thomas Wakley…Over the past two centuries, The Lancet has sought to address urgent topics in our society, initiate debate, put science into context, and influence decision makers around the world. The Lancet has evolved as a family of 20 journals (across Child & Adolescent Health, Diabetes & Endocrinology, Neurology, Oncology, Respiratory Medicine, Rheumatology, etc), but retains at its core the belief that medicine must serve society, that knowledge must transform society, that the best science must lead to better lives (See https://www.thelancet.com/about-us).
The founder of Lancet was an English surgeon who named it after the surgical instrument called a lancet (scalpel), as well as after the architectural term lancet window to indicate the ‘light of wisdom’ or to ‘let in light’ (See https://en.wikipedia.org/wiki/The_Lancet).
Be that as it may, what is of greater interest to us here is what is called the Commissions from the Lancet Journals,- a number of commissions dealing with different problematic issues in the medical field. There is for example The Lancet Commission on the future of health in sub-Saharan Africa (The path to longer and healthier lives for all Africans by 2030).
Again, The Lancet COVID-19 Commission which is the focus of this article is another. This Commission has the Columbia University, New York indefatigable and a world renowned professor of economics, leader in sustainable development, senior UN advisor, Professor Jeffrey Sachs, as its Chair. The Commission also has Commissioners, Task Force Chairs, and Commission Secretariat, all of whom participated in preparing this Statement.
According to the Commission itself, the Lancet COVID-19 Commission was launched on 9 July 2020, to assist governments, civil society, and UN institutions in responding effectively to the COVID-19 pandemic. The Commission aims to offer practical solutions to the four main global challenges posed by the pandemic: suppressing the pandemic by means of pharmaceutical and non-pharmaceutical interventions; overcoming humanitarian emergencies, including poverty, hunger, and mental distress, caused by the pandemic; restructuring public and private finances in the wake of the pandemic; and rebuilding the world economy in an inclusive, resilient, and sustainable way that is aligned with the Sustainable Development Goals (SDGs) and the Paris Climate Agreement (See https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2931927-9).
On 14 September 2020, The Lancet COVID-19 Commission published online a detailed statement titled: ‘Lancet COVID-19 Commission Statement on the occasion of the 75th session of the UN General Assembly’. The Statement contains detailed observations, analysis and priority actions on different areas of COVID-19 pandemic. The full text of the Statement has eleven sections which we can briefly reproduce as follows (See: https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2931927-9).
Section 1: The origins of COVID-19 and averting zoonotic pandemics: The Commission recommends the tracking down of the origins of the virus in an open, scientific, and unbiased way not influenced by geopolitical agendas.
Section 2: The urgency of suppressing the pandemic: The Commission recommends the suppressing of the epidemic through the proven package of non-pharmaceutical interventions (NPIs), as accomplished by several countries including many in the Asia–Pacific region. This should be followed by the introduction of effective and safe vaccines as rapidly as scientific advances permit.
Section 3: Pathways to successful implementation of NPIs: To implement NPIs effectively countries should, with urgency, scale up their public health workforces. The scale up might entail considerable reallocation of public spending as public health is the best investment for suppressing the pandemic and laying the foundation for sustainable development.
Section 4: Sources of recent failure in pandemic control: Several countries persistently failed to control the epidemic thereby incurring some of the world’s highest rates of infections and deaths per million population. Some of the causes include (a) high inequality which in turn exacerbates low social trust and polarised politics as in USA and Brazil; (b) style of political leadership termed medical populism (e.g. President Donald Trump in US, President Rodrigo Duterte of the Philippines, and President Jair Bolsonaro of Brazil; and (c) scarcity of quality research among others. Some solutions for these are (i) all countries should learn from success stories of countries that have suppressed the pandemic or reduced its spread; (ii) all nations should combat the rampant rumour-mongering and misinformation that abound on COVID-19; (iii) political leaders should desist from expressing personal viewpoints that are at odds with the scientific and public health experts of their countries. The same goes for political leaders who are calling for unproven treatments that do not have supporting data and evidence, thereby politicising the process of drug and vaccine discovery. Health professionalism should be strictly followed.
Section 5: Addressing the inequities of the pandemic: The COVID-19 pandemic is widening the gap between the rich and the poor and is likely to bring about a sharp increase in income inequalities. In addition to causing a public health crisis, the pandemic has caused an economic and job crisis worldwide. In addressing these and other-related crisis, the UN Statistical Commission, working with partner UN institutions and national statistical agencies, should prepare near-real-time data on vulnerable populations, and their conditions, with a special focus on poverty, joblessness, mental health, violence, hunger, forced labour, and other forms of extreme deprivation and abuses of human rights.
Section 6: Meeting the urgent fiscal needs of low-income and medium-income countries (LMICs: This calls for emergency financing that secures access of developing countries to financing from international sources, especially from the International Monetary Fund and World Bank.
Section 7: Achieving universal digital access as a key to inclusion: The Commission calls for the collection and publication of timely and internationally consistent data on the state of the pandemic, including humanitarian and economic consequences.
Section 8: Global justice in access to safe and effective vaccines, therapeutic, diagnostics, and equipment. The Commission calls for universal access to the tools to fight COVID-19, including test kits, therapeutics, and prospective vaccines.
Section 9: Promoting a jobs-based green recovery: The Commission calls for an economic recovery that will be based on public-investment-led growth in green, digital, and inclusive technologies, based on the Sustainable Development Goals.
Section 10: Supporting the urgent role of UN institutions: The Commission calls for support for UN institutions and the UN Charter, resisting any attempts at a new cold war. Multilateralism should be strictly followed.
Section 11: The work of the Lancet COVID-19 going forward: Among things, the Commission plans to develop a portfolio of COVID-19 metrics to track how its recommendations are being implemented, and will report on them quarterly.
It is the view of this column that the Lancet COVID-19 Commission has done a commendable job through its Statement which is very apt as it touches on all the important issues of serious concern globally and Nigeria in particular. Given the fact that this column followed the dynamics of COVID-19 pandemics from March 2020, it can say without equivocation that the various issues raised by the Commission in all the sections are very germane in the fight against the virus in Nigeria.
Although Nigeria has a very weak health system, its Presidential Task Force on COVID-19 (PTF on COVID-19) that was established on 9 March 2020, has helped a lot to keep Nigeria focused in the fight against the COVID-19 pandemic. It was able to get the support of the private sector to intensify the fight against the pandemic. The private sector Coalition Against COVID-19 (CA-COVID) joined the Nigerian government to fight the virus on many fronts: awareness creation and public enlightenment on the reality of the virus thereby helping to counter the conspiracy theory about its non-existence; distribution of food items to the vulnerable groups in society; construction of Isolation Centres across the country, and providing enormous material and financial support to the states, among others. This private sector intervention along with that of the government helped to lessen what would have been a serious humanitarian crisis in Nigeria which of course is a major concern of the Lancet COVID-19 Commission.
The call by the Commission for equitable access to vaccine resonated very well with Nigerian President Muhammadu Buhari during his address to the on-going UN General Assembly. In actual fact, this was one of the major issues he raised in his address.
The Presidential Task Force on COVID-19 has to its credit maintained its verve since its establishment in March. It has consistently promoted the use of non-pharmaceutical interventions and pressed for the mandatory use of face masks in public places. It has made the implementation of a risk communication strategy a major part of its duties in the face of a very low compliance level by members of the public.
The issue of health professionalism as against health populism is one area the PTF on COVID-19 took seriously by consistently stating and restating the need for Nigerians to follow science rather than superstition in a country of high level of illiteracy. The recruitment and training of health workers was intensified.
The Nigeria Economic Sustainability Plan (a stimulus package) is being implemented to address both the health and economic crises caused by the pandemic.
In spite of all these, Nigeria needs to study very closely the Lancet COVID-19 Commission Statement as there are many useful lessons to learn. Funding of the health sector is still a big issue. Health sector funding has to be prioritised urgently. In all, there is a lot to learn from the Commission’s Statement to help Nigeria address some other issues of serious concern.
•Prof. Obasi, a public policy expert (& former columnist in the Daily Trust, Abuja, March 2003 to October 2006, & Daily Champion, Lagos, April 2005 to December 2008), is of the Department of Public Administration, University of Abuja. Email: nnamdizik@gmail.com
