The shot that was heard around the world: the Oxford university/AstraZeneca vaccine, introduced in the UK on Monday, is eagerly awaited by developing countries in the fight against coronavirus © AFP via Getty Images

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Welcome to FT Health, a monthly guide to the big issues at the intersection of global health and finance. FT subscribers can sign up for the email version here and non- subscribers here.

For this special edition we asked our writers and readers of FT Health for their thoughts on global health for the year ahead. Here are some of their priorities.

We start with lessons from the current crisis.

Andrew Jack, global education editor and FT Health founder, says:

Even as policymakers cope with the continuing demands of coronavirus, they need to focus on two areas. The first is how to ensure investments being put in place for testing, surveillance and response can be sustained and scaled to apply to a wide range of future pandemic threats. That means more monitoring of a broader range of infectious diseases and better mechanisms to share information.

The second is to show humility by exploring and drawing lessons for their health systems from the varied responses to Covid-19 around the world. That includes identifying better funding models and operating structures, rebalancing investments between prevention, primary and more specialist care and exploring the links between care homes, home-based and hospital-based support for the elderly.

Clive Cookson, science editor, says policymakers must do more to tackle the world's other great infectious disease issue: antimicrobial resistance.

As well as stronger action to clamp down on overuse of existing antibiotics in people and in agriculture, we need governments to firm up financial initiatives for the pharma industry to invest in later stages of clinical trials and pull new antibiotics, which are being generated by small biotech companies and academic researchers, on to the market.

Models are under development to reward companies for producing drugs not on the basis of sales, but to be held back for when they are really needed — one in the UK and another proposed by the US Pasteur Act, a bill introduced in Congress with bipartisan support. The G7 and G20 should take a lead in 2021, with governments setting clear benchmarks for progress to which they can be held accountable.

Darren Dodd, health writer and commissioning editor, says policymakers must urgently address the effects of the pandemic on mental health.

Lockdowns, bereavement, disrupted sleep and the fear of infection, together with the huge increase in economic uncertainty have combined with a squeeze on existing treatments to create a fertile environment for mental ill-health. Women and ethnic minority groups appear to be disproportionately affected. Jumps in the use of antidepressants are just one early warning sign of further problems ahead.

Hannah Kuchler, US pharma and biotech correspondent, points out this “second pandemic” of mental health problems has so far gone untreated as providers become overwhelmed.

Governments that poured money into research and development to speed Covid-19 vaccines to market should now be encouraged to invest in new solutions for treating mental health. The last couple of years have seen the first breakthroughs in pharmaceuticals for depression in decades: Johnson & Johnson's ketamine-derived nasal spray Spravato and Sage Therapeutics first post-partum depression drug Zulresso.

An equivalent to Operation Warp Speed [the US vaccine project] for mental health could take other potential drugs into the clinic. Covid-19 could also help bring in improvements in digitally tracking what helps and what hurts. Large studies of mental health during the lockdowns, completed online and in real time, could accelerate our understanding.

Thank you to all the FT Health readers who submitted some of their own priorities for 2021:

Mike Rann, chairman of the board of trustees of the Power of Nutrition foundation, called for action on global malnutrition.

Before Covid-19 hit, undernutrition was already responsible for almost half of deaths of children under five. Stunting and wasting — due to undernutrition — causes cognitive and physical impairment, meaning children never develop to their full potential. There’s also a big economic impact as nations suffer the effects of lost productivity. A stunted workforce means a stunted GDP. The ripple effect of Covid-19 in developing countries means we could see an additional 2.6m stunted children by 2022. An additional $1.2bn of funding (on top of the recommended $7bn to meet the World Health Assembly’s nutrition targets) is needed per year to mitigate the effects.

These are shocking figures and the task ahead for national governments is huge. On top of committing development aid spending to tackle undernutrition, policymakers should look to build partnerships with philanthropic sources and the private sector to meet the challenge. This year has been designated the Year of Nutrition: in the lead up to the Tokyo Nutrition for Growth Summit next December we have a real and pressing opportunity to make a real difference.

Adeeba Kamarulzaman, president of the International Aids Society, suggested two priorities for policymakers:

We won’t overcome HIV until we overcome inequalities, stigma and discrimination. And we won’t beat zoonotic diseases until we stop invading the few wild places left on earth and begin respecting nature.

The Covid pandemic has re-emphasised both points and therefore my hope for 2021 is that we, as a global community, show greater respect for each other and for the natural world around us. It is in our own self-interest.

By invitation: WHO chief on health as an investment

© Fabrice Coffrini/Reuters

Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, writes:

The fastest way to end the Covid-19 pandemic is to ensure that those at high risk across the world are vaccinated simultaneously. Through the ACT-Accelerator, and its vaccine pillar — the Covax facility — the largest portfolio of vaccines and almost a billion doses have already been secured.

But this is not enough: the accelerator’s funding gap of $4.3bn needs to be filled quickly so that the new health tools can be secured and distributed to every country. This will save lives, stabilise hospitals and drive a truly global economic recovery.

A recent study found that investing in equitable health tools is not only the morally right thing to do; it’s the smart thing to do. Rich countries have already pumped $10tn into their economies. The cost of vaccinating the world equitably and ending the pandemic will pay for itself many times over as supply chains are reopened fully. In five years, those economic benefits would total $466bn.

The Covid-19 pandemic has demonstrated the consequences of chronic under-investment in public health. But we don’t just need more investment; we must also rethink how we value health.

The WHO’s new Council on the Economics of Health for All, staffed by leading economists and health experts, will put “health for all” at the centre of how we think about value creation and economic growth.

Chaired by professor Mariana Mazzucato, the Council will flip common thinking on its head and develop a body of evidence that reflects that health is an investment in the future, not a short-term cost.

We will end the pandemic together if we have a chance to learn together, so that we can prevent the next one, tackle the challenges of our time and realise “health for all”. All roads should lead to universal health coverage.

WHO: Ten global issues to track in 2021

Covid catch-up

Stream chart showing 7 day moving average of Covid deaths in global regions. A recent resurgence in Europe means the global daily average has now eclipsed the global figure of 6,800 from the spring peak now hitting 101,516

There may be welcome news on vaccines but the pandemic continues to rage. From the US, the world’s hardest-hit country with more than 350,000 deaths and 20m cases and where daily infection records continue to hit new records, to the UK, which is back in lockdown with hospitals under severe pressure from rapidly rising case numbers, to soaring infections in Japan and an alarming new wave in Africa. There are increasing fears about the global spread of the “UK variant” of the virus. Tensions between China and the west over the pandemic’s origins continue. (FT, Science)

Key links
FT tracking hub
WHO coronavirus dashboard

News round-up

Vaccine programmes get under way . . . More than 30 countries have now begun immunising their citizens after a flurry of regulatory approvals, including today’s recommendation for Moderna’s vaccine to be approved in the EU. The UK on Monday began administering the AstraZeneca/Oxford university jab, eagerly anticipated in the developing world for its low price — Astra has pledged to sell the vaccine at cost to developing nations — and its ability to be stored at normal refrigerated temperatures.

BioNTech/Pfizer’s product is being rolled out across Europe — albeit with a slow start and subject to a row in the UK over the gap between first and second doses. China has approved its first vaccine for general use and aims to immunise 50m people before the Lunar New Year travel rush next month. India has given the OK to two homegrown efforts but faces criticism over trial data transparency. (FT, Washington Post)

Pie chart of share of vaccine supply in low- and middle-income countries (%) that shows the Oxford/AstraZeneca vaccine is crucial to low- and middle-income countries - it is nearly 44% of supplies

. . . but poorer countries face wait Much of the world may not have access to vaccines until 2022 or later as richer nations suck up supplies and the WHO’s Covax programme to ensure equitable access encounters funding difficulties. Vulnerable groups such as refugees are particularly at risk. (BMJ, LA Times, Guardian)

Bookmark this: There are currently more than 230 vaccine candidates — use our new tracker to follow their regulatory progress and the number of doses administered. And here’s an NYT interactive explaining how each vaccine works.

Helping emerging economies A $9bn credit facility from the Asian Development Bank aims to help vaccination efforts in developing countries. The initiative follows a $20bn package for Asian countries in April and a $20m technical assistance programme in November. The World Bank warned of serious economic setbacks for Nigeria — already suffering from rising unemployment and inflation and falling incomes before the pandemic — a country relying heavily on oil and remittances. (FT)

Column chart of Poverty projections for business-as-usual scenario (millions) showing Nigeria could have 100m people in poverty by 2022

Filling the funding gaps The WHO is considering new financial instruments to help bridge a $28bn funding gap for Covid tools. Here’s an examination of how World Bank pandemic bonds became “the world’s most controversial investment”. (Reuters, Bloomberg)

Top ten killers The WHO’s Global Health Estimates updated the world’s leading causes of death and reinforced the idea that people are living longer but with more disabilities. Non-communicable diseases such as cancer and diabetes now make up seven of the deadly top 10 and account for 16 per cent of all deaths. (WHO, Guardian, FT graphic)

Chart showing the number of deaths from the leading causes of death globally.

Pandemic lays bare inequalities More studies are emerging showing the disproportionate effect of coronavirus on vulnerable communities. The pandemic is also making the world more unequal. Here are five reasons why. (The Lancet, FT)

Column chart of Covid-19 related fiscal measures, by type of economy (% of 2020 GDP) showing Richer countries can spend more to support their economies

Healthy ageing There are now more than 1bn people aged 60 or older, with most living in low- and middle-income countries and many lacking basic resources for a dignified life. The Decade of Healthy Ageing is a UN initiative aiming to “galvanise international action to improve the lives of older people, their families and communities, both during the Covid-19 pandemic, and beyond”. (WHO)

Smoke signals The WHO launched a year-long campaign to help 100m people quit smoking as a fierce row erupted in Australia over a clampdown on vaping. A study from the American Heart Association said the use of e-cigarettes brought no health benefits if smokers merely used them alongside traditional cigarettes. Here’s what the science says about quitting. (WHO, Guardian, Circulation, The Conversation)

AMR alert As our science editor explains above, a global war on superbugs must follow the defeat of Covid-19. Read our explanation of antibiotic resistance in charts and the rest of our special report: The future of antibiotics.

Developing economies in particular struggle with drug resistance

Hygiene and sanitation A WHO/Unicef report said poor sanitation at health facilities has put almost 2bn people at higher risk of Covid-19 and other diseases. Another study estimated the cost of improving water sanitation and hygiene in facilities across India at $3.6bn. Oxfam has designed a new type of handwashing station for use in emergency situations. (WHO, BMJ, Devex)

People of the year Ugur Sahin and Ozlem Tureci, the founders of BioNTech and responsible for the vaccine that kickstarted the global fightback against coronavirus, are the FT’s people of the year. The two German doctor-researchers, both children of Turkish immigrants, epitomise scientific endeavour at its best, the FT editor said.

© Felix Schmitt/Focus/eyevine

Best from the journals

Public health messaging This opinion piece discusses strategies to counteract misinformation on social media such as “deploying countermeasures for misinformation, surveillance of digital data to inform messaging, partnering with trusted messengers, and promoting equity through messaging”. (Jama)

Health workers at risk A global study highlights infections and deaths of health workers from Covid-19 during the early phases of the pandemic. General practitioners and mental health workers were disproportionately affected. (BMJ)

Climate change and pollution The new edition of the Lancet Countdown on Climate Change and Health includes data on the risks of rising temperatures for ageing populations. Outdoor work in countries such as India has been badly affected. In the UK, air pollution was deemed to be the cause of a child’s death in a landmark legal ruling. (Lancet, FT)

Map showing annual heat-related mortality in people aged 65 and over, averaged from 2014 to 2018

Vaccinating children Covid-19 aside, poorer children from vulnerable groups across the world are less likely to be fully vaccinated against preventable diseases. (American Journal of Preventive Medicine)

Access to care A new study examines income inequalities and access to primary care in rich countries. The US performs particularly poorly, with those on lower incomes more likely to experience two or more chronic conditions and more to likely to miss doctor visits, tests and treatments because of cost. Here’s a fascinating interactive on US health inequalities. (Health Affairs, NEJM)

Annual retrospective round-up

Top global health moments of 2020 (Global Health Now)
Best stories of 2020 (Think Global Health)
Bill Gates blog — the year in review
2020s other health breakthroughs (Devex)
Year in review and Framing 2020 picture competition (Lancet)

Young man pictured under his mosquito net in rural Cambodia, from Dr Alexander Kumar in the Lancet’s Framing 2020 competition. © The Lancet

Most popular FT articles 2020

Our most-read health articles this year reflect a real thirst for data — our virus tracking pages were by far the most popular — and a focus on self-care and work-life balance amid the pandemic: are we sleeping enough and drinking and working too much?

Coronavirus

  1. Coronavirus tracked: the latest figures

  2. Yuval Noah Harari: the world after coronavirus

  3. Arundhati Roy: ‘The pandemic is a portal

  4. Coronavirus may have infected half of UK population — Oxford study

  5. How dangerous is the coronavirus and how does it spread?

  6. Elon Musk promised ventilators. These are BPAP machines

  7. Inside Trump’s coronavirus meltdown

  8. Scientists warn of new coronavirus variant spreading across Europe

  9. Doubts raised over AstraZeneca-Oxford vaccine data

  10. Germany’s coronavirus anomaly: high infection rates but few deaths

Non-coronavirus

  1. How much should we really drink?

  2. Is it time to cut back our working hours?

  3. Science: what breakthroughs will the 2020s bring?

  4. How will the selfie generation cope with a new Depression?

  5. Why businesses are refusing to hire smokers

  6. Crispr puts first human in-body gene editing to test

  7. Eight steps for a better sleep

  8. Private equity and Britain’s care home crisis

  9. Amazon launches online pharmacy in challenge to traditional retailers

  10. Google AI system beats doctors in detection tests for breast cancer

The month ahead

Jan 11 UK begins daily update of coronavirus vaccination figures

Jan 12 UK tainted blood inquiry reopens

Jan 13 First anniversary of officials confirming a case of coronavirus in Thailand — the first outside China

Jan 18 FT series continues: The future of AI and digital healthcare

Jan 18-26 WHO Executive Board meeting

Jan 21 FT series continues: The future of antibiotics

Jan 30 First anniversary of WHO declaring coronavirus outbreak a “public health emergency of international concern”

Feb 1-7 Children’s Mental Health Week (UK)

Feb 3 Next edition of FT Health newsletter

Feb 4 World Cancer Day

Feb 6 UN Day of Zero Tolerance to Female Genital Mutilation

End notes

Previous issue National systems must learn lessons of pandemic

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Final thought

The FT finds a glimmer of hope amid the misery of 2020. “Pandemics are an age-old scourge, from the bubonic plague to the 1918 flu pandemic. What has been different this time is that humanity has been able to respond in real time with effectual medicines. After such a challenging year, the triumph of science — both practically and symbolically — is a crucial source of solace.”

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