COVID-19: Protecting the most vulnerable

Today, we face a public health emergency that is unprecedented in recent memory. Beyond its medical consequences, the COVID-19 outbreak—I think it’s time to use the word pandemic—is having far-reaching effects in our everyday lives, and we honestly don’t know how it will unfold.

For many, adjustments will have to be made to this new reality: virtual calls instead of face-to-face meetings, e-learning vs. classroom teaching. Kudos to our leaders, including, in my case, newly-installed Chancellor Fidel Nemenzo, for adapting to the rapidly evolving situation and making difficult decisions that deserve full support.

But even as we look after our own lives, it is sobering to be reminded that self-quarantine and “social distancing” are a privilege that many Filipinos cannot afford. If we are, as we ought, to approach this crisis with social solidarity, then we must look after those who are, for various reasons, most likely to be affected by it.

Who are these “vulnerable groups”? Anticipating future pandemics, Philip Blumenshine and colleagues (2008) identified possible sources of disparities in the event of major outbreaks:

The first category, disparities of exposure, points to factors such as public transportation and crowded living or working conditions as a social determinant of acquiring illness. As many observers have pointed out, the advice to practice “social distancing” is absurd for people who have to ride the MRT everyday—and difficult for “frontliners,” including many of our OFWs.

The third and final category, disparities in treatment once disease has developed, points to factors involving the health care system, and is also very relevant for COVID-19 and the Philippine context. Will the poor have access to good quality of care? Will they even make it to the hospital, given financial, logistical, and cultural barriers? All three categories point to pandemics as a matter of health equity, testing not just our health care system but our values as a nation.

How do we protect vulnerable groups? The above categories offer clues in achieving this. For instance, lowering disparities of exposure can be achieved by, among others, giving more benefits, offering job security to those who may have to isolate or quarantine themselves, and allowing employees to work from home.

Lowering susceptibility is a long-term endeavor, but still, COVID-19 can spur a redoubling of efforts to promote geriatric care and preventive health in the country, and once a vaccine is developed, to make it accessible to vulnerable groups.

As for lowering disparities in treatment, this can only be achieved if, in the words of the Coalition for People’s Right to Health, “health services, tests, and medicines [are] made free and accessible for all.” In this light, it is inspiring to know that our UP-NIH scientists led by Dr. Raul Destura have developed a testing kit at a fraction of the cost of imported ones. Even so, COVID-19 is exposing structural problems like the dearth of health human resources that require urgent—and sustained—action.

Finally, I think beyond the health disparities outlined above, we also have to consider economic disparities arising from COVID-19, including lost income opportunities that will disproportionately impact, once more, the poor.

Fortunately, we have good people in the DOH, other government agencies, and even the private sector who are mindful of social solidarity in these exceptional times. We need more of them. Moreover, we desperately need the competent, coherent leadership that will prioritize, over personal interest, the health of the people—especially those who are likely to be affected by COVID-19 the most.

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