Globalization is a topic that attracts plenty of controversy. Critics of the late 20th century capitalist project to liberalise trade across borders have long argued that it amounts to little more than a new kind of economic colonialism, a way for rich ‘developed’ countries to exploit poorer, less developed nations.
In recent years, it feels as if globalization has earned new opponents coming from all corners. Everyone from environmentalists to populist governments railing against migration seem to be pointing the finger at it as the source of all evils.
Yet globalization is not some political movement or ideal we can choose to buy into or not. It is simply a fact of the world we now live in. Who, for example, would seriously advocate tearing down the digital communication and information networks that connect us regardless of location and across borders?
It is also a distortion to portray globalization as some terrible bogey man that has brought only ill to the world. Any balanced perspective must acknowledge the enormous good it has done in so many fields. One of these is healthcare.
Contemporary events give us one shining example of the benefits of globalization in healthcare in action. The development of COVID-19 vaccines has been a gargantuan global effort that has brought together governments, international and national public health and research institutions, non-profits and private pharmaceutical companies from dozens of different countries, all collaborating to smash previous timescales on effective vaccine rollouts in the face of a deadly novel disease.
I was struck by the comments in a recent article by Heitham Hassoun, Vice President & Medical Director at Cedars-Sinai in California. He pointed out that the Pfizer-BioNTech vaccine now being distributed in Lebanon is being produced in 19 different countries. He also highlighted how benefiting from international relationships and collaboration is nothing new in this part of the world, with history telling us that the Phoenecians were trading far and wide across the Mediterranean and Asia Minor 3,500 years ago.
Just as it is a fact that people have roamed the globe, interacted, integrated and collaborated throughout human history, so it is a fact that we would have had little chance of developing a working COVID-19 vaccine so quickly, nevermind a dozen of them, if it wasn’t for the highly advanced levels of information sharing and cooperative working that are already deeply entrenched in the international healthcare community.
Global collaboration benefits us all
The remarkable speed of COVID-19 vaccine development captures a fundamental truth of a globalised approach to healthcare — it benefits everyone. It is often argued that, beyond philanthropy, richer nations with the best healthcare resources have little to gain investing time, money and effort assisting those where healthcare systems are less developed.
As a counter argument, I love this analogy in an article on the One.org website. If you imagine global healthcare as a garden, some plants have better positions than others, with more access to sunlight, rain and perhaps more nutrient rich soil. You might not think too much about those plants that struggle in the shade, in poor soil where they cling on to survival. But it is these weaker plants that garden pests, a whole host of pathogens and parasites, target. Once they take hold, they can easily spread to the other, healthier plants. Before you know it, your whole garden is at risk.
This is the argument for taking a global approach to tackling communicable diseases. Thanks to vaccination programmes, developed nations happily live free of killers like tuberculosis. But worldwide, TB still infects 10 million people and kills 1.6 million every year. Many of those infections are undiagnosed. It wouldn’t take too long for rising vaccine scepticism in developed nations to result in the return of TB, or for common diseases like measles and rubella to result in infant mortality rates rising rapidly again — a return to dark times past.
The only way to be absolutely sure of preventing this is through coordinated global efforts aimed firstly at eradicating communicable diseases (as happened with smallpox), or otherwise at least keeping transmission below the level at which it begins to rise exponentially (the now famous ‘R number’). This is also a compelling reason why developed nations need to act fast to tackle the stark disparity in global distribution of COVID-19 vaccinations, otherwise the collaborative effort on developing them could be fatally undermined.
There are other reasons why a unified approach to healthcare across the globe benefits rich and poor alike. One is economic. The ravages of disease don’t just hold back development. The worst-case scenario for the economic impact of the 2014 Ebola epidemic in Guinea, Liberia and Sierra Leone was $25.2bn in lost output. In a region that has already experienced decades of devastating civil war, this kind of hammer blow only leads to greater instability, with the potential for more conflict and social upheaval. That ends up costing the rest of the world, in humanitarian aid, in providing for and taking in refugees, in lost trade.
Another fascinating argument for global healthcare collaboration, and specifically for close working ties between more developed and developing nations, is put forward in this paper by the American Medical Association’s Journal of Ethics. It makes the point that, despite being one of the best resourced systems in the world, US healthcare is notoriously expensive and inefficient, with gaping disparities in domestic public health.
The authors of the paper argue that US practitioners can learn a lot from colleagues operating in poorly resourced settings who are nonetheless able to provide high quality, effective, inclusive care through a combination of creativity and dedication — so often the driving forces of excellence born out of necessity.
In this view of global healthcare collaboration, it isn’t simply a case of the rich benefactors extending the hand of kindness to assist the poor and downtrodden. It’s a model based on mutual benefit, recognising that it is those who have less who often master best how to optimize the resources available, who organize for maximum efficiency, who drive innovation in how to approach healthcare delivery.
Put simply, it’s a vision that states, we have a lot to learn from each other. Everyone’s health benefits if we all work together, without borders.