An Autopsy of a Crisis: Five Years After COVID-19

My Learnings and Perspectives

“There have been as many plagues as wars in history; yet always plagues and wars take people equally by surprise.”

- Albert Camus (1957 Nobel Prize Laureate for Literature), La Peste, Vintage, 1947

Introduction

This week, five years after the onset of the COVID-19 pandemic, offers an opportune moment to reflect on a global crisis that profoundly disrupted our lives and left a lasting impact, its effects still reverberating across the world. Much like the narrator in Marcel Proust’s masterpiece Remembrance of Things Past, who resurrects the past through present-day memories, I find myself revisiting my involvement in the global emergency response to the pandemic, drawing insights from what I observed, experienced, and learned.

My involvement in the global emergency response to the COVID-19 began unexpectedly. On a crisp February morning in 2020, after dropping one of my children off at the Metro station, I received a call from Dr. Muhammad Ali Pate, the current Minister of Health and Social Welfare of Nigeria and, at that time, the Global Director for Health, Nutrition, and Population at the World Bank Group. He urged me to consider coming out of retirement to rejoin the institution and help prepare the global emergency response program to contain and mitigate the impact of the rapidly spreading SARS-CoV-2—a novel coronavirus originating in bats that caused the COVID-19 disease.

Although I had retired only a few months earlier, in August 2019, after more than three decades of service, I did not hesitate to accept his invitation—it was my public health duty.

After all, throughout my career at the World Bank Group, I was directly involved in responding to major public health crises, including the cholera, dengue, and malaria epidemics in Ecuador caused by the El Niño phenomenon (1997–1998); the regional response to HIV/AIDS in the Caribbean (early 2000s); the HIV and tuberculosis co-epidemics in Russia, other Eastern European and Central Asian countries, as well as Botswana (2004–2013); the global response to Avian Influenza (2005–2007); the global food security crisis (2008); and, more recently, the Ebola emergency response in West Africa (2014–2016).

Here, I look back at the tumultuous COVID-19 pandemic experience, bringing a public health perspective to reflect on the response and its consequences.

II. A Foretold Social Catastrophe Unfolds

Understanding COVID-19: A Low-Probability, High-Consequence Event

In reading The Spirit of the Green—The Economics of Collisions and Contagions in a Crowded World, a book by Prof. William D. Nordhaus, a co-recipient of the 2018 Nobel Memorial Prize in Economic Sciences, I was captivated by the clarity and eloquence of his chapter on pandemics and other societal catastrophes. Although the main focus of the book is on environmental economics, the insights he offered on the COVID-19 pandemic as a societal catastrophe helped me better grasp some of its dimensions and the lessons for the future.

As argued in Prof. Nordhaus’s book, the COVID-19 pandemic, as a catastrophic viral plague, caused widespread social, economic, and political hardship due to its severity, extent, and speed. These events are rare in modern times as they tend to occur with a frequency of decades, centuries, or even longer. For example, the Great Influenza, one of the deadliest outbreaks in human history, erupted at the height of World War I, in an army camp in Kansas, spread eastward with American troops and then rapidly escalated, ultimately claiming up to 100 million lives worldwide a century ago between 1918 and 1920.

Prof. Nordhaus explains that since pandemics are low-probability but high-consequence events, they present significant challenges for social decision-making in terms of detection, prevention, and mitigation. These challenges are compounded by prevailing attitudes and political institutions, even in technologically advanced countries.

According to Prof. Nordhaus, the two most critical characteristics of deadly infectious agents like SARS-CoV-2, the virus that causes the COVID-19 disease, are their infectiousness and lethality. Infectiousness, measured by the basic reproduction number (R₀), represents the average number of people an infected person will transmit the virus to in the absence of preventive measures. For COVID-19, R₀ was initially estimated at around three, though some variants had higher values. Lethality (L), the percentage of infected individuals who die from the disease, was estimated to range between 0.5% and 2%, significantly lower than that of smallpox (30%).

Hence, per Prof. Nordhaus, understanding pandemic control requires considering the effective reproduction rate, which accounts for the impact of protective measures. Reducing this rate below R₀ is crucial for controlling the spread of disease. For example, if 1,000 people are infected and the effective reproduction rate drops to 0.5, infections will decrease by 50% per transmission cycle. This concept is easily understood when one realizes that the eradication of smallpox and the elimination of polio in most countries today have been the result of the application of effective public health measures.

New Infections Spiked Globally, Fueling Fear and Uncertainty

Since late December 2019, when the first cases were diagnosed in Wuhan, Hubei Province, China, COVID-19 spread rapidly beyond China's borders, with the number of affected countries increasing at an alarming rate. Older adults and people with coexisting chronic health conditions, like coronary heart disease and hypertension, lung disease, or diabetes; health risk factors such as tobacco use and exposure to high levels of air pollution (e.g., residing in international hotspots for COVID-19, such as Wuhan, Northern Italy, and South Korea) were at higher risk of developing severe COVID-19 disease and of in-hospital mortality. This made COVID-19 particularly dangerous.

Five years on from COVID-19, the search for the origin of the SARS-CoV-2 virus spread remains a highly debated and ongoing investigation, with the primary hypotheses centered on natural spillover or a potential laboratory leak. That is, as explained by Prof. Filippa Lentzos, in a post at the Bulletin of the Atomic Scientists, “There is solid evidence based on genetic analysis from scientists in multiple countries that the COVID-19 pandemic resulted from a natural spillover event, with the coronavirus most likely jumping from bats to people, perhaps via an intermediate animal species. What we have less evidence about is where that spillover event happened. While many scientists believe that the coronavirus first infected humans in nature or through the wildlife trade, others think an accident could have occurred during the course of scientific research on coronaviruses or the animals that harbor them.”

On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a global pandemic. At the time, the exponential trajectory of COVID-19 infections was clear. The virus spread rapidly across the world, as evidenced by case trajectories in key countries, which were tracked based on the number of days since each nation reported its 100th confirmed case (Figure 1). The data revealed that infections grew at an alarming rate in many regions. While South Korea successfully slowed its case-doubling time to six days or more through aggressive containment measures, other countries—including Sweden, France, Italy, Australia, Spain, the Netherlands, and the United States—experienced significantly shorter doubling times of just two to four days, indicating a much faster rate of viral transmission.

Figure 1: Case Trajectory of COVID-19 in countries

This exponential surge was driven by three key conditions: (i) the presence of at least one infected individual within a population; (ii) frequent interactions between infected and uninfected individuals; and (iii) a large number of susceptible, uninfected hosts. Exponential growth, while not necessarily the fastest form of spread, posed a relentless challenge—without intervention, it continued to double the number of cases within a fixed period. This relentless nature made it particularly difficult to contain without significant suppression measures.

An Unprepared World Faced the Pandemic Onslaught

Pandemics, as we experienced with COVID-19, present immense challenges due to their sudden onset, rapid spread, and high mortality rates. Beyond its infectiousness and lethality, COVID-19 posed an additional threat because it was highly transmissible from person to person, including through asymptomatic and presymptomatic carriers (WHO, 2020).

The COVID-19 pandemic exposed critical vulnerabilities in global preparedness and response systems. Despite prior warnings from health experts and key donors about the likelihood of a new viral outbreaks and the reemergence of known viruses, particularly after the 2014–2016 Ebola outbreak in West Africa, governments and institutions in most countries across the world were largely unprepared for the scale and speed of the crisis.

The lack of adequate preparedness reflected limited funding allocated to support essential public health services, such as surveillance systems, laboratories and epidemiological intelligence capacity. However, in some countries, even with adequate resources, limited capacity to implement existing contingency plans that included testing, contact tracing, and social distancing, undermined pandemic response efforts. A notable example was the failed rollout of COVID-19 testing in the United States. The Centers for Disease Control and Prevention (CDC) initially developed defective test kits and took weeks to correct the issue. Furthermore, it restricted hospitals and private labs from developing their own tests, delayed widespread testing, and prohibited pooled testing, despite its usefulness when test availability was limited.

Governments play a crucial role in addressing public health crises. As WHO noted, the pandemic underscored the dangers of underinvesting in pandemic preparedness, revealing major gaps in surveillance and health system capacities, as well as leadership and national coordination capacities.

But as the COVID-19 crisis demonstrated, scientific expertise alone cannot stop a pandemic unless political leaders actively shape public opinion and implement effective policies (CFR, 2021). Countries that failed to act decisively suffered severe consequences (Johns Hopkins University, 2021).

A notable failure in several countries was the lack of clear, consistent, and science-based communication from leaders. Political interference in public health messaging led to widespread confusion and resistance to preventive measures.

The COVID-19 pandemic was also accompanied by an infodemic, where both accurate and false information spread rapidly, significantly impacting public health. This led to confusion, mistrust in health authorities, noncompliance with health guidelines, and increased engagement in risky health behaviors. It also fueled anti-vaccination sentiments, further complicating efforts to control the virus and other vaccine-preventable diseases.

At the international level, a significant factor that exacerbated the impact of the COVID-19 pandemic was the lack of coordinated global action. Countries implemented fragmented responses, often prioritizing national interests over collective solutions. When the pandemic struck, major regional and global gaps in pre-positioned emergency supplies, surge workforce capacities, and coordination structures exacerbated national vulnerabilities.

Moreover, the crisis underscored deep-seated inequalities in healthcare access and socioeconomic conditions. Vulnerable populations, particularly in low-income countries, faced disproportionate hardships due to limited healthcare resources and fragile social safety nets.

However, in spite of the dire scenario that the global community faced as the pandemic surged, scientific and technological readiness capacities existed. Indeed, as Professor Nordhaus observed in his book, unlike a century ago, when influenza was mistakenly believed to be caused by bacteria, the world in 2020 had advanced scientific and technological resources at its disposal. This enabled scientists to sequence the SARS-CoV-2 genome within two weeks of its discovery and achieve the unprecedented development, testing, and emergency use authorization of multiple COVID-19 vaccines in record time. The 2023 Nobel Prize in Physiology or Medicine awarded jointly to Katalin Karikó and Drew Weissman was for their decades-long pioneering work that led to discoveries on nucleoside base modifications that supported the rapid development of effective mRNA vaccines against COVID-19.

By December 11, 2020, the Food and Drug Administration (FDA) authorized the first COVID-19 vaccine for emergency use in the United States developed by Pfizer and BioNTech, followed a week after by the Moderna’s jab, and in February 2021, there were three COVID-19 vaccines when the FDA authorized Johnson & Johnson’s shot. An additional group of COVID-19 vaccines became available after receiving emergency use authorization by the WHO.

Widespread vaccination became the most effective intervention for restoring global social and economic stability, as evidence accumulated showing that the new vaccines offered good protection against getting severely ill or dying from COVID-19 since they elicited a potent immune response. By March 2023, a total of approximately 13.3 billion vaccine doses were administered globally.

The World Bank Group’s Fast and Broad Action to Support Countries' Response Efforts

An extraordinary severe pandemic required an extraordinary response, particularly as it became obvious in February and March 2020 that countries with no exception were poorly prepared. Many African, Asian, Eastern European, and Latin American lower-income and middle-income countries required significant technical and financial support to respond to COVID-19.

As countries around the world worked to contain the spread and impact of COVID-19, the World Bank Group mounted the fastest and largest crisis response in its history to help developing countries strengthen their pandemic response. The Bank Group’s support focused on helping countries address the crisis and transition to recovery through a combination of saving lives; protecting the poor; securing foundations of the economy; and strengthening policies and institutions for resilience. Bank’s support complemented and enhanced the stepped-up efforts of WHO and other specialized United Nations agencies.

On April 2, 2020—just weeks after the WHO declared COVID-19 a global pandemic on March 11, 2020—the World Bank’s Board of Executive Directors approved the COVID-19 Strategic Preparedness and Response Program (SPRP). This global public health initiative, launched under the Fast-Track COVID-19 Facility and utilizing the Multiphase Programmatic Approach (MPA), was backed by an initial allocation of $6 billion, complemented by country contributions and partner support.

On the same day, the Board approved under the SPRP the first set of emergency operations totaling $1.9 billion to support 25 developing countries, with additional fast-track operations advancing in over 40 others. In parallel, the World Bank Group mobilized up to $1.7 billion from existing projects, through restructuring and the activation of emergency components within ongoing health operations, to further accelerate the global response. By May 2020, as announced by its President, David Malpass, the World Bank Group was financing emergency programs in 100 countries –home to 70% of the world’s population. By September 2020, the World Bank Group had in place emergency COVID support programs in 111 countries.

Building upon accumulated global knowledge and experience from past World Bank Group-supported programs (e.g., HIV/AIDS, Avian Influenza, SARS, Ebola) and working in close partnerships with member governments and other agencies, the MPA-Program was designed to allow the Bank to provide emergency financial and technical support to countries to respond to the health and economic impacts of COVID-19.

The Program’s design had built-in flexibility to allow changes in fast moving environments, while ensuring a coordinated response across all countries to support global public health. While its overall objective was global (“to expedite countries’ emergency efforts to prevent, detect and respond to the public health threat posed by COVID-19 and strengthen national systems for public health preparedness”), the Program was structured to meet this objective through activities tailored to the specific context and epidemic status of countries. To this end, the activities under the Program were grouped as a “menu of options” in six primary components that were funded under specific national projects.

On October 13, 2020, $12 billion additional financing was approved under the MAP to assist countries to finance the purchase and distribution of COVID-19 vaccines, tests, and treatments for their citizens. On June 30, 2021, World Bank President Malpass announced the expansion of financing available for COVID-19 vaccine financing to $20 billion over the next 18 months, adding $8 billion to the previously announced $12 billion. As of June 30, 2022, the World Bank Group approved operations to support vaccine rollout in 78 countries amounting to $10.1 billion.

The Bank’s private sector arm, the International Finance Corporation (IFC), also provided $4 billion through its Global Health Platform to increase the supply and local production of vaccines and personal protective equipment in developing countries. In addition, the IFC deployed $8 billion in fast-track financing, with the goal of sustaining businesses, preserving jobs, and helping the private sector contribute to an inclusive, sustainable, and resilient recovery.

The Multilateral Investment Guarantee Agency (MIGA), another member of the World Bank Group, launched a $6.5 billion facility to support private sector investors and lenders in responding to the pandemic. The facility redirected resources to urgent needs, including medical equipment purchases, working capital for small and medium enterprises, and short-term government financing.

At the same time, the World Bank Group and the International Monetary Fund (IMF) called on the G20 to establish the Debt Service Suspension Initiative (DSSI), which was launched in May 2020. The initiative allowed 48 of 73 eligible countries to redirect resources toward pandemic response and protecting vulnerable populations. Before expiring in December 2021, the DSSI had suspended an estimated $12.9 billion in debt-service payments.

At the forefront of the multilateral crisis response, the World Bank Group delivered an unprecedented $204 billion in financial support between April 2020 and March 2021 to help countries combat the impacts of the COVID-19 pandemic across sectors. This support was tailored to address the health, economic, and social shocks faced by countries during the crisis.

II. The Social and Economic Impact of the Pandemic

The COVID-19 pandemic profoundly impacted global health, economies, and societies. Between 2020 and 2023, the COVID-19 pandemic resulted in over 7 million confirmed deaths, an additional 70 million people living in extreme poverty, and well over $10 trillion in estimated economic losses.

While the economic cost of the pandemic has been significant, it is important to highlight that social distancing and other countermeasures should be interpreted as the price society must pay due to imperfect information about which individuals carry the virus and the lack of adequate health care systems to manage the patient peak loads. For example, as we saw in Latin America, countries were forced to adopt more stringent social distancing measures due to limited testing, weak health systems, and years of underinvestment in health care following prolonged economic stagnation.

Reflecting on this crisis reveals critical lessons in public health policies and actions, broad social impacts, and lasting economic ramifications.​

Disruption of Routine Health Services

In early 2020, COVID-19 emerged as an unprecedented global health crisis, prompting governments worldwide to implement lockdowns, travel restrictions, and emergency health measures.

As documented on a June 2020 note, many countries faced simultaneous public health emergencies that further strained already limited resources. In Central America, Honduras struggled with a surge in COVID-19 cases amid a dengue fever outbreak. Similarly, Singapore and Brazil reported record dengue infections, while Pakistan battled rising COVID-19 cases alongside endemic malaria, tuberculosis, and polio. Meanwhile, in the Democratic Republic of Congo (DRC), a new Ebola outbreak in Equateur Province compounded the challenges posed by the pandemic, highlighting the devastating impact of concurrent epidemics on vulnerable health systems.

The pandemic strained healthcare and social protection systems, tested frontline workers' resilience, and pushed scientific communities to accelerate treatment and vaccine development. In 2020–2021, over 90% of countries reported continued disruptions in the delivery of essential health services, impacting maternal and child health, routine immunizations, and chronic disease management.

For example, immunization campaigns were halted in many places: at one-point, routine vaccination was “substantially hindered in at least 68 countries”, leaving approximately 80 million infants at risk of diseases like measles and polio due to missed shots​. Extended delays in shipments of vaccines exacerbated the situation.

Services for HIV, tuberculosis, malaria, cancer care, and preventive screenings were also scaled back as hospitals became overwhelmed​ by the surge of COVID-19 cases. Elective surgeries and primary care visits were postponed in a majority of countries, which can have long-term health consequences​.

As I documented on a note in early 2021, the surging patient caseloads hospitalized or admitted to intensive care units (ICU) pushed hospitals and ICUs closer to 100% capacity in many countries, creating an extraordinary strain on resources and personnel and making quality-of-care standards harder to maintain. Reducing ICU-acquired healthcare-associated infections (HAIs) and curbing the spread of multidrug-resistant (MDR) nosocomial pathogens—particularly among critically ill COVID-19 patients—required urgent and sustained attention.

Proven strategies to deal with this problem include adherence to guidelines on ICU design and operation, strict environmental disinfection using methods like ultraviolet light or hydrogen peroxide vapor and minimizing cross-contamination by using disposable or thoroughly disinfected equipment. Items such as privacy curtains and shared medical devices have to be managed carefully to limit pathogen spread. Waterborne HAIs also posed risks, that necessitate measures like maintaining proper chlorine levels and avoiding contamination near handwashing sinks. In cases of outbreaks linked to plumbing, intensive interventions are also needed. Additionally, judicious use of antibiotics through robust stewardship programs are essential to prevent the emergence and transmission of resistant strains, ensuring better patient outcomes and more effective infection control.

The pandemic also revealed another global public health crisis, as mental health concerns skyrocketed. Rising unemployment, underemployment, changes in work arrangements and burnout, loss of income and rising poverty, altered daily routines, social isolation and loneliness, violence, and the complications from long-COVID imposed a heavy toll on people’s mental wellbeing. A 2021 global study published in The Lancet reported a significant increase in the prevalence of both major depressive and anxiety disorders among all genders—a worrisome finding because these disorders were already leading causes of disability worldwide. Yet, in spite of the growing need, mental health and psychosocial support services were disrupted or difficult to access as well.

An assessment that I did during this period also concluded that COVID-19 stress due to lockdown and isolation had the potential to increase the risk of developing alcohol use disorders (AUD) and of relapses among people struggling to overcome this disorder. Studies had shown that there is a clear relationship between anxiety and AUD. Both prolonged drinking and alcohol withdrawal are associated with an increased incidence of anxiety; people with general anxiety and panic disorders often self-medicate their condition with alcohol; and people with anxiety who self-medicate with alcohol often develop AUD.

As with the Ebola outbreak in 2014-2015, these disruptions underscored how the repurposing of available resource to focus on COVID-19 exacerbated other health problems as access to routine health services were severely constrained. As a result, lives were lost because basic health needs went unmet. This outcome offers a cautionary lesson: pandemic responses must balance fighting an outbreak with sustaining essential health services for other health needs.​

To ensure health systems remain functional during public health emergencies, pandemic response plans should integrate continuity measures for non-pandemic care, as seen in some hospitals during COVID-19, where separate areas were designated for non-COVID patients to safely receive care. Other measures include securing supply chains for routine medicines and vaccines, and investments in surge capacity (backup staff, stockpiles of essential medicines, mobile clinics) and training healthcare workers to handle both outbreak duties and routine care. Real-time data monitoring is crucial for identifying service disruptions and guiding resource allocation, while maintaining funding for routine care prevents negative long-term health consequences.

Also, as underscored by the experience in several European countries, including France, Germany, and Italy, that temporarily suspended the use of AstraZeneca’s COVID-19 vaccine in March 2021 amid concerns about its safety, while authorities awaited clarification from the European Medicines Agency (EMA) and the WHO, the role of pharmacovigilance or the monitoring of the safety in the use of medicines and vaccines needs to be considered as another essential public health services that requires development and strengthening.

The importance of pharmacovigilance in guiding health system decision-making becomes clear when one understands that pre-marketing clinical trials for vaccines to evaluate their safety and efficacy typically involve limited patient groups under strict criteria, often excluding vulnerable populations such as the elderly, children, pregnant women, and those with co-morbidities. Consequently, post-marketing surveillance is essential to capture real-world effects across diverse populations with varying genetic, dietary, and lifestyle factors—the effectiveness of a new drug.

Equally important, as derived from the European experience, was the realization of the need to communicate clear, data-driven information about vaccine safety and side effects to vaccine-hesitant populations who already distrust governments—a concern that not only applied to AstraZeneca but to all COVID-19 vaccines authorized for emergency use. A series of World Bank case studies prepared over this period illustrate the importance of this often overlooked but essential public health service that is fundament to create and sustain trust in the health sector and in its institutions.

In summary, by prioritizing both emergency response and essential health services, future crises can be managed without exacerbating overall healthcare burdens. Indeed, a false dichotomy between emergency response and routine health care needs to be avoided. By applying this lesson, future public health emergencies can be managed in a more holistic way that does not inadvertently trade one health catastrophe for another.

Quality improvement must be at the heart of restoring and strengthening health services. While enhancing providers’ knowledge and introducing new tools, technologies, and medicines is important, true improvement requires sustained, system-wide effort involving all actors in service delivery.

For quality improvements to be sustainable, they must be institutionalized through supportive policies, organizational structures, performance management, and reliable funding. This creates a “quality improvement culture” embedded at every level of the health system. Active engagement of frontline teams—working to clear standards, monitoring outcomes, and adjusting as needed—is essential to maintain performance and improve population health. Such an approach can help rebuild trust in health services in the post-COVID-19 era.

Lockdowns and Their Effect on Education and Learning

COVID-19 containment measures, particularly school closures, carried immense social costs, disrupting education for 1.6 billion learners across 190+ countries at the peak of the crisis in April 2020 (UNESCO). This marked the largest education disruption in modern history. Education shifted to online and home-based learning with mixed success, as children in well-resourced families adapted, while those in low-income and rural areas faced significant barriers, leading to severe learning losses and widened inequalities.

Learning Loss and Economic Fallout

Studies indicate many students fell behind in core skills. In low- and middle-income countries, the percentage of children unable to read a simple text by age 10 (“learning poverty”) was projected to rise from 53% pre-pandemic to 70% due to school closures (World Bank).

The rich world was also impacted. For example, in the United States, the National Assessment of Educational Progress (NAEP), often referred to as America's Report Card, released its latest findings in January 2025, highlighting the profound impact of the COVID-19 pandemic on student achievement. As observed in a recent The Economist article, longer closures meant more remote teaching, which in turn is associated with higher rates of absenteeism. And absenteeism, unsurprisingly, is linked with poor academic performance. The data reveals that the pandemic has effectively erased approximately two decades of educational progress across the United States.​

Across the world, millions lost a full year or more of schooling, exacerbating gaps between rich and poor students. The World Bank, along with other agencies, estimated that pandemic-related learning losses could result in $21 trillion in lifetime earnings lost—recent evidence for Brazil, India, and Mexico (among others) corroborates large losses (World Bank).

Rising Dropout Rates

A Center for Global Development report highlighted that dropout rates varied widely across low- and middle-income countries in the first two years of the pandemic. However, it found that older children consistently faced higher dropout risks, and evidence suggested that girls were more likely to drop out than boys in some regions.

In rural Kenya, the dropout rate for secondary school-aged girls tripled from 3.2% pre-pandemic to 9.4%, alongside a doubling in the risk of pregnancy before completing school. Similarly, in South Africa, dropout rates tripled across all school ages, with the highest rates among the poorest households. Nigeria and Brazil recorded the highest dropout rates. In Nigeria, school enrollment declined from 90% in 2019 to 82% in 2020, with adolescents (15–18 years) experiencing twice the dropout rate of younger children (5–11 years). In São Paulo, Brazil, the risk of dropping out tripled, potentially increasing dropout rates to 35% among lower and upper secondary students.

Impact on Child Health and Safety

Schools provide critical nutrition, health services, and protection. With closures, 370 million children missed out on school meals, worsening malnutrition in low-income families (UNICEF). Confinement at home also heightened risks of abuse, neglect, and child labor. Reports from 2020–2021 suggested increases in child marriage and forced labor, further jeopardizing children’s education and futures (UNICEF Data).

The COVID-19 pandemic has left scars on education, deepening disparities, and negatively impacting long-term economic and social development. Focused interventions are needed to recover lost learning, support at-risk students, and strengthen education systems to mitigate future crises.

Human Capital Development Erosion

A World Bank report, Collapse and Recovery: How COVID-19 Eroded Human Capital and What to Do about It, provides a comprehensive analysis of how the pandemic disrupted human capital development for young people under 25, particularly in low- and middle-income countries. Key findings include:

• Health and Early Development: Millions of children missed critical healthcare, including vaccinations, and faced increased stress due to orphanhood, domestic violence, and poor nutrition, leading to declines in cognitive and social development.

• Education Losses: Preschoolers lost over 34% of learning in language and literacy and 29% in math. School closures caused significant learning losses, with students losing 32 days of learning for every 30 days of closure.

• Youth Employment Crisis: By the end of 2021, 40 million fewer people had jobs than expected, worsening youth unemployment. In several countries, 25% of young people were neither in education, employment, nor training.

• Economic Consequences: Cognitive deficits in today’s toddlers could reduce their future earnings by 25%. Students in low- and middle-income countries may face a 10% loss in future earnings, amounting to $21 trillion globally.

These findings illustrate that without urgent action, these setbacks could have lasting consequences for earnings, economic growth, and social stability.

The Economic Shock of COVID-19

As the International Monetary Fund (IMF) observed, “With countries implementing necessary quarantines and social distancing measures to contain the pandemic, the world entered a ‘Great Lockdown’.” As the IMF report put, the magnitude and speed of collapse in economic activity that followed was unlike anything experienced in our lifetimes.

The historic economic downturn triggered by the pandemic, pushed the global economy into a deep recession, despite unprecedented policy support (World Bank). In 2020, as shown in Figure 2, global GDP contracted by –3.0%, far surpassing the -0.1% drop during the 2009 financial crisis (IMF). This was a downgrade of 6.3 percentage points from January 2020, a major revision over a very short period. The IMF concluded that this made the ‘Great Lockdown’ the worst recession since the Great Depression, and far worse than the Global Financial Crisis.

Figure 2 (adapted from IMF 2020):

Most countries fell into recession, causing mass unemployment and business closures, particularly in sectors reliant on face-to-face interaction such as tourism and retail. Small businesses and informal workers faced the greatest hardships, with limited financial buffers and no safety nets (World Bank).

Fiscal Responses and Rising Debt

Governments responded with unprecedented stimulus measures, totaling $11.7 trillion globally by late 2020, or 12% of world GDP (IMF). Wealthier nations deployed massive relief efforts, stabilizing economies but driving global public debt to a record 100% of GDP. Developing countries, already burdened with high debt, faced severe financial constraints, limiting their ability to recover (IMF). The uneven fiscal response widened the gap between advanced and low-income economies.

Uneven Recovery and Rising Inequality

Recovery has been highly uneven. Advanced economies and China rebounded in 2021, while poorer nations, lacking vaccines and financial resources, lagged behind (World Bank). The crisis deepened inequality, disproportionately affecting low-wage workers, women, and youth, who were overrepresented in hard-hit sectors (IMF). Women faced setbacks due to job losses and increased caregiving responsibilities, while young workers experienced record-high unemployment (IMF).

Global Poverty Reduction Stalls: A Lost Decade Ahead

Assessments by the World Bank Group showed that global poverty reduction slowed to a near standstill during the pandemic, making 2020-2030 a potentially lost decade for progress.

World Bank Group’s estimates indicate that today, 8.5% of the global population—nearly 700 million people—live in extreme poverty, surviving on less than $2.15 per day. The vast majority, approximately three-quarters, reside in Sub-Saharan Africa or conflict-affected regions, where systemic challenges and instability continue to undermine economic opportunity. Beyond extreme poverty, 44% of the world's population—around 3.5 billion people—live on less than $6.85 per day, the poverty line for upper-middle-income countries. Population growth has kept the absolute number of people in poverty virtually unchanged since 1990, highlighting a persistent global crisis.

The pandemic deepened economic disparities, stalling progress toward shared prosperity. Weak economic growth and widening income gaps have left billions struggling to advance. The World Bank Group suggests that to reach a minimum prosperity standard of $25 per day—comparable to high-income countries—global average incomes would need to increase five-fold, a target that remains out of reach for many.

According to the World Bank Group, inequality remains a major challenge. One in five people lives in economies with high inequality, concentrated mainly in Latin America, the region with the highest level of inequality in the world, and Sub-Saharan Africa, where wealth disparities are deeply entrenched. In contrast, only 7% of the global population resides in countries with low inequality, reflecting the stark divide in global economic structures.

As stressed by the World Bank Group, without urgent policy action, rising poverty and inequality will continue to threaten global stability, economic resilience, and social cohesion. The path forward requires targeted interventions—strengthening social safety nets, expanding economic opportunities, and addressing structural inequities—to ensure that prosperity is not a privilege for the few but a shared reality for all.

Takeaways

The COVID-19 pandemic was a stark reminder of the ongoing and future challenge of newly emerging infectious diseases--those that have never been recognized before, and those diseases that have been around for decades or centuries and are reemerging or resurging in different forms or geographies.

A major driver behind this trend is the increasing frequency of zoonotic diseases—those transmissible between animals and humans—highlighting how human encroachment on nature, biodiversity loss, ecosystem disruption, rapid urbanization and the conglomeration of people living in large mega-cities with limited access to basic services, natural disasters, and climate change are accelerating the emergence of these threats.

Over 70% of emerging infectious diseases originate in animals, domestic or wild (Taylor et al., 2001). Human activities such as agriculture, logging, and mining increase contact between humans and wildlife, creating opportunities for transmission (World Bank Group 2022, Berthe, F 2020). At the same time, the overuse of antibiotics in humans, animals, and food systems has led to the rise of antimicrobial-resistant “superbugs,” posing a serious threat to countries across all income levels.

In a highly interconnected world, zoonotic viruses can rapidly cross borders. Armed conflict, displacement, and weak health systems further hinder effective response efforts, while global supply chains remain highly vulnerable to disruption during health crises.

Despite decades of experience dealing with infectious diseases outbreaks, a key question remains: Have countries truly learned the lessons necessary to improve preparedness and response to public health crises? Historically, the urgency that mobilizes action during outbreaks has often faded once the immediate threat is contained, except in some countries such as South Korea, whose experience during the period between the MERS and COVID-19 outbreaks offers valuable lessons to mount responses to ongoing crises and prepare for future public health emergencies.

A Global Imperative

The pandemic underscored that investing in building strong, resilient health systems is not optional—it is essential. Strong disease surveillance, well-equipped laboratories, and a trained workforce across human and animal health sectors are foundational. These must be supported by capable health infrastructure and function as part of a coordinated system able to detect threats early, respond rapidly, and provide treatment and care throughout a crisis.

Also, as suggested in a The Lancet study focusing on data from 177 countries, improving pandemic preparedness and response may benefit from greater investment in risk communication and community engagement to strengthen public confidence in health guidance, as well as from the enhancement of health promotion targeting key modifiable risks to help reduce fatalities in future pandemics.

Yet, one of the most consistent post-crisis failures is the lack of sustained, predictable funding for these essential public health services. During periods of shifting political priorities or fiscal tightening, these investments are often deprioritized—despite the fact that the cost of unpreparedness is far greater than the investment required for prevention.

Five years on, the global repercussions of COVID-19—economic, social, and human—remain profound. As the risk of future health emergencies persists, the lessons from this pandemic must form the foundation for long-term action. Preparing for future disease outbreaks and epidemics demands strengthened capacities for prevention, preparedness, and response—underpinned by predictable, sustained, and flexible financing at both national and international levels.

Investing in Public Health Preparedness

A 2022 WHO/World Bank report to the G20 Finance and Health Task Force estimated the need for an additional $10.5–15 billion annually in domestic investment to strengthen health systems—an investment with high returns in terms of lives saved and economic and social disruption avoided. This requires:

• At the national level: Making health system resilience a core budgetary priority, protected over the medium to long term. This calls for high-level political commitment, expansion of domestic resources mobilization, and improved tax administration. Pro-health taxes, such as those on tobacco, alcohol, and sugar-sweetened beverages can help expand the tax base and collect additional public revenue for priority social investments and programs, including essential public health services, and reduce health risks associated with chronic diseases.

• At the international level: Strengthened global cooperation and financing. Key initiatives include the Pandemic Fund, launched in 2022 to support low- and middle-income countries; the G7/G20-endorsed 100 Days Mission to speed up development of tests, vaccines, and treatments; and the One Health Joint Plan of Action, which fosters collaboration across human, animal, and environmental health sectors.

Conclusion

COVID-19 exposed critical vulnerabilities in health systems globally. To prevent similar devastation in the future, countries must take bold, sustained, and coordinated action to build stronger, more resilient health systems that can prevent, detect, and respond to outbreaks—while maintaining the capacity to delivery routine medical care for other health needs in times of crisis.

This requires visionary leadership, long-term political will, and investment—not just in health infrastructure, but in international collaboration and equitable access to countermeasures. The real challenge is not just knowing what to do—it is committing and doing it.

The next pandemic is not a question of if, but when. Building strong, resilient health systems must be recognized as a shared global responsibility and an essential element of a well-managed, just, and sustainable society—the kind of society we should all strive to live in.

Source of Picture: © Medscape

Source of Picture: The then 87-year old Mother of the author, Sra. Elena Loyola Marquez, being administered the first dose of the COVID-19 vaccine in February 2021.