Three-D Issue 34: Public Health Emergencies: structural health inequalities and the Higher Education response to Covid-19

Melanie Brown
Bournemouth University

The Covid-19 pandemic has brought many things into focus and shifted priorities, and a focus on health and mental wellbeing has been the most noticeable shift. We are hearing terms such as “pandemic”, “public health emergency” and “health crisis” used in the media and in daily conversations. The Higher Education sector has responded to this health crisis, showing unity in a very difficult time.

This pandemic has coincided with global movements and conversations about institutional racism and privilege and the Black Lives Matter movement. This has further highlighted the need to re-examine how our laws and societies privilege some lives over others. From a public health emergency response, this mirrors the fact that global responses to health pandemics are much greater and coordinated when these pandemics impact on Western countries.

For instance, MSF (Doctors Without Borders) has highlighted that diseases primarily prevalent in developing countries attract very poor research and development funding. Several of the large commercial pharmaceutical developers have announced either a reduction in tuberculosis drug research and development programmes, some have ceased the programme altogether.1

The right to health is universal, and incorporates the right to medicines as an “essential component” of this right.2 Access to essential and appropriate medicines is an issue globally, but is an issue greatly magnified in the developing countries: approximately half of the population in Africa and Asia have restricted or no access to essential drugs.3 There has long been an issue with access to appropriate medicines in developing countries, and the problem presents itself as twofold: the high costs of purchasing (or manufacturing where the capacity exists) the medicines; and the lack of innovation into diseases predominantly affecting developing countries.4

The majority of health emergencies will start as a localised outbreak, and will evolve or multiply to become a national or international emergency.5 If a public emergency reaches a certain level, it is categorised as a PHEIC “public health emergency of international concern”, meaning an extraordinary event poses a health risk to other countries and will likely “require a coordinated international response.”6 Covid-19 is a PHEIC, as was Ebola, and also SARS in 2003.

The global outbreak of Ebola in 2014-2016 emphasises the complexity of issues that affect a state’s ability to handle a public emergency. Guinea, Sierra Leone and Liberia have all suffered long-term civic unrest which has had a significant impact on their health care systems, for example.7 If a state is unable to control the transmission of a disease, this greatly increases the chances of it becoming a PHEIC. States can declare that something is a public emergency and implement emergency provisions,8 and then find that the crisis persists: Zimbabwe declared that the level of HIV/AIDs in their country was a national emergency, initially for 6 months, which then became 5 years.9 These structural difficulties impact on the ability of some countries to rapidly respond to public health emergencies.

The Covid-19 pandemic has devastated lives around the world, and at the same time has brought communities and individuals together in international co-ordinated responses. Within the Higher Education sector, there has been a strong commitment to provide resources and research to combat the virus and safe lives.

Universities have responded in a more social and holistic manner than the law requires for public health emergencies, choosing to move campus to online teaching even before the full lockdowns that occurred. Universities are also signalling that there will be blended face-to-face and online teaching in the next academic year. Some universities, such as Cambridge University,10 have stated that all lectures for the next academic year will be online, as a way of keeping staff and students safe.

These have been unprecedented and dramatic changes to the entire HE sector, and demonstrate that the social and political perception of the public health emergency presented by Covid-19 is eliciting wider responses than the law requires. These changes and the subsequent drop in student numbers and revenue generation is also posing the very real risk that some UK universities will become insolvent; and the government has announced emergency financial plans for these universities to help them survive the pandemic.11 This financial support would come with substantial conditions, such as cutting courses that are deemed to provide less secure employment options, and cutting pay for senior staff.

The universities in the UK have launched many health initiatives and resources aimed at protecting mental health and wellbeing during the lockdown in particular, combatting the effects of social isolation. Universities have provided counselling services to staff and students, and self-care advice.

The #WeAreTogether campaign is highlighting the responses from universities to the Covid-19 pandemic. Researchers at many UK universities are collaborating on research aimed at understanding the Covid-19 virus and developing a vaccine; to generate vital PPE equipment for healthcare workers; providing access to university laboratory testing equipment; making ventilators; undergraduate student nurses are working on the frontline in the NHS; and providing resources to protect vulnerable people during the pandemic, from both the disease and from potential health scams.12

The international effort to find a vaccine for Covid-19 has cumulated in the COVAX Facility, which will involve at least 165 countries working together to provide fair and equitable access to COVID-19 vaccines worldwide. 75 of these countries will use their own finances to partner with 90 lower-income countries, to ensure that as many people as possible can access the vaccine once it is created.13

The collaborative global response to Covid-19 has been astonishing; and the Higher Education response has been highly commendable. However, the pandemic’s coincidence with the Black Lives Matter movement further re-emphasises the structural inequality of the healthcare and pandemic responses around the world, with diseases that impact more on Western countries being given greater research and funding priority. We need to ensure that the same global and Higher Education sector response to Covid-19 is just as strong for other pandemics, even if they do not result in epidemics in Western countries. We also need to ensure that universities are supported through the crisis and that their vital contributions are not overlooked.



Holger Hestermayer, “Human Rights and the WTO: The Case of Patents and Access to Medicines” (OUP, 2007) xxxiv

Philippe Cullet “Patents and medicines: the relationship between TRIPS and the human right to health” (2003) 79 International Affairs 139, 143

Philippe Cullet “Patents and medicines: the relationship between TRIPS and the human right to health” (2003) 79 International Affairs 139, 140

Douglas MacPherson “Bioterrorism- Health emergency preparedness and response” (2003) 8(2) Paediatric Child Health, 93, 95

World Health Organization “International Health Regulations” (2nd ed, World Health Organization, 2005), 9

Mark Siedner, Lawrence Gostin, Hilarie Cranmer and John Kraemer “Strengthening the Detection of and Early Response to Public Health Emergencies: Lessons from the West African Ebola Epidemic” (2015) 12(3) PLoSMed e1001804

If public or national emergencies are thought to be related to terrorism somehow, the response from the government can often be rather drastic, such as the UK’s infamous derogation from Article 5 of the European Convention on Human Rights following 9/11.

Michael Blakeney and Getachew Mengistie “Intellectual property policy formulation in LDCs in Sub-Saharan Africa” (2011) 19 Africa Journal of International and Comparative Law, 66, 84

BBC, “Cambridge University: All lectures to be online-only until summer of 2021” 19th MY 2020. Available at <>

Sean Coughlan, “Emergency loans for universities about to go bust” 16th July 2020. Available at <>

Universities UK, “How universities are helping fight Covid-19” Available at <>

World Health Organisation, “More than 150 countries engaged in COVID-19 vaccine global access facility” 17th July 2020. Available at <>

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