Document Type : Letter to editor
1 Department of Psychiatry, Roozbeh Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
2 Cardiovascular Research Center, Shahid Rajaei Educational & Medical Center, Alborz University of Medical Sciences, Karaj, Iran
3 Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
Since the identification and global spread of COVID-19 in Wuhan, China to date (1 September 2020), more than 26,506,670 people worldwide have been infected with the disease and more than 876,677 people have died of the disease (1). Observing what has happened during this period and paying attention to the way governments have dealt with this recent situation in the long run have raised serious concerns about slow and late steps of governments from the beginning of the spread of the disease (2).
Considering past conditions and the performance of governments in the face of public health problems reveals that, despite differences in governments’ public health performance and significant achievements in controlling issues such as infant mortality rate and expansion of rural health care, traditional public sector bureaucracies in many parts of the world have resulted in inefficient and unfair public health services (3). A clear example of this situation can be seen in the previous remarks made by the Director-General of the World Health Organization (WHO) on tuberculosis. Addressing world leaders and referring to the deaths of 1.5 million people each year, he pointed to the unsuitable status of this preventable and treatable disease (4). Also, recently the Director-General of the WHO has emphasized the need for the integrated readiness of the government and society in this regard (5). It is obvious that COVID-19 is dangerously expanding worldwide and this situation requires much more attention given the serious and alarming risk of the disease.
Under these circumstances, governments have the role of informing the masses about how to deal with the disease and trying to provide them with the necessary care and protection. But that’s only a part of the puzzle. The role of the masses in forcing the state to move towards a double effort and to take on more serious responsibilities and duties, rather than depend on international global health institutions, relates to the people themselves and to independent institutions. Such a role as a historical record was seen at the time of the SARS epidemic in China in previous years. At that time and conditions, disease control was only possible through mass mobilization (6).
In this context, the role of reference groups in informing and directing the masses to make a rational request to governments is crucial. Given the current situation, health and medical groups still appear to have such a privileged position to play a prominent role in informing the society, along with other social groups (7). Based on experiences gained from the early waves of the pandemic, governments could not minimize both the mortality and morbidity of the disease and the negative economic effects of the spread of the disease at the same time (8). It seems that the need for measures such as the expansion of quarantine conditions and the responsible and strict implementation of the necessary restrictions in this area is a demand that should be explained to the masses by reference groups. Under these circumstances, this demand can be implemented with more reliability. This could be an effective step to compel governments to undertake more serious and fundamental interventions to control COVID-19. As a short experience, there are several weaknesses in this area.
Successful experiences about the performance of some governments in the recent pandemic have shown that the implementation of such policies for maintaining public health is accompanied by increased public trust in formal structures and mutual accountability of governments in advancing the goals and programs (9).
It is important to note that some governments also suffer from a serious shortage of funds to implement COVID-19 fighting programs despite the tendency to take serious measures, and in this regard, the support provided by international institutions can play an important role. Eliminating economic pressures with political implications (10) in these circumstances can also be part of the process of helping to control this worrisome disease more properly.
The steadfast movement of governments to maintain the health of the masses as the first and most important possible priority in the current difficult situation and the role of reference and influential groups such as medical groups in educating the masses are the main factors in the success of governments in controlling the disease and maintaining mass health. Implementing the necessary constraints with adequate executive support and efforts to properly establish the current pandemic management framework, including equal distribution of resources, identifying new resources, and targeting vulnerable people can be part of these current pandemic management strategies.
Conflict of Interest
The authors declare that there is no conflict of interest.