When it came to global health in 2021, the science delivered but solidarity did not. After another tumultuous year, what will 2022 and beyond be like for global health preparedness? While no country is out of the woods with regard to the pandemic, one thing is worth remembering as we look toward 2022: 2021 witnessed a truly historic achievement in global health.

The world successfully developed new tools to prevent Covid-19, with nine vaccines being listed by the World Health Organisation (WHO) for emergency use at record pace. The pandemic was actually worse in 2021 than it was the year before. In December 2020, Covid-19’s confirmed global death toll hit 1.5 million. Just one year later, that number exceeded five million.

The coronavirus will come back to haunt every country without a push to get the whole world vaccinated in 2022. So far the world has delivered nine billion vaccines, but they have been distributed unequally. It is a global injustice, and the most vulnerable people remain the most at risk. WHO says 98 countries have not yet met the target of vaccinating 40 per cent of their populations. Only one in four healthcare workers in Africa have been fully vaccinated despite serving on the pandemic frontlines.

Solidarity itself is in crisis mode. The uneven distribution of Covid-19 vaccine is one of the greatest policy failures of our times. Narrow nationalism, vaccine hoarding and stockpiling vaccines by wealthier countries have undermined equity. Technology transfers that could rapidly scale up vaccine production are being stalled by some powerful countries and giant pharmaceutical companies.

Humanitarian operations (COVAX, UNICEF, CEPI, GAVI) continue to go underfunded, leading to devastating health consequences for children and women. In many parts of the world women lack access to safe, affordable, high quality care when delivering their babies, and children are deprived of nutrition, basic vaccines and a clean environment to grow up in. Every six seconds a pregnant woman, newborn baby or child dies somewhere in the world. Most of these deaths occur in low-income countries.

When talking about preventable deaths, the inequalities are stark, and Covid-19 has made the situation much worse, disrupting routine services, stressing health systems that are already under pressure. Recent estimates suggests that there have been more than two maternal and child deaths for every official Covid-19 death in low-income countries. This year also witnessed the consequences of gender inequality across global health sectors. Almost 75 per cent of the world’s healthcare workers are female, yet leadership opportunities remain largely out of reach.

We cannot defeat the pandemic or reach a global vaccination rate of 70 per cent without healthcare workers who are well-compensated and included in decision-making. In 2021, we saw growing recognition that climate change was a public health emergency with no immediate solution. We have seen the consequences of a changing climate on global health: heat stress, air pollution, changing patterns of vector-borne diseases like malaria and food insecurity from drought and floods.

Since the beginning of Covid-19 pandemic, unemployment, financial instability, disruption to education, social isolation, domestic violence, fear of life-threatening disease and sudden loss of loved ones have become increasingly common. All of these are risk factors for mental health conditions. We are watching rates of suicide and mental illness increase as a global mental health crisis escalates.

As in 2020, last year we witnessed the erosion of hard-won gains in global health, a drop in overall immunisation rates and a rise in malaria deaths. Twenty-three million kids under the age of 1 missed out on basic childhood vaccines. There were 14 million more malaria cases in 2020 than in previous years and a 12 per cent increase in malaria deaths.

The pandemic has reversed years of global progress in tackling tuberculosis and for the first time in over a decade, TB deaths have increased in the 30 countries with highest burden of TB, according to the WHO’s 2021 Global TB report.

The sudden onset, wildfire-like spread and devastation caused in health, economic, social and political spheres by Covid-19, this zoonotic infection is a signal that we need to be more much more vigilant and respectful toward our environment. We are constantly reminded that zoonotic jumps, virus spillover from animals into humans, cannot be neglected anymore. The emergence of the novel coronavirus and the accelerated journey from Alpha to Omicron is an unfortunate convergence of many ecological and epidemiological drivers of disease spillover.

The pandemic has highlighted the importance of the One Health approach for preventing emerging infections and better understanding their epidemiology and management. We recognide that the health of all living organisms is interdependent, the product of connections among humans, animals, plants and the environment they share. We cannot risk complacency. We cannot predict when the next Delta or the next Omicron will come. Omicron is a test of our preparedness for the unexpected.

Until we have better vaccines that last longer, offer broader protection against diverse variants or block transmission more effectively, we will need to be on guard. Countries with sufficient resources will make choices about how to deploy them as rapidly as possible, both equitably and collectively. The choices will heavily influence the pace at which the pandemic ends.

The world needs more resilient, equitable, people-centric systems to get through the current pandemic. Universal health coverage is one of the most effective ways to do that. The global recession caused by the pandemic has had huge implications for access to health services. A new global monitoring report by the World Bank shows that healthcare costs have further pushed more than half a billion people into extreme poverty.

Governments that have invested in a comprehensive people-centric approach to Covid-19 were found to be more effective at withstanding the pandemic shocks. Another key priority in 2022 will be strengthening joint capacity for pandemic prevention, preparedness and response. Pandemics are not ended by a magic bullet but by a combination of essential measures: leader-level commitment, financing, equitable access to global public goods, new legal instruments and a stronger WHO.

By failing to protect poorer countries, we fail to protect ourselves. For every million unnecessary infections, there are another million chances for the virus to mutate. There needs to be international equity with vaccine rollouts. The principles of human rights must be at the heart of worldwide pandemic recovery efforts. Humanity can pull together and achieve great things, guided by solidarity, equity, justice and dignity.

Daniel Tjen is a former surgeon general of the Indonesian Military (TNI).