Despite being warned for decades, many countries were unprepared for the Covid-19 pandemic. While some have managed to contain the virus, the response to pandemics in most countries has been mediocre at best; in some countries it has been disastrous. In mid-March 2021, nearly 2.7 million deaths were attributed to SARS-CoV-2, and many more aspects of its health and social impact are likely to emerge in the long run. Although there are no official global figures, it is likely that tens of thousands of health care victims and other frontline workers will be among the victims; At the end of 2020, Amnesty International estimated that more than 7,000 health workers had died from Covid. Not only did such workers risk their lives, they have had a challenging year to say the least. Many continue to work in under-resource systems, with inadequate Personal Protective Equipment (PPE), in a situation that was both unprecedented and fully foreseeable.
While the heroism of health workers has been celebrated and we have gained a renewed appreciation for the risks faced by many frontline workers in providing basic services, less attention has been paid to those who have refused to work in such dangerous conditions and to those who have pointed out that no health care provider needed to run such a high risk. Many have rightly argued that heroism was necessary only because of government neglect, underfunding, and lack of preparation for a pandemic we knew was coming. Many workers are rightly angry. Although there are no official figures, Covid-19 appears to have led to a substantial increase in the number of strikes by health workers.
In February 2020, experts in Hong Kong, faced with an unknown ‘pneumonia’, called for borders to be closed in an effort to limit its spread until more information about the nature of the virus was considered a pandemic about a month later). Despite calls from experts and health professionals, the Hong Kong government failed to act with support from the general public. At the end of January, unions repeatedly called for a dialogue with the government on border closure. When that attempt failed, a vote was taken on strike action, for which there was overwhelming support. From 3 to 7 February 2020, health workers in Hong Kong went on strike and made a number of demands, including the closing of the borders and an adequate supply of personal protective equipment and facilities to contain the potential spread of the virus.
Such action is not limited to Hong Kong. Amid increasing cases of Covid-19, health workers in Zimbabwe went on strike in June 2020 due to a lack of personal protective equipment and low salaries. Strike by health workers is indeed a global phenomenon. In the United States, nurses have gone on strike and in the United Kingdom pharmacists and nurses have threatened to strike. Doctors in South Korea launched a nationwide strike in August, and health workers in Kenya, Spain, Bosnia and Peru all went on strike at some point during the pandemic.
Health workers even went on strike after Myanmar’s military coup in February 2021, a spokesman noted [did] I don’t want to work for the regime that staged the military coup. “1 Such action must be seen in the context of wider unrest. In Venezuela, for example, many health workers have had no option to retire during the pandemic. In what has been described as a crisis within a crisis, Covid-19 has exacerbated many of the problems facing Venezuela’s ailing healthcare system. While there has been unrest, the Venezuelan government has sought to silence critics, deny shortages of personal protective equipment and blame health workers. The government also denies that an estimated 200 health workers have died, arguing that only 12 deaths have been attributed to Covid-19.2
While these situations can be distinguished in several ways and health workers have gone on strike (or protested) for myriad reasons, the common demands underlying nearly all of these actions relate to inadequate responses to Covid-19 and inadequate protection for frontline workers; every group that takes action has explicitly requested more PPE.
Experts in the fields of law, ethics and medicine have long debated whether and when strike action by health care personnel may be warranted. While these debates focused on the risks that strikes pose to patients, these actions also pose risks to health workers – for example, they can damage morale and team cohesion, and strikes have been violently suppressed in many countries. Other risks relate to the public’s perception and potential wider harm to both society and healthcare as a whole.3 But perhaps most fundamentally, strikes raise questions about what health care providers owe society and what society owes them.
However, previous debates may not have had to deal with such unprecedented circumstances: Should doctors in Myanmar, for example, continue to work under a military government during a pandemic? While we can’t easily answer this question, there are some important considerations when assessing strikes during Covid-19. Perhaps most obvious is that the pandemic has increased the stakes for such actions. On the one hand, it could be argued that health workers are needed more than ever; on the other hand, it could also be argued that they cannot be expected to work with inadequate personal protective equipment and other protective equipment. In addition to these dilemmas, Covid-19 has not only highlighted our collective vulnerability, but also revealed the impact of decades of underfunding and neglect, as well as a more recent disregard for science. In many ways, debates over the risks of strikes have led to a deadlock, as these dilemmas are only present because of deeper structural problems.
In an article published about six months before the first cases of Covid-19 were reported, entitled “ Invest in Public Health Now or Save Problems for the Future, ” Finch argues that the continued underfunding of public health in England is likely future implications, increasing the need for services and increasing costs in the longer term.4 Underfunding was one of many problems facing the UK’s health care system before the pandemic, and decades of austerity would have contributed to tens of thousands of preventable deaths.5
Covid-19 has brought about some of the most profound changes in social life in living memory. It has also shed light on many challenges that might otherwise have been pushed aside: underfunding, neglect and indifference to health and healthcare. It has left us with two related issues: What must be done to avert strikes? And more importantly, how can we address broader structural deficiencies?
How we can identify the root cause of these problems will vary from country to country, as will who should be responsible for them and what can be done to resolve them. Contrasts can be drawn here between countries with good resources, but globally there are even greater differences, especially given the likely future impact of Covid-19 in low- and middle-income countries. Yet everywhere immediate action can be taken in response to warnings about long-term effects on the mental health of health workers: support must be provided now and in the future.
While it is tempting to say that we also have to pay health care providers more and improve their working conditions, and we do, such actions will have little impact in the long run if health care systems continue to be neglected. It would be nice to say that it doesn’t take a pandemic or strike to force countries to face these problems, but the past 12 months warrant a certain amount of skepticism. Even if Covid-19 continues to affect millions of people, we can only hope it prompts a reassessment, not only of the way health workers are treated, but of the value we place on health and healthcare.