2021—The Year in Global Health

2021 was a hard year by any standard. A rapidly mutating and fast-spreading virus, a legion of follow-on impacts of the pandemic, extreme weather events, and many other issues harried and worried us. But, as difficult as it is to imagine, there were bright moments and good news that helped us make it to 2022.

Before we look ahead to a better year, here are some of the themes that shaped the year in global health.

The Pandemic at Warp Speed

January 6, 2021

• 1,844,847 deaths

December 22, 2021

• 5,375,682 deaths

—Source: Johns Hopkins University

The numbers tell the story of COVID-19 in 2021. COVID-19 deaths nearly tripled from early January to today.

The Variants

Even as vaccine-rich countries glimpsed normalcy on the horizon in early summer, the Delta variant quickly swept across the globe and reached 90+ countries by late June. Delta drove repeated surges in multiple countries into December.

The world changed on Nov. 24: South Africa health officials were first to report a new variant: Omicron, with 50 mutations and  astonishing transmissibility. New COVID-19 cases in Africa leapt 83% in 1 week in early December.

After the first Omicron case in the US was reported on December 1. Less than 3 weeks later, Omicron would make up 73% of all new cases in the US. And the worst of the Omicron surge is yet to hit most countries.

Vaccine Inequity

Efforts to immunize all of humanity against COVID-19 disintegrated into a cut-throat negotiating game as wealthy countries soaked up an outsized portion of available vaccines.

Ethics 101: WHO chief Tedros Adhanom Ghebreyesus scolded rich countries on August 4 for ramping up booster vaccines as billions of people were still waiting for their first dose.

And another thing: Rich countries haven’t been donating vaccines to the initiative as promised. COVAX has secured legally binding commitments for 4.5 billion doses but expects to have just 1.4 billion doses by the end of this year. And COVAX’s flawed distribution failed multiple countries.

COVID-19’s Follow-on Impacts

The coronavirus has caused much more than illness and death. It spawned countless repercussions from mental health to a global supply chain breakdown. Some issues were predictable and some impossible to foresee:

TB deaths climbed worldwide for the first time in a decade, according to a October 14 WHO report that directly tied the increase to the pandemic.

Measles outbreaks may be more likely in the near future, after the number of infants missing their first vaccination jumped by 3 million last year—the largest increase in 20 years.

Malaria’s 241 million cases and 627,000 deaths in 2020 reflect increases of 14 million and 69,000 respectively—both were largely attributed to pandemic disruptions, according to WHO’s global malaria report released on December 6.

Hate crimes against Asian Americans soared in the US (including a March 16 shooting in Atlanta left 6 people of Asian descent and 2 others dead) following political rhetoric blaming the pandemic on China.

Did the pandemic make US drivers worse? 2020 saw a 7.2% rise in US traffic fatalities and an 18% jump in the first 6 months of this year. Experts tied poor behavior on the road to widespread feelings of isolation and depression—which aligns with other pandemic-era trends like rising drug overdoses, alcohol sales, and homicides.

Big Covid Bungle

The CDC abruptly announced May 13 that fully vaccinated people didn’t need to wear masks inside. CDC chief Rochelle Walensky proclaimed, “We have all longed for this moment.”

Then on July 27, the CDC did an embarrassing about-face. The reason: Delta-driven cases nearly tripled in 2 weeks, hitting 37,000 on July 20.

Misinformation

As people battled a virus, they also battled themselves. The weapon of choice: misinformation, which fueled protests and attacks on public health in the US and November riots in European cities like Rotterdam, Brussels, and Vienna.

Future Pandemics

“After pandemics, societies transform,” wrote Lancet editor-in-chief Richard Horton and Physicians for Human Rights executive director Donna McKay in a January GHN commentary. But “if we focus on the virus alone, we will fail.”

A rare special session of the World Health Assembly took on that challenge in late November and made a few steps toward a much-needed accord to govern future pandemic responses. But “strong terms such as ‘legally binding’ and ‘treaty’” were dropped after pushback from countries including the US.

The 2021 Global Health Security Index released in December revealed there’s much work to be done before the next pandemic strikes: The average overall score in preparedness was 38.9 out of 100.  

Opioids/Fentanyl

The US continued its faltering efforts to stem opioid overdoses, as fentanyl-related deaths  “increased sharply” in 2019 and 2020, particularly in the Midwest, West, and South, according to the CDC. From May 2020 through April 2021, drug overdose deaths exceeded 100,000 in a 12-month period for the first time.

64% of the deaths involved synthetic opioids—chiefly fentanyl.

Climate Change

In 2021, climate change became more real than ever before: A blistering heat wave struck the Pacific Northwest in late June, and catastrophic floods swept through Germany a month later in just two of the year’s extreme weather events that included droughts, massive forest fires, and typhoons.

The “greatest threat”: 230+ medical journals united in publishing an unprecedented joint statement in September warning that climate change is the “greatest threat” to global public health and requires the same laser focus given to COVID-19.

Suffer the children: Compared to those born in 1960, today’s newborns may endure 7X more heatwaves, 2X more wildfires, and 3X more droughts, flood, and crop failures.

Gun Violence

A horrific 7 days of mass shootings in 7 days in March in the US highlighted the plague of gun violence. In 2020, gun deaths jumped 25% over 2019 numbers.

Don’t Forget The Good News

While 2021 and the ongoing pandemic have worn down many of us, there were bright spots as well.

Malaria vaccine: The WHO recommended widespread use on October 6 of the RTS,S malaria vaccine among children in areas of high transmission, creating the potential to save tens of thousands of lives every year.

Fewer tobacco users: The number of tobacco users fell last year to 1.3 billion, down from 1.32 billion in 2015. A Nov. 16 WHO report projected the trend will continue an estimated 1.27 billion tobacco users by 2025.

Polio endgame continues: The Global Polio Eradication Initiative announced a new plan on June 10 to tackle the disease with $5.1 billion and a reenergized vision.

End AIDS: The UN agreed June 8 on ambitious new goals for ending the AIDS pandemic by 2030: Preventing 3.6 million new HIV-infections and 1.7 million AIDS-related deaths by 2030. 

And the Best News of the Year…

Annalies, our associate editor, shared the happy news on Nov. 16 of the birth of her beautiful baby girl, Mathilda (Tilda for short).

Fave Friday Diversions

And where would be without GHN’s Friday Diversions? Here are our 2 faves from 2021:

Burr Man: Every August for 800 years, 1 lucky Scot gets to parade around South Queensferry in Edinburgh in a head-to-toe suit of burrs. It has 3 holes—1 for whisky and 2 for seeing, per Atlas Obscura.

Robo-Flop: Hard-luck Pepper the Robot is an inept tech slacker with a heart of silicon. The serially fired bot got canned from jobs at a bank, a funeral business, and a nursing home.  “Because it has the shape of a person, people expect the intelligence of a human,” said Chiba Institute of Technology’s Takayuki Furuta.

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That closes the book on 2021. Here’s hoping for a healthier, happier year ahead.