A new report issued by the Lancet Commission looks at the first two years of the pandemic to consider what the world did right (spoiler: not much), what the world got wrong, and how we can end this public health emergency and prepare for future ones. According to the commission, the failures cost us 17.7 million unnecessary deaths globally — a figure that includes some 6 million reported deaths plus an estimate of unreported deaths. (Not to mention the many people still struggling with the long-term consequences of a prior infection with COVID-19.)

Here are four ways the world messed things up:

Countries failed to coordinate and cooperate.

One of the central findings of the commission's report was the lack of coordination among governments. Nations didn't consult with one another, for instance, as they locked down and reopened in a seemingly random manner. "We saw seesaw swings across countries, which gave the virus and the variants a superhighway for transmission into areas where previously it had not entered," says Dr. Srinath Reddy, president of the Public Health Foundation of India and a co-author of the report. Instead of a coherent global strategy, each country took care of itself "in an incredibly haphazard way," says Jeffrey Sachs, director of the Center for Sustainable Development at Columbia University and chair of the commission.

Nations didn't do their homework.

Before COVID-19, the Global Health Security Index assembled rankings on which countries would be best and worst prepared for a hypothetical pandemic. "They proved to be very misleading," says Sachs. Many of the nations at the top of those lists, he explains, ended up with high death rates and difficulties countering the virus. (In case you were wondering, the U.S. ranked first in terms of "preparedness for pandemics and epidemics.") The one region of the world that punched above its weight was the Western Pacific. "There wasn't confusion, consternation or deep public debate about basic public hygienic measures of wearing face masks, social distancing, [and] avoiding potential super spreader events," says Sachs. The result was that the Western Pacific had some of the lowest mortality rates globally and, he says, "did not suffer worse outcomes in economic terms than other regions of the world."

Inequity was a "wicked accomplice" of the virus. In other words, we didn't share!

The commission commended the rapid development of vaccines but faulted the nations that developed and acquired these highly effective tools for focusing on their profitability at the expense of not sharing them more widely. "While immunity is the splendid armor that protects us against the virus," says Reddy, "inequity is the wicked accomplice of the virus." In other words, lack of widespread, aggressive vaccination has allowed COVID-19 to evolve, evade and persist.

When it came to an array of possible medical responses, "global and national decisions didn't consider the less vocal voices of our communities," says Gabriela Cuevas Barron, honorary president of the Inter-Parliamentary Union and co-author of the report. She's referring to immigrants, refugees, the elderly, Indigenous populations, women and children, prisoners, and those with disabilities, fewer resources and reduced access to health care.

The public was infected by a plague of resistance.

The commission noted widespread public resistance to basic prevention and safety measures. This was due, in part, to confusing and conflicting government messages. But misinformation and disinformation campaigns aimed at the very heart of public health science were also responsible, amplified and further distorted on social media. "We must actually ensure that people's confidence in science grows," says Reddy, "and we counter the anti-science movements that pose a serious public health threat all across the world. And the political compulsions that sometimes drive policymakers to perpetuate such movements must also be called out."

To address these failures going forward, the commission laid out a handful of fixes. Among them:

People of the world, let's cooperate!

Despite a widespread feeling in many parts of the world that the pandemic is behind us, Sachs assures us it most certainly is not — "New variants, hugely uneven vaccine coverage, and quite possibly serious surprises still to come. In other words, we are not prepared for ending this pandemic." The commission urges strong international cooperation to finish this thing off.

Create a combo platter of preventive and curative measures: Vaccination-plus!

According to the report, the optimal strategy for bringing the pandemic to an end involves a combination of mass vaccination, testing, treatment for both new infections and long COVID, installing public health measures like face masks and social distancing, and financial and social supports to ease periods of isolation and quarantine for individuals. "We have to be prepared and make sure that we will leave no one behind in the future," says Cuevas Barron.

Expand the World Health Organization

The commission believes the WHO should enlarge its Science Council, a body of scientific leadership that directly consults with the director-general about "high-priority scientific issues and advances in science and technology that could directly impact global health." Their hope is that growing this group with diverse representation will help address future emerging infectious diseases, with a special focus on understanding "exposure routes and the highest-risk environments for transmission."

A response from WHO

The World Health Organization welcomed the report but felt it didn't fully characterize the global health body's role in addressing the pandemic.

The day after the report was published, the World Health Organization expressed appreciation for the work of the Lancet Commission and underscored its endorsement of strengthening the WHO and increasing its budget. It agreed with the Commission that the pandemic is not yet over, "though the end is in sight."

To that end, Director-General Tedros Adhanom Ghebreyesus announced on Wednesday that the WHO has released "six short policy briefs that outline the key actions that all governments must take now to finish the race." However, the global health body took exception with what it felt were "key omissions and misinterpretations" by the Commission of the WHO's response to the pandemic, which it considered to be "immediate, multi-year, [and] life-saving."

A last word about lessons learned

Reddy says the lesson of the pandemic and the essence of the report is that global trust is needed to respond to a global threat. "Global health might have derived its initial impetus from a sense of shared vulnerability," he says, "but now it must draw momentum from a sense of shared values. We must actually stand and work together."

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