To the Editor — A recent Comment1 and accompanying Editorial2 in Nature have raised the question of whether it is time to revise the United Nations (UN) Sustainable Development Goals (SDGs) and their various targets in the wake of the COVID-19 crisis. In their Comment, Naidoo and Fisher argue that it is ”likely that many of the 169 targets will not be met by 2030” and that ”some could even be counterproductive”1. We argue for a more optimistic view and hold that the COVID-19 pandemic may help spur efforts to realize the UN’s 2030 Agenda.
Rather than calling for a revision of the SDGs, COVID-19 should be seen as a catalyst for progress. COVID-19 has effectively unveiled the inequities and governance dysfunctions that the SDGs are poised to rectify3,4. By its very nature, a pandemic teaches that no one should be left behind and that no one is safe until everyone is safe.
Indeed, COVID-19 makes extant challenges impossible to ignore. It brings to the fore the consequences of not having health insurance or access to healthcare, not having water or a food supply during lockdown situations, or not having civil rights. With health as a lens, it is apparent how the myriad targets incorporated into the SDGs are interlinked and interdependent5.
As Naidoo and Fisher note, the UN was founded to bring peace to a planet threatened by weapons that were far-reaching and dangerous. Viruses with pandemic potential are similarly far-reaching and dangerous. Now a supranational governance system is needed on par with that built 75 years ago, but this time the global challenge is to save future generations from the scourge of pandemics, not just from the scourge of war. Through efficient global coordination, medicines and vaccines must be able to be dispatched when an epidemic erupts, just as peace forces are called on when a conflict erupts. Security means transborder passage not only of troops but also of medicines and vaccines. From this perspective, the existing global governance system for health must not be allowed to implode. As pointed out by The Lancet–University of Oslo Commission on Global Governance for Health6,7, the development of supranational governance organizations has not kept pace with the development of society at large. However, this ‘stickiness’ and other global governance dysfunctions6,7 call for refinement and modernization, not abandonment. The WHO and other important supranational organizations must be strengthened, not undermined.
What is needed is the development of a universal preparedness for health, in the spirit of the SDGs. While universal health coverage addresses present problems and challenges, universal preparedness for health takes the future as its yardstick. This implies an anticipatory approach to health: the root causes of zoonotic transmission must be investigated and vaccine strategies against zoonotic viruses must be developed before their pandemic potential is translated into a pandemic8. This time the world was caught unprepared — the next pandemic virus should be given the shortest head start possible.
The SDGs instruct that universal preparedness for health requires a radical systems approach: health must be seen in the broadest of contexts, with due attention to social structures and infrastructure, working and living conditions3 and with strategies to counteract climate change, loss of biodiversity and human destruction of wild habitat9. In line with the overarching goal of leaving no one behind, preparedness means paying particular attention to vulnerable groups such as ethnic minorities, the elderly and people with underlying medical conditions. The ‘oneness of humanity’ thinking that so permeates the SDGs will stand to be tested once a vaccine against COVID-19 is at hand. A just and equitable distribution of affordable vaccines would represent a concrete and important step toward the realization of the SDGs.
Faced with the immense challenges embodied by the SDGs and accentuated by COVID-19, the last thing that one should do is to resort to pessimism or lower one’s ambitions. The biggest threat to the implementation of the SDGs is resignation and indifference. The unique health challenges now being experienced should be used to leverage the implementation of the SDGs and help in navigation of “the forest of targets”1 that these goals embody. The SDGs are not up for revision but are more urgent and relevant than ever.
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The authors declare no competing interests.
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Ottersen, O.P., Engebretsen, E. COVID-19 puts the Sustainable Development Goals center stage. Nat Med 26, 1672–1673 (2020). https://doi.org/10.1038/s41591-020-1094-y