Although they have been warned for decades, many countries were unprepared for the Covid-19 pandemic. Although some managed to contain the virus, the pandemic response in most countries was weak at best; in some countries it was disastrous. As of mid-March 2021, nearly 2.7 million deaths have been attributed to SARS-CoV-2, and many more aspects of the health and social impact are likely to come to light in the long run. Although there are no official global figures, there are probably tens of thousands of health care and other frontline workers among the casualties; late in 2020, Amnesty International estimated that more than 7,000 health workers had died from Covid. Besides endangering their lives, it has had a difficult year, to put it mildly. Many still work in underspent systems, with inadequate personal protective equipment (PPE), dealing with an unprecedented and completely foreseeable situation.
While the heroic deeds of health workers are being celebrated and we have been re-appreciating the risks that many front workers face when providing basic services, less attention has been paid to those who have refused to work under such dangerous conditions, and those who pointed out that no health worker needs to place such a high risk. Many have rightly argued that heroism is only necessary because of government neglect, underfunding and the lack of preparation for a pandemic we knew. Many workers are rightly angry. Although there are no official figures, it appears that Covid-19 has led to a significant increase in strikes by health workers.
In February 2020, experts in Hong Kong asked in front of an unknown ‘pneumonia’ to close the borders in an attempt to mitigate its spread until more could be determined about the nature of the virus (which on 11 February would is considered a pandemic about a month later). The Hong Kong government, despite calls from experts and health care workers, has failed to act with the support of the general public. At the end of January, unions repeatedly called for dialogue with the government regarding the closure of the border. When the attempt failed, there was a vote on strike action, for which there was overwhelming support. From 3 to 7 February 2020, health workers in Hong Kong went on strike, making a number of demands, including closing borders and adequate supplies of PPE and facilities to manage the potential spread of the virus.
Such actions are not limited to Hong Kong. Amid the multiple cases of Covid-19, health workers in Zimbabwe went on strike in June 2020 due to a lack of PVB and low salaries. In fact, strikes by health workers have been a worldwide phenomenon. In the United States, nurses went on strike, and in the United Kingdom, pharmacists and nurses threatened to go on 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 one point during the pandemic.
Health workers even went on strike after the military coup in Myanmar in February 2021, with a spokesman saying they were ‘simple’ [did] does not want to work for the regime that hosted the military coup. ”1 Such actions must be understood in the context of broader unrest. In Venezuela, for example, many health workers had no option but to stop working during the pandemic. In what has been described as a crisis within a crisis, Covid-19 has exacerbated many of the problems in Venezuela’s poor healthcare system. Although there was unrest, the Venezuelan government tried to silence critics, deny PPE shortages and blame the health workers. The government also denies that an estimated 200 health workers died and claims that there were only 12 deaths attributable to Covid-19.2
Although these situations are distinguished in different ways and health workers have stopped (or protested) for numerous reasons, general claims underlying almost all of these actions are related to inadequate responses to Covid-19 and inadequate protection for frontline workers; each group that performed explicitly demanded more PPE.
Experts in law, ethics and medicine have long debated whether and when strikes can be justified by health care professionals. Although these debates have centered on the risks that strikes pose to patients, these actions also pose risks to health care workers – they can, for example, damage the morale and cohesion of the team, and in many countries strikes have been violently suppressed. Other risks are related to public perceptions and potentially broader harm to society and the healthcare community as a whole.3 Perhaps, however, it is essential that strikes raise questions about what health workers owe to society and what society owes them.
In previous debates, however, such unprecedented circumstances should not have been taken into account: should doctors in Myanmar, for example, have to work under a military government during a pandemic? Although we can not easily answer this question, there are some important considerations in assessing strikes during Covid-19. Perhaps the most obvious is that the pandemic has increased the importance of such action. On the one hand, it can be argued that health workers are needed more than ever; on the other hand, it can also be argued that they are not expected to work with inadequate PBT and other protections in place. Beyond these dilemmas, Covid-19 not only highlighted our collective vulnerability, but also revealed the impact of decades of underfunding and neglect as well as a more recent contempt for science. In many ways, debates about the risks associated with strike action have led to a stalemate, as these dilemmas are only present due to deeper structural problems.
In an article published about 6 months before the first cases of Covid-19, entitled ‘Investing now in public health or storing up problems for the future’, Finch argues that the ongoing underfunding of public health in England is likely future implications, to increase the need for services and increase costs in the longer term.4 Underfunding was one of the many problems facing healthcare in the UK before the pandemic, with decades of austerity presumably contributing to tens of thousands of deaths that could have been prevented.5
Covid-19 has led to some of the most profound changes in social life in memory. It also shed light on many challenges that could otherwise be set aside: underfunding, neglect, and indifference to health and health care. This left us with two related issues: what should be done to prevent strike action? And more importantly, how can we address broader structural failures?
How we arrive at the cause of these problems will differ from country to country, as will who should be responsible for what and what can be done to solve these problems. Contrasts can be drawn here between countries with good resources, but there are even stronger differences worldwide, especially given the likely future impact of Covid-19 in low- and middle-income countries. Yet some immediate steps can be taken everywhere 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 need to pay health workers more and improve their working conditions, and we do, such actions will have little long-term impact if healthcare systems are neglected. It would be nice to say that it should not take a pandemic or a strike to force countries to address these issues, but the last twelve months justify a certain skepticism. Although Covid-19 still affects millions of people, we can only hope that it is not only a re-evaluation of the treatment of health workers, but also of the value we attach to health and health care.