Recovery, the Unfinished Business of the Pandemic
In India, over 23 crore people were pushed into poverty during the pandemic years, with rural and informal sector workers bearing the brunt, and the economic spillover continues to be seen in the form of increased government debt, rising inflation, a stagnating hospitality industry and other things, even after half a decade has passed since the onset of COVID.
In the health sector, the disruption to routine immunisation services led to measles outbreaks in numerous Sub-Saharan countries, while a UNICEF report warned that about 23 million children missed out on essential vaccines in 2020 alone.
Mental health outcomes also deteriorated sharply. Data from the WHO shows that there was a 25% global increase in anxiety and depression in the first year of the pandemic.
These aftershocks demonstrate that recovery is not a passive return to normalcy – it is a protracted and complex phase that demands sustained attention, governance and resource mobilisation.
The COVID-19 pandemic has triggered worldwide efforts to mitigate the scale and impact of future health emergencies, including amendments to the International Health Regulations (IHR); the creation of the Pandemic Fund and the WHO Pandemic Intelligence Hub; and the ACT-Accelerator, COVAX and One Health initiatives.
The latest – and most talked-about – in this series of efforts is the WHO Pandemic Agreement, which was adopted on May 20, 2025 after three years of negotiations and discussions. It will become a legally binding international instrument on pandemic prevention, preparedness and response once it is signed by 60 countries.
After India's vote in favour of the resolution to adopt the agreement, making it an official state party to the agreement, the prime minister has talked about its importance for vulnerable populations in the Global South that disproportionately bear the effects of health challenges.
In order to successfully achieve this goal, the agreement needs to accomplish two things – chart out obligations targeted towards vulnerable populations, and highlight the specific ways in which pandemics' disproportionate impact on the Global South can be mitigated.
While the agreement does lay the ground for equity in both aspects, it falls short of outlining implementable measures to achieve these goals meaningfully without hindering sovereign decisions. Notably, the Pathogen Access and Benefit-Sharing (PABS) annex, a critical component tied to equity and access, still has another year to be worked out, further delaying clarity on how benefit-sharing commitments will be operationalised.
Commendably, the agreement talks about the need to provide affordable health and other social support services to 'persons in vulnerable situations'. It also calls for the mitigation of the socioeconomic impacts of pandemics on such persons. However, it misses an opportunity to guide state parties on when and how this should be done at the domestic and trans-national levels, especially at the time of recovery.
Integrating recovery into the pandemic agreement
Article 3 of the agreement, titled 'Preparedness, health system resilience and recovery', gestures toward the importance of post-pandemic strategies. However, recovery is buried within broader health system resilience goals and mentioned only in passing. It refers vaguely to 'developing post-pandemic health system recovery strategies' without outlining how, when or by whom such strategies must be developed, implemented or monitored. This diluted treatment effectively renders recovery a discretionary task, rather than an obligation.
There is no requirement for countries to assess the long-term impacts of pandemics on vulnerable populations, nor is there any architecture for coordinating recovery efforts, allocating responsibilities or ensuring accountability.
In the light of this gap, recovery must be established as a clear, foundational pillar within the pandemic agreement – not a vague aspiration buried under resilience.
It is important to acknowledge at the onset that international treaties cannot impose rigid mandates on sovereign states. However, by creating shared expectations and enabling frameworks, they can support states in fulfilling recovery goals without infringing on national autonomy.
Rather than prescribe uniform recovery models, the agreement can promote adaptable, equity-based cooperation that complements domestic efforts while ensuring accountability and consistency across borders.
The agreement should require states to develop standalone national recovery frameworks tailored to their contexts, with explicit mandates for implementation, periodic review and transparent reporting. Recovery should be understood broadly – not just as restoring health systems but as encompassing social, economic and mental health dimensions affected by pandemics.
A comprehensive recovery approach must prioritise impact assessments focused on marginalised and vulnerable populations – including gender minorities, workers in the informal sector, migrants, senior citizens, homeless populations, persons with disabilities and ethnic minorities – who disproportionately suffer during crises.
These assessments should directly inform targeted economic and social policies, such as livelihood restoration, social protection adjustments and reintegration support, to prevent widening inequalities in the post-crisis phase.
Further, recovery goals must be multi-dimensional and should account for the wide-ranging impact of pandemics across different key areas. Accordingly, the agreement should embed principles for access to justice and redressal mechanisms for harms suffered during pandemics, the restoration of disrupted education systems, safeguards for the continuity of essential public and welfare services, mechanisms for the review of governmental decisions and actions during the state of exception, and the rebuilding of public trust through transparent and participatory governance.
The absence of these dimensions risks a recovery that is piecemeal and opaque, weakening institutional integrity and leaving societies more vulnerable to future crises.
International cooperation in recovery efforts
In order to achieve the aim of equity, especially across the Global North-Global South divide, the international community must direct its attention to recovery efforts across national borders. The agreement must institutionalise mechanisms for international coordination and solidarity during the recovery phase, facilitating sharing of expertise, resources and data across countries to reduce regional vulnerabilities and promote equitable resilience.
The bodies set up under the agreement do not account for this adequately, in terms of function or finances.
The mechanisms set up under the agreement, such as PABS, deal with important functions like pathogen and data sharing, and pharmaceutical supply and distribution. There are no such systems established for recovery.
The Coordinating Financial Mechanism previously established under the IHR has been envisaged as the mechanism to promote sustainable financing for the implementation of the pandemic agreement as well. Its mandate under the pandemic agreement is to 'support strengthening and expanding capacities for pandemic prevention, preparedness and response, and contribute to the prompt availability of surge financing response necessary as of day zero, particularly in developing country Parties.'
This conspicuously and concerningly misses recovery as a crucial stage of assessing impacts and developing strategies for rebuilding, which is especially crucial for low and middle-income countries in the Global South, including India.
The cultural impact of international documents
Understandably, international agreements cannot impose specific obligations in the same way that domestic laws can. Given the legally binding nature of the pandemic agreement, it should also refrain from interfering with sovereign and context-specific decisions adopted at the national and sub-national levels.
At the same time, beyond policy prescriptions, international treaties play a critical role in shaping legal cultures and empowering civil society to demand justice and reform. By embedding preparedness, resilience-building and recovery within the pandemic agreement, the global community will be able to create a shared vocabulary and normative framework that activists, policymakers and courts can invoke domestically to advance equity and resilience.
India's past experience has illustrated this dynamic vividly. The Vishakha Guidelines on workplace sexual harassment, which transformed protections for women, were grounded in India's commitments under the Convention on the Elimination of All Forms of Discrimination Against Women. Similarly, the Convention on the Rights of Persons with Disabilities has influenced landmark judicial decisions and legislative reforms enhancing disability rights and access to welfare in India.
What can be done to prioritise recovery?
While laying out the rules or procedure and terms of reference, the Intergovernmental Working Group empowered under the agreement must lay down specific provisions on recovery, including indicative domestic guidance, mechanisms for international cooperation and sustainable financing or recovery that recognises marginalisation and prioritises equity.
Embedding principles that prioritise domestic and international efforts will shift recovery from a discretionary afterthought to a binding commitment that demands accountability without prescribing inflexible solutions. It provides states with a flexible but clear mandate to build inclusive, adaptive recovery architectures that address the deep, lasting fallout of pandemics.
Shreyashi Ray is a senior resident fellow with the health team at the Vidhi Centre for Legal Policy. Anchal Bhatheja is a research fellow at the centre.
Hashtags

Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles


The Hindu
2 minutes ago
- The Hindu
Why India's hepatitis crisis needs urgent attention
World Hepatitis Day, observed on July 28, is a global call to action to eliminate viral hepatitis, the second deadliest infectious disease after COVID-19. This year's theme, 'Hepatitis: Let's Break It Down', urges the dismantling of financial, social, and systemic barriers that delay timely diagnosis, treatment, and prevention of this silent killer. Understanding hepatitis Hepatitis refers to inflammation of the liver, primarily caused by five viruses: A, B, C, D, and E. Hepatitis A and E are transmitted through contaminated food or water and usually result in acute illness. Hepatitis B, C, and D, however, are more insidious and are transmitted through blood, unsafe medical procedures, unprotected sex, or from mother to child. If left untreated, these can lead to chronic liver disease, cirrhosis, or liver cancer. According to the World Health Organization's 2024 Global Hepatitis Report, India bears the world's second-highest burden, with 2.98 crore Hepatitis B and 55 lakh Hepatitis C cases. Alarmingly, nearly 90% of those infected are unaware of their condition and often present only when irreversible liver damage has set in. Despite the availability of vaccines for Hepatitis A and B, and curative treatments for Hepatitis C, hepatitis still claims one life every 30 seconds. Challenges that need addressing In line with the WHO's target to eliminate viral hepatitis as a public health threat by 2030, India must address pressing challenges such as high diagnostic costs, limited screening, and persistent stigma. Strengthening the healthcare response through routine screening, community-level education, and policies that ensure affordable access to diagnostics and treatment is essential. Across the country, public health institutions, medical colleges, and civil society partners are intensifying efforts through awareness campaigns, screening programs, and policy advocacy to improve access to diagnosis and treatment. Recent initiatives have included national summits bringing together experts and stakeholders to develop comprehensive elimination strategies. On this World Hepatitis Day, let's break the silence, end the stigma, and build a hepatitis-free world. Join the movement. Get tested, get treated, and protect your family. (Dr. Vivek Shanmugam is a liver transplant surgeon & managing trustee, Chennai Liver Foundation . Info@
&w=3840&q=100)

Business Standard
2 minutes ago
- Business Standard
World Hepatitis Day 2025: History, theme, measures, messages, quotes & more
Hepatitis is a medical condition marked by inflammation of the liver, often triggered by autoimmune disorders, certain medications, viral infections, or excessive alcohol consumption. Of particular global concern is viral hepatitis, caused by hepatitis A, B, C, D, and E viruses—each with distinct modes of transmission and varying impacts on health. To raise awareness of hepatitis and its harmful health impacts, 28 July is designated as ' World Hepatitis Day '. This day offers an opportunity to step up national and worldwide initiatives to support early identification, prevention, and efficient treatment choices for hepatitis. What is the theme of the World Hepatitis Day 2025? The World Health Organization (WHO) has announced that this year's theme is "Hepatitis: Let us Break It Down," which highlights the significance of lowering obstacles to hepatitis prevention, diagnosis, and treatment through service simplification and integration into national healthcare systems. Today is World #Hepatitis Day. Did you know❓ Hepatitis is the second leading infectious cause of death globally, with hepatitis B and C claiming 3 500 lives every day. Learn how to protect yourself and your loved ones ???? — World Health Organization (WHO) (@WHO) July 27, 2025 What is the history and significance of World Hepatitis Day? Dr. Baruch Samuel Blumberg, also known as Barry Blumberg, a physician and geneticist, identified the Hepatitis B virus in 1967 and then created the first vaccine, for which he got the Nobel Prize. After that, July 28th, his birthday, was announced 'World Hepatitis Day' to honor his achievements and contributions. The day is extremely important because it provides a chance to raise awareness of viral hepatitis worldwide and to push for improved choices for diagnosis, treatment, and prevention. In order to enhance access, integrate care, and eradicate hepatitis as a public health concern by 2030, it is important that we take immediate action. Causes of Hepatitis? • Viral hepatitis (A, B, C, D, E) • Autoimmune hepatitis • Alcohol-related liver disease • Drug-induced liver injury • Non-alcoholic steatohepatitis (NASH). Treatment of Hepatitis? World Hepatitis Day 2025 serves as a reminder that hepatitis is a medical ailment that can be treated and is not a moral fault. Numerous lives can be saved with early discovery, prompt treatment, and extensive education. Hepatitis is much easier to treat now than it was in the past because of advancements in transplant techniques and contemporary antiviral medications. But timing is everything. A few crucial actions to conduct are also listed below: • In public education, use jargon-free language. • Lessen the stigma attached to hepatitis • Include screening in your regular physical examinations. • Make specialized liver care more accessible, particularly in rural areas. Inspiring Messages For World Hepatitis Day 2025 Let's raise our voices, not just awareness—hepatitis is preventable and curable. One test can save a life. Get screened. Stay protected. Don't wait for symptoms. Know your status and take control. Empower communities with knowledge, and we can end the silent killer. Vaccinate, educate, eliminate—three steps to a hepatitis-free world. Together, we can eliminate hepatitis. It starts with awareness. Early detection leads to full protection—screen for hepatitis today. Hepatitis doesn't discriminate, and neither should healthcare. A healthier future is possible—join the fight against hepatitis. Every life matters. Every action counts. End hepatitis now. Quotes For World Hepatitis Day 2025 'Awareness is the first step toward prevention.' – Anonymous 'Hepatitis may be silent, but our action should be loud.' – Unknown 'Saving lives starts with sharing knowledge.' – Dr. Margaret Chan 'It takes a village to raise awareness and a world to eliminate hepatitis.' – Public Health Advocate 'Ignorance fuels infection. Education ends epidemics.' – Global Health Leader 'Testing is not a shame. Silence is.' – Patient Advocate 'Prevention is better than cure, and awareness is better than fear.' – Unknown 'A simple test today can mean a longer tomorrow.' – Anonymous 'Let's make hepatitis history, not headlines.' – WHO Campaign 'The virus is strong, but we are stronger together.' – Unknown.
&w=3840&q=100)

Business Standard
an hour ago
- Business Standard
Long-Covid, viruses: New research looks for links to chronic fatigue
Millions of people who recover from infections like Covid-19, influenza and glandular fever are affected by long-lasting symptoms. These include chronic fatigue, brain fog, exercise intolerance, dizziness, muscle or joint pain and gut problems. And many of these symptoms worsen after exercise, a phenomenon known as post-exertional malaise. Medically the symptoms are known as myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). The World Health Organization classifies this as a post viral fatigue syndrome, and it is recognised by both the WHO and the United States Centers for Disease Control and Prevention as a brain disorder. Experiencing illness long after contracting an infection is not new, as patients have reported these symptoms for decades. But Covid-19 has amplified the problem worldwide. Nearly half of people with ongoing post-Covid symptoms – a condition known as long-Covid– now meet the criteria for ME/CFS. Since the start of the pandemic in 2020, it is estimated that more than 400 million people have developed long-Covid. To date, no widely accepted and testable mechanism has fully explained the biological processes underlying long-Covid and ME/CFS. Our work offers a new perspective that may help close this gap. Our research group studies blood and the cardiovascular system in inflammatory diseases, as well as post-viral conditions. We focus on coagulation, inflammation and endothelial cells. Endothelial cells make up the inner layer of blood vessels and serve many important functions, like regulating blood clotting, blood vessel dilation and constriction, and inflammation. Our latest review aims to explain how ME/CFS and long-Covid start and progress, and how symptoms show up in the body and its systems. By pinpointing and explaining the underlying disease mechanisms, we can pave the way for better clinical tools to diagnose and treat people living with ME/CFS and long-Covid. What is endothelial senescence? In our review, our international team proposes that certain viruses drive endothelial cells into a half-alive, 'zombie-like' state called cellular senescence. Senescent endothelial cells stop dividing, but continue to release molecules that awaken and confuse the immune system. This prompts the blood to form clots and, at the same time, prevent clot breakdown, which could lead to the constriction of blood vessels and limited blood flow. By placing 'zombie' blood-vessel cells at the centre of these post-viral diseases, our hypothesis weaves together microclots, oxygen debt (the extra oxygen your body needs after strenuous exercise to restore balance), brain-fog, dizziness, gut leakiness (a digestive condition where the intestinal lining allows toxins into the bloodstream) and immune dysfunction into a single, testable narrative. From acute viral infection to 'zombie' vessels Viruses like SARS-CoV-2, Epstein–Barr virus, HHV-6, influenza A, and enteroviruses (a group of viruses that cause a number of infectious illnesses which are usually mild) can all infect endothelial cells. They enable a direct attack on the cells that line the inside of blood vessels. Some of these viruses have been shown to trigger endothelial senescence. Multiple studies show that SARS-CoV-2 (the virus which causes Covid-19 disease) has the ability to induce senescence in a variety of cell types, including endothelial cells. Viral proteins from SARS-CoV-2, for example, sabotage DNA-repair pathways and push the host cell towards a senescent state, while senescent cells in turn become even more susceptible to viral entry. This reciprocity helps explain why different pathogens can result in the same chronic illness. Influenza A, too, has shown the ability to drive endothelial cells into a senescent, zombie-like state. What we think is happening We propose that when blood-vessel cells turn into 'zombies', they pump out substances that make blood thicker and prone to forming tiny clots. These clots slow down circulation, so less oxygen reaches muscles and organs. This is one reason people feel drained. During exercise, the problem worsens. Instead of the vessels relaxing to allow adequate bloodflow, they tighten further. This means that muscles are starved of oxygen and patients experience a crash the day after exercise. In the brain, the same faulty cells let blood flow drop and leak, bringing on brain fog and dizziness. In the gut, they weaken the lining, allowing bits of bacteria to slip into the bloodstream and trigger more inflammation. Because blood vessels reach every corner of the body, even scattered patches of these 'zombie' cells found in the blood vessels can create the mix of symptoms seen in long-Covid and ME/CFS. Immune exhaustion locks in the damage Some parts of the immune system kill senescent cells. They are natural-killer cells, macrophages and complement proteins, which are immune molecules capable of tagging and killing pathogens. But long-Covid and ME/CFS frequently have impaired natural-killer cell function, sluggish macrophages and complement dysfunction. Senescent endothelial cells may also send out a chemical signal to repel immune attack. So the 'zombie cells' actively evade the immune system. This creates a self-sustaining loop of vascular and immune dysfunction, where senescent endothelial cells persist. In a healthy person with an optimally functioning immune system, these senescent endothelial cells will normally be cleared. But there is significant immune dysfunction in ME/CFS and long-Covid, and this may enable the 'zombie cells' to survive and the disease to progress. Where the research goes next There is a registered clinical trial in the US that is investigating senescence in long-Covid. Our consortium is testing new ways to spot signs of ageing in the cells that line our blood vessels. First, we expose healthy endothelial cells in the lab to blood from patients to see whether it pushes the cells into a senescent, or 'zombie,' state. At the same time, we are trialling non-invasive imaging and fluorescent probes that could one day reveal these ageing cells inside the body. In selected cases, tissue biopsies may later confirm what the scans show. Together, these approaches aim to pinpoint how substances circulating in the blood drive cellular ageing and how that, in turn, fuels disease. Our aim is simple: find these ageing endothelial cells in real patients. Pinpointing them will inform the next round of clinical trials and open the door to therapies that target senescent cells directly, offering a route to healthier blood vessels and, ultimately, lighter disease loads.