COVID-19 dominated the news cycle this year. The first large-scale global pandemic in 100 years has now killed more than 5 million people worldwide since it began in 2020. Over 275 million people have been diagnosed with it. And at least 115,000 health workers have lost their lives to the virus, though the number is likely much higher.

But while COVID-19 is affecting every aspect of global health and development right now, there was much more to 2021. Here are some of the moments that caught our attention this year:

January: WHO declares 2021 the Year of the Health and Care Worker.

For the first time ever, the World Health Organization and global health community dedicated this year to a group of people we at IntraHealth have been passionate about for over 40 years, and who’ve put their lives on the line to respond to COVID-19: health workers.

These past two years have showed us how crucial health workers are to not only pandemic response but to keeping essential health services available every day. Health workers put themselves at great risk to save the lives of others and as COVID-19 continues into 2022, health workers will be just as important.

"If we’re going to build the resilient health systems we need worldwide to end this pandemic—and to be ready for the next one—we need to ensure the safety of health workers and respect for their rights," says Polly Dunford, president and CEO of IntraHealth.

Learn more: The Frontline Health Workers Coalition, Seed Global Health, Smile Train, G4 Alliance, and IntraHealth International kicked off the Act for Health Workers Campaign to share health workers’ stories and provide information about how we can all take action and advocate for them.

Read: Health Workers Are Essential, During the Pandemic and Beyond

February: We fall short on vaccine equity.

On February 23, Ghana became the first country outside India to receive COVID-19 vaccine doses shipped via the COVAX Facility. But only 600,000 doses were delivered, a far cry from covering the 31 million people of Ghana and billions of people in need of shots around the world. As this article is being written, Africa still has the lowest vaccination rate of any continent, with just 11% of the population having received a dose of the vaccine.

“More than 39 million doses of vaccine have now been administered in at least 49 higher-income countries,” said WHO Director-General Tedros Adhanom Ghebreyesus in a speech in January, 2021. “Just 25 doses have been given in one lowest-income country. Not 25 million; not 25 thousand; just 25. I need to be blunt: the world is on the brink of a catastrophic moral failure—and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries.”

Now, as higher-income countries roll out vaccine booster shots, lower-income countries are still struggling to administer first doses.

Read: Health Workers Need to Be at the Center of Our Global Vaccine Rollout

March: One year in, women bear the brunt of the pandemic.

As we marked the one-year anniversary of the pandemic, the United Nations released data showing that violence against women has spiked due to COVID-19. They reported that 736 million women—or a third of all women globally—have now experienced physical or sexual violence in their lifetime.

As the informal economy has shrunk, women have lost their jobs, lost access to sexual and reproductive health services, and had to pay more for childcare. UN Women announced that COVID-19 threatened to push 47 million additional women into extreme poverty. And Oxfam reported that 13 million more child marriages are projected to take place by 2030 because of the pandemic.

Girls have lost access to education due to school closures and child pregnancies have increased as a result.

The long-term effects of this gender inequity could shape the future of the health workforce. Women make up 70% of all health workers worldwide. Not only do they already face gender-related barriers on the job and greater exposure to COVID-19—but the interruption in girls’ education could stymie the growth of the health workforce for decades to come.

            Read: 4 Ways to Prevent Sexual Harassment in the Health Workforce

April: Data show the risk of dying early from diabetes is going up—not down.

“Diabetes is the only major noncommunicable disease for which the risk of dying early is going up, rather than down,” the World Health Organization reported in April. The number of people with diabetes has quadrupled in the last 40 years.

Diabetes and other noncommunicable diseases (NCDs) disproportionately affect the health of people in low- and middle-income countries, driving an estimated 100 million people into poverty. And during the pandemic, people living with NCDs—especially diabetes—have a much higher risk of becoming severely ill or dying from COVID-19.   

Combatting NCDs has been a focus for the health workforce for years, but the onset of COVID-19 has made it more urgent than ever that countries build and maintain strong primary health care teams to keep these diseases at bay.

            Read: Door-to-Door Hypertension Care in Dakar Brings a Pervasive Public Health Problem to Light

May: A call for full access to health services for people living with disabilities.

At the 2021 World Health Assembly, Australia and Israel co-sponsored a resolution that called on member states to make sure disabled people have full access to health services.

The resolution not only urges all countries to incorporate disability services into primary health care programs, but it calls for the WHO to create a global research agenda on disabilities and a global report on disabilities by 2022.

Community health workers, it says, will be crucial to providing equitable, safe, high-quality, accessible, and inclusive health services.

People with disabilities have long been left out of the primary health care conversation, and COVID-19 has only exacerbated that.

June: UNAIDS sets new targets to end AIDS by 2030.

In early June, UNAIDS published a new report—Global Commitments, Local Action—with the goal of ending AIDS by 2030. That means preventing 3.6 million new HIV infections and 1.7 million AIDS-related deaths by 2030.

United Nations Member States adopted a political declaration just days after the report was published, a move that helps guide policies and puts pressure on governments to honor their commitments.

And while the world did not meet the HIV targets set five years ago at a similar UN meeting, the possibility of ending AIDS by 2030 is still attainable.

“To end AIDS by 2030, governments must commit to take a people-centered, rights-based approach to HIV, to work on policy and law reform, to engage and support communities, and to end inequalities,” said Winnie Byanyima, executive director of UNAIDS.

This means increasing health services, strengthening the health system, and supporting health workers—all during a pandemic.

Read: For Stronger HIV Services in South Sudan, This Team Looks to the Data

July: A withdrawal at the Tokyo Olympics shines a spotlight on mental health.

When US gymnast Simone Biles decided to withdraw from the Tokyo Olympic games due to mental health concerns, it sparked a global conversation.

A worldwide focus on mental health is long overdue. A 2021 WHO report found that although there has been more attention on the importance of mental health and wellbeing, it hasn’t translated to the scale-up of high-quality mental health services around the world.

“We must heed and act on this wake-up call and dramatically accelerate the scale-up of investment in mental health, because there is no health without mental health,” said Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. 

For many health workers, the past two years have been the most challenging of their careers. The emotional and physical toll of being on the front lines of the pandemic is great. They face exposure to the virus at work, stigma from their friends and families, and the high-stress challenge of keeping other services accessible to clients during a crisis.

The complex effects of trauma and stress caused by the pandemic only add to the urgency of our global reckoning. The tremendous need for services for post-traumatic stress disorder, psychosis, anxiety, depression, bipolar disorder, and much more will only grow as the pandemic lingers.

August: The Taliban seizes control of Afghanistan.

On August 15, members of the Taliban entered Afghanistan’s capital, Kabul, and President Ashraf Ghani fled the country, signifying the end of American military presence in the country.

And while the remaining US military personnel were evacuating, health services in Afghanistan were shutting down and the country headed toward total economic collapse. Foreign aid money stopped and sanctions began, affecting over 22.8 million people with food insecurity and 8.7 million who are nearing famine, reported the World Food Programme and Food and Agriculture Organization.

This also left health facilities without supplies and health workers.

“Many of these facilities have now reduced operations or shut down, forcing health providers to make hard decisions on who to save and who to let die,” said a WHO statement. “Only 17% of all Sehatmandi health facilities—the country’s largest health project—are now fully functional. This breakdown in health services is having a rippling effect on the availability of basic and essential health care, as well as on emergency response, polio eradication, and COVID-19 vaccination efforts.”

In November, the Taliban announced they would allow the WHO polio vaccination campaign to restart, which has the potential to reach over 3 million children and could indicate the Taliban’s willingness to improve other health services.

September: First person of African origin appointed to lead PEPFAR.

On September 27, President Biden announced that he would nominate John Nkengasong to lead the President’s Emergency Plan for AIDS Relief (PEPFAR). Nkengasong was the founding director of the Africa CDC and is the first person of African origin to lead PEPFAR, the $7 billion US program that works to end AIDS globally.

Nkengasong has over 30 years of experience working on HIV/AIDS and was one of the founding leaders of PEPFAR.

Some have called the nomination a “brain drain” for Africa, as Nkengasong was one of many health workers leaving the continent to work for a US-based program. Others point out that this is a big move toward new thinking about who should be leading humanitarian programs.

“We’re happy to see the world beginning to respond to decolonization and the unequal balance of power in global leadership,” said Dr. Ayoade Olatunbosun-Alakija, co-chair of the African Union’s African Vaccine Delivery Alliance.

            Read: To Decolonize Global Nursing and Midwifery, Let’s Rethink How We Train Health Workers

October: Malaria vaccine to the rescue—kind of.

The World Health Organization announced in October that they had approved the RTS,S vaccine from GlaxoSmithKline. “This is not only the first authorized malaria vaccine, it's also the first vaccine ever approved for use against a parasitic disease in humans,” wrote NPR’s Goats and Soda reporter Jason Beaubein.

But questions about the vaccine remained, such as how effective it will be and how it will be rolled out. The vaccine requires four doses and reduces the risk of contracting malaria by 40% and the risk of death by only 30%. And while Gavi, the Vaccine Alliance, has committed an initial investment of US$155.7 million for a three-year campaign, there are still a series of steps that need to take place before children can start to receive the vaccine.

Sound familiar?

The COVID-19 vaccine rollout has taught us that this type of global effort takes more than funding—it needs health workers to put jabs in arms.

November: Youth voices steal the show at Glasgow climate summit.

“The climate crisis is the single biggest health threat facing humanity,” wrote the 3,500+ signatories of the Healthy Climate Letter, a call to action published during the United Nations Climate Negotiations (COP26) that represented over 45 million health workers .

“As health professionals and health workers, we recognize our ethical obligation to speak out about this rapidly growing crisis that could be far more catastrophic and enduring than the COVID-19 pandemic.”

Joining health workers in calling for massive action were young people all over the world, including thousands of students who protested in Glasgow during the COP26 summit. Many of them directly criticized the leaders at the summit, calling for concrete solutions instead of false promises.

“Climate change is affecting everyone around the world,” said Patience Nabukalu, a 24-year-old activist from Uganda. “There are many people who are dying [and] there are many people who are affected by the crisis.”

Dominating most of the news coverage, it was clear: youth are focusing on the future and they are ready to take the lead.

Watch: Next Generation Health Workers

December: A new COVID variant emerges, and officials call for more booster shots.

In late November, the WHO named the B.1.1.529 Omicron variant a variant of concern. And while more than half the world’s countries still haven’t vaccinated 40% of their populations, many other countries are scrambling to provide a third “booster” shot for their citizens.

“It is very clear our vaccine for the Omicron variant should be a three-dose vaccine,” said Ugur Sahin, co-founder and chief executive of BioNTech.

So while vaccinating more people should be the priority over giving boosters to those already immunized, we end 2021 the same way we started: with calls for vaccine equity and getting vaccines to people who still haven’t received their first shots.

“If the story of 2020 was arguably the sprint to discover a vaccine, and the story of 2021 was the sprint to produce them, the story of 2022 has to be the sprint to turn those vaccines into vaccinations,” said USAID Administrator Samantha Power.

The people administering those vaccines—and millions more to come—will be health workers.  

Photo at top by Levi Dieguez for IntraHealth International.