The US State Department clearly signalled last week that it was eyeing specific talent from the developing world, especially those with skills to mitigate the effects of Covid-19.
Public health sectors across the world are under inordinate pressure amidst the unprecedented and dynamic Covid-19 outbreak, with governments across the world continuously adapting measures amidst epidemiological, economic, and social behavioural concerns. At the time of writing, with a figure of over 140,000 the US (a new epicentre of the pandemic), now has the highest number of confirmed cases in the world, overtaking Italy, China, and Spain. Both now and in the post-Covid-19 world, a maelstrom of debates will rage as to whether or not governments marshalled all available information and resources quickly enough to combat the outbreak effectively, or whether complacency, amplified by an unprepared health sector, led to needless deaths.
Amid the escalating Covid-19 pandemic, the news that the US State Department was now encouraging foreign medical professionals to contact the nearest US Embassy or Consulate for a visa appointment is, in this light, not without due cause, yet certainly not without critique. The State Department clarified its original message in a later briefing, asserting that no new applicants were being sought, that the call was only for those already accepted for work or study placements. Still, the stated insistence for those “particularly […] working to treat or mitigate the effects of Covid-19” clearly signalled that specific talent was sought. In any case, two highly fractious questions have been spotlighted by the development: how chronically unprepared the infamous US healthcare system really is, coupled with the more scathing question of whether the US is now ‘stealing the world’s doctors’?
The accusation is not new, with charges of greed as well as feelings of dishonesty and betrayal sometimes directed at the doctors themselves who choose to migrate. But the predicament is all the more alarming when considering how pivotal any available physicians would be in the poorer, less affluent countries of the world where the practice of social-distancing, self-quarantine, and in some cases even handwashing, are all but unaffordable luxuries. Some may explain-away the predicament as merely the result of ‘globalisation’, which then opens a slew of related questions as to inequality ingrained, sustained, and in times of crisis, amplified by the phenomenon of globalisation and the nature of the global economy. Clearly, both push and pull factors must be considered together. In 2012, the New York Times reported that a quarter of physicians working in the country were trained overseas. According to the American Immigration Council, that proportion remained approximately the same by 2018. Beyond the usual thorny fault-lines associated with the state of play of the US healthcare system, including renewed calls for universal health care, the popular picture portrayed of a systematic shortage of doctors is part of the story.
Beyond mere physician count, it is the level of access that Americans have to adequate healthcare that must also feature in the debate. In a recent article, Harvard Business Review identified further factors that compound the ills the US healthcare system harbours, including: the uneven distribution of primary care physicians, the unaffordability of primary health care especially for those without medical insurance, inefficient use of physician labour, as well as inflexible care models and hours. The development touches a further nerve when considering the flurry of anti-immigration measures the Trump administration has incited, with accusations of anti-Muslim bias and a hostility to so-called low-skilled immigration. The latter sentiment also bears some similarity with the UK’s proposed ‘points-based’ immigration system, though in both cases one hopes that the absolute necessity of low-skilled professions in times of lockdown will now be more clearly understood and appreciated.
The prospect of undocumented migrants unable to access healthcare as Covid-19 spreads is particularly worrying. The Trump administration has also introduced tougher public assistance regulations for immigration which potentially allows the government to deny green cards and visas to those dependent on public benefits. This has led to large-scale fear in immigrant communities, afraid that seeking healthcare may ultimately lead to deportation. More so, the perils of economic downturn, which may then lead to deaths unrelated to Covid-19 as in the case following the financial crisis, such as suicides and unaffordable healthcare, are also extremely disturbing. With unsurprising challenges the US economy now faces, as elsewhere, together with a perceived sluggish US response to the outbreak despite the experiences of other countries around the world, healthcare will surely heavily feature in any general election to come. But what can be drawn from the event is how far governments change in times of an emergency, for better or for worse, and what, if any, of these changes will remain in place or galvanise wholesale improvements not only to public health sectors but to the general status of economic inequality across the world. If the above development does take place, the winners it seems, both for medical talent and as such broadly the effectiveness of health care systems, are as simple as it may sound, those with money.