Authors: Justin Koonin, Dheepa Rajan, Eliana Monteforte, Marjolaine Nicod

In September 2019, at the UN High-Level Meeting on Universal Health Coverage, world leaders endorsed the most ambitious and comprehensive political declaration on health in history.

This Declaration included a commitment to “engage all relevant stakeholders, including civil society, the private sector and academia, as appropriate, through the establishment of participatory and transparent multi-stakeholder platforms and partnerships”[1].

The test of that commitment has come swiftly. Faced by the COVID-19 crisis, it is crucial that leaders recognise the interconnectedness of UHC and health emergencies and remember their UHC commitments.[2]

The willingness of most governments to place trust in medical and scientific experts to guide their responses to the emerging epidemic is encouraging. However, with notable exceptions, civil society organisations (CSOs) have been left on the margins.

An analysis of the COVID-19 taskforces of 24 countries[3] finds almost no representation from civil society and community representatives.  Another rapid survey of 175 CSOs from 56 countries[4] reports a majority of respondents finding little or no opportunity for civil society to contribute to their government’s response.  However, most CSOs reported working independently of the government to ensure COVID-19 awareness, continuity of care, and psychosocial support.

The cost of such omissions will be measured in lives.

For it is the most marginalised – the elderly, indigenous communities, people living with a disability or an underlying health condition, those living in poverty or without adequate employment or shelter, among many others – who are most vulnerable to COVID-19 and the secondary impact of governments’ dramatic attempts to isolate their residents.

It is precisely the role of civil society to bridge the gap between governments and these groups – to reach those who do not readily access mainstream medical care, to translate health messaging into a language which resonates, and to create trust in the health response.

Across the globe, civil society and communities are scrambling to feed, clothe, house and keep safe vulnerable people whose lived experiences of marginalisation make centralised government calls for lockdowns an almost unbearable impost. Even more concerning are reports that COVID-19 is being used as an excuse to target marginalised populations, unreasonably increase the powers of police, and restrict space for civil society[5].

Leaders should not consider the impact of government responses on these groups as a secondary afterthought, but rather central to the response. It is difficult for this to happen when affected groups are not at the table.

The central call of the UN 2030 SDG Agenda is to “leave no one behind”[6], beginning with those furthest behind. It is now time that the world’s leaders back up those words with meaningful action.

[1] United National High Level Meeting on Universal Health Coverage Political Declaration, para. 54,

[2] UHC2030 Co-Chairs’ statement on COVID-19 and UHC,

[3] WHO and UHC2030 Civil Society Engagement Mechanism. Covid taskforce analysis of 24 countries across 6 regions, forthcoming 2020