Our vulnerable world of vanishing safety nets

Perhaps the most tragic statistic is that 10.5 million of the world's children are now orphaned by covid-19 (doi:10.1136/bmj.o2838).1 The impact is greatest, as ever, in the poorest countries and among the most disadvantaged populations. [...]far, solutions are few and specific initiatives rare, even in rich countries. Helen Salisbury argues that safety netting—"come back if she doesn't get better”—works only if patients and carers have easy access to primary care doctors (doi:10.1136/bmj.o2936).3 When workforce shortages make out-of-hours appointments, and home and return visits, harder, what sense is there in the media vilifying doctors for providing virtual consultations and a virtual safety net (doi:10.1136/bmj.o2934)?4 Innovation, a popular solution to health service crises, isn't so welcome when it can be used as an excuse to advance an agenda against health professionals. Management strategies have been established (doi:10.1136/bmj-2022-070750), although endometriosis is easily missed (doi:10.1136/bmj-2021-068950) and remains a complex and disabling illness whose symptoms are hard to relieve.910 Investing in women was a reason for Sri Lanka's favourable health outcomes and prosperity relative to other south Asian countries, but an economic collapse has triggered a health crisis and reminds us of the importance of strengthening health systems and access to essential drugs (doi:10.1136/bmj-2022-073475).11 Those were two of the factors that Adrian Hill and Sarah Gilbert sought to overcome with their approach to the manufacture and distribution of a covid vaccine (doi:10.1136/bmj.o2592).12 Their institution's partnership with AstraZeneca and vaccine breakthrough ended up being a first mover disadvantage, despite its aspirations for global equity.