Using Global Health Lessons to Sustain Medical Student Activism Beyond COVID-19.

To the Editor: During the COVID-19 pandemic, medical students have developed innovative means of delivering care to patients to better address social determinants of health. For example, medical students at our institution, Columbia University Vagelos College of Physicians and Surgeons, founded the COVID-19 Student Service Corps to improve community health literacy, support telehealth appointments, deliver meals and personal protective equipment, and target other social determinants like patient mobility and social support. 1 Harvard Medical School and at least 9 other academic medical centers have implemented comparable student service models. 2 As domestic COVID-19 transmission declines, however, institutional support for these programs may wane, which could jeopardize valuable patient and community services. To sustain these student-led programs beyond the COVID-19 pandemic, we can draw lessons from global health practice: Ensure the local community dictates the agenda of operational planning. Global health organizations, as a best practice, strive to put local stakeholders at the center of conversations about health system recovery. Similarly, medical students should prioritize local community perspectives in plans to transition COVID-19 relief programs. Including community leadership in program oversight can elucidate programmatic blind spots in local health needs. Leverage newly formed infrastructure to support wider health initiatives beyond COVID-19. Many student-led relief programs have established a significant presence in their communities, including staff, space, and systems of practice. To retain this valuable infrastructure, students should work with local organizations to tackle long-term primary health care needs beyond COVID-19. In global health, this constitutes a "diagonal" approach: using disease-specific or "vertical" programs to simultaneously strengthen "horizontal" community health systems. Focus on social and political determinants of health. The COVID-19 crisis has highlighted how political considerations are a key determinant of how well—and for whom—health systems function during emergencies. Medical institutions have a responsibility to use their sociopolitical capital to address systemic inequities and enhance resilience in a lasting way, just as international bodies seek similar goals. Student-run organizations can advance such changes through increased political activism and engagement. By applying global lessons to local efforts, medical students can help ensure that recent activism continues to build a more sustainable, just future beyond COVID-19.