Written by: Dana Craig
The COVID-19 pandemic has turned the world upside down. Throughout the past nine months, this new virus has endangered our health, destabilized our economy, and circumvented our freedom to do as we please. For millions of privileged people around the globe, though, COVID-19 is the only disease affecting daily life. Not everyone is so lucky. As wealthy nations pour funding into COVID-19 research, resources to combat HIV/AIDS, tuberculosis (TB), and malaria are drying up even as new infections rise. If these issues are not addressed quickly, decades of progress in the battles against these diseases may disappear overnight.
While COVID-19 continues to spread, efforts to prevent HIV/AIDS, TB, and malaria face delays and even complete stoppages as countries scramble to combat a new, immediate threat. Disruptions due to lockdowns, restrictions on gatherings, and the shutdown of transportation services keep healthcare professionals from continuing their work and inhibit patients from accessing care. The situation is further complicated by the fact that malaria and TB present many of the same symptoms as COVID-19 during early onset; this similarity makes healthcare workers reluctant to attend to people infected with either of these diseases.
Disruptions in care are taking a serious toll on some of the world’s most vulnerable nations. In a talk about the impact of COVID-19 on Africa, Dr. Rosemary Mburu, director of WACI health, remarked that current data trends show the emergence of COVID-19 causing a ten-year setback in the fight against HIV/AIDS, malaria, and TB. Every year the combination of these three diseases leads to 1.2 million deaths in Africa, and COVID-19 threatens to exacerbate those losses in ways that will continue affecting Africa for years after Western nations secure a vaccine and move on with business as usual.
A recent study by Imperial College London found that “In high-burden settings, deaths due to HIV, tuberculosis, and malaria over 5 years could increase by up to 10%, 20%, and 36% respectively, compared [to a situation where] there was no COVID-19 pandemic.” The disruptions most severely affecting the fight against these illnesses varies for each disease.
For HIV/AIDS, the greatest negative impact will come from a prolonged interruption in antiretroviral therapy. Individuals living with HIV need to take a steady stream of antiretrovirals (ARVs) to suppress HIV and prevent the onset of AIDS syndrome. Although new long-acting injectable ARVs are on the horizon, most antiretroviral products available to patients today need to be taken daily. COVID-19 severely limits the ability of many patients to access medical care and fill their ARV prescription, which leaves them vulnerable to dangerous spikes in their HIV viral load. Over time, unmanaged HIV will deteriorate an individual’s immune system until the onset of AIDS.
For TB, the biggest problems will come from reductions in the timely diagnosis and treatment of new cases. The deadliest infectious disease in the world, TB kills 1.5 million people a year. Like COVID-19, TB spreads easily through close contact and causes both fever and respiratory distress. Containing the spread of TB also requires careful isolation of patients during treatment. An inability to identify and contain new cases quickly could lead to the dangerous spread of TB throughout populations whose health systems are already struggling under the pressure of COVID-19.
Finally, the Imperial College London study found that the greatest surge in malaria cases will come from an interruption in planned net campaigns. Netting is one of the most effective ways to protect vulnerable populations from the mosquito bites that spread malaria, and every year organizations distribute thousands of nets in at-risk countries. Friends of the Global Fight estimate that a severe disruption in these services could cause malaria-related deaths to double in Sub-Saharan Africa.
The Global Fund conducted a survey of their supported HIV, TB, and malaria prevention programs across 106 countries and discovered that three-quarters are experiencing disruptions to their services as a result of the pandemic. While this may seem like yet another inevitable consequence of a disease that feels so out of our control, we must recognize that there are solutions to these setbacks and that our commitment to these solutions could eventually save millions of lives.
Global Fund’s survey found that across communities affected by one or more of these diseases, new and innovative approaches are emerging to enable the continuation of key services. These ideas range from dispensing multiple months of HIV treatment at once to using apps to monitor TB patients virtually. All of these new programs, however, require more funding if they hope to continue. Global Fund estimates that to effectively respond to COVID-19 and simultaneously mitigate the negative effects of the pandemic on HIV, TB, and malaria, they will need an additional 5 billion dollars. The monetary resources to achieve this goal exist, but not in the countries that need them most.
The impact of COVID-19 on HIV, TB, and malaria brings into even greater contrast the economic disparities between the world’s wealthiest nations and the poorest. The Trump administration demonstrated both the presence and danger of this power imbalance in March of this year when it allegedly offered the German company CureVac a large sum of money to move the company’s vaccine research and development operations exclusively to the United States. The world reeled at the implications of this reported move: the prioritization of national interests so far above those of global health could leave vulnerable countries floundering.
Now, Dr. Rosemary Mburu voices her concern that the desire of rich countries to monopolize future COVID-19 treatments could further harm African nations whose health and economic infrastructures are already under the incredible strain of multiple deadly diseases. “The global response […] must be equitably distributed,” she contends. “Africa must not access the vaccine five years after the rest of the world has accessed the vaccine.” Why? Because “the world’s health security is only as strong as the weakest health system.”
If concern for all people around the world is not sufficient to motivate an equitable distribution of the vaccine, then Dr. Mburu’s observation offers a vital second argument. It took a single accidental exposure to the COVID-19 virus in a market in Wuhan, China to spark a global pandemic that has shut down most of the world for the last eight months. By now, no country can claim in good faith to be invincible to disease. It is now clear that a weak health infrastructure in one country leaves the whole world vulnerable. We have a responsibility as members of a global community to recognize this interdependence and to commit to strengthening all health systems. With increased stability in healthcare, future disease outbreaks need not completely derail our ability to battle other illnesses.
To protect our collective health and to respect the lives of people around the world, we need to open our eyes to the reality that COVID-19 is not the only threat to global wellbeing. Dr. Winne Byanyima of UNAIDS expressed the world’s obligation perfectly: “The right to health means that no one disease should be fought at the expense of another.” We have the brainpower and the resources to combat this pandemic while simultaneously keeping up the fight against other diseases as long as we commit to the responsibilities of global citizenship. Now more than ever we understand that people around the world are inextricably interconnected. A virus knows no borders, and if we’re going to equitably protect our world, we’ll have to do the same.