Years of progress in fighting infectious diseases in the world’s poorer nations have been wiped out after resources were redirected to tackle the pandemic and treatment disrupted, experts have warned.
Health professionals have been redeployed to focus on coronavirus, while lockdowns and social distancing have stymied prevention programs, stoking concerns that deaths from HIV, tuberculosis and malaria in some nations are now on track to exceed those caused by the pandemic so far.
Peter Sands, executive director of the Global Fund to Fight Aids, Tuberculosis and Malaria, one of the largest global health funders, said the knock-on impact of the crisis on the treatment of these conditions had been “pretty devastating”.
“For the first time in the 20-year history of the Global Fund, we’ve seen significant reversals across all three diseases,” he said. “When you think how much effort and how many billions of dollars have been invested to get us to where we are, it’s a tragedy to go backwards.”
Sands said HIV prevention had been badly hit, with services hampered by social distancing, lockdowns and school closures. In the more than 100 countries where the fund invests, the number of people reached by prevention services fell 11 per cent between 2019 and 2020, HIV testing by 22 per cent and mothers receiving medicine to prevent transmission of HIV to their babies by about 5 per cent. “In the longer run, one would expect to translate into numbers of new infections,” he added.
Meanwhile, about 1mn fewer people around the world had been treated for TB, a year-on-year fall of 18 per cent and back to 2012 levels. Sands said about 1.5m people had died from the disease in 2020, “which takes us back to where we were in 2017”.
Malaria testing had fallen about 4 per cent, while the numbers losing their lives stood at approximately the same level as in 2012, reflecting “the first real reversal in the deaths trajectory of malaria that we’ve seen for [a] very long time ”, added Sands.
On Wednesday, the Global Fund laid out an investment case, appealing to multilateral donors for an additional $ 18bn “to get back on track to end AIDS, TB and malaria” and accelerate progress towards the UN’s Sustainable Development Goal of health and wellbeing for all ”by 2030.
The weakness of many health systems in lower-middle income nations put the global south at a disadvantage once the pandemic took hold, as countries sought to tackle a novel disease alongside their customary burden of infectious disease, said Dr Solomon Zewdu, the Gates Foundation’s deputy director for health in Africa.
“From the very beginning it was a juggling act for just about every country on the [African] continent, ”he said.
He said that with Sars-Cov-2 set to become endemic, tackling the virus should no longer constrain the fight against other diseases.
Dr Rudi Eggers, director of Integrated Health Services for the World Health Organization, said about 36 per cent of countries had reported disruptions to disease control. The biggest impact had been felt by TB programs, with almost half of the countries reporting that diagnosis and treatment had been affected. Globally, said the WHO, the disruptions were estimated to have led to about 100,000 more TB deaths between 2019 and 2020.
Eggers said about 49 per cent of countries had said HIV testing had been affected.
The picture is not entirely bleak, with new approaches developed during the pandemic proving their worth.
Dr Bharati Kalotee heads a program in India supported by the Global Fund that used volunteers to seek out TB cases. She said the number identified had tumbled from 97,000 in the first quarter of 2020 to about 26,000 in the next three months. But the program had adapted by harnessing digital tools such as messaging apps and video conferencing to monitor infected people, and by bringing services closer to communities, including home delivery of drugs.
Professor Guy Marks, president of the International Union against Tuberculosis and Lung Disease, believed the crisis had engendered a new understanding of the impact of unchecked outbreaks. “Covid has really focused attention on the fact that. . . you can’t have a well-functioning economy and a thriving society in the context of an uncontrolled infectious disease, ”he said.