2021 World AIDS Day report - Unequal, unprepared, under threat: why bold action against inequalities is needed to end AIDS, stop COVID-19 and prepare for future pandemics [EN/AR]

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Humanity is threatened by an expanding list of pandemics. AIDS is colliding with COVID-19 to deadly effect because much of the world remains dangerously under-prepared and under-resourced to confront the pandemics of today and tomorrow.

Over four decades, advances in science, human rights and public health investment have driven remarkable success against AIDS for some locations and populations. This progress has shown what is possible when countries and communities work together against a deadly contagion.

Considerable gaps remain. Entrenched inequalities stand in the way of further progress against AIDS and leave the world vulnerable to future pandemics. The colossal new challenges created by COVID-19 threaten the gains made thus far.

Just six months before this year’s World AIDS Day, United Nations (UN) Member States agreed to a new approach—to address inequalities, to close gaps in HIV service access by 2025 and to get on track to the global goal of ending AIDS by 2030. Those agreed actions are not being made at the required speed and scale.

UNAIDS data show that the curves of HIV infections and AIDS-related deaths are not bending fast enough to end the pandemic. A failure to build on the gains made thus far would result in 7.7 million AIDS-related deaths during this decade. Most of those deaths can be avoided if the world follows the Global AIDS Strategy 2021–2026 and achieves the 2025 targets agreed by the UN General Assembly.

There is no time to spare. Health systems and communities are now being pushed to the breaking point by a coronavirus pandemic that the world was woefully unprepared for, despite clear warnings by infectious disease experts and even Hollywood blockbuster films. Worse yet, two years of the COVID-19 crisis has so far failed to inspire a unified global response to the new pandemic: wealthy nations hoard vaccines and struggle to convince sufficient proportions of their populations to get vaccinated, while low- and middle-income countries are left exposed to the full force of the next wave of SARS-CoV-2 infections.

What is at stake is bigger than AIDS. The actions and interventions that need greater political leadership, policy attention and funding to end AIDS are also critical for turning the tide against COVID-19. As world leaders and the major economies within the G20 work to establish a global framework for pandemic prevention, preparedness and response, the hard-won successes and bitter failures from the response to AIDS have experiences to share. These experiences reveal that critical elements of the Global AIDS Strategy are largely missing from pandemic preparedness efforts and plans—things that must not be neglected if the world is to make good on its pledge to end AIDS within the next decade, to swiftly defeat COVID-19 and to proactively confront the pandemics of tomorrow.

Five critical elements of the Global AIDS Strategy that are needed to strengthen global pandemic prevention, preparedness and response architecture

Community-led and community-based infrastructure. Where public health systems have engaged community-led networks and organizations and empowered those most affected by pandemics, they have been more successful at countering disinformation, ensuring the continuity of health services, and protecting the rights and livelihoods of the most vulnerable.

Equitable access to medicines, vaccines and health technologies. It took decades for HIV tests and medications to become widely available and easily affordable for all who need them. Millions of lives were lost along the way. The vaccine inequalities of today’s COVID-19 pandemic echo the treatment inequalities of the early AIDS response. At the beginning of November 2021, just 2% of people in low-income countries were fully vaccinated against COVID-19, compared to 65% in high-income countries (1). In mid-November, the daily number of boosters administered globally (largely in high-income countries) was six times larger than the daily number of primary doses in low-income countries (2). The outrage caused by the unconscionable withholding of antiretroviral medicines from low-income countries in the 1990s and early 2000s led to the establishment of mechanisms that make generic versions of cutting-edge HIV technologies quickly affordable and accessible. These mechanisms must be strengthened further to ensure that all urgently needed medicines, vaccines, diagnostics and other health technologies are considered as public goods.

Supporting workers on the pandemic front lines. Health workers, social workers, teachers and unpaid caregivers are the heroes of pandemic responses, risking their health to provide care and ensure that basic goods and services remain available. Yet they often work in unsafe and exploitative working conditions, they are chronically underpaid and under-resourced, and they are underappreciated during all but the most acute phases of crises. Elevating essential workers and providing them with the resources and tools they need is critical to keeping them on the job.

Human rights at the centre of pandemic responses. Rights violations undermine trust and drive people away from public health measures. This continues to be a barrier to ending AIDS in many places, and a lack of respect for rights is also undermining COVID-19 measures. Conversely, evidence and experience show that advancing human rights improves public health. Key elements of rights-based pandemic responses that build public trust include limiting the use of criminal law to enforce public health measures, identifying rights violations where they happen, effective judicial and human rights institutions, and independent civil society groups capable of holding governments and other actors accountable.

People-centred data systems that highlight inequalities. In a world awash in data, it is easy to pick and choose the data points that reinforce biases and protect personal and political interests. Pandemic responses should be shaped by the objective triangulation of a wide range of data. The collection, analysis and use of both quantitative and qualitative data—in a way that is ethical and maintains the confidentiality of individuals’ private information—is critical to understanding who is most affected during disease outbreaks, who is being reached with services, who is not being reached and why