COVID-19 Threatens the Poor and Marginalized More than Anyone

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Peter Sands, Executive Director at The Global Fund to Fight AIDS, Tuberculosis and Malaria

At the Global Fund to Fight AIDS, Tuberculosis and Malaria, we are acutely conscious that the people we serve, the poorest and most marginalized across the world who suffer most from HIV, TB and malaria, are also likely to be the most affected by COVID-19. In the countries in which we invest, weak health systems will not be able to contain an outbreak that appears to be able to outflank even the most determined preventative strategies. Those who get infected will not receive the level of care better-funded systems can offer.

Perhaps even more alarming is the potential knock-on impact on prevention and treatment of HIV, TB and malaria. During the 2014-15 Ebola outbreak in West Africa additional deaths from HIV, TB and malaria as an indirect consequence of the outbreak exceeded deaths directly caused by Ebola. Mothers delayed bringing children with fevers into clinics, fearing they might catch Ebola. Access to treatment for people with HIV and TB was interrupted. Community health workers, doctors and laboratories devoted their energies and resources to the Ebola outbreak. It is all too easy to see how COVID-19 could overwhelm fragile health systems, leading to many dying from the respiratory complications the coronavirus causes, but perhaps even more dying from a resurgence in HIV, TB and malaria.

The stakes are extraordinarily high. Each year, nearly 2.6 million die from the three biggest infectious diseases affecting humanity, roughly half the death toll of a decade ago, but still an immense number of lives. To put this in context, that rate means roughly 440,000 people have died from HIV, TB and malaria since COVID-19 was identified just two months ago.

Following the success of our Replenishment Conference in October 2019, at which donors pledged an unprecedented US$14 billion, we are intensely engaged with countries and other partners to design and launch the next phase of interventions, with the objectives of cutting the annual death toll from HIV, TB and malaria by almost half by 2023, and of sharply reducing new infection rates. Doing more of the same won’t get us to the Sustainable Development Goal 3 target of ending the epidemics of HIV, TB and malaria by 2030. We must step up the fight.

COVID-19 could knock us off track. While we don’t yet know whether people infected with HIV, TB and malaria will prove more vulnerable to the new virus, the evidence thus far suggests that those with other health conditions are likely to be more severely affected if they catch COVID-19. People living with HIV are immunocompromised, and people with TB may have pre-existing respiratory dysfunction. As the relatively weak health systems in the countries in which we invest struggle to respond to COVID-19, there’s a significant risk that prevention and treatment programs for HIV, TB and malaria will be disrupted. Resources and attention will be directed towards countering the immediate threat. Fear of catching COVID-19 will deter some of those needing timely diagnosis and treatment for HIV, TB and malaria from accessing health services. There’s also a danger that media hype, fear and hastily implemented public health measures to achieve “social distancing” could exacerbate stigma and human rights-related barriers faced by marginalized communities.

The Global Fund response has three main strands. First, we are identifying and mitigating potential risks to our core mission of fighting the three epidemics. For example, it may make sense to launch pre-emptive prophylactic initiatives in high-burden malaria areas affected by COVID-19. This is a strategy we’ve used to protect children during the current Ebola outbreak in northeastern Democratic Republic of Congo. We’re also monitoring supply chain risks. Since many of the drugs, diagnostics and insecticide-treated nets we deploy are manufactured in China, there’s a danger that factory closures could disrupt supply.

Second, we are working with countries to identify how the capabilities and infrastructure we’ve been investing in can be adapted to strengthen the response to COVID-19. The Global Fund is the largest multilateral provider of grants to strengthen systems for health, investing over US$1 billion a year in key components such as community health workers, disease surveillance systems, supply chains, diagnostic tools and laboratory networks. We are working closely with partners to ensure such investments can be utilized effectively as part of national response strategies. Whilst alert to the risks of being diverted from our core mission, we are introducing new flexibilities in our grants to enable countries to respond at pace to the evolution of COVID-19.

Third, we are closely engaged with our global health partners, such as Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations (CEPI) and the World Bank, under the overall leadership of WHO, to ensure we act in close coordination in response to COVID-19, and in sustaining the remarkable progress we’ve been making towards the SDG 3 goal of health and well-being for all. COVID-19 is an immense test of the global health community. Only by working together can we protect the poorest and most vulnerable. Only by working together can we mitigate the direct – and indirect – impact of COVID-19 on those most at risk.