COVID-19 a turning point for infectious diseases
We ended 2019 with a palpable sense of excitement and expectation. More people were receiving lifesaving treatment for HIV, tuberculosis and malaria than ever before. And a record-breaking fundraising conference meant we had the resources to get the world back on track to ending the epidemics by 2030.
Then the coronavirus disease (COVID-19) pandemic hit and everything changed.
The Global Fund’s latest annual “Results Report,” released on Monday, reveals how high the stakes are. Health programs supported by the Global Fund — a partnership made up of governments, civil society, technical agencies, the private sector and people affected by the diseases — saved 6 million lives in 2019 alone. That represents 20 percent more than the previous year and brings the total number of lives saved since 2002 to 38 million.
However, our 2019 results predate the emergence of COVID-19. The reality is that the results from 2020 will look very different. In addition to direct deaths from the new virus itself, the knock-on effects of the COVID-19 pandemic on the fight against HIV, TB and malaria could be catastrophic. In 2020, we could lose all we have achieved in the previous decade.
Recent modeling studies by the World Health Organization, the Joint United Nations Program on HIV/AIDS and the Stop TB Partnership indicate that deaths from the three epidemics may as much as double in the coming year as health and community systems are overwhelmed, treatment and prevention programs are disrupted, and resources are diverted. Our own surveys in 106 of the world’s poorest and most vulnerable countries show that approximately three-quarters of lifesaving services for HIV, TB and malaria have already been moderately or significantly disrupted this year.
We cannot let this happen. To protect hard-won gains and to sustain momentum, we must massively increase collaboration, resources and innovation. Devising a globally coordinated strategy to combat COVID-19 and improve global health security will require sustained and determined leadership from the G20 and other organizations, as well as the support of the private sector and philanthropists. And we must also apply the lessons we learned from fighting HIV, TB and malaria to maximize our effectiveness in combating the new virus.
The fights against HIV, TB and malaria show how a united world, led by strong communities, can drive even the most formidable infectious diseases into retreat. Deaths caused by the three diseases have dropped by nearly half since the peak of the epidemics in countries where the Global Fund invests.
But we still had a long way to go, even before the impact of COVID-19. In 2019, there were 690,000 AIDS-related deaths and 1.7 million new HIV infections — far too many. Human rights barriers to accessing heath care services, stigma, discrimination, and gender inequality continue to impede progress, making key populations and adolescent girls and young women much more vulnerable to infection. In sub-Saharan Africa, for instance, five in six newly infected adolescents aged 15 to 19 are girls.
TB remains the world’s leading infectious disease killer, affecting the poorest and most marginalized communities. The percentage of people with TB “missed” by health systems — people who go undiagnosed, untreated and unreported — dropped significantly from 40 percent in 2017 to about 30 percent in 2018. But approximately 1.5 million people still died from this preventable, treatable disease in 2018 — a shocking number. Even before COVID-19, we were not making fast enough progress on deaths or infections to achieve a significant shift in trajectory.
In the fight against malaria, the number of deaths worldwide continues to decline — from 585,000 in 2010 to 405,000 in 2018. However, after making massive gains in malaria control in the earlier part of the decade, progress has slowed significantly, and the disease continues to take a heavy toll on pregnant women and children.
Today, the world is grappling with an extraordinary global health crisis that has already destabilized the global economy and threatens to derail the fight against HIV, TB and malaria, as well as the entire Sustainable Development Agenda. We are at an inflection point. We can surrender the gains we have made and allow our progress toward the Sustainable Development Goals to be sharply reversed or we can act with speed and scale, investing far greater resources than have yet been committed, to counter both the direct impact of COVID-19 and to mitigate the consequences for HIV, TB and malaria.
The Global Fund was created as the world’s response to the biggest infectious disease threats and, as the latest report demonstrates, this extraordinary partnership has proven remarkably successful. Leveraging its capabilities and experience, the Global Fund has reacted decisively to the emergence of COVID-19. Since March, it has approved more than $700 million of payments to 103 countries and 11 multi-country programs, including many countries from the Organization of Islamic Cooperation (OIC), to fight COVID-19, protect front-line health workers, adapt existing HIV, TB and malaria programs to protect progress, and reinforce systems for health. In the Middle East, programs supported by the Global Fund provide essential HIV, TB and malaria services to key and vulnerable populations, including refugees, internally displaced people, women, children and other populations in Iraq, Jordan, Lebanon, Palestine, Syria and Yemen.
To protect hard-won gains and to sustain momentum, we must massively increase collaboration, resources and innovation.
The Global Fund is playing a key role in the Access to COVID-19 Tools Accelerator, an unprecedented global coalition to accelerate the development and equitable deployment of new tools to fight the virus, including tests, treatments and vaccines.
However, our emergency response fund will run out of money by the end of this month. The Global Fund urgently needs $5 billion over the next 12 months to continue to fight COVID-19, protect health workers and systems for health, and defend progress in the fights against HIV, TB and malaria. Private sector support is also crucial beyond the money. The rapid deployment of supply chain and information technology solutions, for example, is critical to helping low-income countries quickly strengthen their capacities to fight COVID-19.
The battle against COVID-19 cannot be considered in isolation. We must view this not just as a fight against a specific virus, but as a catalyst to finish the fights against HIV, TB and malaria, and to strengthen preparedness against future pathogens. In the fight against infectious diseases as formidable as these, no one is truly safe until everyone is safe.
- Peter Sands is the Global Fund’s Executive Director.