“It is staggering to think that we could lose so much so fast, that so many lives, all that effort, all those billions of dollars that got us this far could be lost. We cannot let that happen.” Peter Sands, Global Fund Executive Director.
While we are all doing our best to adjust to the realities of living with COVID-19, the global health community is trying to assess the impact on other infectious diseases, particularly on HIV/AIDS, TB, and malaria. Resources allocated to address these persistent infectious diseases were very quickly mobilized to respond to this new threat.
I was stunned as I heard experts in the docuseries, The Pandemic Paradox, HIV on the Edge (Center for Strategic and International Studies, 2020) warn that HIV infection rates could return to rates as high or higher than the peak of the global pandemic in 2004. We are in danger of rolling back the advances made in fighting HIV. According to Dr. Anthony Fauci, “The [HIV] epidemic risks are still high. We are always in danger of a rebound.” Dr. Peter Piot of the London School of Hygiene and Tropical Medicine concurs, “There is a high risk of resurgence of the HIV pandemic.” If we fail to heed their warnings, we could lose the battle to contain HIV/AIDS.
I heard an astounding calculation by Annette Reinisch of The Global Fund that they anticipate an additional 540 000 AIDS related deaths, 525 000 TB deaths, 392 000 malaria deaths in 2020 over and above the death rates reported in 2018.
People around the globe are afraid to access health services due to law enforcement of lockdown orders as well as fears of contagion. In Zimbabwe, Constancia Mavodza of the Biomedical Research and Training Institute reports that, “During lockdown you could not move anywhere outside of a 5km radius. Clients could not get to their clinic to get their medication.”
Patients are unable to get refills of medications because they cannot get to clinics or because they fear going to clinics. In South Africa, Linda-Gail Bekker of the Desmond Tutu Health Foundation reports that they are seeing one tenth of the people who normally come in for services and, diagnostics for TB, malaria and HIV have been reduced by half.
Clinics are also experiencing stockouts due to disruptions in supply chains. The Global Fund found that 5-10% of countries are experiencing stockouts of anti-retroviral treatment (ART) for HIV.
Long before COVID-19, HIV clients have been asking for multi-month ART supply given the challenges they face getting to clinics due to distance and travel costs. The corona virus pandemic is revealing that providing multi-month drug supply to clients is not just a strategic approach but a survival strategy. With chronic diseases like HIV we need to trust that people can manage their own illness.
In the 21st century, we are still using a 19th century approach to healthcare that is dependent on clients coming into healthcare facilities. COVID-19 is forcing us to use varied methods, including telemedicine, community-based and integrated service delivery, to reach clients where they are and to offer multiple health services simultaneously.
Here is what has to be done:
- We need to package services. Instead of siloed systems, we need client-centered services. We can limit exposure to infectious disease by packaging services together in one location. We need to build smart services that do more than one thing at any one time.
- According to Allan Maleche of Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN), door to door distribution of malaria nets in Kenya provides an opportunity for healthcare workers to check on other health issues in the home.
- In South Africa, for example, health workers deployed to deliver HIV, TB and malaria testing in the community are now also integrating corona virus testing into their repertoire.
- Working with communities. Context matters. The community needs to be at the forefront of the response informing health care delivery. Healthcare services should be targeted to the specific needs of communities. Funding agencies (government and non-government) need to work with community organizations to determine how the money can best be used to meet the community’s needs.
- Ensure expanded funding. We need to make sure that governments and funding agencies are not reallocating funds and resources. Rather healthcare funding and resources need to be expanded.
Healthcare systems globally are not only in need of expanded funding, they are also in need of reform and innovation. We must bring healthcare systems into the 21st century.