How the lessons the world learned in the fight against HIV can help us defeat COVID-19
World AIDS Day reminds us that while we battle to contain COVID-19, we still haven’t finished the fight against the last big pandemic to hit humanity. After four decades and the loss of over 32 million lives, the battle against HIV is still unwon. In 2019, 690,000 people died from Aids-related illnesses while an estimated 1.7 million additional people were infected with HIV – the same number as in 2018. And while more than 26 million people are on treatment, more than 12 million are still waiting for it. In some areas, progress has stalled or is reversing.
As we battle with COVID-19, we must draw on the lessons from the fight against HIV to inform our response to the new virus. Perhaps most important is to learn from what we got wrong. In retrospect, we were shockingly slow to ensure equitable access to life-saving medicines. At the beginning, the cost of treatment was more than US$10,000 a year – far out of reach for most people. It took more than seven years before HIV treatment could reach the poorest countries. In that time, more than 5 million people were getting infected every year. More than 3 million were dying every year before the Global Fund and PEPFAR were created, making anti-retroviral therapy available in hard-hit regions like Africa. That was a terrible injustice that contributed to the continued spread of the virus.
Today, too many are still getting infected due to limited access to preventative tools like condoms and pre-exposure prophylaxis (or PrEP). The world has been far too slow to recognise how much the disease was driven by human rights and gender-related inequities. When people are blocked from accessing health services because of their sexuality, gender identity, drug use, sex work, race or health status, they become all the more vulnerable to infection and illness. Conversely, we were arguably far too quick to lose interest: once HIV was removed as a significant public health threat in the richest countries in the world, it fell off the global health security radar screen and was seen as a humanitarian or development issue. Without wanting to diminish the extraordinary generosity of the donors supporting the Global Fund, the reality is that the world hasn’t committed sufficient resources to finish the fight. Even before the disruption of COVID19, we were off track against our targets for mortality and new infections. Now we are even further off course.
In the fight against COVID-19, we must not repeat these mistakes. That’s why the global coalition called (ACT) Accelerator, bringing together governments, scientists, businesses, civil society, philanthropists and global health organizations has two objectives: to accelerate the launch of new diagnostics, therapeutics and vaccines; and to ensure immediate equitable access to these new tools. We must also recognise the inequalities that fuel the pandemic and be courageous and creative in tackling their root causes and in breaking down human rights-related barriers to health. We must also leverage the reach and dynamism of community-led organisations to protect the most vulnerable. If we don’t learn these lessons from the fight against HIV, COVID-19 will become another ‘residual pandemic”, a disease that poses limited threat to people in rich countries, but that still kills millions elsewhere in the world, particularly the poorest and most marginalised.
For those of us focused on the fight against HIV, adding COVID-19 to the list of unfinished fights would be a terrible outcome, since it would compete for already inadequate health and development budgets. Instead, we should seize this opportunity to inject new impetus into the fight against HIV. If the right answer for COVID-19 is a global approach that leaves no one behind, that’s also the right answer for HIV. And TB. And malaria.
A concept of global health security that only focuses on infectious diseases that might kill people in rich countries is morally and politically untenable. It’s also not practical, because the infrastructure and capabilities used to fight diseases like HIV and TB are the tools required to combat new pathogens. Many countries’ COVID-19 responses were based on the capacities put in place to fight these earlier pandemics. Moreover, the more we let diseases linger unbeaten, the more opportunity the pathogens have to mutate into nastier forms. We should take MDR-TB as a warning.
The global response to HIV changed the path of global health, inspiring unprecedented global solidarity, stimulating new scientific discoveries and catalysing an intensity of community-led interventions never seen before. The impact went way beyond HIV. We need the global response to COVID-19 to have a similarly transformational impact on global health, changing the way we think about health security, data, equitable access and innovation. As we enter the next phase of the fight against COVID-19, we should commit to protecting everyone – whoever they are, and wherever they live - from the deadliest infectious diseases. We should see the response to COVID-19 not just as response to a particular virus, but as a catalyst to finish the unfinished fights against HIV, TB, and malaria, and to reinforce our defences against future pathogens.
This article originally appeared on 1 December 2020 in The Telegraph.