The impact of COVID-19 on HIV, TB and malaria is like nothing we have seen in the 20 years we have been fighting these diseases. While our journey over the two decades has had its fair share of challenges, we always pushed forward. Until now.
COVID-19 has pushed us off track in significant ways. For TB, the new pandemic has been devastating. In 2020, the number of people treated for drug-resistant TB in the countries where the Global Fund invests dropped by 19%, with those on treatment for extensively drug-resistant TB falling by 37%. This means around one million fewer people with TB were treated in 2020 compared with 2019.
For HIV, the impact has also been significant. While it is encouraging that the number of HIV-positive people receiving antiretroviral treatment has continued to grow, the declines in prevention services and testing in 2020 were alarming. People reached with HIV prevention programs and services declined by 11%, while HIV tests taken declined by 22% compared with 2019. Because of the disruptions resulting from COVID-19, the people at greatest risk of infection have had less access to the information and tools they need to protect themselves.
Thus far, interventions to combat malaria appear to have been less disrupted by COVID-19 than the other two diseases. Other than suspected cases of malaria tested – which fell by 4% compared with 2019 – rapid adaptation of malaria services seems to have limited the reverses. However, progress stalled: we did not see the year-on-year growth in provision of malaria services that we need to beat the disease.
These numbers are stark confirmation of what we feared might happen when COVID-19 struck. In many countries, COVID-19 has overwhelmed health systems, lockdowns have disrupted service provision, and critical resources have been diverted from the fight against HIV, TB and malaria to fight the new virus. The pandemic has disproportionately impacted the people most affected by existing diseases: the poor, the marginalized, those without access to health care. People avoided going to health centers for treatment out of fear of catching COVID-19 – or of being stigmatized for having COVID-like symptoms such as cough or fever, which could also be treatable malaria or TB.
Yet it would have been even worse without the rapid and determined actions that took place across the Global Fund partnership to mitigate the impact of COVID-19 on the three diseases. Decades of experience in fighting HIV, TB and malaria with Global Fund support enabled many low- and middle-income countries to respond quickly to COVID-19, using the laboratories, disease surveillance systems, community networks, trained health workers and supply chains put in place to fight HIV, TB and malaria. By the end of 2020, we had invested about US$1 billion to support more than 100 countries fight COVID-19 and mitigate its impact on HIV, TB and malaria. To save lives from both the direct and knock-on impacts of COVID -19, we worked intensively with partners across the world, in countries and through the Access to COVID-19 Tools (ACT) Accelerator.
These efforts prevented an even more catastrophic impact on HIV, TB and malaria. Yet the setbacks we have seen mean that infections and deaths will inevitably rise, reversing the positive trajectory we have achieved for many years. Even more worrying is what’s been happening in 2021, with the highly transmissible Delta variant causing havoc in many countries, once again overwhelming health systems and disrupting other disease programs.
Because of this we have ramped up our investments in the fight against COVID-19. As of August 2021, we had approved a further US$3.3 billion to support 107 countries and 16 multi-country programs to respond to the pandemic with critical tests, treatments and medical supplies, protect front-line health workers, adapt lifesaving HIV, TB and malaria programs, and reinforce fragile systems for health.
But to beat COVID-19 and protect our hard-won gains against HIV, TB and malaria, we must do more. The direct and knock-on death tolls from the COVID-19 pandemic are already staggering, and the longer it continues the deeper will be the scars – in health, the economy and society. 20 years ago, the Global Fund was created to step up the fight against the three infectious diseases that were then killing most people. Working as partnership, we proved they could be beaten back – and an extraordinary 44 million lives have been saved. Now we must step up again: to arrest the new pandemic, get back on track against HIV, TB and malaria, and build resilient systems for health that can protect everyone, everywhere, from future pathogens.
Right now, COVID-19 presents a daunting challenge. But if we have the political will, commit more resources, and continue to innovate and collaborate, we can turn the tide on this virus, as we did with HIV, TB and malaria, and ultimately defeat it. We should seize this moment to make everyone safer from the deadliest infectious diseases, whether COVID-19, the earlier pandemics of HIV, TB and malaria, or future pandemic threats. Let us not just beat this pandemic, but use it as a catalyst to build a better, more equitable and healthier world.
This op-ed was originally published by Health Policy Watch on 17 September 2021.