Beyond COVID-19: Ripple Effects of a Pandemic

We are all asking many pressing questions about COVID-19 – how long it will last, how many people will be affected, how to protect ourselves and our communities – but questions about COVID-19 go well beyond the pandemic itself.

We have seen in recent weeks that COVID-19 will have a ripple effect on global healthcare systems, the global economy, institutions of all shapes and sizes, and people all over the world. It is pushing healthcare systems to and beyond their limits and forcing the world to reckon with our collective level of pandemic preparedness. It is having a serious economic impact, from a global stock market crash to business closures resulting from government directives to ‘shelter at home’; most industries have been  hard-hit by the pandemic.

But one of the most critical implications of COVID-19 is its effect on global public health programs. It’s sobering to consider the many pressing health issues that that need greater attention in 2020, and still need to be addressed while going through an unprecedented shock to the health system. Now more than ever, society needs to work together to keep fighting – and saving lives – both within the current pandemic and beyond to the vital fights that are underway to end the epidemics of HIV, TB and malaria.

What impact will COVID-19 have on these other communicable diseases?  What impact will it have on the vulnerable populations – particularly women and girls?   

COVID-19 and the fight against other infectious diseases

In a video describing the Global Fund’s response to COVID-19, Global Fund Executive Director Peter Sands emphasized the importance of keeping up the fight against HIV, TB and malaria while we face the pandemic; “we must keep in mind what’s at stake in delivering the Global Fund’s core mission. Without diminishing the threat from COVID-19 one iota, it’s worth recalling that some 500,000 people have died from HIV, TB and malaria since COVID-19 emerged in Wuhan in early January. We must help countries respond to COVID-19 in a way that protects and reinforces the fight against the three big epidemics, rather than in a manner that diverts attention and resources. We must continue to emphasize that in combatting COVID-19, as in the fight against HIV, TB and malaria, the focus should be on the most vulnerable.”

Echoing this sentiment, WHO issued two statements regarding the importance of ensuring the continuity of malaria and TB services during the COVID-19 pandemic. WHO’s message on the relationship between malaria and COVID-19 featured a plea for countries to “not scale back… planned malaria prevention, diagnostic and treatment activities” in the face of the pandemic, and highlighted the importance of keeping health workers safe in the face of these infectious diseases; WHO said they would provide related guidance soon. The message on TB and COVID-19, and the accompanying information note, focused on assisting “national TB programs and health personnel to urgently maintain continuity of essential services for people affected with TB during the COVID-19 pandemic” by providing information and guidelines.

Of course, there are more similarities to and overlap between, the fights against the three diseases and COVID-19. As Mr. Sands and the WHO suggest above, both efforts require a special focus on vulnerable populations.

Forty years of responding to the HIV epidemic has generated significant experience and lessons learned. Discussing the intersection between health systems, human rights and pandemic-related stigma, UNAIDS Executive Director Winnie Byanyima said, “successful responses to global epidemics are always grounded in a respect for human rights and community leadership. Countries that have made the biggest inroads in reducing the impact of HIV have done so by adopting approaches that empower communities to screen, test and seek treatment if necessary and to protect themselves and others from the virus.”

Ambassador Deborah Birx, U.S. Global AIDS Coordinator and recently-appointed leader of the U.S. COVID-19 response team, said during a White House press briefing, “I just wanted to conclude with a group of clients and patients that we are all very worried about. These are individuals that we call long-term survivors from HIV. They’re here, across the country, [and] have survived more than four decades with HIV. Many of them still carry a level of immunocompromised. To all of them out there, please take care of yourself… to ensure you don’t get exposed.”

Risks of co-infection

While medical experts are still learning about COVID-19, evidence suggests that people with HIV, TB and malaria may be among the most vulnerable. For example, TB affects many of the same people at risk of COVID-19; people with underlying autoimmune diseases or chronic respiratory illnesses and people who can’t afford or don’t have access to health care. If this proves to be the case, there might be specifically high vulnerability throughout parts of the world with high HIV-positive or malaria-endemic populations, for example.

Africa, as a continent heavily burdened with malaria and poor health systems, is at high risk in these circumstances. There are increasing fears that COVID-19 could impact the fight against malaria, which claimed 405,000 lives in 2018, with Africa accounting for 94 percent of the global burden. COVID-19 is putting pressure on national and local health systems, and on markets and businesses large and small.

COVID-19 could derail progress on malaria, as well as other diseases, through disruption to treatment or other interventions, or to supply chains of critical medicines and medical supplies. Experience from the 2015 Ebola outbreak in West Africa suggests that unless mitigating action is taken, additional deaths from existing diseases such as malaria can be comparable or greater than those from the outbreak itself.

“We are seeing that the virus has a more severe impact on people with underlying health conditions and so it is logical to hypothesize that we may see more severe COVID-19 illness in a population that is malnourished, has malaria as well as a mound of other infections,” said Dr. Ngozi Erondu, an associate fellow in the Global Health Program at Chatham House in London.

Threats of COVID-19 pandemic to women and girls

A guidance note released by the UN Population Fund earlier this month sheds light on how the pandemic can have different impacts on women and men. It highlights that sexual and reproductive health and rights are a significant public health issue and still requires high attention during the COVID-19 pandemic. It notes that in times of crisis, increased household tensions can increase the risk of domestic violence. At the same time, the systems for protecting women and girls may weaken or break down. With schools around the world closed during the pandemic, girls are more exposed to sexual violence and unwanted pregnancy.

Risks to women and girls also increase if health systems divert resources from sexual and reproductive health care to respond to the epidemic, and if supply lines begin to creak under the strain of the pandemic. The guidance note goes on to state that sexual and reproductive health services and commodities are often overlooked in times of crisis, yet women continue to require family planning, menstrual health supplies and maternal health care. Already, countries have seen health systems forced to allocate staff and resources towards critical care services and away from other areas of care.

The fight against the three diseases, and so many other medical issues, may be affected by issues stemming from supply chain disruptions caused indirectly by countries’ response to the pandemic, and by workers being unable to work. This is exacerbated in countries where there are already supply chain issues resulting in procurement delays and long stock outs of drugs and other commodities. With many health commodities being produced in East and Southeast Asia, the COVID-19 epidemic has impacted production of pharmaceutical and other health-related products, in some cases bringing production to a halt. With factories in Asia on lockdown due to quarantines to contain the spread of COVID-19, many commodities are being produced and shipped late, thus causing serious delays at a country level.

The Sahel Women’s Empowerment and Demographic Dividend Project (SWEDD), supported by UNFPA and the World Bank across seven countries in the Sahel region in Central and West Africa is already feeling the impact.  Generating a demographic dividend relies on significant investments in empowering women and young people, particularly in the areas of education, reproductive health, including family planning, and job creation for people with the potential to be productive. Provision of family planning and other sexual and reproductive health commodities are central to women’s health, empowerment and sustainable development and may be impacted as supply chains undergo strains from pandemic response. This, in countries where supply chain management is already facing challenges, with frequent delays in procurement orders and long stock out periods.  These countries all now have registered cases of COVID-19.

Finally, a pandemic-related issue that effects both work on SRH and fighting infectious disease is the simple fact that health workers, NGOs, and so many people adjacent to formal and informal health systems are increasingly unable to be present to treat and advise people on health, due to risks of spreading COVID-19. Additionally, people with a medical condition may not be able to be treated due to hospital occupancies being reached, and people with any disease that causes coughing may not be able to reach a healthcare facility due to the stigma of appearing to spread COVID-19, which also applies to health workers exposed to sick patients. All of these factors can lead to stalled or reversed progress on all kinds of global health issues.

Private sector playing its part

The private sector has and continues to be an indispensable advocate, partner and stakeholder in addressing epidemics, and many other health issues. Companies and business leaders are responding to COVID-19 in various ways: working to assist their employees and communities; repurposing physical and digital capabilities (from critical technology such as ventilators to PPE to awareness-raising campaigns and policy dialogues); developing potential tests, vaccines and treatments; investing through financial and product donations; making donations and using the full range of resources at their disposal. Corporate initiatives and public-private partnerships are sure to stay in focus as we continue to fight COVID-19, and we will continue to track this activity.

These initiatives and all others are welcome as the areas hardest hit by the pandemic are increasingly health facilities in Europe, the U.S. and other areas beyond where the early outbreaks took place, and these systems are starting to be stretched by the high case load. There are many questions remaining, but some of the most pressing on our mind should be: How do we keep up the fights we had been working so hard on before the epidemic? How can we best protect vulnerable geographies and populations? And how can we prepare for the next pandemic?

WHO and public health authorities around the world are taking action to contain the COVID-19 outbreak. All sections of our society – including government and businesses – have a role to play to slowing and containing the spread of this disease. GBCHealth will support the efforts of WHO and other global health organizations; we encourage countries, businesses and citizens to strictly adhere to WHO guidelines on preventing and managing the disease.

No matter what, it is clear that the global community is capable of incredible solidarity and cooperation towards a goal and is resolute in its pursuit of saving the lives of our families and ending these pandemics. This solidarity should be our aim for promoting health, prosperity and universal access no matter where we are in the world.

Matt RomneyBeyond COVID-19: Ripple Effects of a Pandemic