As the world faces the colliding pandemics of COVID-19, HIV, tuberculosis and malaria, UNAIDS supports the call for bold, bipartisan support by the United States of America for global efforts against these concurrent health challenges
GENEVA, 31 July 2020—The United States of America has long led the world in its response to infectious pandemics. As the largest bilateral donor to the global response to HIV, investing more than US$ 85 billion in the United States President’s Emergency Plan for AIDS Relief (PEPFAR) since 2003, the United States, working with multilateral organizations, the United Nations, civil society and affected countries, has played a pivotal role in reducing new HIV infections and AIDS-related deaths. The United States has contributed generously to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), investing US$ 16.7 billion since 2002.
Collectively, these investments have saved millions of lives, particularly on the African continent. Yet, as UNAIDS’ latest global report shows, much work remains. Of the 38 million people living with HIV, 12.6 million are not accessing life-saving treatment. Prior to COVID-19, we were off track on our goal of fewer than 500 000 new HIV infections by 2020; in 2019, 1.7 million people became newly infected with HIV. COVID-19’s early impact on the African continent portends a major health disaster that, if unmitigated, will have both direct and long-term residual effects.
At a time when many governments and economies, particularly in Africa, are reeling from COVID-19 and struggling to maintain health and social services, continued leadership by the United States in global health is essential—it could be the difference between a health challenge and a health catastrophe.
With the world now facing colliding pandemics, turning away from any one of them to focus solely on any of the others risks a surge in new infections and deaths. The exponential harm of several concurrent pandemics will bring unprecedented suffering and economic fallout. The coronavirus’ effect on AIDS, tuberculosis and malaria programming will be devastating if not buffered. In June, the Global Fund reported that 85% of the programmes it supports in 106 countries struggled with disruption to service delivery, including 18% with high or very high disruptions. UNAIDS estimates that a six-month complete disruption in treatment could cause more than 500 000 additional deaths in sub-Saharan Africa over the coming year, bringing the region back to 2008 AIDS mortality levels. Even a 20% disruption could cause an additional 110 000 deaths. Such an outcome would represent unacceptable and preventable collateral damage from the COVID-19 pandemic, wiping out nearly two decades of progress.
The United States Global Leadership Coalition is calling on Congress to allocate US$ 20 billion in the next Emergency Supplemental Funding Bill for COVID-19. The global health community supports this request and calls for including an explicit allocation of US$ 700 million for one year, or US$ 1.4 billion over two years, for bilateral global HIV and tuberculosis programmes under PEPFAR and US$ 4 billion over two years for the Global Fund’s COVID-19 Response Mechanism. These funds will offset the impact of COVID-19 on PEPFAR and Global Fund programmes while supporting PEPFAR’s and the Global Fund’s work to combat COVID-19, including through increasing testing and care. The Global Fund’s currently available resources for COVID-19 will be fully depleted in weeks. The need is urgent.
The spread of COVID-19 is accelerating across Africa; its impact is increasingly concerning. The surge in patients is overpowering caregivers and hospitals. Recent reports suggest that more than 10 000 health-care workers have been infected. While accurately reporting cases of COVID-19 is challenging given limited testing, South Africa has more than 452 000 confirmed cases, making it the country with the fifth highest number of cases in the world. This has put enormous additional pressure on inpatient and outpatient capacities already burdened to the breaking point with HIV, tuberculosis, noncommunicable diseases, maternal and child health issues and trauma. The health systems, hospitals and health-care professionals are struggling to cope. The estimated 17 000 excess deaths from natural causes from 6 May to 14 July 2020 indicate the impact of the compounded burden. Provinces and districts previously facing pre-existing health system issues are the hardest hit; they lack functional bed capacity and adequate oxygen supply.
South Africa is not alone. In the week leading to 20 July 2020, new COVID-19 cases in Kenya increased by 31%, and by 50%, 57% and 69%, respectively, in Madagascar, Zambia and Namibia. Many low-income countries with a high HIV burden are making sacrifices in the fight against COVID-19, but they are losing the battle. Many of their economies are undermined by COVID-19. Government receipts have shrunk and many of them also face considerable debt service burdens. In four out of five of the countries with the highest HIV prevalence (Eswatini, Lesotho, Namibia and South Africa), the ratio of debt to gross domestic product is greater than 40%, with South Africa predicted to reach a record high of 80% in 2020 due to declining consumption and investments during the COVID-19 crisis.
The global health community’s requests for additional funding reflect needs in three areas:
- Scaling up health-care workforces to offset task-sharing/task-shifting due to COVID-19.
- Ensuring a supply of personal protective equipment and training on the safe use of, and proper disposal of, personal protective equipment for health-care workers.
- Protecting continuity of HIV, tuberculosis, malaria and other priority services (including laboratories and diagnostic efforts) and responding to cost escalations due to COVID-19.
COVID-19 presents not only challenges but also opportunities for even greater progress against HIV, tuberculosis and malaria, three of the world’s most pernicious killers. For example, as COVID-19 keeps people living with HIV from safely accessing HIV clinics, reports from 87 countries in which UNAIDS operates indicate that 44 of them have implemented policies to enable multimonth dispensing of antiretroviral medicines, a necessary innovation that ensures continuity of care, essential for viral load suppression, and cost savings, for HIV. Similarly, COVID-19 has disrupted clinic-based services for people who use drugs while catalysing innovative and effective service delivery models, such as “take home” approaches to opioid substitution therapy, approaches that should become the new normal.
PEPFAR, the Global Fund and UNAIDS are helping to utilize the infrastructure developed through the HIV response to contribute to effective COVID-19 efforts. For example, newly credentialed personnel—including more than 280 000 new health-care workers trained by PEPFAR—are now first responders to COVID-19. Reports from countries as diverse as India, Senegal and Uganda illustrate the essential support delivered by HIV community workers, who go door-to-door in lockdowns, distributing HIV prevention materials, treatment and information on how people can protect themselves from COVID-19 and access testing. COVID-19 responses in many countries are also benefiting from laboratory systems that have been vastly improved and expanded as a result of HIV investments.
The work of PEPFAR, the Global Fund and UNAIDS is interdependent and tightly coordinated; the three entities bolster the others’ success in all countries in which we operate. Working in concert, we have been highly effective in helping the United States Government achieve its goal of saving the most lives in the shortest window of time. Now is the time to protect past investments by exercising global leadership in the fight against COVID-19. Doing so will have the added benefits of protecting Americans at home.
“UNAIDS appreciates that COVID-19 is having a disproportionate impact on the American people. However, as we have learned from HIV, no one is safe from a virus, which knows no borders, or political divides, until all are safe. No pandemic can be stopped without global solidarity. Working together will help to accelerate the safety of the whole world. We count on the United States to build on decades of leadership in global health, maximizing and protecting impacts made to date on HIV, tuberculosis and malaria, by strongly supporting efforts against COVID-19,” said Winnie Byanyima, Executive Director of UNAIDS.
UNAIDS
The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.
