The Fatal Consequences of COVID-19 on AIDS, Tuberculosis and Malaria

Global Fund Executive Director Peter Sands informed attendees of the 2020 International AIDS Society Conference of a grim reality surrounding COVID-19: “We face the really sobering prospect that if we do not mount an effective response, we could find ourselves losing maybe a decade’s worth of gains in terms of the reduction of death, the reduction of infections of [HIV/AIDS].” With cases of COVID-19 on the rise, the global responses to HIV/AIDS, tuberculosis (TB) and malaria have all been severely curbed. As these four deadly diseases threaten to shock health systems across the world, it is imperative to provide robust funding and support for HIV/AIDS, TB and malaria initiatives as COVID-19 continues to spread across the globe.

COVID-19 is rapidly accelerating across low- and middle-income countries, such as South Africa and India. Public hospitals in these nations are not only running low on medical oxygen and beds to treat COVID-19 patients, but also experiencing disruptions in health services for HIV/AIDS, TB and malaria. For instance, according to a July 2020 survey from the Global Fund, COVID-19 has disrupted service delivery for approximately 66 percent, 75 percent and 80 percent of global malaria, TB and HIV/AIDS programs, respectively. The diversion of funding, research activities and services from the treatment and prevention of AIDS, TB and malaria to COVID-19 activities could cause surges of the diseases due to undiagnosed and untreated infections. 

Moreover, as a result of lockdowns that aim to slow the proliferation of COVID-19, individuals diagnosed with HIV must confront impediments in procuring their daily antiretroviral medications (ARVs) and accessing treatment services. In addition, due to lockdowns halting work and subsequently curbing income, low-income individuals diagnosed with HIV also lack the financial capability to retrieve their medications. 

However, due to limited incomes with which to purchase food, even low-income HIV patients who retained adequate supplies of ARVs prior to lockdowns have been unable to take their prescribed dosage. Now facing food insecurity, low-income HIV patients fear the side effects of taking medication without food. For instance, Beatrice Oceer, a 33 year-old HIV-positive patient from Northern Uganda, skipped medication as she lacked food with which to take ARVs. She died days after local lockdowns began. 

As a six-month disruption in HIV treatment could result in more than 500,000 additional deaths in Sub-Saharan Africa over the next year, it is vital to prevent a devastating regression to decades-old mortality levels. Lockdowns and supply chain blocks could precipitate further price increases of ARVs and low-income HIV patients will have to decide between purchasing food or medication. Supporting monthly ARV home delivery and providing assistance for virtual treatment programs would limit disruption of HIV treatment in Sub-Saharan Africa and help preserve gains made in the fight against HIV/AIDS.

In order to control the spread of malaria in high-risk endemic regions, community health workers dispense insecticide-treated nets during door-to-door distribution campaigns. Though, due to COVID-19 lockdowns, distribution of these vital nets has subsided. In addition, accelerated demand for COVID-19 diagnostic tests and therapies has triggered shortages and price increases of malaria rapid diagnostic tests and active pharmaceutical ingredients in malaria medications. Ultimately, these disruptions to malaria prevention and treatment could result in annual malaria deaths doubling to 769,000 in 2020. 

Similarly, COVID-19 has disrupted TB treatment and prevention services. As individuals with respiratory complications fear visiting clinics during lockdowns due to possible contact with COVID-19 patients, some countries have reported reductions in TB testing. However, once nations ease lockdowns, patients with delayed diagnoses and interrupted treatments will seek care for more advanced stages of TB – after months of deferring medical consultations. The Stop TB Partnership estimates a three-month lockdown and ten-month period of recovery would result in an additional 6.33 million cases of TB and additional 1.37 million deaths from TB globally between 2020 and 2025. 

Additionally, many countries frequently implement mass vaccination campaigns and screenings to protect populations from infectious diseases such as TB, polio and measles. Disruptions to these campaigns due to COVID-19 preclude millions of children from receiving life-saving vaccinations, which could increase rates of infant and child mortality.

For example, during the 2014-2016 Ebola epidemic in West Africa, resources diverted from basic health services prompted increases in HIV/AIDS, TB, malaria and maternal mortality. Furthermore, researchers at Imperial College London note that a parallel diversion of resources due to COVID-19 would increase deaths attributable to HIV, TB and malaria by 10 percent, 20 percent and 36 percent, respectively, over five years in high burden settings. 

To preserve gains in the fight against HIV/AIDS, TB and malaria from the past decade, it is critical that countries around the world amplify funding during the COVID-19 pandemic. With a U.S. commitment of $4 billion over two years for the Global Fund COVID-19 Response Mechanism, the Global Fund could deploy funds to protect these disease programs and safeguard gains. To assist with the global COVID-19 response, the Global Fund has already deployed $1 billion and requires a further $5 billion this year for rigorous testing, contact tracing and treatment services in countries receiving Global Fund grants. Yet, the organization anticipates an expanded need for funding to support the responses to COVID-19, HIV/AIDS, TB and malaria next year as well. 

Millions could die if health systems are overwhelmed and rendered incapable of providing treatment and prevention services for HIV/AIDS, TB, malaria and COVID-19. Supporting the global fight against HIV/AIDS, TB and malaria is more important than ever.