The Global HIV Response as a Pathway to Stronger Pandemic Preparedness

By: Chris Collins, Annette H. Sohn, Chris Beyrer, Mike T. Isbell, Quarraisha Abdool Karim and Allan Maleche.

Weighty debates are now taking place about the future of global health, including how to improve pandemic preparedness and response (PPR), build stronger health systems, expand needed financing and achieve the ultimate goal of Universal Health Coverage. But this is no time to diminish our focus on ending the HIV pandemic. Millions do not have access to lifesaving care and prevention services, and social inequities increasingly drive new infections and avoidable deaths.  The world is off track to meet the internationally endorsed goal of ending HIV as a major public health threat by 2030.

The infrastructure and core principles of the HIV response have much to contribute to current planning for a safer, healthier and more equitable world. If we want health systems to reflect core values of access, community decision-making and global solidarity, we should be building on the HIV response and finding ways to integrate pandemic preparedness without putting HIV programs at risk. The Global Fund, PEPFAR and UNAIDS have all documented numerous ways in which HIV-related health care personnel, communities and infrastructure were repeatedly harnessed to help countries educate their populations and deliver services around COVID-19. 

Unfortunately, the global dialogue on PPR has largely failed to fully consider the critical role that established, disease-specific programs (including HIV) played in national and regional COVID-19 responses, and the potential for these programs to contribute to stronger PPR in the future.  Last week, we published a review article in PloS Global Public Health that explores many of the points of intersection between the HIV response and core priorities of stronger PPR, including surveillance, supply chains, primary care, the health care workforce, community systems, biomedical research, political leadership, governance, financing and a commitment to global solidarity. 

The future of “global health” is on the table later this year in dialogues at the G7, G20 and high-level United Nations meetings.  As they do their work, policy makers should avoid building new silos in global health and look for opportunities to invest in and build out from existing HIV platforms that are already making health systems more inclusive and resilient – including the Global Fund, PEPFAR, and national programs. 

Leveraging HIV programs for PPR and broader health will require significant additional resources along with careful monitoring to ensure HIV programming truly benefits from synergies with PPR – such as expanded investments in the health care workforce.

The global HIV response has often been called “exceptional” because community advocacy and political leadership mobilized significant resources and aimed at universal access to quality services without discrimination.  With substantial new investments, there is a major opportunity to reinforce and leverage this response, bringing what is exceptional about the HIV effort to pandemic preparedness and health systems strengthening. 

The global HIV response is a pathway to a safer world and a more equitable and healthy future.