Cases of malaria, HIV/AIDS and other diseases could surge worldwide in coming months as global health systems rally to battle the coronavirus pandemic, global health experts tell CNN.
More than half a dozen experts and humanitarian aid officials, some of whom served in the US government, expressed concern that the virus that has already claimed more than 268,000 lives could have devastating ripple effects on broader global health and security.
These experts worry about backslides against diseases like tuberculosis and measles and warned of the potential for widespread famine, as humanitarian organizations seek to balance their response to the outbreak with their efforts to combat ongoing challenges.
“If you don’t get Covid-19 but die of malaria, obviously you’re no better off. All that work cannot just stop because the attention shifted elsewhere, it must continue,” said Bill O’Keefe, the executive vice president for Mission, Mobilization and Advocacy at Catholic Relief Services.
‘We have to find a way to continue’
The battle will play out on many fronts and require a response on them all, said Gayle Smith, the President and CEO of the ONE Campaign, an advocacy group fighting extreme poverty and preventable disease.
“The pointy end of this crisis is the pandemic, but the ripple effects on broader public health, on food security, on local economies, on macroeconomies is such that we’ve got to have a multifaceted response to it,” Smith said. “Otherwise, you solve something over here and then you catch your breath and you look over and you’ve got another crisis on your hands on the other side.”
O’Keefe said his organization had been “really ridiculously busy” and was able to adapt work like malaria bed net distribution for the pandemic. However, others who spoke to CNN said there was already evidence that health treatments are being affected by closures, lockdowns, supply chain disruptions and even fear of going to medical establishments.
In India, health workers have seen an almost 80% drop in daily tuberculosis notifications, and “it’s not because it’s not spreading, it’s because we don’t know about it because people won’t, are not using services,” said Amanda Glassman, executive vice president and senior fellow at the Center for Global Development, which works to reduce poverty in developing countries.
Smith said there was “anecdotal evidence already emerging” of clinic closures, leaving people being unable to access services.
“Some of the field work that is done because of lockdowns in various places has been interrupted,” she said.
Glassman told CNN that “we have to find a way to continue to sustain the other really essential health services or we’re going to be stuck with a worse health situation than we began with.”
Experts warn disruptions in immunization campaigns could have devastating consequences. Smith, a former US Agency for International Development (USAID) administrator, noted that there were resurgences of measles and malaria during the Ebola epidemic.
“Our community’s concerned about the impacts in countries that are battling measles, cholera, polio, outbreaks like that at the same time that they have to contend with the spread of Covid-19,” said Noam Unger, the vice president for development policy, advocacy and learning at InterAction, an alliance of international NGOs and partners.
In late March, the World Health Organization recommended that governments “temporarily pause preventive immunization campaigns where there is no active outbreak of a vaccine-preventable disease.”
The United Nations Children’s Fund (UNICEF) said last week there had been a 70% to 80% drop in vaccine shipments from late March because of logistical constraints related to the pandemic.
UNICEF spokesperson Marixie Mercado said dozens of countries were at risk of running out of supplies, including at least five countries that experienced measles outbreaks in 2019.
“Disruptions in routine immunization campaigns, particularly in countries with weak health systems, could lead to disastrous outbreaks in 2020 and well beyond,” she said.
The Measles and Rubella Initiative – which is comprised of the American Red Cross, the US Centers for Disease Control and Prevention, the WHO, the UN Foundation, and UNICEF – estimates that 117 million children are at risk of missing their measles vaccine due to the pandemic.
Hit with ‘greater ferocity’
Many developing countries are already at a disadvantage when it comes to fighting the coronavirus, experts told CNN, and the secondary consequences of the outbreak – like supply chain disruptions and staffing shortages – could be devastating.
“Globally, 42% of health care facilities don’t have hand hygiene at the point of care. Only 55% of health care facilities even have access to basic water services,” InterAction’s Unger said.
Steve Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies, noted that lower income countries already display a “lack of preparation across the board in terms of protective gear for providers, in terms of test kits, vials, in terms of systems that can do screening and contact tracing, provide oxygen at facilities.”
And the global economic slowdown will hit these trade-dependent countries with “greater ferocity,” he said, likely leaving them even less able to get the supplies needed to protect their health workers.
In early April, the US froze shipments of PPE abroad due to critical shortages in the US. A State Department spokesperson said this week that the US, “through the generosity of the American people and the innovation of our world-beating private industry, is providing medical supplies and ventilators to countries that need them to fight Covid-19.”
Morrison said that those who study global health also worry about cuts in funding for other diseases and health challenges.
“There’s fear that funding will fall because of the colossal cost of Covid. There will be stress on donors,” he told CNN.
The State Department spokesperson told CNN that “within current funding levels, USAID is adjusting its Global Health activities to support the Covid response, given (the) new operating environment,” but did not give further specifics about the adjustments.
O’Keefe said being ready for the risk of insecurity, damage to livelihoods and health threats in the rest of the world will mean, “in part, providing adequate funding in a flexible way.”
The ONE Campaign’s Smith said that means resources for Covid shouldn’t drain other funding. “Absolutely our hope is that resources for Covid will be additional. … We have to fight this pandemic, but if, while we’re fighting this pandemic, we see the erosion of public health or other development gains, then we’re ultimately taking a step backwards.”
Advocates hope Congress will include at least $12 billion in international assistance in their next supplemental package.
Nancy Lindborg, the president and CEO of the US Institute of Peace, noted that amount is “a tiny fraction” compared to the trillions spent or allocated to fight the pandemic, “but a very useful fraction for safeguarding a more secure healthier future for the world, but also for the United States.”
‘Big, big, big, big, big, big concern’
Another “big, big, big, big, big, big concern,” O’Keefe said, are fears of widespread global food insecurity.
The UN has said the world is already facing multiple famines of “biblical proportions” and that the pandemic could push an additional 130 million people to the brink of starvation.
Lindborg said she was particularly concerned about the Horn of Africa, where countries are also facing drought and swarms of locusts.
“It is quite possible that they’ll tip into famine, large swaths of that region. And having worked the famine of 2011, I would hope never to have large scale famine happen again,” Lindborg, a former senior official at USAID, said. “I mean those famines are a truly terrible additional loss of life. So you’ve got you’ve got the possibility of large scale death, both from disease, but also from hunger.”
She also expressed concern about “conflict-affected places like Yemen, Syria, the Sahel, where you’ve got drought, coupled with rising violent extremism.”
“What Covid does is it just stresses all these places that were already pretty stressed, that needed a lot of help already … and then cranks up the pressure,” Lindborg said.
Despite the broad challenges, ONE Campaign’s Smith said, “there’s some very good signs that there are efforts underway to protect the gains that have been made over the past many years.”
She pointed to efforts by the Global Fund to Fight AIDS, Tuberculosis and Malaria, which “is in fact about walking and chewing gum at the same time, continuing their work on HIV AIDS and malaria, but they’ve also set up the facility and put their own resources into fighting Covid at the same time.”