Opinion: COVID-19 is a turning point for infectious diseases

We ended 2019 with a palpable sense of excitement and expectation. More people were receiving lifesaving treatment for HIV, tuberculosis, and malaria than ever before. And a record-breaking fundraising conference meant we had the resources to get the world back on track to ending the epidemics by 2030.

Then the COVID-19 pandemic hit, and everything changed.

The Global Fund’s latest annual “Results Report,” released Monday, reveals how high the stakes are. Health programs supported by the Global Fund — a partnership made up of governments, civil society, technical agencies, the private sector, and people affected by the diseases — saved 6 million lives in 2019 alone. That represents 20% more than the previous year and brings the total number of lives saved since 2002 to 38 million.

However, our 2019 results predate the emergence of COVID-19. The reality is that the results from 2020 will look very different. In addition to direct deaths from the new coronavirus itself, the knock-on effects of the COVID-19 pandemic on the fight against HIV, TB, and malaria could be catastrophic. In 2020, we could lose all we have achieved in the previous decade.

Recent modeling studies by the World Health Organization, UNAIDS, and the Stop TB Partnership indicate deaths from the three epidemics may as much as double in the coming year as health and community systems are overwhelmed, treatment and prevention programs are disrupted, and resources are diverted. Our own surveys in 106 of the world’s poorest and most vulnerable countries show that approximately three-quarters of lifesaving services for HIV, TB, and malaria have already been moderately or significantly disrupted this year.

We cannot let this happen. To protect hard-won gains and to sustain momentum, we must massively increase collaboration, resources, and innovation. We must also apply the lessons we learned from fighting HIV, TB, and malaria to maximize our effectiveness in combating the new virus.

The fights against these three diseases show how a united world, led by strong communities, can drive even the most formidable infectious diseases into retreat. The deaths they have caused have dropped by nearly half since the peak of the epidemics in countries where the Global Fund invests.

But we still had a long way to go, even before the impact of COVID-19. In 2019, there were 690,000 AIDS-related deaths and 1.7 million new HIV infections — far too many.

Stigma, discrimination, gender inequality, and human rights barriers to accessing heath care services continue to impede progress, making key populations and adolescent girls and young women much more vulnerable to infection. In sub-Saharan Africa, adolescent girls and young women ages 15 to 24 accounted for 24% of HIV infections in 2019 — more than double their 10% share of the population.

TB remains the world’s leading infectious disease killer, affecting the poorest and most marginalized communities.

The percentage of people with TB “missed” by health systems — people who go undiagnosed, untreated, and unreported — dropped significantly from 46% in 2013 to around 30% in 2018. But approximately 1.5 million people still died from this preventable, treatable disease in 2018 — a shocking number. Even before COVID-19, we were not making fast enough progress on deaths or infections to achieve a significant shift in trajectory.

In the fight against malaria, the number of deaths worldwide continues to decline — from 585,000 in 2010 to 405,000 in 2018. However, after making massive gains in malaria control in the earlier part of the decade, progress has slowed significantly, and the disease continues to take a heavy toll on pregnant women and children.

Today, the world is grappling with an extraordinary global health crisis that has already destabilized the global economy and threatens to derail the fight against HIV, TB, and malaria, as well as the entire Sustainable Development Agenda.

We are at an inflection point. We can surrender the gains we have made and allow our progress toward the Sustainable Development Goals to be sharply reversed. Or we can act with speed and scale, investing far greater resources than have yet been committed, to counter both the direct impact of COVID-19 and to mitigate the consequences for these three diseases.

The Global Fund was created as a response to the biggest infectious disease threats, and as the latest “Results Report” demonstrates, the partnership has proven remarkably successful.

Leveraging its capabilities and experience, the partnership has reacted decisively to the emergence of COVID-19. Since March, it has approved more than $700 million to 103 countries and 11 multicountry programs to fight COVID-19; protect front-line health workers; adapt existing HIV, TB, and malaria programs to protect progress; and reinforce systems for health.

It is also playing a key role in the Access to COVID-19 Tools — or ACT — Accelerator, an unprecedented global coalition to accelerate the development and equitable deployment of new tools to fight COVID-19, including tests, treatments, and vaccines.

To continue to fight COVID-19, funding is essential. A total of $5 billion over the next 12 months will help the Global Fund support this work, protect health workers and systems for health, and defend progress in the fights against HIV, TB, and malaria.

The battle against COVID-19 cannot be considered in isolation. We must view this not just as a fight against a specific virus, but as a catalyst to finish the fights against HIV, TB, and malaria and to strengthen preparedness against future pathogens by building resilient and sustainable systems for health. In the fight against infectious diseases as formidable as these, no one is truly safe until everyone is safe.