In the first half of this year the Coronavirus pandemic has taken the lives of over 300,000 people. The response by much of the world has been all-encompassing: many billions of people have lived through some form of lockdown which has only now been lifted in parts of the world.
But we need to keep in mind that many other diseases that were with us pre-Covid-19 have not gone anywhere. Indeed, they will probably be more deadly in the years to come thanks to the current pandemic and our response to it.
In Africa one of the biggest killers is AIDS and related illnesses, including tuberculosis. In 2018 around 470,000 people died of AIDS-related deaths in sub-Saharan Africa. In that same year, nearly 26 million people were living with HIV in the region and about two-thirds of them (16.4 million people) were taking antiretroviral therapy.
Now, thanks to disruptions in the supply chain and health clinics that are closed or overwhelmed, many millions of sub-Saharan Africans are at risk of having their treatment interrupted for a number of months.
This is of grave concern to the WHO. When treatment is adhered to, a person’s HIV viral load drops to an undetectable level, keeping that person healthy and preventing onward transmission of the virus. But when antiretroviral therapy is not taken regularly, the viral load increases, leading to worse health and, ultimately, death. Even relatively short interruptions can have a significant impact on a person’s health and their ability to transmit HIV.
According to modelling organised by the WHO and UNAIDS, a six-months interruption in antiretroviral therapy could lead to more than 500,000 extra deaths from AIDS-related illnesses over the next year in sub-Saharan Africa. The number of deaths would continue to be significantly higher for another five years – an annual average excess in deaths of 40% is predicted for those years. At the same time, a disruption of this length of time would also result in a sharp increase in the number of new child HIV infections: as much as 37% in Mozambique, 78% in Malawi, 78% in Zimbabwe and 104% in Uganda.
Even a shorter disruption of three months would see a reduced but still significant impact on HIV deaths. While more sporadic interruptions of antiretroviral therapy supply would lead to sporadic adherence to treatment. This would lead to the spread of HIV drug resistance, with long-term consequences for future treatment success in the region.
All of the numbers that these models spit out need to be taken with a grain of salt.
The assumptions underlying such models can always be questioned and the final numbers are dependent on these assumptions. However, even if the number of people affected due to a break in HIV therapy is not entirely accurate, it again shows another of the unintended consequences of the world’s response to the pandemic.
As the Executive Director of UNAIDS argued “There is a risk that the hard-earned gains of the AIDS response will be sacrificed to the fight against Covid-19, but the right to health means that no one disease should be fought at the expense of the other.”
However, in a world of finite resources, we of course do exactly that all of the time. We are all concerned about the fight against Covid-19 at the moment and that means that other diseases are just not going to have as high a priority. But we should try to remember what the cost of our single-minded focus is.