Estimates from the United Nations, the International AIDS Society, the Stop TB Partnership and the Imperial College London predict the supply chain disruptions caused by the coronavirus pandemic could lead to at least one million extra deaths caused by AIDS, tuberculosis and malaria as resources traditionally used to fight these diseases are diverted to combat outbreaks of COVID-19.
A majority of these deaths are likely to occur in Africa, where there have been more than 481,000 cases and at least 11,400 deaths caused by the coronavirus. Countries including South Africa, Egypt, Nigeria, Ghana and Algeria have been particularly hard hit. While the total case and death numbers are currently lower than other regions of the world, including the United States, India and Brazil, the World Health Organization (WHO) has repeatedly warned of the dangers of the pandemic in Africa, which has some of the least developed health care infrastructure in the world.
At the same time, the virus is claiming the lives of nurses, doctors and other medical workers as they try to fight and contain the pandemic. The situation has also meant that institutions such as Médecins Sans Frontières, which have in the past provided resources to fight HIV/AIDS, have been forced instead to focus on treating patients with COVID-19.
The looming crisis was highlighted by Dr. Anton Pozniak, president of the International AIDS Society. He told CNN, “The social distancing efforts and lockdowns to control the spread of [coronavirus] have disrupted HIV prevention and treatment programs and put vital HIV research on hold.”
His comments were highlighted by the release of the United Nations Global AIDS Update 2020, which paints a dire picture for the years-long progress in eliminating the HIV/AIDS pandemic. Its models show that, if medical supplies for AIDS are disrupted for six months, there will be between 471,000 and 673,000 excess AIDS-related deaths in in sub-Saharan Africa alone by the end of 2021.
The report also summarizes the state of the fight against that pandemic over the past ten years. There are currently 38 million people living with HIV worldwide, but only 25.4 million are currently getting some form of treatment, a gap of 12.6 million human beings. At the same time, there was a 23 percent reduction of new HIV infections from 2010 to 2019, mostly focused in eastern and southern Africa. At the same time, there has been a rise in infections elsewhere in the world, including a 72 percent increase in eastern Europe and central Asia, a 22 percent increase in the Middle East and North Africa and a 21 percent increase in Latin America.
In total, there were 690,000 AIDS-related deaths in 2019, along with 1.7 million new infections worldwide. UN models had estimated that 2020 would have been the first year the number of AIDS-related deaths fell below 500,000, to 470,000. Instead, the skyrocketing coronavirus pandemic threatens to set back control over HIV by at least 12 years.
WHO Director-General Dr. Tedros Adhanom Ghebreyesus noted at yesterday’s opening of the 23rd International AIDS conference that, “A new WHO survey showed access to HIV medicines has been significantly curtailed as a result of the pandemic. Seventy-three countries have reported that they are at risk of stock-outs of antiretroviral medicines (ARVs).” ARVs are one of the main ways that HIV is treated. They must be taken regularly to keep patients healthy and prevent onward transmission of the virus.
“The findings of this survey are deeply concerning,” Dr. Tedros concluded.
A similar report from Imperial College London shows that malaria epidemics in the same region, sub-Saharan Africa, could spread unchecked in the wake of the coronavirus pandemic, causing at least 380,000 more deaths than expected.
Malaria is caused by a parasite primarily transmitted through mosquito bites, which introduces the disease from the mosquito’s saliva into a victim’s blood. Its symptoms include fever, tiredness, vomiting, headaches, seizures, coma and death. There were 228 million reported infections in 2018 worldwide resulting in 405,000 deaths. The disease is most common in Africa, Asia and Central and South America.
While it is deadly, the most effective way of controlling the spread of malaria is by distributing insecticide-treated mosquito nets. They cost about $2 each, last up to four years and protect on average two people each. There is a large risk, however, that as the pandemic continues to grow exponentially in regions already hard hit from malaria, the supply chains for new nets will collapse. This threatens to double the number of expected deaths caused by malaria.
It should also be noted that in the Imperial College article, it projects that in a scenario where the coronavirus is either not contained or suppression measures are lifted—the current situation in the United States, Brazil, India, South Africa and other countries—the ultimate death toll for the pandemic itself will be on the order of 3.3 million.
The coronavirus pandemic has also exacerbated the risk of contracting and dying from tuberculosis. The Stop TB Partnership recently released findings showing that, even if there is some form of lockdown and recovery to halt the coronavirus, there could still be 6.3 million excess infections and 1.4 million excess deaths of tuberculosis. To quote from the report, “global TB incidence and deaths in 2021 would increase to levels last seen in between 2013 and 2016 respectively – implying a setback of at least 5 to 8 years in the fight against TB, due to the COVID-19 pandemic.”
TB is currently the number one cause of death from an infectious disease on the planet and has been one of the most lethal bacteria throughout history. There were about 10 million active cases worldwide in 2018, and nearly one in four people are suspected to have a latent TB infection. While it is manageable with antibiotics, it still kills an estimated 1.5 million people each year. The pathogen is also one of the more resistant to treatment with drugs.
Having tuberculosis also places one at greater risk of dying from COVID-19. In India, which currently has 720,000 coronavirus cases and more than 20,000 confirmed deaths, there are about 7,370 new cases of TB and 1,230 new deaths caused by the disease each day. It amounts to about 2.7 million new tuberculosis infections and just under 450,000 new deaths each year. The combination of the two diseases has the potential to produce a public health catastrophe in the country and region of epic proportions.
These dangers also exist in large parts of Africa. Nigeria and South Africa have the second and fourth highest death rates of tuberculosis in the world, respectively, and fourth and second highest death rates of COVID-19 in Africa. Indonesia, which has the third highest death rate of TB in the world, is one of the countries hit hardest by the pandemic in southeast Asia, sitting at 65,000 cases and growing.