Author: Stephen Frain
The second lecture of the 2021 IIEA Development Matters series, supported by Irish Aid, was delivered by Peter Sands, Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria, who addressed the topic of enhancing global health preparedness for the future. More specifically, he focused on the impact of the COVID-19 pandemic on the fight against HIV/AIDS, tuberculosis (TB) and malaria and how the international community can build on its pandemic preparedness going forward. The Global Fund is an international financing and partnership organisation that works with civil society, technical agencies, the private sector and those affected by communicable diseases to accelerate the end of epidemics and pandemics.
In opening remarks, Ambassador Michael Gaffey, Permanent Representative of Ireland to the United Nations and Other International Organisations in Geneva, recalled Ireland’s long-standing relationship with The Global Fund as a founding member when it was first established in 2002. Noting how COVID-19 has demonstrated the centrality of global health to international development, he expressed hope for Ireland to deepen its cooperation with The Global Fund to achieve the shared goal of eradicating HIV/AIDS, TB and malaria.
The Impact of COVID-19 on the Fight Against Other Infectious Diseases
While The Global Fund was established to accelerate the end of HIV/AIDS, TB and malaria, it has found itself deeply involved in the fight against COVID-19. Mr Sands described the emergence of the pandemic as “the perfect storm” of economic, health, and social crises. He underscored the knock-on effects and regressive impact the COVID-19 pandemic is having on efforts to eliminate these diseases. Most disconcerting, he said, is the likelihood that the incremental deaths from malaria in countries such as Chad, Niger, Mali, and others in the Sahel region, will exceed the death toll of COVID-19 in those countries. Moreover, as it currently stands, TB kills more people than COVID-19 in low and middle-income countries. He highlighted the fact that the health system infrastructure in these countries was already under pressure fighting existing infectious diseases before the start of the current pandemic, so the disruptive effect of COVID-19 has only served to compound and exacerbate the difficulties these countries face.
Preparation for the Next Pandemic
According to Mr Sands, the world will have to deal with more infectious diseases with pandemic potential in the not-so-distant future. With that in mind, he emphasized that the global system infrastructure that is invested in now to fight COVID-19 will play a crucial role in shaping the international response to the next pandemic. He advocated, therefore, that the international community’s response should be forward-looking and based on long-term strategies. The greatest challenge in this respect is ensuring sustainable finance for global health. With this in mind, Mr Sands called for a more systematic and assertive approach to dealing with infectious diseases to avoid COVID-19 and the risk of future pandemics becoming long-term development issues.
One of the key avenues that The Global Fund has identified to enhance global health preparedness is through its COVID-19 Response Mechanism (C19RM). The C19RM is an initiative of The Global Fund to mitigate the impact of COVID-19 on efforts to combat HIV, TB and malaria whilst urgently improving health and community systems in areas affected by these diseases. C19RM allocates its funding through three core pillars: (i) COVID-19 Response; (ii) COVID-19 related adaptation of programs to fight HIV, TB and malaria; and (iii) strengthening health and community systems. Although the Mechanism has already been allocated 3.7 billion US dollars in funding, Mr Sands confirmed that The Global Fund intends to set aside a further 4 billion to continue its work in this respect.
Collaboration: The ACT Accelerator
Mr Sands emphasised that the response of The Global Fund is not an act in isolation, but rather it forms part of a broader coordinated global approach. An example of collaboration in this respect is the Access to COVID-19 Tools (ACT) Accelerator, of which The Global Fund is a founding funder and participant member. Established in April 2020, the ACT Accelerator is a coalition of governments and organisations that work on the development and production of equitable access to tools to combat COVID-19. Mr Sands highlighted how The Global Fund is helping lead coordination on the provision of diagnostics and the strengthening of health systems. Nevertheless, he stressed that the full potential of the opportunities presented by the ACT Accelerator cannot be realised until its current funding gaps are addressed.
Figure 1 Access to COVID-19 Tools (ACT) Accelerator
Sustainable Finance for Global Health
Mr Sands stated that the COVID-19 pandemic has shone a light on how global health is financed and that it has provided The Global Fund and other key development actors with a platform to advocate for transformative approaches as to how it is organised. As was the case most recently with the H1N1 (Swine Flu) pandemic and the Zika virus epidemic, both of which still exist, the international community becomes highly focused on the issue at the height of outbreaks, but funding inevitably peters away although the viruses themselves still exist. Mr Sands suggested creating stronger incentives for how we sustain the spending. This could entail the inclusion of health risks in IMF assessments and investing in preparedness to be more able to detect and respond to new pathogens, new viruses, new bacteria, especially in rural Africa.
The Societal and Economic Impact
In Mr Sand’s view, the COVID-19 pandemic has brought into sharp relief the knock-on implications of infectious diseases on societies and their economies. This is not only the case for COVID-19 but for all infectious diseases which have gone before it and still exist. So, Mr Sands argued for a joined-up response which includes both humanitarian aid for immediate responses and development assistance to better solidify health system infrastructure which is most vulnerable. Doing so would ensure that global health preparedness adopts as holistic an approach as possible,
The Long-Term Ramifications of COVID-19 on Global Health
Mr Sands noted the increased focus within the international community on preparing for the next pandemic but cautioned against it becoming its exclusive focus. Recalling the interconnectivity of the current COVID-19 pandemic response with the world’s preparedness, he highlighted the implications of an exclusive focus on future pandemics on the fight against COVID-19 in the Global South. An example of this, he said, was in India, which is currently faced with record numbers of COVID-19 deaths, while multilateral fora such as the G-7 turn to global health preparedness for the future. Such an outcome would lead to COVID-19 becoming a long-term challenge to development and would add to the already lengthy list of diseases that the Sustainable Development Goals seek to end.
In this Decade of Action for the Sustainable Development Goals, much of the progress achieved so far in terms of good health and reduced inequalities, has been put into jeopardy by the onslaught of the COVID-19 pandemic. This has not only been the case because of the deadliness of the pandemic itself, but also because of its knock-on effect on societal and economic development and the battle to end HIV/AIDS, TB and malaria. Global health preparedness, as Mr Sands illustrated, must be viewed in its totality. The Global Fund is committed to enhancing global health preparedness for future pandemics, but only in such a way that addresses the problems we currently face. Mr Sands concluded by quoting WHO Health Emergencies Programme Executive Director, Mike Ryan: “none of us are safe until all of us are safe”.