Opinion: “The Covid-19 Pandemic Is Threatening Decades Of Progress In Global Health”
With ever-present news of climbing case counts and deaths from Covid-19, and now the hopeful arrival of a vaccine, it can be easy to neglect the impact of the coronavirus on other health challenges around the world. The pandemic has caused sweeping disruptions to all aspects of our global health systems and has hindered individuals’ ability to access routine healthcare in all countries. Precautions that were necessary to slow the spread of the coronavirus such as pausing vaccination campaigns, are threatening to overturn decades of progress in addressing both infectious and chronic diseases that have improved the health of millions of people globally.
Vaccination coverage this year has plummeted to levels last seen in the 1990s. For some vaccinations, a delay of a few months is not a huge problem and can simply be made up once immunization programs are up and running again. However, for highly contagious diseases like measles, even a short pause in vaccinations can lead to a spike in cases and death, mostly among children under five years old.
Before the pandemic started, the measles crisis was a growing concern for many public health officials. In 2019, measles cases increased in all regions in the world, and the World Health Organization (WHO) reported 207,500 deaths from measles, the highest number in 23 years. This year, twenty-six countries have paused their measles vaccination campaigns to stop the spread of the coronavirus, leaving 94 million people at risk of missing these crucial vaccinations. The WHO and UNICEF predict that with measles vaccination campaigns on their current path, more child deaths will occur as a result of measles than as a result of Covid-19.
In addition to suspending measles vaccinations, over sixty planned polio vaccination campaigns have been postponed in twenty-eight countries due to Covid-19. While pausing polio vaccination campaigns was important to keep both healthcare workers and communities safe, there are now growing polio outbreaks. This is an especially heart-wrenching effect of the Covid-19 pandemic, given how close we are to eradicating the disease from the world. There are now only two countries in the world – Afghanistan and Pakistan – in which polio is still endemic.
Covid-19 is also harming children by decreasing access to nutrition around the world. Researchers estimate that acute malnutrition in children could rise by over fourteen percent if the issue is not addressed. Malnutrition in childhood can have lifelong consequences and can also decrease children’s ability to fight off infectious diseases. Researchers have estimated that malnutrition might even account for up to one-quarter of all childhood Covid-related deaths. We know that children are unlikely to die from Covid-19 directly. However, the pandemic poses a threat to children indirectly by making it harder, and in some cases impossible, to receive routine, life-saving public health interventions such as vaccinations and access to essential nutrition.
This pandemic is also threatening to undermine gains in controlling infectious diseases that impact both children and adults. Malaria, HIV, and tuberculosis (TB) are often known as the big three infectious diseases because of the large number of people these diseases infect each year. The impact of Covid-19 on malaria has been of special concern to public health officials. Some models predicted that malaria deaths in Sub-Saharan Africa could as much as double if prevention and treatment were severely hindered. Thankfully, this has not been the case, but there has been an increase in the number of malaria cases and deaths in the wake of Covid-19. HIV testing has significantly decreased during the pandemic. This could lead to more new infections of HIV as individuals may unwittingly spread the virus if they are unaware of their HIV-status. Similarly, the number of undiagnosed cases of TB is increasing due to Covid-19 as people may be unable to access healthcare facilities in the middle of the pandemic. This will also likely result in an increase in the number of new TB cases around the world, as those who do not know they are infected with TB may continue to spread the bacterium to others.
The impact of COVID-19 on measles, polio, and the big three infectious diseases are a tremendous amount for any health system to handle. However, the pandemic has also interrupted routine care for chronic diseases such as diabetes and hypertension, reproductive health services for mothers and their infants, and neglected tropical disease control programs such as trachoma and leishmaniasis, further heightening the stress on health systems globally.
There is a recent example of the ripple effects of an epidemic causing more deaths than the epidemic itself. During the 2014-2016 Ebola outbreak, more people died from malaria in Guinea than died due to Ebola because of disruptions to malaria prevention activities caused by the outbreak. To prevent deaths both from Covid-19 itself and from other health challenges that the pandemic is exacerbating, we must implement innovative public health programs. We are already seeing this in some countries that are combining programs focused on deworming or the provision of vitamin A with vaccinations. In planning these public health activities, to keep healthcare workers and communities safe, countries must provide adequate personal protective equipment – masks, gloves, goggles, hand sanitizer, soap – and enforce social distancing guidelines.
The Covid-19 pandemic has demonstrated how interconnected the world is and the enormous impact that one infectious disease can have on all other aspects of our health. Addressing Covid-19 means not only stopping the spread of the coronavirus, but also tackling the many indirect health consequences. In a world where outbreaks of emerging infectious diseases are at an unprecedented rate, we need to build strong health systems to address epidemics while continuing to provide vital, routine to all care as safely as possible.
This article was originally published on Forbes.com. Reprinted with permission.
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