The quest to end the COVID-19 and HIV pandemics

25 October 2021

Opinion by

Winnie Byanyima, Executive Director of UNAIDS

Chikwe Ihekweazu, Director General of the Nigeria Centre for Disease Control

At a time when millions have lost work, Queen Kennedy got a new job. As a woman living with HIV in Nigeria, she answered the call to become a community pharmacist. Lockdowns lowered access to HIV treatment and prevention. But through an International Community of Women Living with HIV West Africa initiative, Queen and her colleagues home deliver HIV medicines. They also conduct adolescent HIV prevention sessions.

“I willingly accepted to do this work because as a woman living with HIV, I know what it really means staying without antiretroviral therapy,” Ms Kennedy said. “People may develop drug-resistant strains, whose long-term effects could be worse than COVID-19.” 

Stories like this remind us that COVID-19 did not meet a world free from health crises. Today, we are witnessing COVID-19’s collision with a 40-year-old HIV pandemic that has claimed 37 million lives globally. At the same time, most of the developing world is still grappling with recurring and emerging disease outbreaks that have disrupted lives and left long-lasting scars. In some regions these health emergencies have become endemic, driven by interlinked vulnerabilities, disparities and inequalities.

From 24 to 26 October, nearly two years into the COVID-19 pandemic, global health leaders across sectors will gather in Berlin, Germany, for the World Health Summit. How do we leverage this moment? What lessons can we draw from responding to COVID-19, HIV, malaria, tuberculosis, Ebola and other health emergencies? And how can we enhance systems for health around the world and build a global health architecture that serves us all, leaving no one behind?

Early responses to HIV took place in emergency mode—but in rapidly building our capacities, the AIDS response has built clinics and labs, expanded the health and science workforces and supported community-led systems that have been critical in the COVID-19 response. We now know that these elements have been imperative for broader pandemic prevention, preparedness and response. As a result, life-saving HIV treatment is being delivered to 27.5 million people around the world, resulting in a 47% reduction in AIDS-related deaths since 2010. Global solidarity and shared responsibility, science, civil society activism, politics and the private sector have been critical in achieving this progress.

HIV infrastructure has been instrumental to making the COVID-19 response rapid, decisive and agile. Countries such as South Africa, India and Nigeria repurposed and redeployed this capacity to expand surveillance, testing and community-led responses. This was particularly important in Nigeria, where at the onset of the COVID-19 pandemic there were just four laboratories that had diagnostic capacity for COVID-19. By repurposing some existing HIV and tuberculosis laboratories and through other interventions led by the country, there are now more than 150. One of the key lessons from previous pandemics for this one, is to build an integrated response from the onset.

However, this infrastructure and capacity does not exist everywhere. And most worryingly, we are witnessing inequality between countries in terms of access to COVID-19 vaccines. The lessons and solidarity from the AIDS response are being ignored as COVID-19 vaccine production technologies and know-how remain in the hands of a few pharmaceutical companies and vaccine manufacturers. While more than 60% of Europeans have been vaccinated, only 4% of Africans have had their shot. Nine out of 10 people in developing countries are unlikely to get a dose this year. We need to reclaim the benefits of solidarity and interconnectedness that will allow all of us to recover from this pandemic and build a better future. The pandemic and post-pandemic worlds need a humanity where every life is valued.

Pandemics thrive on human-made inequalities. These we can and must close. At the intersections where COVID-19 and HIV collide, we find the most-at-risk and vulnerable people. They were among the first to lose their livelihoods and continue to face unequal access to health care and social services. Inequality in access to technology further deepened the impact of COVID-19. It created a divide of who could continue to work and earn and who could continue their studies.

Registration for vaccination over digital platforms has excluded those who cannot access those platforms. Delivery of vaccination through fixed facilities has the potential to leave out marginalized communities poorly served by the traditional health system and deepen inequality in access. To end AIDS and end COVID-19, we need to end inequalities, which requires a whole-of-society approach—where communities are at the centre of prevention, preparedness and response.

The pace of the spread of COVID-19 highlights the need for an urgent response. Ebola quickly overwhelmed the health systems of affected countries in West Africa, but the response capacity across countries was lost thereafter. With COVID-19 and the continued response to HIV, the focus must be on drawing on local and regional capacities and strengthening national health systems to prevent, detect and respond, not just to one emerging disease, but to any.

If we get this right, so much is won. If we get it wrong, the global health deficit grows.

As global leaders we owe several things to the next generation. We owe them adaptable systems capable of addressing the multi-dimensional aspects of pandemic prevention and preparedness. We owe them comprehensive and integrated health services harnessed through universal health coverage to ensure equitable and affordable access to health by all. We owe them true global partnerships and collaboration for better data and knowledge-sharing. We owe them faster local and global analytics to inform innovation and decision-making. And we owe them short-term public health responses and longer-term development approaches that factor in local vulnerabilities.

Ultimately, we need a synergized, coordinated public health and development response that will allow us to end the two current, colliding pandemics and be better prepared for the next.