Dr. Joy Shu’aibu, program director of Sightsavers in Nigeria, a group focused on eliminating some serious, neglected tropical diseases, has seen her work stalled since March as a result of the coronavirus.
It’s worrisome on many different levels, she says — and on the ground, it’s made it hard to get much-needed medications to people with diseases such as lymphatic filariasis, which causes massive swelling and trachoma and can lead to blindness.
“There are lots of medications, and on account of COVID-19, some of those medications are about to expire,” Shu’aibu said. “It’s kind of a difficult situation we find ourselves in.”
Shu’aibu says her work hit pause in March in response to safety guidelines issued by the World Health Organization in response to concerns that outreach efforts by groups like hers could further the spread of COVID-19. As a result, groups are limiting their work to case management and vector control to curtail transmission.
Although the pandemic shows no signs of letting up anytime soon, with cases surging and most of the world still susceptible, concerns are mounting over the singular focus on COVID-19; it could set back years of progress in efforts to stem the spread of other, long-standing communicable diseases.
“I’m afraid that if we do not find a balance between meeting the needs of people with neglected, tropical diseases in a safe way, we may lose the gains that we have made.”
“I’m afraid that if we do not find a balance between meeting the needs of people with neglected, tropical diseases in a safe way, we may lose the gains that we have made,” Shu-aibu said.
A modeling study recently published in The Lancet journal projected a big impact of COVID-19 on diseases like HIV, tuberculosis and malaria in low- and middle-income countries.
“It’s important for countries not just to focus on the imminent crisis,” said Britta Jewell, researcher and co-author of the modeling study at Imperial College London.
Jewell’s group estimates that COVID-19’s adverse impact could mean deaths from HIV, tuberculosis and malaria increase by as much as 10%, 20% or 36%, respectively, over the next five years, compared to if there were no pandemic.
“If countries choose to focus completely on the COVID-19 epidemic and neglect maintaining essential prevention and treatment services for HIV, TB and malaria, we could see deaths that are on the same order of magnitude of those that would be caused by COVID-19 itself,” Jewell said.
Her projections, in part, come from potential interruptions in HIV treatments, which help suppress the disease and its spread, missed early detection and treatments for TB, and halts to critical mosquito bed net campaigns that can prevent malaria.
Similarly, another modeling study published in the journal Nature this past week found that if nothing is done, the six-month impact of COVID-19 on malaria efforts in sub-Saharan Africa could lead to a sharp rise in deaths.
An estimated one-sixth of the world’s population suffers from a mix of neglected tropical diseases, which are found in tropical and subtropical regions. Organizations like Sightsavers work to contain them by offering medications, testing and preventive care.
Dr. Yaya Coulibay, a senior researcher at the University of Bamako in Mali, says his work, too, overseeing some neglected tropical disease programs, has been held up. Mass drug administration programs have stopped for many of these parasitic and bacterial diseases, he said.
The timing is troubling, he says, as the rainy season approaches.
“To eliminate or stop the transmission [of these diseases], before the peak of high vector [insect] density, you need to treat people to help get the parasite load as low as possible. So, when vectors come and bite people, they have less chances to get infected and infect other people.”
“To eliminate or stop the transmission [of these diseases], before the peak of high vector [insect] density, you need to treat people to help get the parasite load as low as possible,” Coulibay said. “So, when vectors come and bite people, they have less chances to get infected and infect other people.”
Diverting resources from other communicable diseases to fight COVID-19 is one tension, but another is the fear that people avoid getting health care altogether to stay away from places where they think they’ll get infected, according to Dr. Alpha Mahmoud Barry, a public health specialist and epidemiologist who is a member of a coronavirus control committee in Guinea.
As the director of the health nongovernmental organization Santé Plus in Guinea, Barry has worked in HIV and AIDS for years and has seen this happen before.
“Like when we had Ebola, people are afraid of going to the hospital,” he said, referring to the West Africa Ebola outbreak in 2014 when many people avoided the hospital at all costs for fear of winding up in the Ebola wards.
Studies found that deaths from other diseases, like malaria and HIV, actually went up at that time, even eclipsing the number of deaths caused by Ebola.
Barry, who is based near a major health center in the capital, Conakry, said he is already seeing signs that this could happen again amid COVID-19. It’s almost like people think malaria and HIV have gone away, he said.
“We are not talking about them anymore; it’s like we think HIV is already eradicated,” said Barry, who is in the middle of a study to find out how widespread HIV is among women and children in the country.
HIV has not been eradicated, and it could start to spread faster if efforts to contain it aren’t ramped up again soon.
A report from the Global Fund projects that nearly $30 billion will be needed to effectively respond to COVID-19 and the ongoing threat of diseases like HIV, TB and malaria. As US Congress debates its latest supplemental funding for COVID-19, global aid advocates are pushing for more support, which has been absent from previous relief bills.
The dilemma, though, is also pushing community and global health leaders alike to reassess how to keep up critical work on non-COVID-19 diseases while continuing to fight the pandemic, according to Claire Standley, a professor at the Center for Global Health and Security at Georgetown University.
“How can these services coexist with the realities of COVID-19? Are these opportunities that these control programs can use to rethink how preventive services are delivered? I think that’s the question that needs to be asked rather than, ‘OK, we’re stopped, so these services can’t happen.’”
“How can these services coexist with the realities of COVID-19?” Standley said. “Are these opportunities that these control programs can use to rethink how preventive services are delivered? I think that’s the question that needs to be asked rather than, ‘OK, we’re stopped, so these services can’t happen.’”
For Shu'aibu, whose neglected tropical disease programs have essentially been on hold in Nigeria since March, figuring out how to adapt is key. She is focusing on how to deliver medications door-to-door to avoid mass distribution drives that require large gatherings.
“There’s a lot of work that has gone into the past three to four months, lots of tools have been developed, operation procedures modified so when the time comes for resumption we’re doing that safely, ensuring we do not cause any harm,” Shu’aibu said.
That work also includes setting up training for health workers and trying to get personal protective equipment for them.
Shu’aibu hopes they act fast so that years of relentless work to contain other diseases don’t take major steps backward, and that those medicines sitting on the shelf get to people who need them before the end of the year.