Response to a new epidemic must not displace responses to older ones
The Covid-19 pandemic has worsened inequalities and heightened people’s vulnerabilities, especially the 25.6-million people living with HIV in Sub-Saharan Africa
Since the start of the Covid-19 outbreak, reports from the UNAids country offices in the eastern and southern African region trickle in every day on the loss of livelihoods and the resulting food insecurity and general deprivation in the region, especially among the millions of people who make a living from the informal sector — such as sex workers, informal traders and domestic workers.
This loss of livelihood is not only being experienced by people who reside on the African continent, but also people from the African Diaspora who used to send remittances home to their families and loved ones.
According to the World Bank, in 2018 remittances to Sub-Saharan Africa amounted to a staggering $48.2bn — exceeding the $43.9bn official development assistance (ODA) to the region. In fact, remittances have exceeded ODA since the mid-1990s. These remittances are forecast to drop 23% to $37bn in 2020 due to the impact of the Covid-19 pandemic.
The UN World Food Programme has warned that about 265-million people in Sub-Saharan Africa could face acute food insecurity by the end of 2020, up from 135-million people before the crisis, because of income and remittance losses. The Covid-19 outbreak has simultaneously affected both demand and supply. This was not a gradual impact that followed the usual business cycle. It was global. And it was sudden and dramatic.
The African economy largely depends on trade with Europe and China and the export of primary products, such as oil, coffee, cocoa, metals and minerals. The demand for these commodities has plummeted. The price of commodities has followed the drop in the price of oil, which reached a record low of $18 a barrel in March. Although oil prices are making a slow recovery, they are well below what they were a year ago. Overall demand for commodities remains low.
Our economies also depend heavily on tourism from these same places — another industry that did not so much grind to a halt as have the emergency brakes slammed on to avoid a head-on collision. The Covid-19 pandemic compounds inequalities and heightens people’s vulnerabilities, especially the 25.6-million people living with HIV in Sub-Saharan Africa.
A recent UNAids report shows that lockdowns and other Covid-19-related restrictive measures have affected both the transport of goods across the value chain of production and the distribution of HIV medicines. Barriers to the supply chain and a forecasted economic shock indicate a possible fluctuation in the availability of antiretroviral medicines and a possible increase in cost. Manufacturers are facing logistics issues that put people living with HIV and people at higher risk of HIV infection at risk of life-threatening disruptions to health and HIV services.
Voluntary medical male circumcision, condom production and distribution, pre-exposure prophylaxis, HIV testing and treatment, and other programmes have all been negatively affected. A modelling group convened by the World Health Organisation and UNAids has estimated that a six-month disruption to HIV services could lead to an additional 500,000 deaths from Aids-related illnesses (including tuberculosis) in Sub-Saharan Africa in 2020—2021.
If services to prevent mother-to-child HIV transmission were similarly halted for six months, the estimated increases in new child infections would more than double in Malawi, Uganda and Zimbabwe, and increase by 83% in Mozambique. A six-month total disruption in these services is an extreme scenario and is unlikely to happen. What this points to is that HIV service disruptions caused by lockdowns and the additional burden Covid-19 has placed on health systems are real.
In Sub-Saharan Africa we are lucky to have “veterans of the Aids response” who are heading up the Covid-19 response. We bring 30 years of experience to the Covid-19 response that we must use as lessons to confront this new pandemic. What we have learnt is that communities, in all their heterogeneity and diversity, must be at the centre of any health response.
Covid-19 has showcased community resilience and innovation across the region, for example networks of people living with HIV are doing home deliveries of antiretroviral medication so their peers can avoid health facilities and protect themselves from Covid-19 infection. We are proud that decades of experience and the infrastructure built for responding to HIV are being used in the response to the coronavirus and that activists all over the world are working hard to make sure that the disruption to HIV services is avoided or at least minimised.
We have seen many governments stepping up to implement the WHO guidelines of multi-month dispensing of antiretroviral medicines for three to six months to ensure people living with HIV have a continuous supply of treatment. We are pleased that to date the Global Fund to Fight Aids, Tuberculosis & Malaria has allocated up to $1bn to help countries fight Covid-19.
But we are equally worried about the fragility of HIV/Tuberculosis services that are being repurposed for Covid-19. We cannot take money and resources from one disease to treat another. The response to a new epidemic should not displace responses to older epidemics. We must continue to invest in the Aids response and, now more than ever, we need global solidarity that prioritises the public health crisis on this continent.
Africa already has high sovereign debt and borrowing in the post-Covid-19 will be for necessities such as medicine, equipment, and food. During the global financial crisis of 2008, stimulus packages targeted the financial sector to help revive ailing economies and get money to circulate in the system. This time, we need stimulus packages to put food into people’s mouths. Africa is only reaching its peak of the Covid-19 pandemic just about now and it is going to get worse before it gets better. We will likely experience a depression.
Developed countries can afford to adopt an approach of “infinite liquidity” — that is, doing whatever it takes to revive the economy and protect production. In the US alone the stimulus package looks set to top $2-trillion, the largest in its history. In Africa we don’t have similar unlimited resources to rescue our economies.
In 2019, 18 African countries were classed as being in debt distress or close to it. This was before the Covid-19 outbreak. If Covid-19 never happened, perhaps we could still be talking conditional debt restructuring or suspended debt payments being halted. Not anymore. Sub-Saharan Africa requires debt cancellation to protect the health and wellbeing of the 1.1-billion people who call it home.
• Chuma is UNAids regional director for Eastern and Southern Africa.
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