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Coronavirus: the dangers of distraction
Despite the intensifying globalisation of travel, trade and information in recent years, the current pandemic — like those of the past — shows that most countries only respond to an infection when it arrives on their doorstep. While health services are understandably focused on handling the surge of patients, the pandemic response highlights at least three risky distractions.
The first is the tension between short and long-term medical responses. While in most countries the current focus is on a lockdown of people to limit the spread of infection, along with urgently improving supplies of protection equipment, respirators and test kits for frontline workers, there is a need to start reflecting on an “exit strategy”.
As some researchers are now arguing, efforts will need to escalate to differentiate between the most vulnerable and others who have survived infection and developed immunity, so they can return to essential work and support the economic recovery. Otherwise, the financial and associated health burden of poverty and isolation will end up being heavy. The models driving much of current policy do not consider economic and ethical factors.
The second is the balance between coronavirus and existing burdensome illnesses. There are already reports of patients with cancer and other conditions receiving lower priority. High rates of childhood vaccination against preventable diseases will be difficult to sustain with prolonged social distancing. In lower-income countries, people with infections such as tuberculosis risk being turned away.
A final concern is the move away from international to domestic solidarity. Countries have closed borders, sought to restrict export of medical supplies and limited financial aid to their neighbours. But the neglect of international efforts to support or even focus on Africa and other poorer regions risks causing a disproportionate financial burden. In refugee camps, with scant medical support or even soap, the human toll could be devastating.
To its credit, the Global Fund to Fight Aids, TB and Malaria has announced up to 5 per cent of its grants can be spent on Covid-19. More countries need to show similar solidarity to mitigate the damage to others or face the repercussions themselves.
Sir Alimuddin Zumla, Professor of Infectious Diseases and International Health, University College London, and joint guest editor of the International Journal of Infectious Disease special issue on TB.
Following World TB Day, what progress and pitfalls do you see in tackling the disease?
We are moving forward, but very slowly. New drugs are being rolled out, with a simpler, shorter all-oral treatment, and I’m optimistic we’ll have a vaccine in 2-3 years’ time. We have seen political commitment from the presidents of Indonesia, Mozambique and the Philippines; the prime ministers of India and Pakistan and Nigeria’s First Lady. I hope it is now backed by domestic funding and their attention is not distracted by the Covid-19 pandemic.
How worried are you that coronavirus is proving a distraction?
Whole health services are now focused on Covid-19. Cancer patients are having access problems. In Africa, we need to keep regular services afloat. Social distancing will make TB support challenging. Ministers are being politically pushed to respond because you’ve got to be seen to be doing something. But the best thing they can do is to make sure current services for TB, as well as HIV, malaria and maternal and child health, are not disturbed and Covid-19 is aligned to them.
Are there better ways to connect the medical response to TB and coronavirus?
There is a programme to expand TB GeneXpert diagnostics test equipment for coronavirus. Both cause lethal respiratory tract infections. People present with the same symptoms of cough, fever and breathlessness. We should take the opportunity to align community messages and exploit synergies in health services provision including around diagnosis. With TB, as with Covid-19, we need to focus on the host, not the pathogen. For TB, that means tackling malnutrition, poverty, stress and poor living conditions.
Focus on . . . the spread of coronavirus
Financing the crisis The IMF and World Bank are facing unprecedented demands from developing countries for help fighting coronavirus. The UN has called for a $2.5tn rescue package but the UN Security Council has been criticised for being “paralysed” by the US/China showdown over who was to blame for the disease spreading. Five world leaders wrote in the FT on the need for geopolitical turf wars to be set aside. (FT, Guardian, Foreign Policy, FT)
China’s soft power After initial criticism of the way it handled the epidemic, China is keen to show itself as a responsible global power, sending doctors and masks overseas as its rates of domestic infections drop.
DRC: On life support The world’s biggest outbreak of measles in the Democratic Republic of Congo is one example of serious disease that has had little publicity in the shadow of Covid-19. A Unicef report highlights a health system struggling to cope with Ebola, cholera, malaria and measles amid ongoing armed conflict. (Al Jazeera, Unicef)
Safer surgery At least 4·2m people worldwide die within 30 days of surgery each year, and half of these deaths are in low- and middle-income countries. New surgical guidelines aim to save thousands of these lives, especially in the poorer countries that are disproportionately affected. (British Journal of Surgery)
Inequality in global health The new edition of the Global Health 50/50 report says inequalities in power, privilege and priorities are undermining global health efforts. More than 80 per cent of those who lead the big international health organisations are from high-income countries and just five per cent are women from low- and middle-income countries. At the current rate of progress, gender parity in senior management will not be achieved until 2074. (Global Health 50/50)
Focus on . . . TB As Sir Alimuddin Zumla notes in our interview above, progress on tackling diseases such as tuberculosis — still the world’s top infectious killer — could suffer from the world’s focus on Covid-19. The WHO says the preventive treatment agreed by world leaders in 2018 has fallen far short of its target. In that year alone, 10m people fell ill with TB and 1.5m lost their lives. TB also remains the top cause of death among people with HIV. Spending on TB in south-east Asia needs to be doubled from current levels to $2bn a year to make a serious attempt at ending the disease. As with coronavirus, young people remain key to prevention. (WHO, BMJ, The Conversation)
Hunt for coronavirus drug The WHO and Unitaid, the UN-backed group funding global innovation, welcomed a proposal from Costa Rica for companies to pool intellectual property for all medical interventions, enabling governments or generic drugmakers to manufacture and sell at much lower prices. A “therapeutics accelerator” is giving $20m to speed drug trials.
Scientists are investigating three main types of drug: antivirals to stop the virus from replicating; anti-inflammatories that treat the lungs after the immune system is overwhelmed; and antibodies derived either from recovered Covid-19 patients or developed in labs, to be given to the seriously ill or as a temporary prophylactic for healthcare workers. (FT)
Vaccines and tests Johnson & Johnson announced a potential vaccine for Covid-19 that could be available early next year. The Coalition for Epidemic Preparedness Innovations is sponsoring several vaccine projects, although Richard Hatchett, who heads this partnership of governments, industry and charities, voiced fears about unequal access to treatment. He referred to the H1N1 flu in 2009, when the wealthiest countries secured contracts for deliveries of treatments that monopolised supplies. Tobacco companies are also getting involved. See too our guide to coronavirus testing. (FT, Devex)
Disease mapping An innovative attempt at plugging health gaps in areas without detailed maps is blending satellite imagery with machine-learning algorithms. (Devex)
Washing and sanitation If there’s one public health essential we’ve learned over the past few months, it’s the importance of washing your hands. But what if you don’t have access to clean water? World Water Day this month was a time to remember that 40 per cent of the world’s people lack access to basic handwashing facilities at home, and 780m have no access to a quality water source. A UN report says climate change makes the goal of achieving access to safe drinking water and sanitation within ten years difficult. (Reliefweb, UN Water)
Tackling obesity Childhood obesity, recognised by the WHO as one of the world’s most serious public health challenges, is linked to higher risk of anxiety, depression and premature death. People with obesity in childhood have a three-times higher risk of dying in early adulthood than their peers. An urban health foundation in London is taking a data-driven approach to tackling the problem. (PLoS Medicine, FT)
Combating diabetes Obesity is also a key driver of (Type-2) diabetes. An estimated four-fifths of diabetics, more than 336m people, live in lower- and middle-income countries, but there is no equivalent for the disease of the large-scale international support given to organisations such as the Global Fund to Fight Aids, TB and Malaria. Read the full FT report: Combating Diabetes
HIV hopes and fears Research has now been published on only the second HIV patient ever to be “cured” of the disease, thanks to a stem cell transplant from donors with a HIV-resistant gene. Africans with a disability are at much higher risk of HIV — and less likely to receive treatment. Read how the discovery of HIV led to a transatlantic research war. (The Lancet HIV, Economist, PBS)
Fighting FGM UN targets to end female genital mutilation by 2030 are seriously off track, according to a coalition of global campaign groups. Unicef figures show FGM is inflicted on at least 200m women and girls in 31 countries, 27 of which are in Africa, and are likely to be grossly understated. (Equality Now)
Best from the journals
Drug prices and UHC High medicine prices are a real threat to fledgling universal health coverage schemes. This study looks at the alternative of “value-based” tiered pricing which reflects both the ability of different countries to pay and the value that any medicine provides to local patients.
Children with cancer Some 11m children will die of cancer between now and 2050 without additional investment. The disease kills more than 100,000 children a year but 80 per cent of these cases are curable. Low‐and middle-income countries where children have poor access to health services are disproportionately affected. (Lancet Oncology)
Climate change Heat stress, caused by the body’s inability to cool down properly through sweating, could affect more than 1.2bn people a year by 2100, says a new study — more than four times the number affected today. Some want the WHO to declare climate change a global public health emergency. (Environmental Research Letters, BMJ)
Antibiotic alert A meta-study of antibiotic use shows three trends: city dwellers use more than those in rural areas; the elderly use more than the middle-aged, and usage decreases as education increases — but only in rich countries. (International Journal of Hygiene and Environmental Health)
Pick of the pods
Coronavirus vaccine Seth Berkley, head of Gavi, the Vaccine Alliance, urges governments to set aside nationalism in the search for a vaccine. (CBC, 13m)
The pandemic and the poor What does the coronavirus crisis mean for low-income countries and international development? A discussion with Amanda Glassman of the Center for Global Development. (UN Global Dispatches, 28m)
Urban health How do you build a healthy city? FT correspondents discuss initiatives in six cities, from tackling loneliness in Copenhagen to healthier eating in Tokyo.
Obamacare turns ten A discussion on the history, impact and prospects for the Affordable Care Act, which gave millions of Americans access to healthcare, but remains under threat. (Kaiser What the Health, 46m)
Epidemics in movies What do films like Contagion tell us about society’s view of epidemics? Some depict disease as a threat to society from outside, “foreign” forces, while others address threats to liberty, but both are linked to a breakdown in trust. (CDC Emerging Infectious Diseases, 32m)
The month ahead
April 7 World Health Day celebrating the work of nurses and midwives
April 14 First World Chagas Disease Day
April 19-20 G20 (virtual) meeting of health ministers, Riyadh
April 24-30 World Immunisation Week
April 25 World Malaria Day
May 6 Next issue of FT Health
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“Many short-term emergency measures will become a fixture of life. That is the nature of emergencies. They fast-forward historical processes,” writes Yuval Noah Harari on the world after coronavirus. The storm will pass. But the choices we make now could change our lives for years to come.
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