Malaria, tuberculosis, and HIV : how can the impact of COVID-19 be minimised

The COVID-19 pandemic is adding pressure to already stretched health care systems worldwide. Low and middle-income countries are experiencing significant challenges when resources are scarce. Years of progress in the fight against malaria, ebola, HIV and Tuberculosis could be lost.

The Lancet Global Health just released a paper authored by a group led by Alexandra Hogan^[1] entitled: “HIV, tuberculosis, and malaria: how can the impact of COVID-19 be minimised?”.

The authors’ modelling study estimates the number of excess deaths from HIV, tuberculosis, and malaria that could plausibly occur as a consequence of the COVID-19 pandemic. They conclude that, in high-burden settings, HIV, tuberculosis, and malaria deaths over a 5-year period could increase by 10%, 20%, and 36%, respectively. Although the loss of life-years from this knock-on impact will probably be less than the direct impact of COVID-19, in high-burden countries, it could be of the same order of magnitude. In the case of malaria, the main reason is the disruption of mosquito nets distribution campaign that takes place every three years. In the case of HIV, the major cause would be disruptions to antiviral therapy. Reductions in timely diagnosis and treatment of new cases would explain the TB rise.

The overall impact of COVID-19 will vary according to the duration of pandemic-induced disruptions to the prevention and treatment programs and the efficiency of policies to reduce virus transmission, says the study. The more controlled is the response, the less health care systems will be under stress, and the faster programmes to prevent and treat other diseases can return to normal.

Now will not be the first time that a disease outbreak is responsible for the rise of other diseases. In 2015, Neil Ferguson and Azra Ghani from the Target Malaria team at Imperial College London co-authored a paper^[2] about the impact of the 2014 Ebola outbreak on endemic malaria countries. Their model found that if malaria care had ceased as a result of the Ebola epidemic, untreated cases of malaria would have increased by 45% in Guinea, 88% in Sierra Leone, and 140% in Liberia in 2014. The paper also noted that mass drug administration and distribution of insecticide-treated bednets timed to coincide with the 2015 malaria transmission season could largely mitigate the effect of Ebola virus disease on malaria.

We need to understand that COVID-19 exists in addition to, not instead of, other existing health problems. While we do not have robust health care systems, we will be subjected to setbacks on other diseases control. Research and innovation are also crucial. New tools such as gene drive mosquitoes could reduce the burden, save lives and free resources to other urgent needs.

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[1] Hogan AB, Jewell BL, Sherrard-Smith E, et al. (2020) Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study. Lancet Glob Health; published online July 13. https://doi.org/10.1016/S2214-109X(20)30317-X

[2] Walker PGT, White MT, Griffin JT, et at (2015) Malaria morbidity and mortality in Ebola-affected countries caused by decreased health-care capacity, and the potential effect of mitigation strategies: a modelling analysis. Lancet Infect Dis.; 15: 825–32. https://doi.org/10.1016/S1473-3099(15)70124-6