Rich countries have invested billions in global responses to Covid. Low-income countries would like to be able to spend it on bigger issues.

“Unfortunately, people in some countries who are afraid have a much greater impact in terms of resource availability,” said Lucica Ditiu, executive director of the Stop TB Partnership. “Fear will always generate money.”

Ditiu and others ask if Covid-19-obsessed donors are effectively spending large sums of new international aid and if they are listening to local experts. Although health officials noted that it was important for the world to respond to Covid-19, they said the unique threat that Covid posed in rich countries had led low-income countries to follow them in giving the priority to Covid over other diseases.

This, they said, has likely led – and will continue to lead – to more deaths in their countries than a more nuanced approach could have.

Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, an organization that works to end diseases that pose deadly threats in developing countries, has also invested billions in the fight against Covid -19. He said he recognizes the power dynamics at play.

“When we talk about pandemics, there are actually two sources of inequity and one gets a lot of attention; the other doesn’t,” he said.

The first point of inequity is widely observed and reported, he said: who gets the vaccines, treatments and supplies needed to fight an outbreak – especially when there aren’t many supplies for everyone.

“But the second, and perhaps most insidious, inequity is who can say what is defined and treated as a pandemic? What things are we focusing on with the full power of global scientific and financial resources?” J ‘ asked “The harsh reality is that we tend to talk about things like pandemics when they are a threat to people living in rich countries, and as soon as they become less of a threat to people living in rich countries , we start using other language like endemic and epidemic.

The disease in the developing world

Diseases like HIV, TB and malaria have together likely killed more people than Covid-19 since 2020, along with deaths from older illnesses concentrated in relatively few low-income countries.

The WHO has recorded about 1.5 million dead of tuberculosis in 2020, as well as more than 1.2 million HIV and combined malaria.

Officially, there were approximately 1.8 million deaths from Covid-19 in the same time frame, although public health experts say that figure – like many during the pandemic – is likely an undercount.

Yet for some in developing countries, existing epidemics are proving to be a bigger problem than Covid-19.

“Unfortunately, if you look at the number of people infected with TB, it’s a big number compared to Covid,” said Choub Sok Chamreun, who works on HIV, malaria and TB responses – as well as on strengthening community health care – in Cambodia. “They forget about other illnesses.”

I noticed that last year, when rich countries gave out booster doses to young and healthy people, in defiance of the WHO warns it could prolong pandemicdeveloping countries were stuck in social distancing and waiting for vaccines to arrive.

Those who have worked to end TB in developing countries have been amazed to see a Covid-19 vaccine developed in months when they have waited a lifetime for improvements in TB vaccinations. “If they pay attention to tuberculosis like [Covid-19]I think we can end TB easily,” said Sok Chamreun.

Concerns about priorities don’t just come from health officials in developing countries. Last month, John Nkengasong, head of the United States President’s Emergency Plan for AIDS Relief, or PEPFAR, told Science magazine that a generation-long US campaign to fight AIDS in the developing world is in danger of backsliding.

“When you talk about a pandemic, the first thing PEPFAR partner country leaders think of now is COVID. They forget that there is a silent pandemic of HIV/AIDS,” he said. “If we take our eyes off this ball, the gains we’ve made over the last 20 years can erode very, very quickly.”

Donors respond

Developing country donors said much of the funding for the Covid-19 response to developing countries was being distributed separately from – and in addition to – existing funding.

And some donors, like the Sands Global Fund, said they were specifically directing resources not only to Covid-19, but also to the ripple effects of the pandemic, such as reduced preventive care. Countries have started using more money for side effects than for direct responses to Covid-19, Sands said.

At the same time, Covid-19 was, from the outset, a new disease, and the extent of the threat it posed is still unknown. Health experts warn that the uncontrolled spread increases the likelihood of potentially more dangerous new variants, especially in low-income countries where vaccination rates remain low. Others have pointed to the imminent threat of the long Covid, a still mysterious syndrome.

Atul Gawande, assistant administrator for global health at USAID, defends the efforts of the American development agency.

“For our Agency and our work around the world, we do not have the luxury of focusing on one public health crisis at a time – even in an unprecedented global pandemic,” he said in a statement. communicated to POLITICO. “Eventually, we hope to make COVID-19 a manageable endemic respiratory disease and part of our ‘regular’ global health operation. But for now, we continue to treat it as a public health emergency of international concern. , as defined by WHO.

Gawande said it would be wrong to view US efforts to help developing countries as short-sighted. He pointed to the Biden administration’s Global Health Worker Initiative, which aims to build a workforce that can work to end multiple diseases at once. Meanwhile, existing U.S.-funded Covid-19 programs are being expanded to also treat diseases like tuberculosis, according to a USAID spokesperson.

“A Missed Opportunity”

Yet health advocates working in developing countries said the process should have worked the other way, with new programs aimed at tackling Covid-19 piggybacking on existing campaigns to tackle the disease. .

Many who have worked for a long time to improve health care in low-income countries, such as Simon Bush, director of rare tropical diseases at Sightsavers in Ghana, said systems integration would not only have strengthened the work already in course, but also made the Covid response more effective.

“It’s not easy, but if you have a structure in place, why not start, maybe, with that, build on it?” he asked in an interview in March, when governments were hustle to increase low rates of vaccination against Covid-19 in low-income countries. “It’s a lost opportunity if we start from scratch rather than looking at what we have.”

Bush said the work to stop rare tropical diseases was similar to Covid-19 responses: reaching remote communities, solving last-mile delivery issues and achieving high coverage rates for treatments.

“We have different ways of administering and mass treating,” he said. “There are models – not that can simply be transplanted, but that can be adapted and adopted.”

Others working to fight long-standing scourges supported Bush’s view. “Investing in existing malaria platforms could be the fastest and most cost-effective way to scale up Covid testing and treatment,” said Martin Edlund, CEO of Malaria No More.

Ditiu, who has worked on care coordination for TB, said the issue of siled responses predates the Covid-19 pandemic. She said it’s all too common for a group responding to a disease to set up a new framework to fight it, not realizing that another organization has already created something nearly identical in the area.

Some lawyers hope their message gets through. In June, the World Bank’s Board of Directors approved a new Financial Intermediate Fund for Pandemic Prevention, Preparedness and Response that will direct resources to low- and middle-income countries to help them strengthen disease surveillance. diseases, laboratory systems, health personnel, emergency communication and community engagement.

The WHO is also brokering an agreement among member countries to set out commitments to developing countries in preparation for the next global pandemic.

Ditiu said she hopes these efforts will set a new tone. “For most countries, Covid-19 is not their biggest threat,” she said. “Donors need to be humble enough to really listen to what the country’s plans and priorities are.”